The Audio PANCE and PANRE

Physician Assistant Board Review Podcast

Podcast Episode 108: Did You Miss Us? The Audio PANCE and PANRE is Back!

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Podcast Episode 108 - The Audio PANCE and PANRE is BackWelcome to episode 108 of the Audio PANCE and PANRE Physician Assistant/Associate (PA) Board Review Podcast.

Join me today as we cover ten board review questions for your PANCE, PANRE, EOR, and EOC exams.

Resources and links from today’s episode:

I hope you enjoy this free audio component of the examination portion of this site. Smarty PANCE includes over 2,000 interactive board review questions, along with flashcards, ReelDx cases, integrated Picmonics, and lessons covering every blueprint topic available to all Smarty PANCE members.

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Interactive exam to complement today’s podcast

1. A 25-year-old woman comes to the office due to fatigue and dizziness for the past several months. She works as a nurse and finds it increasingly difficult to complete her shifts. The patient reports heavy menstrual periods lasting 7-8 days each month. She has no significant medical history and is not on any medications. Blood pressure is 100/60 mm Hg and pulse is 75/min. BMI is 22 kg/m². Physical examination reveals pale conjunctivae and spoon-shaped nails. Hemoglobin is 8.5 g/dL. Which of the following sets of additional laboratory findings is most likely to be seen in this patient?

A. Low ferritin, high TIBC, low serum iron
B. High ferritin, low TIBC, high serum iron
C. Low ferritin, low TIBC, high serum iron
D. High ferritin, high TIBC, low serum iron
E. Low ferritin, high TIBC, high serum iron

Answer and topic summary

The answer is A.  Low ferritin, high TIBC, low serum iron

The most likely additional laboratory findings in this patient are low ferritin, high total iron-binding capacity (TIBC), and low serum iron, which are indicative of iron deficiency anemia. Her history of heavy menstrual periods and symptoms of fatigue and pallor suggest chronic blood loss leading to iron deficiency. Ferritin is a marker of iron stores, and low levels indicate depletion of iron reserves. High TIBC reflects increased capacity of the blood to bind iron due to low iron levels.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Hematology ⇒ Cytopenias ⇒ Anemias ⇒ Iron deficiency

2. A 4-year-old girl presents with fever and neck pain. She has had a runny nose, cough, and sore throat for the past five days. Two days ago, she developed a high fever and worsening neck pain, and today, she has refused to eat or drink. Her immunizations are up to date. Temperature is 39.5°C (103.1°F), pulse is 130/min, and respirations are 26/min. Examination reveals bilateral anterior cervical lymphadenopathy, a muffled voice, and trismus. The child holds her neck stiffly and resists any movement. The tonsils are erythematous and covered with white exudates. Lateral neck radiograph reveals a widened prevertebral space. Which of the following is the most likely diagnosis?

A. Epiglottitis
B. Peritonsillar abscess
C. Retropharyngeal abscess
D. Bacterial tracheitis
E. Acute bacterial sinusitis

Answer and topic summary

The answer is C. Retropharyngeal abscess

Retropharyngeal abscess is the most likely diagnosis given the presentation of fever, neck pain, refusal to eat or drink, trismus, and a widened prevertebral space on lateral neck radiograph. This condition commonly occurs in young children and can result from a spread of infection from the upper respiratory tract. The stiff neck and resistance to movement are classic signs of a deep neck space infection such as a retropharyngeal abscess.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint EENT ⇒ Oropharyngeal disorders ⇒ Diseases of the teeth and gums => Infectious and inflammatory disorders => Deep neck infection

3. A 30-year-old woman comes to the office due to left hand and wrist pain after tripping and falling onto an outstretched left hand while jogging. Examination shows severe tenderness to palpation of the radial dorsal aspect of the wrist. Range of motion and sensation are preserved. X-ray of the wrist is normal. Which of the following is the best next step in management of this patient?

A. Immediate MRI of the wrist
B. Application of a thumb spica splint and follow-up in 1-2 weeks
C. Reassurance and advise rest and ice
D. Referral to an orthopedic surgeon
E. Repeat X-ray in 1 week

Answer and topic summary

The answer is B. Application of a thumb spica splint and follow-up in 1-2 weeks

The best next step in management is the application of a thumb spica splint and follow-up in 1-2 weeks. The clinical presentation is suggestive of a scaphoid fracture, which may not be visible on initial X-rays. Immobilization with a thumb spica splint helps to stabilize the wrist and prevent complications. Follow-up imaging or clinical re-evaluation can help confirm the diagnosis if symptoms persist.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal -> Upper extremity disorders -> Fractures and dislocations of the forearm, wrist and hand

4. A 38-year-old man comes to the office due to left knee pain for the past 4 days. He twisted his knee while playing soccer and felt a sharp pain immediately but was able to continue playing. The next morning, he noticed swelling in the knee and significant pain on the medial side of the knee, especially with stairs and squatting. He is able to fully extend the knee but experiences a catching sensation when walking, and the pain is interfering with his daily activities. Which of the following is most likely to be found on examination of this patient’s knee?

A. Positive Lachman test
B. Positive McMurray test
C. Positive patellar apprehension test
D. Positive anterior drawer test
E. Positive varus stress test

Answer and topic summary

The answer is B. Positive McMurray test

The most likely finding on examination of this patient’s knee is a positive McMurray test. This test is used to detect meniscal tears, which are suggested by the patient’s history of twisting injury, medial knee pain, swelling, and the catching sensation. A positive McMurray test indicates a meniscal tear when pain or a click is felt during the maneuver.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Disorders of the Knee ⇒ Soft tissue injuries of the knee

5. A 16-year-old girl is brought to the emergency department after a syncopal episode during a basketball game. Fifteen minutes prior to fainting, she experienced palpitations and shortness of breath. She was walking towards the bench when she suddenly “passed out” and regained consciousness a few seconds later. She has no prior history of fainting or head injury. She feels better after receiving intravenous normal saline. Vital signs are normal. Physical examination reveals a grade 3/6 systolic ejection murmur at the left upper sternal border. Which of the following is the most likely cause of this patient’s syncope?

A. Vasovagal syncope
B. Hypertrophic cardiomyopathy
C. Long QT syndrome
D. Aortic stenosis
E. Wolff-Parkinson-White syndrome

Answer and topic summary

The answer is B. Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most likely cause of this patient’s syncope. HCM is characterized by asymmetric left ventricular hypertrophy, which can obstruct blood flow during exertion. The symptoms of palpitations, shortness of breath, and the presence of a systolic ejection murmur at the left upper sternal border are suggestive of HCM. This condition is a common cause of sudden cardiac death in young athletes.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Cardiomyopathy ⇒ Hypertrophic Cardiomyopathy

6. A 60-year-old woman comes to the office for a routine wellness examination. She has a history of chronic obstructive pulmonary disease (COPD), hypertension, hyperlipidemia, and squamous cell carcinoma of the skin. The patient has a 35-pack-year smoking history and currently smokes one pack of cigarettes per day. She typically consumes one glass of wine each night. Family history is significant for lung cancer and stroke. The patient had a routine screening mammogram 2 years ago that was normal. During the visit, it is discussed that she is at increased risk for developing lung cancer due to her smoking history. According to the US Preventive Services Task Force, which of the following is the most appropriate lung cancer screening test for this patient?

A. Chest X-ray
B. Sputum cytology
C. Low-dose computed tomography (LDCT)
D. Positron emission tomography (PET) scan
E. Magnetic resonance imaging (MRI)

Answer and topic summary

The answer is C. Low-dose computed tomography (LDCT)

Low-dose computed tomography (LDCT) is the most appropriate lung cancer screening test for this patient. According to the US Preventive Services Task Force, annual screening with LDCT is recommended for adults aged 50 to 80 years who have a 20-pack-year or more smoking history and currently smoke or have quit within the past 15 years. LDCT is preferred over chest X-ray because it is more sensitive in detecting early-stage lung cancer.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒ Neoplasms ⇒ Lung cancer

Also covered as part of the Family Medicine EOR and Emergency Medicine EOR topic lists

7. A 30-year-old man has had asthma for the past 8 years. His symptoms are frequently triggered by pollen and exercise. Over the past year, he has visited the emergency department twice for asthma exacerbations, each time requiring oral corticosteroids. He uses his albuterol inhaler about 3 times per week for symptom relief and experiences nighttime symptoms approximately once a week. According to the GINA guidelines, which of the following would be the most appropriate step in therapy to maintain remission between his asthmatic attacks?

A. As-needed low-dose ICS-formoterol (LABA)
B. Daily low-dose ICS-formoterol (LABA)
C. Medium-dose ICS-formoterol (LABA)
D. Add-on long-acting muscarinic antagonist (LAMA)
E. Oral prednisone

Answer and topic summary

The answer is B. Daily low-dose ICS-formoterol (LABA)

According to the GINA guidelines, the most appropriate step in therapy for this patient, given his symptoms and frequency of exacerbations, is daily low-dose ICS-formoterol (LABA). This recommendation corresponds to Step 3 of the GINA guidelines, which is suitable for patients who have symptoms most days, wake with asthma once a week or more, or have frequent use of a reliever inhaler.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒ Other Pulmonary Disease ⇒ Asthma

8. A 3-week-old boy is brought in for a routine health visit. He was born to a 30-year-old multigravida at 39 weeks gestation by cesarean delivery for breech presentation. Birth weight was appropriate for gestational age at 3.5 kg (7 lb 11 oz); current weight is 3.8 kg (8 lb 6 oz). Physical examination reveals a positive Ortolani maneuver with a palpable “clunk” on the left hip. An ultrasound of both hips confirms a dislocated left hip with a shallow acetabulum. Which of the following is the best next step in management of this patient?

A. Immediate closed reduction and spica casting
B. Pavlik harness application
C. Referral for physical therapy
D. Observation and follow-up in 6 months
E. Surgical open reduction

Answer and topic summary

The answer is B. Pavlik harness application

The best next step in the management of a newborn with a confirmed hip dislocation and shallow acetabulum is the application of a Pavlik harness. The Pavlik harness is the first-line treatment for developmental dysplasia of the hip (DDH) in infants younger than 6 months. It maintains the hip in flexion and abduction, allowing the acetabulum to mold around the femoral head and promote normal hip development.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Lower extremity disorders ⇒ Developmental Dysplasia of the Hip

9. A 65-year-old woman presents with a sore on her nose. Four weeks ago, she noticed a painless lesion on the tip of her nose; in the past week, the lesion became ulcerated. The patient has a history of significant sun exposure from working as a gardener. Examination shows a 5- x 6-mm scaly papule with a central ulcer located on the tip of the nose. The rest of the facial skin, including the oral mucosa and tongue, is free of lesions. There are no palpable cervical or submandibular lymph nodes. The rest of the physical examination is normal. Which of the following is the most likely diagnosis?
A. Basal cell carcinoma
B. Actinic keratosis
C. Herpes simplex virus infection
D. Squamous cell carcinoma
E. Melanoma

Answer and topic summary

The answer is A. Basal cell carcinoma

The most likely diagnosis is basal cell carcinoma (BCC), the most common type of skin cancer. It typically presents as a painless, slowly growing lesion that may ulcerate. The location on sun-exposed skin and the description of a scaly papule with a central ulcer are characteristic of BCC. BCC rarely metastasizes but can cause significant local destruction if not treated.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Dermatology ⇒ Dermatologic Neoplasms ⇒ Basal cell carcinoma

Also covered as part of the General Surgery EOR and Family Medicine EOR topic list

10. A 62-year-old woman is being seen in the primary care clinic for evaluation of leg pain. She has a history of hypertension, diabetes mellitus, and coronary artery disease. She reports having right calf pain associated with activity. The woman states that after walking approximately 2 or 3 blocks, she develops a cramping discomfort in her calf region that resolves with rest. She denies any change in skin color or temperature, edema, numbness, muscular weakness, chest pain, palpitations, shortness of breath, dizziness, or other associated symptoms. Her blood pressure is 145/85 mm Hg, pulse rate is 78/min, respirations are 18/min, oxygen saturation is 99% on room air, and temperature is 36.9°C (98.4°F). Her heart and lung examinations are normal. Evaluation of her lower extremity includes some dependent rubor with noted blanching on elevation. Her dorsalis pedis and posterior tibial pulses are palpable but diminished. There is mild muscular atrophy and hair loss compared to the contralateral extremity. Which of the following corresponds to the appropriate ankle-brachial index (ABI) used in the diagnosis of this patient’s disorder?

A. ABI greater than 1.4
B. ABI 1.0 – 1.4
C. ABI 0.9 – 1.0
D. ABI 0.5 – 0.8
E. ABI less than 0.5

Answer and topic summary

The answer is D. ABI 0.5 – 0.8

The appropriate ankle-brachial index (ABI) for the diagnosis of peripheral artery disease (PAD) in this patient is between 0.5 and 0.8. An ABI within this range indicates moderate arterial disease, which is consistent with the patient’s symptoms of claudication (pain with walking that resolves with rest) and physical findings such as diminished pulses and dependent rubor. The recommendation for patients with an ABI in this range is to refer to a vascular specialist.

Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Vascular Disease ⇒ Peripheral artery disease

Also covered as part of the General Surgery PAEA EOR topic list

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