Podcast Episode 105: Ten PANCE, PANRE, and Rotation Review Questions

The answer is A. Telangiectasia

The patient has basal cell carcinoma, which is a skin cancer with low metastatic potential. It commonly occurs on the face (70% of the time). There are different types of BCC (nodular vs. superficial vs. infiltrative). However, nodular is the most common (80%) and typical characteristics you may see include a papule with a rolled border, pearly-like look, flesh-colored, and telangiectasia. Risk factors for BCC include UV radiation, certain genes, inherited disorders, etc.

The answer is A. Neglect

The most common type of elder abuse is neglect, which refers to the failure of a trusted person to protect an older person from harm or provide for their needs. Self-neglect is also common, which is when an older person can’t proide their own care. Some warning signs include bruising, lacerations, skin tears, spiral fractures, malnutrition, pressure ulcers, and dehydration. If you even suspect an older adult is being neglected, you should report this immediately to adult protective services (or similar agencies) and treat the medical complications immediately.

The answer is B. Staphylococcus aureus

A hordeolum (stye) is an abscess of the eyelid that is acute. It will usually present with pain and swelling of the eyelid. The most common pathogen indicated is Staphylococcus aureus. Risk factors include dirty eye makeup, rosacea, and seborrheic dermatitis. A way to differentiate hordeolums from chalazions is that Hordeolums are Hot (aka warm/tender).

Treatment may include warm compresses (10 min up to 5 times daily) plus massaging the eyelid to aid in drainage.

The answer is D. Pericarditis

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can impact almost any organ. It’s important to be aware of how SLE clinically presents in order to get to a diagnosis and treatment.

The most common clinical features overall are fatigue (80-100%), arthralgia/arthritis (>90%), fever (>50%), and Raynaud phenomenon (~50%). You may also see the classic malar rash that spares nasolabial folds.

Cardiac complications are common (50%) in SLE, and they lead to morbidity and mortality. The most common cardiac manifestation is pericarditis. Other cardiac issues these patients may have include pericardial effusion, myocarditis (rare), and valvular dysfunction.

The answer is D. Systemic hypertension

Aortic dissection is a life-threatening emergency and is defined by a tear of the inner layer of the aorta. On an exam, you may be asked about the classifications:

– Standford Classification: Stanford A is ascending aorta and Standford B is descending aorta

– DeBakey Classifications: type I is Both (ascending + descending aorta), type II is Ascending aorta, and III is Descending aorta. (Hint: It spells out BAD.)

The most important & common risk factor is systemic hypertension. Known causes of acute, severe increases in blood pressure include weight lifting, energy drinks, and cocaine. The classic presentation is “tearing and ripping chest pain with pulse deficits.” Treatment is lowering the BP via IV beta-blockers for both Type A and B and then surgery (for Type A).

The answer is D. Erythema infectiosum

Erythema infectiosum is a condition characterized by a fever with a rash. It is caused by parvovirus B19 infection. The classic presentation is a “slapped cheek” rash on the face and an erythematous, lacy reticular rash on the trunk and extremities. Some call it the “fifth disease.” It is a common childhood viral exanthem. Diagnosis is usually clinical (serology can be done though). The disease is self-limiting and no specific therapy is warranted (most of the time).

The answer is E. Fibromyalgia

Fibromyalgia is the most common cause of generalized muscle/bone pain in young adult females. Patients with fibromyalgia also usually have fatigue, cognitive fog, sleep disturbances, morning stiffness, headaches, paresthesias, and depression. On a physical exam, you will see tenderness to palpation at multiple sites. Initial treatment includes patient education, aerobic exercise, management of concurrent issues (e.g., sleep and psychiatric), & tricyclic antidepressants (e.g., amitriptyline 10 mg).

The answer is A. Bisphosphonates

Osteoporosis is characterized by low bone mass and skeletal fragility leading to decreased bone strength. There are no clinical symptoms of osteoporosis until a patient has an actual fracture. Vertebral fractures in particular, are the MOST common clinical manifestation of osteoporosis.

Diagnosis is made by a DEXA scan (T-score < -2.5 standard deviations) or a fragility fracture.

Lifestyle changes that can be made include exercise and cessation of smoking. The first-line pharmacological agent is oral bisphosphonates (e.g., alendronate or risedronate).

The answer is D. Infective endocarditis

The patient has infective endocarditis (IE), which is an infection of the endocardial surface of the heart. Risk factors include pre-existing valvular or congenital heart disease, IVDU, indwelling cardiac devices, IV catheters, or recent dental/surgical procedures. The most common symptoms include fever (90%), new murmur (85%), and petechiae (20-50%). Other textbook findings include Janeway lesions (non-tender macules on palms/soles), Osler nodes (tender nodules on pads of fingers/toes), and Roth spots (hemorrhagic lesions of the retina). The best diagnostic test is a transesophageal echocardiogram. The modified Duke criteria can be used as a diagnostic guide but must be interpreted in light of pretest probability. At least 3 sets of blood cultures should be obtained. Treatment includes IV antibiotics and removal of any infected device.

The answer is E. All of the above are diagnostic 

Type 2 diabetes mellitus is a very prevalent, serious disease that impacts about 9% of adults in the United States. Risk factors include family history, obesity, sedentary lifestyle, smoking, and poor diet habits. Initial symptoms include polyuria, polydipsia, polyphagia, and blurred vision. Diagnosis is made by one of the following answer choices seen on the first slide. First-line therapies include metformin and lifestyle changes (i.e., weight loss + exercise). Early combination therapy can be considered at treatment initiation to extend the time to treatment failure. It is VERY important to reach tight glycemic control as soon as possible in diabetic patients. Complications of diabetes include microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (stroke, myocardial infarction).