The Audio PANCE and PANRE Physician Assistant Board Review Podcast

Listen to Podcast Episode 109: Ten PANCE, PANRE, and Rotation Review Questions If you can't see the audio player, click here to listen to the full episode. Welcome to episode 109 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: View my PANRE-LA Performance Score and see my process for taking PANRE-LA Questions Learn all about the new Smarty PANCE QBank Sign up for our PANCE and PANRE Test-taking Masterclass Sign up for the Entire Blueprint Email Series Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram and Facebook Join the Smarty PANCE Member's Community, then sign up for a study group to get updates about upcoming webinars 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. You can download and listen to past FREE episodes here, on iTunes, Spotify, Amazon Music, and all podcasting apps. On each episode page, you can listen to all the latest episodes, take interactive quizzes, and download more resources. Interactive Exam to Complement Today's Podcast 1. A 70-year-old man presents for evaluation of poorly controlled hypertension despite adherence to five different classes of antihypertensive medications. His medical history includes coronary artery disease with a myocardial infarction 3 years ago, peripheral artery disease, and type 2 diabetes mellitus. He reports no changes in his medication regimen and denies any recent lifestyle modifications. Physical examination reveals a blood pressure of 190/110 mm Hg in the left arm and 180/100 mm Hg in the right arm. His BMI is 24 kg/m². On auscultation, there is no abnormal heart sound. Which of the following additional findings is most likely to be seen in this patient? A. Elevated serum aldosterone-to-renin ratio B. Continuous murmur over the carotid arteries C. Diminished femoral pulses D. Continuous bruit in the lateral periumbilical area E. Pitting edema in the lower extremities Answer and topic summary The answer is D. Continuous bruit in the lateral periumbilical area Renal artery stenosis is a significant cause of secondary hypertension, particularly in patients with a history of atherosclerotic disease, as seen in this patient with coronary artery disease and peripheral artery disease. Resistant hypertension, uncontrolled despite multiple medications, is a hallmark. A continuous bruit in the lateral periumbilical area indicates turbulent blood flow through a narrowed renal artery, supporting this diagnosis. Incorrect Answers: A. Elevated aldosterone-to-renin ratio suggests primary aldosteronism, less likely given the atherosclerotic history pointing to renal artery stenosis. B. A carotid murmur indicates carotid artery disease, unrelated to this hypertension scenario. C. Diminished femoral pulses align with peripheral artery disease, but don’t explain the resistant hypertension. E. Pitting edema suggests heart failure or venous insufficiency, not specific to renal artery stenosis. Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Renal System ⇒ Congenital or structural renal disorders ⇒ Renal vascular disease 2. A 70-year-old woman comes to the emergency department due to sudden-onset chest pain followed by shortness of breath. The pain started 2 hours ago, and she experienced an episode of syncope lasting about 1 minute shortly after the pain began. She has a history of untreated hypertension and hyperlipidemia. Blood pressure is 180/95 mm Hg in both arms; pulse is 110/min and irregular; and respirations are 22/min.

Listen to Podcast Episode 108: Ten PANCE, PANRE, and Rotation Review Questions If you can't see the audio player, click here to listen to the full episode. Welcome 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: Sign up for our new PANCE and PANRE Test-taking Masterclass Review the Asthma GINA guidelines and the lung cancer screening guidelines Sign up for the Entire Blueprint Email Series Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram and Facebook Join the Smarty PANCE Member's Community, then sign up for a study group to get updates about upcoming webinars. 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. You can download and listen to past FREE episodes here, on iTunes, Spotify, Amazon Music, and all podcasting apps. On each episode page, you can listen to all the latest episodes, take interactive quizzes, and download more resources. 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,

Listen to Podcast Episode 107: This vs. That - PANCE Blueprint Comparisons You Need to Know (Episode 1) In today's session, we will be discussing five questions related to PANCE/PANRE Blueprint topics. These questions will cover similar presentations and crucial comparisons that are important for you to know. These topics are often used by PANCE/PANRE test question writers, so it's essential to learn how to differentiate between them. This is the first part (episode 1) of a series. If you can't see the audio player, click here to listen to the full episode. Links from today's episode: Sign up for our new PANCE and PANRE Test-Taking Masterclass. Check out my first blog in our "This vs. That" Blueprint series: The PANCE Blueprint Showdown: Crohn's Disease vs. Ulcerative Colitis. Want a question of the day that covers the Blueprint - ALL of it? Sign up for the Entire Blueprint Email Series. Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram and Facebook for more daily questions. Join the Smarty PANCE Member's Community, then sign up for a study group to get updates about upcoming webinars. 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. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and all podcasting apps. You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page. Interactive exam to complement today's podcast 1. A 32-year-old woman presents with a 6-month history of loose bowel movements, approximately eight per day. Blood has been present in many of them. She has lost 30 pounds. For the past 6 weeks, she has had intermittent fever. She has had no previous gastrointestinal (GI) problems, and there is no family history of GI problems. On examination, the patient looks ill. Her blood pressure is 130/ 70 mm Hg. Her pulse is 108 beats/ minute and regular. There is generalized abdominal tenderness with no rebound. A sigmoidoscopy reveals a friable rectal mucosa with multiple bleeding points. Which of the following is the most likely diagnosis? A) Crohn's Disease B) Ulcerative Colitis C) Infectious Colitis D) Irritable Bowel Syndrome (IBS) E) Ischemic Colitis Answer and topic summary The answer is B) Ulcerative Colitis The patient’s symptoms of chronic bloody diarrhea, weight loss, fever, and the sigmoidoscopy findings of a friable rectal mucosa with multiple bleeding points are consistent with a diagnosis of ulcerative colitis (UC), which is a form of inflammatory bowel disease (IBD). UC typically involves the rectum and may extend proximally to involve other parts of the colon. Incorrect answers: A) Crohn’s Disease: This is another type of IBD. However, Crohn’s usually presents with non-bloody diarrhea, abdominal pain, and may involve any part of the GI tract from mouth to anus, often with skip lesions. In this case, the bloody diarrhea and the findings on sigmoidoscopy are more indicative of ulcerative colitis. C) Infectious Colitis: Although infectious causes can lead to similar symptoms, the duration of this patient’s symptoms (6 months) is much longer than typically seen with infectious colitis. Additionally, fever is less common in infectious colitis. D) Irritable Bowel Syndrome (IBS): IBS is a functional GI disorder characterized by abdominal pain with a change in bowel habit. It does not cause weight loss, fever, or bloody stools. E) Ischemic Colitis: This typically presents acutely in older patients or those with vascular risk factors. The clinical presentation often includes abrupt onset of abdominal pain and bloody diarrhea.

Listen to Podcast Episode 106: Ten PANCE, PANRE, and Rotation Review Questions + Review of Adrenal Insufficiency If you can't see the audio player, click here to listen to the full episode. Welcome to episode 106 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me today as we cover ten board review questions for your PANCE, PANRE, EOR, and EOC exams. Links from today's episode: Sign up for our new PANCE and PANRE Test Taking Masterclass Sign up for the Entire Blueprint Email Series Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram and Facebook Review adrenal insufficiency and adrenal disorders Join the Smarty PANCE Member's Community, then sign up for a study group to get updates about upcoming webinars. 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. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and all podcasting apps You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page. Interactive exam to complement today's podcast 1. A 22-year-old female with an unknown past medical history presents to the ER with a prolonged seizure lasting more than 5 minutes per EMS. Her airway was supported, and IV access was obtained en route to the ER. Her blood glucose is 120. Her vitals are stable, and laboratory studies are relatively unremarkable. Which of the following would be an appropriate medication to give to this patient? A. Calcium gluconate B. Propofol infusion C. Lorazepam D. Clonidine E. Narcan Answer and topic summary The answer is C. Lorazepam The patient has status epilepticus, which is defined as >5 minutes of continuous seizures or > 2 discrete seizures between which there is incomplete recovery of consciousness. Most episodes of status epilepticus in adults are due to a brain lesion or a toxic/metabolic disturbance (e.g., alcohol withdrawal, hypoglycemia, etc). Immediate management of status epilepticus includes stabilizing the airway, placing pulse oximetry and cardiorespiratory monitors, establishing IV access, and getting a glucose level. The first-line pharmacological agent given is a benzodiazepine (e.g., lorazepam or diazepam). Keppra, valproate, or other anti-seizure medication can be given as well. Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Neurology ⇒ Seizure disorders ⇒ Status epilepticus Also covered as part of the Internal Medicine EOR and Emergency Medicine EOR topic list 2. A 41-year-old male presents to the ER after a construction accident that left him with severe right eye pain and decreased visual acuity. On a physical exam, you notice a teardrop-shaped pupil. Which of the following is the most likely diagnosis? A. Globe rupture B. Acute angle-closure glaucoma C. Retinal detachment D. Corneal laceration E. Metallic foreign body Answer and topic summary The answer is A. Globe rupture Mechanical globe injuries occur when there is a laceration or full-thickness rupture through the cornea and/or sclera. Globe rupture (also called an open globe) follows blunt eye injury (e.g., motor vehicle crash, assault, thrown ball, etc). Globe lacerations occur after trauma from a sharp-penetrating object (e.g., knife or high-velocity projectile). PE signs include subconjunctival hemorrhage, irregularly-shaped pupil, hyphema (anterior chamber bleeding), decreased visual acuity, and limited EOM. This is an emergency and a patient should see an ophthalmologist immediately. Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint EENT ⇒ Traumatic disorders ⇒ G...

Listen to Podcast Episode 105: Ten PANCE, PANRE, and Rotation Review Questions If you can't see the audio player, click here to listen to the full episode. Welcome to episode 105 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me today as we cover ten board review questions for your PANCE, PANRE, EOR, and EOC exams. Links from today's episode: Sign up for the Entire Blueprint Email Series Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook Review systemic lupus erythematosus (SLE) Review the diabetes diagnostic guidelines Review gestational diabetes screening guidelines Review basal cell carcinoma and our comparison tables of the Blueprint dermatologic neoplasms Join the Smarty PANCE Member's Community, then sign up for a study group to get updates about upcoming webinars. 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. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and all podcasting apps You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page. Interactive exam to complement today's podcast 1. A 68-year-old male farmer presents with a flesh-colored papule with a rolled border located on the right side of his forehead. As you examine the lesion closely, you notice something else about the lesion. Which of the following physical exam findings would make you more suspicious of malignancy? A. Telangiectasia B. Nikolsky sign C. Hypopigmentation D. Tenderness to palpation E. Central umbilication Answer and topic summary 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. 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 2. Which of the following is the most common type of elder abuse? A. Neglect B. Emotional abuse C. Physical abuse D. Sexual abuse E. Financial exploitation Answer and topic summary 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. Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Psychiatry ⇒ Abuse and Neglect ⇒ Child/elder abuse 3. Which of the following is the most common bacterial cause of a hordeolum? A. Streptococcus pyogenes B. Staphylococcus aureus C. Clostridium perfringens D. Propionibacterium species E. Enterobacter aerogenes Answer and topic summary The answer is B. Staphylococcus aureus A hordeolum (stye) is an abscess of the eyelid ...

Listen to Podcast Episode 104: Ten PANCE, PANRE, and Rotation Review Questions If you can't see the audio player, click here to listen to the full episode. Welcome to episode 104 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me today as we cover ten board review questions for your PANCE, PANRE, EOR, and EOC exams. Links from today's episode: Sign up for the Entire Blueprint Email Series Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook Join the Smarty PANCE Member's Community, then sign up for a study group to get updates about upcoming webinars. 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. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and all podcasting apps You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page. Smarty PANCE is not sponsored or endorsed by, or affiliated with, the National Commission on Certification of Physician Assistants. Interactive exam to complement today's podcast When is screening for gestational diabetes done? A. 16 weeks B. 22 weeks C. 24 weeks D. 32 weeks E. 34 weeks Answer and topic summary The answer is C. 24 weeks Prenatal care is extremely important. Screening for gestational diabetes is routinely done in pregnant patients at 24 weeks of gestation (typically until 28 weeks). Pregnancy is associated with insulin resistance, mostly because of the placenta’s secretion of human placental lactogen. There are bad consequences of gestational diabetes, so it is critical it is diagnosed and treated adequately. The initial test is a one-hour 50-gram oral glucose tolerance test (GTT). A positive test >135 mg/dL. If a patient tests positive, they need to undergo the second test, which is a three-hour 100 mg oral GTT. The cut-offs are debated, but generally, the following are positive results: fasting > 95 mg/dL, 1 hour>180 mg/dL, 2 hours>155 mg/dL, 3 hours>140 mg/dL. Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Reproductive System ⇒ Complicated Pregnancy ⇒ Gestational diabetes Also covered as part of the Women’s Health EOR topic list 2. A 60-year-old male with a history of alcohol abuse and esophageal varices is brought to the ER with lethargy, delirium, weakness, and nausea. He is normotensive and afebrile. On physical exam, he is ill-appearing with jaundice, spider angiomas, a distended abdomen, and 3+ pretibial pitting edema. Based on his history and clinical presentation, which of the following electrolyte abnormalities would you expect to see in this patient? A. Hyponatremia B. Hypocalcemia C. Hypercalcemia D. Hyperphosphatemia E. Hypermagnesemia Answer and topic summary The answer is A. Hyponatremia The patient has hypervolemic hyponatremia secondary to cirrhosis. The causes of hypervolemic hyponatremia are cirrhosis, nephrotic syndrome, and CHF. Symptoms include nausea, headache, lethargy, and seizures. It’s important to have an approach to hyponatremia since it is the most common electrolyte abnormality in the hospital. First, it’s important to rule out pseudohyponatremia due to proteins, glucose, or mannitol. Also, make sure it’s not a diuretic causing hyponatremia. Next, consider the volume status – are they hypervolemic, hypovolemic, or euvolemic? Hypovolemic causes are more obvious (emesis, hemorrhage, etc.); however, urinary sodium can help differentiate between hypovolemia and euvolemia. If uNA < 20, then this means the renin-angiotensin-aldosterone system is on and trying...

Listen to Podcast Episode 103: Ten PANRE & PANRE-LA Intervention Complex Practice Question If you can't see the audio player, click here to listen to the full episode. Welcome to episode 103 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me today as we cover ten NCCPA-style board review questions for your PANRE and PANRE-LA exams. Special from today's episode: Take the new PANRE & PANRE-LA (Intervention Complex) Practice Exam: Covers all the topics tested within the new PANRE (Intervention Complex) performance expectation with links to Smarty PANCE lessons. PANRE & PANRE-LA Blueprint 8-Week Schedule and Study Planner Read The New 2023 PANRE and PANRE-LA: Everything you Need to Know Members can try out the newly updated PANRE-LA Smart Search Tool (you must log in to access the search bar) Sign up for the Entire Blueprint Email Series to get daily questions for the next 478 days! Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook Join the Smarty PANCE Member's Community, then sign up for a study group to get updates about upcoming webinars 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. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps. You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page. Here is an interactive exam to complement today's podcast 1. A 65-year-old man presents to your office with complaints of constipation for the past six months. He says that he has difficulty passing stools, which are hard and dry. He also reports occasional abdominal pain and bloating. He denies any weight loss, blood in stools, fever, or night sweats. His medical history is significant for hypertension and type 2 diabetes mellitus. His medications include metformin, lisinopril, and aspirin. He does not smoke or drink alcohol. On physical examination, his vital signs are normal. His abdomen is soft and nontender, with normal bowel sounds. There are no masses or organomegaly palpable. Which of the following is the most appropriate next step in evaluating this patient? A) Colonoscopy B) Barium enema C) Thyroid function tests D) Stool osmolarity E) Dietary modification Answer and topic summary The correct answer is A) Colonoscopy Colonoscopy is a procedure that involves inserting a flexible tube with a camera into the colon to visualize the mucosa and detect any abnormalities such as polyps, tumors, inflammation, or bleeding. It is indicated for patients with chronic constipation who are older than 50 years or have any red flag features for colorectal malignancy, such as weight loss, blood in stools, anemia, or a family history of colon cancer. This patient meets the age criterion and should undergo colonoscopy to rule out any serious causes of his constipation. Answer explanations: Barium enema is an imaging test that involves injecting a contrast agent (barium sulfate) into the rectum and taking X-rays of the colon. It can show structural abnormalities such as diverticula, strictures, masses, or volvulus. However, it is less sensitive and specific than colonoscopy for detecting colorectal malignancy. Therefore, it is not the preferred test for this patient. Thyroid function tests are blood tests that measure the levels of thyroid hormones (T3, T4) and thyroid-stimulating hormone (TSH). They can help diagnose thyroid disorders such as hypothyroidism or hyperthyroidism. Hypothyroidism can cause constipation due to decreased gastrointestinal motility. However,

Listen to Podcast Episode 102: Ten PANCE, PANRE, and Rotation Review Questions If you can't see the audio player, click here to listen to the full episode. Welcome to episode 102 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me today as we cover ten board review questions for your PANCE, PANRE, EOR™, and EOC™ exams. Special from today's episode: Read The New 2023 PANRE and PANRE-LA: Everything you Need to Know Members can try out the newly updated PANRE-LA Smart Search (you must log in to access the search bar) Sign up for the Entire Blueprint Email Series Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook Join the Smarty PANCE Member's Community then sign up for a study group to get updates about upcoming webinars. 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. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps. You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page. Interactive exam to complement today's podcast 1. Which of the following is NOT true about a non-ST elevation myocardial infarction? A. Non-enteric-coated, chewable aspirin 325 mg should be given B. Troponins are elevated C. It happens due to a partially occluded epicardial coronary artery D. Patients need a 12-lead EKG E. You will always see ST depressions Answer and topic summary The answer is E. You will always see ST depressions A non-ST elevation myocardial infarction (NSTEMI) is defined by the absence of persistent ST-elevation with elevated cardiac biomarkers (e.g., troponin I or T, CKMB, etc). It happens due to a partially occluded epicardial coronary artery (leading to subendocardial ischemia). NSTEMI typically presents as pressure-type chest pain. Patients with a suspected NSTEMI should receive a 12-lead EKG within 10 minutes of arrival. ST depression, transient ST-elevation, and/or T-wave inversions may be seen on EKG, but they are NOT required for the diagnosis of NSTEMI. The most important medication to give is non-enteric-coated chewable aspirin 325 mg. Other meds include sublingual nitroglycerin, oxygen as needed, beta-blockers (assuming no C/I), high-intensity statin, ACE inhibitors (if CKD, DM, or EF < 40%), P2Y12 inhibitor (e.g., clopidogrel), anticoagulation, and possibly PCI with stenting or CABG. Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Cardiology ⇒ Coronary Heart Disease ⇒ Acute myocardial infarction ⇒ Non-ST-Segment Elevation MI (NSTEMI) Also covered as part of the Family Medicine EOR, Internal Medicine EOR, Emergency Medicine EOR topic list 2. A 22-year-old G1P0 female at 28 weeks gestation with a history of diabetes presents to the clinic with fever, chills, and dysuria. Vitals show tachycardia (115 bpm), tachypnea (22 bpm), and hypotension (90/58 mmHg). Physical exam reveals suprapubic tenderness. Labs reveal leukocytosis, hyponatremia, and hyperglycemia. Urine dipstick is positive for nitrites, blood, glucose, and ketones. Which of the following is the next best step? A. Send home with oral antibiotics and analgesics B. Reassurance and oral rehydration solution C. Admit to hospital for antibiotics, fluids, & insulin D. Order outpatient CT scan of the abdomen E. Refer to an outpatient nephrologist for workup Answer and topic summary The answer is C. Admit to hospital for antibiotics, fluids, & insulin The patient most likely has pyelonephritis, which is an infection of the upper urinary tract and kidneys.

Welcome to episode 101 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me today as we cover ten board review questions for your PANCE, PANRE, and rotation exams. Special from today's episode: Join the Smarty PANCE Member's Community then sign up for a study group to get updates about upcoming webinars. Check out our updated End of Curriculum™ (EOC) Exam Course Sign up for the Entire Blueprint Email Series Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook I hope you enjoy this free audio component of the examination portion of the Smarty PANCE website. The full board review website includes over 2,000 interactive board review questions, flashcards, and blueprint lessons available to all members of Smarty PANCE. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps. You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page. Listen to Podcast Episode 101: Ten PANCE, PANRE, and Rotation Review Questions If you can't see the audio player, click here to listen to the full episode. Interactive exam to complement today's podcast 1. A 75-year-female smoker with a history of atrial fibrillation and hypertension presents to the ER complaining of a 2-hour history of right-sided weakness and aphasia that has now resolved. Her physical exam and vital signs are completely unremarkable. CT head is unremarkable. Which of the following is the most likely diagnosis? A. Subarachnoid hemorrhage B. Transient ischemic attack C. Cerebral venous sinus thrombosis D. Multiple sclerosis E. Complicated migraine Answer and topic summary The answer is B. Transient ischemic attack The patient had a transient ischemic attack (TIA), which is characterized by transient neurological symptoms without objective evidence of acute infarction. Symptoms vary, but patients may have hemiparesis, hemiplegia, aphasia, or vision loss. Risk factors include alcohol, hypertension, smoking, diabetes, illicit drug use, and atrial fibrillation. Urgent evaluation is needed in patients with symptoms of TIA (e.g., coagulation studies, TTE, EKG, CT or MRI head, imaging of the cervicocephalic vasculature via carotid US, CTA, or MRA). Treatment for high-risk patients includes dual antiplatelet therapy (ASA + clopidogrel) for 21 days and risk factor management (statin, exercise, etc). Remember the risk of an actual stroke is high after a TIA. View blueprint lesson Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Neurology ⇒ Vascular Disorder ⇒ Transient ischemic attack Also covered as part of the Internal Medicine EOR, Family Medicine EOR, and Emergency Medicine EOR topic list 2. A 26-year-old female presents with a history of miscarriages and recurrent pulmonary embolism. She is diagnosed with antiphospholipid syndrome. Which of the following is the mainstay of treatment for this condition? A. Dual antiplatelet therapy (DAPT) B. Aspirin and heparin C. Dabigatran D. Warfarin E. Heparin Answer and topic summary The answer is D. Warfarin Antiphospholipid syndrome (APS) is an autoimmune disease defined by venous thromboembolism, arterial thrombosis, and obstetric morbidity in the presence of circulating antiphospholipid antibodies (aPLs). It is the most common form of acquired thrombophilia. aPLs include lupus anticoagulant, anticardiolipin, anti-b2-glycoprotein I antibodies. Clinical features include DVTs (32%), thrombocytopenia (22%), livedo reticularis (20%), stroke (13%), PEs (9%), and fetal loss (8%). The mainstay of treatment is warfarin. Other anticoagulants have been found to be less effective than warfarin so far. View blueprint lesson Smarty PANCE Content Blueprint Review:

Welcome to episode one hundred of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me today as we cover atrial fibrillation for the PANCE, PANRE, and EOR™ exams. Special from today's episode: Join the Smarty PANCE Member's Community then sign up for the Sunday Funday Study Group. Once you have signed up, you can access the Webinar replay of this episode here Check out our updated End of Curriculum™ (EOC) Exam Course (now with orthopedics!) Sign up for the Entire Blueprint email series Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook Below you will find the audio of today's podcast. The Audio PANCE/PANRE and EOR PA Board Review Podcast I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of Smarty PANCE. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps. You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page. Listen to Podcast Episode 100: Atrial Fibrillation for the PANCE and PANRE If you can't see the audio player, click here to listen to the full episode.

Welcome to episode 99 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me as I cover ten PANCE, PANRE, and EOR™ review questions from the Smarty PANCE Instagram/Facebook page and the smartypance.com board review website. Special from today's episode: Join the Smarty PANCE Member's Community Check out our all-new End of Curriculum™ (EOC) Exam Course (still in development) Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook Below you will find an interactive exam to complement today's podcast. The Audio PANCE/PANRE and EOR PA Board Review Podcast I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of Smarty PANCE. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps. You can listen to the latest episode, take an interactive quiz, and download more resources below. Listen Carefully Then Take the Practice Exam If you can't see the audio player, click here to listen to the full episode. Podcast Episode 99: Ten PANCE/PANRE and EOR Topic Blueprint Questions 1. A 42-year-old male on lithium presents with polyuria, nocturia, and polydipsia. Laboratory findings are remarkable for slightly elevated sodium. Which of the following is the most likely diagnosis? A. Neurogenic diabetes insipidus B. Nephrogenic diabetes insipidus C. Type 2 diabetes mellitus D. SIADH E. Adrenal insufficiency Click here to see the answer The answer is B. Nephrogenic diabetes insipidus Nephrogenic diabetes insipidus (DI) is a condition where the kidneys are resistant to the effects of ADH. Nephrogenic DI can occur secondary to lithium toxicity or chronic lithium use, pregnancy, inherited disorders, and electrolyte issues. Clinical features include polyuria, nocturia, and polydipsia. Serum sodium is either normal or high. In this patient, lithium has entered the collecting duct, accumulated, and interfered with ADH’s capacity to increase water permeability. Treatment options for this patient include amiloride or thiazide diuretics. In general, whether or not lithium is discontinued depends on many factors. VIEW BLUEPRINT LESSON Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Endocrinology ⇒ Pituitary Disorders ⇒ Diabetes insipidus Also covered as part of the Internal Medicine EOR and Emergency Medicine PAEA EOR topic list 2. A 50-year-old female presents with poor appetite, low energy, poor concentration, and feelings of hopelessness on most days for the past 3 years. She denies suicidal ideation. She has never had a past manic or hypomanic episode. Which of the following is the best treatment option? A. Haloperidol B. Fluoxetine C. Lorazepam D. Amitriptyline E. Risperidone Click here to see the answer The answer is B. Fluoxetine This patient has dysthymia, or persistent depressive disorder. The DSM V criteria follow: Depressed mood ≥ 2 years on most days At least 2 of the following: appetite changes, sleep changes, low energy, low self-esteem, poor concentration, hopelessness Not without symptoms > 2 months at a time No mania or hypomania episodes, ever Like other psychiatric disorders, symptoms can’t be attributable to drugs, and the symptoms must cause distress/impairment. 1st line treatment is selective serotonin reuptake inhibitors and psychotherapy. VIEW BLUEPRINT LESSON Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Psychiatry ⇒ Depressive disorders ⇒ Persistent depressive disorder (dysthymia) Also covered as part of the Psychiatry EOR, Emergency Medicine EOR, and Pediatric PAEA EOR topic list 3.

Welcome to episode 98 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me as I cover ten PANCE, PANRE, and EOR™ review questions from the Smarty PANCE Instagram/Facebook page and the smartypance.com board review website. Special from today's episode: Join the Smarty PANCE Member's CommunityCheck out our all-new End of Curriculum™ (EOC) Exam Course (still in development)Follow Smarty PANCE and The Daily PANCE Blueprint on InstagramFollow Smarty PANCE and The Daily PANCE Blueprint on Facebook Below you will find an interactive exam to complement today's podcast. The Audio PANCE/PANRE and EOR PA Board Review Podcast I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of Smarty PANCE. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps.You can listen to the latest episode, take an interactive quiz, and download more resources below. Listen Carefully Then Take the Practice Exam If you can't see the audio player, click here to listen to the full episode. Podcast Episode 98: Ten PANCE/PANRE and EOR Topic Blueprint Questions 1. An 81-year-old female presents to the ER with acute onset of low back pain. She complains of bowel dysfunction and loss of sensation over her inner thighs. Physical exam reveals decreased lower extremity reflexes. Which of the following is the best diagnostic test for the likely diagnosis? A. Lumbar radiographsB. MRI of the lumbosacral spineC. CSF fluid analysisD. Scoliosis studiesE. None of the above Click here to see the answer The answer is B. MRI of the lumbosacral spine Cauda equina syndrome is a surgical emergency caused by severe stenosis in the lumbar spine (often due to acute disc herniation). Clinical manifestations include bowel/bladder dysfunction, decreased lower extremity reflexes, sciatica, saddle anesthesia (loss of sensation over the perineum, buttock, medial aspect of thighs), and decreased anal sphincter tone. Symptoms can develop acutely or chronically. An emergent MRI of the lumbosacral spine is the preferred diagnostic test. Surgery is the preferred treatment. Click here to view the Smarty PANCE lesson Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Spinal Disorders ⇒ Cauda equina syndrome Also covered as part of the Emergency Medicine PAEA EOR topic list 2. Which of the following is the most common cause of Cushing syndrome? A. IatrogenicB. Bronchogenic carcinomaC. Pituitary adenomaD. Adrenal adenomaE. Obesity Click here to see the answer The answer is A. Iatrogenic Cushing syndrome is a condition defined by too much cortisol. The most common cause of Cushing syndrome is exogenous steroid therapy (i.e., medical providers prescribing steroids). Other causes include a pituitary ACTH-secreting adenoma, adrenal tumors, and ectopic ACTH production from neoplasms. Classic clinical features include buffalo hump, moon-facies, purple striae, easy bruising, weight gain, depression, and weakness. Laboratory tests will be remarkable for elevated cortisol. Late night-salivary cortisol or 24-hour urinary free cortisol is typically the initial screening test. A low-dose dexamethasone test can be done. Referral to an endocrinologist is usually done at this point (or even prior). Click here to view the Smarty PANCE lesson Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Endocrinology ⇒ Adrenal Disorders ⇒ Cushing’s syndrome Also covered as part of the Internal Medicine EOR, Family Medicine EOR, and Emergency Medicine PAEA EOR topic list 3. A 73-year-old female presents with facial flushing, wheezing, and watery diarrhea for a few months. Her symptoms are worsened by certain foods.

Welcome to episode 97 of the Audio PANCE and PANRE PA board review podcast. Today is a bonus episode rounding out this fabulous five-part podcast series with Joe Gilboy PA-C, all about cardiac murmurs. In this week's episode, we continue our discussion of cardiac murmurs with ten PANCE and PANRE murmur questions. We'll cover the ins and outs of all the NCCPA content blueprint valvular disorders and learn how to identify and differentiate them from one another. If you haven't already, make sure to listen to our previous podcast episodes where we covered tricuspid stenosis, aortic valve murmurs, mitral valve murmurs, pulmonic valve murmurs, and HOCM and MVP. Podcast Episode 97: Murmurs Made Incredibly Easy - 10 PANCE and PANRE Murmur Questions Below is a transcription of this podcast episode edited for clarity. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and most podcasting apps.You can listen to this latest episode and access even more resources below. [00:00:00] Welcome back, everybody. This is Joe Gilboy. I work with Stephen Pasquini over there at Smarty PANCE. And today is the most dreaded podcast of all because you know what I'm going to do. That's right. I'm going to ask cardiac murmur questions. And I know it's the most dreaded thing in the world. Let's do this together because what I want to try to do here is make sense of it all. So, let's just kind of recap some basic rules before we start going down this thing. You know, the previous lectures, what have I been barking about? What's Joe been saying? First - inspiration, right? Expiration left. [00:00:40] Inspiration, right? Expiration left. So, with inspiration, the right-sided murmurs sound louder. So that's the tricuspid and the pulmonic valve regardless of if it's stenosis or regurgitation. Expiration - left. What am I saying? Everything on the left side sounds louder with expiration, whether it’s aortic or mitral - your call. [00:01:01] It can be stenotic or regurgitation, it doesn't matter, but it'll sound louder. What is squatting? Squatting is a party. So, what are you doing? You're bringing it all the blood flow back home. And so, if I bring all the blood flow back home, just from a laminar flow physics point of view, I bring more blood flow back home to the heart, more blood flow over a valve specifically with a diseased disease valve, it sounds louder. [00:01:29] So, right off the bat, squatting will do what? It's going to make all my murmurs sound louder. That's the whole point to decrease venous return. In other words, take blood flow away from the heart. What do I do? Well, those are going to be Valsalva and standing. So, what am I doing when I do Valsalva and standing? [00:01:56] Taking blood flow away from the heart. So, what's going to happen to all my murmurs when I stand and perform Valsalva? It takes blood flow away from the heart. Exactly. And then hand grip. What did handgrip do? So, in school, what'd you learn about hand grip? Well, it increases afterload, right? So, what they're really saying to you is this, and this is how I want you to visualize it. [00:02:18] When I do hand grip, what I'm really doing is this. You're right. I'm increasing the afterload. But you must stop and think this one out for a second, folks. What’s really in the heart? Which valve must fight afterload? [00:02:39] Say you increase the peripheral vascular resistance for whatever reason. So, you increase the afterload, who fights it? And your answer will be... oh, wait for a second, Joe, that's the aortic valve in the left ventricle. Exactly. So, when I perform handgrip, who am I really challenging? Oh, I'm challenging the aortic valve and everything behind it. [00:03:00] Exactly. So that's the point I need inside your head? Then remember our last podcast was about our low-volume lovers. Who were our low-volume lovers?

Welcome to episode 96 of the Audio PANCE and PANRE PA board review podcast. Today is part five of this fabulous five-part series with Joe Gilboy PA-C, all about cardiac murmurs. In this week's episode of the Audio PANCE and PANRE podcast, we continue our discussion of cardiac murmurs with a focus on Mitral Valve Prolapse (MPV) and Hypertrophic Obstructive Cardiomyopathy (HOCM). We'll cover the ins and outs of these two NCCPA content blueprint murmurs and learn how to identify and differentiate them from other types of murmurs. If you haven't already, make sure to listen to our previous podcast episodes where we covered tricuspid stenosis, aortic valve murmurs, mitral valve murmurs, and pulmonic valve murmurs. HOCM and MVP (a brief introduction) Hypertrophic Obstructive Cardiomyopathy (HOCM) is a cardiac abnormality that leads to the muscle in the wall of the heart growing and thickening to the point that it blocks blood flow exiting the heart. The condition can be mild or severe, and it can lead to a variety of symptoms, including shortness of breath, chest pain, and irregular heartbeat. Complications may include heart failure, an irregular heartbeat, and sudden cardiac death. HOCM is a hereditary condition, and it is usually diagnosed in adulthood. There is no cure for HOCM, but treatments are available to manage the symptoms and help reduce the risk of complications. With proper care, people with HOCM can live long and healthy lives. *Hypertrophic cardiomyopathy is covered under the PANCE cardiology content blueprint -> cardiomyopathy -> hypertrophic cardiomyopathy HOCM is also covered as part of the PAEA EOR pediatric rotation -> cardiovascular topic list -> hypertrophic cardiomyopathy Mitral Valve Prolapse (MPV) is a condition in which the leaflets of the mitral valve bulge or prolapse back into the left atrium during systole. This may cause blood to flow backward into the left atrium, leading to a heart murmur. In some cases, MPV may also cause symptoms such as fatigue, dizziness, chest pain, and shortness of breath. While MPV is usually benign, it can occasionally lead to serious complications such as heart failure or stroke. Treatment for MPV typically involves lifestyle modification and management of symptoms. In severe cases, surgery may be necessary to repair or replace the mitral valve. *Miral valve prolapse is covered under the PANCE cardiology content blueprint -> valvular disorders -> mitral valve prolapse Podcast Episode 96: Murmurs Made Incredibly Easy (Part 5 of 5) – MVP and HOCM Below is a transcription of this podcast episode edited for clarity. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and most podcasting apps.You can listen to this latest episode and access even more resources below. Welcome back, everybody out there in the podcast world. This is Joe Gilboy, and I work with Stephen Pasquini at Smarty PANCE. Today is part five of our five-part series covering heart murmurs - one of the most dreaded subjects in PA land. Today we are going to cover what I call the low-volume lovers. And who are the murmurs that like low blood volumes? In other words' low blood volumes make these murmurs sound louder? That is Hypertrophic Obstructive Cardiomyopathy (HOCM) and mitral valve prolapse. Hypertrophic Obstructive Cardiomyopathy (HOCM) So, what is happening with HOCM? Let us go back and view this from a pathophysiology point of view. So what do you have with HOCM? I have this young adult, and he is going to start exercising. So what is the left ventricle going to do on a typical day during exercise? You will stress out the left ventricle, which can lead to hypertrophy.  I want everybody to look in the space you are in right now. Maybe you are in a room. Perhaps you are in a car. I want you to look at the volume of this room or car and look at the wall. ...

Welcome to episode 95 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me as I cover ten PANCE, PANRE and EOR review questions from the Smarty PANCE Instagram/Facebook page and the smartypance.com board review website. Special from today's episode: Follow Smarty PANCE and The Daily PANCE Blueprint on InstagramFollow Smarty PANCE and The Daily PANCE Blueprint on Facebook Below you will find an interactive exam to complement today's podcast. The Audio PANCE/PANRE and EOR PA Board Review Podcast I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of Smarty PANCE. You can download and listen to past FREE episodes here, on iTunes, Spotify, on Google Podcasts, Stitcher, and most podcasting apps.You can listen to the latest episode, take an interactive quiz, and download more resources below. Listen Carefully Then Take the Practice Exam If you can't see the audio player, click here to listen to the full episode. Podcast Episode 95: Ten PANCE/PANRE and EOR Topic Blueprint Questions 1. A 52-year-old patient is admitted with a lower gastrointestinal bleed. He is given 2 units of packed red blood cells. A few hours later the patient develops a fever but has no other symptoms or changes in vital signs. Lab studies reveal no significant changes. Which of the following is the most likely diagnosis? A. Transfusion-associated circulatory overloadB. Acute immune-mediated hemolytic reactionC. Transfusion-related acute lung injuryD. Febrile non-hemolytic transfusion reactionE. None of the above Click here to see the answer The answer is D. Febrile non-hemolytic transfusion reaction The most common transfusion reaction is a febrile non-hemolytic transfusion reaction (FNHTR). Patients with FNHTR may present with a fever a few hours after receiving packed red blood cells (PRBCs), which is caused by the small number of white blood cells and cytokines that can be found in each unit of PRBCs. Treatment consists of giving acetaminophen and ruling out other causes of fever (e.g., central line infection, urinary tract infection, etc). Incorrect Answers: Transfusion-associated circulatory overload (Choice A) occurs when the volume of the transfused component causes hypervolemia. Acute immune-mediated hemolytic reaction (Choice B) occurs when there are antibodies presented to blood donor antigens. Patients may present with hypotension, fever, or coagulopathic lab abnormalities. Transfusion-related acute lung injury (Choice C) is due to antibodies reacting with antigens leading to the release of mediators that causes edema in the lungs. Symptoms include fever, hypoxia, and dyspnea. VIEW BLUEPRINT LESSON Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Hematology ⇒ Immunologic disorders ⇒ Transfusion reaction 2. Which of the following is not a side effect of lithium? A. HyperparathyroidismB. HypothyroidismC. Cognitive fogD. TremorsE. All are side effects Click here to see the answer The answer is E. All are side effects  Lithium is the first-line treatment for bipolar disorder. It has many side effects that you should remember, such as hypothyroidism, hyperparathyroidism, nephrogenic diabetes insipidus, cognitive fog, and tremors. Lithium levels should be monitored to avoid toxicity. Remember, bipolar disorder is characterized by the symptoms DIG FAST: Distractibility, Irritability, Grandiosity, Flight of ideas, Activity increased, Sleep deficits, and Talkativeness. VIEW BLUEPRINT LESSON Smarty PANCE Content Blueprint Review: Covered under ⇒ PANCE Blueprint Psychiatry ⇒ Bipolar and related disorder Also covered as part of the Emergency Medicine EOR, Psychiatry EOR, and Family Medicine PAEA EOR topic list 3. Which of the following best explains the pathophysiology of vasovagal...

Welcome to episode 94 of the Audio PANCE and PANRE PA board review podcast. Today is part four of this fabulous five-part series with Joe Gilboy PA-C, all about cardiac murmurs. In this week's episode of the Audio PANCE and PANRE podcast, we continue our discussion of cardiac murmurs with a focus on the tricuspid valve. We'll cover the ins and outs of tricuspid valve stenosis and learn how to identify it and differentiate it from other types of murmurs. If you haven't already, make sure to listen to our previous podcast episode where we covered aortic valve murmurs and mitral valve murmurs, and pulmonic valve murmurs. The Tricuspid Valve The tricuspid valve, or right atrioventricular valve, is a one-way valve that sits between the right atrium and right ventricle of the heart. It is essential for right ventricular filling and for preventing the backflow of blood from the right ventricle into the right atrium when the right ventricle contracts during systole. When functioning properly, the tricuspid valve is a passive structure that opens and closes in response to the pressure of the blood flowing through the heart. The right atrium receives deoxygenated blood from the superior and inferior vena cava. The tricuspid valve which separates the right atrium from the right ventricle opens during ventricular diastole, allowing the deoxygenated blood to flow from the right atrium into the right ventricle, and closes during ventricular systole preventing the backflow of blood from the right ventricle into the right atrium as the right ventricle contracts to pump blood into the lungs out through the pulmonary artery. Tricuspid Valve Stenosis Tricuspid stenosis is a narrowing of the tricuspid valve or one of its three leaflets. If the tricuspid valve is narrowed or stenotic, it will not open properly during diastole, increasing the volume of blood in the right atrium. When the right ventricle contracts the stiffened tricuspid valve also fails to close completely and tricuspid regurgitation develops. Nearly all cases are caused by rheumatic fever. Podcast Episode 94: Murmurs Made Incredibly Easy (Part 4 of 5) – Tricuspid Valve Stenosis Below is a transcription of this podcast episode edited for clarity. You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and most podcasting apps.You can listen to the latest episode and access even more resources below. Welcome everybody, this is Joe Gilboy PA-C and I work with Stephen Pasquini at Smarty PANCE. Today, we will continue this series on heart murmurs. Today's topic is tricuspid stenosis. So, sit back, listen to my voice, and try not to take notes. Don't do anything other than just listen and follow my logic. I promise you, when this is all said and done, you'll be looking at heart murmurs and more specifically, tricuspid stenosis in a vastly different light. I want you to view the tricuspid valve. Just think about it. There you are the right atria. The tricuspid valve opens during diastole and closes during systole. There's all your blood in the right ventricle, and it goes out through the pulmonary valve to get oxygenated out in the lungs. So now, I want you to think about this for a second. I have a tricuspid valve that is stenotic. It's stiff and hard to open. When are you going to have problems opening this valve? During diastole? Or during systole? You are going to have problems with this during diastole because that's when the tricuspid valve is supposed to open up. Because it's supposed to be closed during systole. So, it's a diastolic murmur, it's considered a mid-diastolic murmur. Now give this some more thought. Okay, so you're in the right atria - Is it easier or harder to push through this stenotic valve? Oh, it's a lot harder. And so, where's the blood flow going to back up to? Into the right atrium and now that right atrium,

Welcome to episode 93 of the Audio PANCE and PANRE physician assistant/associate board review podcast. Today is part three of this extraordinary five-part series with Joe Gilboy PA-C, all about cardiac murmurs. In this week's episode of the Audio PANCE and PANRE podcast, we continue our discussion of cardiac murmurs with a focus on the pulmonic valve. We'll talk about the different types of murmurs (stenosis and regurgitation) that can occur with the pulmonic valve and how to differentiate them from other types of murmurs. If you haven't already, make sure to listen to our previous podcast episode where we covered the aortic valve murmurs and mitral valve murmurs. The Pulmonic Valve Pulmonic valve stenosis (PVS) and pulmonic valve regurgitation (PVR) are two common heart valve diseases. PVS is a narrowing of the pulmonic valve, while PVR is leakage of blood back through the pulmonic valve. Both conditions can lead to significant heart problems if left untreated. Pulmonic valve stenosis PVS is the most common congenital heart disease, affecting approximately 1 in 1000 people. It can lead to right heart failure and/or pulmonary hypertension (high blood pressure in the lung arteries). PVS is caused by an abnormally thickened pulmonic valve or localized stenosis which means that it has a narrowing of the valve. Pulmonic valve stenosis has several different causes including: Congenital heart disease – this means that the abnormal valve was present from birth but is often undiagnosed until adulthood. For example, children with Down's syndrome or Noonan syndrome are more likely to have an undiagnosed congenital heart defect such as PVS. It commonly is a component of tetralogy of Fallot.Cocaine use in pregnancy – research has shown that there is a link between the use of cocaine in pregnant women and children with PVS, particularly if it is used close to the time of conception or later stages of pregnancy.Infection during pregnancy can cause an inflammatory response which may lead to heart problems for the baby.Autoimmune disease – PVS is sometimes associated with other autoimmune diseases, such as lupus. Symptoms of PVS can vary depending on the type of stenosis that is present and how much it has advanced. Mild cases may not cause any symptoms at all; however, it is common for patients to experience breathlessness, fatigue, chest pain, and palpitations. Heart sounds include increased splitting of S2 and a harsh crescendo-decrescendo ejection murmur heard best at the left parasternal 2nd or 4th intercostal space when the patient leans forward; the murmur grows louder immediately with Valsalva release and with inspiration. People with PVS may need to take some medication to ease their symptoms. For example, diuretics can help remove excess fluid; beta-blockers reduce the workload on the heart and therefore lower blood pressure and heart rate, and long-acting calcium channel blockers can reduce the force of contraction of the heart's left ventricle. Pulmonary valve replacement is an effective treatment for severe PVS, which involves surgically implanting a new pulmonary valve to replace the defective one. Because the valve only affects the blood flow through one part of the heart, this surgery can often be carried out using minimally invasive techniques. For milder cases of PVS that do not cause symptoms then medication or exercise may be prescribed instead. Regular exercise helps to strengthen the left ventricle (the main pumping chamber) which is important for people with PVS. For more information, view our lesson on pulmonary stenosis. Pulmonic valve regurgitation Pulmonic valve regurgitation is leakage of blood back through the pulmonic valve. It can lead to right-sided heart failure and/or pulmonary hypertension (high blood pressure in the lung arteries). This means that it has a leakage of the valve. It can be caused by any condition that impairs cardiac function,

The Audio PANCE/ PANRE Podcast Episode 92. Cardiac Murmurs Made Incredibly Easy Part 2 of 5. Mitral valve stenosis & regurgitation with Joe Gilboy PA-C.

Welcome to episode 91 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Today is part one of an extraordinary five-part series with Joe Gilboy PA-C, all about cardiac murmurs. It's time to throw away everything you have ever learned that made you hate cardiac murmurs (you know those crazy line diagrams) and let Joe hard-wire your brain for success. I promise you that by the end of this podcast, you will no longer be afraid of murmurs, but you will welcome them into your brain with a whole heart, open arms, and the need to share this podcast with all your classmates. Below is a transcription of this podcast episode slightly edited for clarity. You can download and listen to past FREE episodes here, on iTunes, Spotify, on Google Podcasts, Stitcher, Amazon Music, and most podcasting apps.You can listen to the latest episode and access even more resources below. Welcome, everybody. This is Joe Gilboy PA-C, and today is part one of a five-part series on the two most dreaded words that every pa student and recert PA hates. Are you ready for the two words? Heart murmurs! Today we're going to start talking about heart murmurs, and we are going to break this down into a five-part series: The first part is going to be on the aortic valve (today’s episode)The second part will cover the mitral valveThe third will be all about the pulmonic valveThe fourth part will be about the tricuspid valveAnd then, in the fifth part of this series, we're going to wrap this all together We're going to cover each valve one at a time. We will look at it and try to really make sense of it all. Because I know what you did in PA school, you had that little diagram that you made, you know, systolic or diastolic murmurs. You've memorized certain things. And then you get to that test question, and you're completely clueless on it, you're like, “I have no idea what they just said, Joe, I have no idea.” And then you're back to scrambling, looking for some word that's going to trigger you. And that's the key point- all the trigger words, all those high-value trigger words, they're gone. That's what the creators of the PANCE did about two to three years ago. They took all the trigger words out. Key point: Don’t rely on keywords (trigger words) for your PANCE because they’re gone! So now, let's look at this differently. You did it your way. How did it work out? Probably not so well. So, guess what, we're going to do it my way. And that's what I want to do here. Let's start with the aortic valve. So, think about it for a second. I want you to picture the aortic valve. Opening during systole, closing during diastole. That's really what it's supposed to do. Go ahead and picture that in your head. And for those who are in a safe place, close your eyes because it makes more sense. The valve is going to be open during systole and is going to be closed during diastole. Now, who gets fed right after the aortic valve? Well, that'd be the coronary arteries. If I'm lacking blood flow to my coronary arteries, how's that feel? I’ve got chest pain. What's the second thing that gets fed after the aortic valve? Well, that'd be my internal and external carotid arteries. If I lack blood flow to my internal or external carotids, how will I feel? Lightheaded with syncope and dizziness. Where does blood flow third? That would be my left subclavian artery, and if I lack blood flow, then I get left arm pain. And then, of course, everything down south after that. Aortic Stenosis Okay, so let's start with the first one—aortic stenosis. So, think about this for a second. Stop memorizing. Start thinking. I have this stenotic aortic valve, and it can’t open up. So that's my question to you. When are you going to have problems with this valve? During systole or diastole? It is supposed to open during systole. And it won't. It’s too stenotic.

Welcome to episode 90 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast. Join me as I cover ten PANCE, PANRE and EOR review questions from the Smarty PANCE Instagram/Facebook page and the smartypance.com board review website. Special from today's episode: Follow Smarty PANCE and The Daily PANCE Blueprint on InstagramFollow Smarty PANCE and The Daily PANCE Blueprint on Facebook Below you will find an interactive exam to complement today's podcast. The Audio PANCE/PANRE and EOR PA Board Review Podcast I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of Smarty PANCE. You can download and listen to past FREE episodes here, on iTunes, Spotify, on Google Podcasts, Stitcher, and most podcasting apps.You can listen to the latest episode, take an interactive quiz, and download more resources below. Listen Carefully Then Take the Practice Exam If you can't see the audio player, click here to listen to the full episode. Podcast Episode 90: Ten PANCE/PANRE and EOR Blueprint Questions 1. A 32-year-old male presents with acute ascending symmetrical paralysis and diminished reflexes in his bilateral lower extremities. He has a history of bloody diarrhea a few days ago. What did he likely eat that led to his symptoms? A. Uncooked rice B. Mayonnaise C. Uncooked chicken D. Soft unpasteurized cheese E. None of the above Click here to see the answer C. Uncooked Chicken This patient has Guillain-Barré Syndrome (GBS), an acute immune-mediated polyneuropathic disorder. Clinical features include ascending symmetrical paralysis, diminished tendon reflexes, and respiratory muscle weakness. GBS is typically precipitated by an infection. Campylobacter jejuni infection is the most common precipitant of GBS. It is commonly found in uncooked poultry. Cerebrospinal fluid analysis helps confirm the diagnosis. Treatment includes plasmapheresis and IV immune globulin. View lesson: Guillain-Barré Syndrome 2. Which of the following disorders is characterized by a scaly, rough erythematous patch that appears on sun-exposed areas? A. Seborrheic keratosis B. Keratosis pilaris C. Actinic keratosis D. Lichen planus E. Pityriasis rosea Click here to see the answer Answer: C. Actinic keratosis Actinic keratosis (AK) is a skin lesion that results from atypical keratinocyte proliferation. Risk factors include UV radiation, fair skin, and sunburns. AK can present in various ways, but classically you will see an erythematous, scaly macule, papule, or plaque. A shave or punch biopsy can confirm the diagnosis. However, AK is often diagnosed clinically. Treatment depends on the location and extent of the condition. Options include cryotherapy, fluorouracil, and imiquimod. It is important to remember that AK can develop into SCC. View Lesson: Actinic keratosis (AK) 3. A 42-year-old male is admitted for typical pneumonia. He is given IV azithromycin and ceftriaxone. His QT interval becomes prolonged and he develops a polymorphic ventricular tachycardia. Which of the following is the most appropriate pharmacological management? A. Intravenous calcium gluconate B. Intravenous magnesium sulfate C. Intramuscular epinephrine D. Oral amiodarone E. Oral procainamide Click here to see the answer B. Intravenous magnesium sulfate The patient developed torsades de pointes (Tdp), which is a specific type of polymorphic ventricular tachycardia in patients with a long QT interval. It is a ventricular dysrhythmia characterized by rapid (>100 bpm), irregular, wide QRS complexes that vary in size and shape. Diagnosis is made via EKG. Examples of meds that prolong the QT interval include antiarrhythmics (amiodarone, sotalol), antimicrobials (fluoroquinolones, macrolides),