Episode 109: The Audio PANCE and PANRE Board Review Podcast
Description
Listen to Podcast Episode 109: Ten PANCE, PANRE, and Rotation Review Questions
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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.
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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
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. Pulses are symmetric and equal in all extremities. There is an S4 gallop. ECG shows atrial fibrillation with rapid ventricular response. Serum troponin is elevated. Chest x-ray shows an enlarged cardiac silhouette, and a CT scan confirms aortic dissection. Which of the following is the best next step in management?
A. Administration of aspirin and nitroglycerin
B. Immediate thrombolytic therapy
C. Initiation of anticoagulation with heparin
D. Emergency pericardiocentesis
E. Emergent aortic repair surgery
The answer is E. Emergent aortic repair surgery
This patient’s sudden chest pain, syncope, hypertension, and CT-confirmed aortic dissection necessitate emergent surgical repair to prevent catastrophic complications like rupture. The enlarged cardiac silhouette and symptoms align with this diagnosis, making surgery the priority.
Incorrect Answers:
- A. Aspirin and nitroglycerin treat acute coronary syndromes, but nitroglycerin could worsen dissection by lowering blood pressure.
- B. Thrombolytics are contraindicated due to bleeding risk in dissection.
- C. Heparin is inappropriate in acute dissection due to bleeding risk, despite atrial fibrillation.
- D. Pericardiocentesis addresses tamponade, a possible complication, but isn’t the primary treatment for dissection.
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ Vascular Disease ⇒ Aortic aneurysm/dissection
3. A 25-year-old woman with a history of frequent sinus infections presents to the clinic for evaluation of ear pain. She recently returned from a vacation involving several flights. During the descent of her last flight, she experienced severe pressure and pain in her ears, followed by fullness and reduced hearing in her right ear. She has tried decongestants and nasal sprays without relief. On examination, the tympanic membrane appears retracted and immobile on pneumatic otoscopy. Which of the following is the most likely diagnosis?
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