Podcast Episode 107: This vs. That – PANCE Blueprint Comparisons You Need to Know (Part 1)
Description
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
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. The duration and pattern of symptoms in this patient are more consistent with IBD.
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Colorectal disorders ⇒ Inflammatory bowel disease
2. A 27-year-old female presents to the emergency department with a 3-day history of a widespread painful rash. She reports having started a new medication for her seizures 1 week ago. On examination, you note erythematous macules that are coalescing into large areas of epidermal detachment. The mucous membranes of her mouth, eyes, and genital region are also affected, and the skin involvement covers more than 30% of her body surface area. A skin biopsy reveals full-thickness epidermal necrosis. Based on her presentation and the medication history, which of the following diagnoses is she most likely suffering from, and which medication most likely contributed to this condition?
A) Erythema multiforme major secondary to Levetiracetam (Keppra)
B) Toxic Epidermal Necrolysis (TEN) secondary to Carbamazepine
C) Stevens-Johnson syndrome (SJS) secondary to Metformin
D) Acute generalized exanthematous pustulosis secondary to Lisinopril
E) Stevens-Johnson syndrome (SJS) secondary to Atorvastatin
The answer is B) Toxic Epidermal Necrolysis (TEN) secondary to Carbamazepine
The patient’s presentation with widespread epidermal necrosis, mucous membrane involvement, and skin detachment affecting more than 30% of her body surface area is suggestive of Toxic Epidermal Necrolysis (TEN). SJS and TEN are considered a spectrum of the same disease, with SJS affecting less than 10% of body surface area, SJS-TEN overlap affecting 10-30%, and TEN affecting more than 30%. The diagnosis can be confirmed by biopsy (showing necrotic epithelium) if clinical characteristics (eg, target lesions progressing to bullae, ocular and mucous membrane involvement, Nikolsky sign, desquamation in sheets) are inconclusive. Immediate discontinuation of the offending drug is paramount. Patients with TEN often require transfer to a burn unit or an intensive care unit for supportive care. Fluid and electrolyte balance, pain control, and prevention of secondary infections are critical. Immunomodulatory agents like IVIG (intravenous immunoglobulin) or cyclosporine may be considered, but their efficacy is still under debate.
Option A: Erythema multiforme major: Presents with targetoid lesions and is less severe than SJS and TE
United States
