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.
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Listen to Podcast Episode 101: Ten PANCE, PANRE, and Rotation Review Questions
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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.
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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: