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.
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Below you will find an interactive exam to complement today's podcast.
The Audio PANCE/PANRE and EOR PA Board Review Podcast
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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
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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.
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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
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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.