PANCE Practice Questions and answers, 2022. 100% pass rate.

PANCE Practice Questions and answers, 2022. 100% pass rate. which type of hypersentitivy rxn is the most severe? requiring emergency tx? - ✔✔type 1 Type IV< III< II < I in an alcoholic pt with global confusio ...

PANCE Practice Questions and answers, 2022. 100% pass rate. which type of hypersentitivy rxn is the most severe? requiring emergency tx? - ✔✔type 1 Type IV< III< II < I in an alcoholic pt with global confusion, ataxia (gait imbalance), nystagmus + ocular msl paralysis - ✔✔wernicke's encephalopathy Tx: IV thiamine which type of hypersensitivity rxn is characterized by antigen -antibody rxns mediated by IgE -- that results in hypotension, shock, urticaria, or angioedema? - ✔✔type I best diagnostic test for carpal tunnel syndrome ? - ✔✔electromyogram males with early onset of poor gait that is progressively worsening. Plus pseudohypertrophy of the calves and + Gowers sign (need to lift oneself "climb up" up when getting up) and a positive fam history a Muscle bx to confirm this dx would show: - ✔✔duchenne muscular dystrophy which tests differentiate between nerve and muscular problems? - ✔✔electromyogram and nerve conduction studies Cushing's syndrome pt should immediately stop which meds? - ✔✔steroids. Lambert-Eaton myasthenic syndrome - ✔✔immune mediated disorder where ACH is not properly released - this causes weakness in scapular and pelvic girdle muscles. and difficulty climbing stairs or impotence. deep tendon reflexes are decreased or absent. overdose cholinesterase inhibitors such as pyridostigmine or neostigmine can cause what ? (usually prescribed for MG) - ✔✔cholinergic crisis. excessive salivation, lacrimation, emesis, urinary incontinence, gynecomastia, sparse body hair, small soft testes - ✔✔klinefelters' syndrome (XXY) retinal a. emboli can cause brief episodes of monocular blindness known as - ✔✔amaruosis fugax inhibition of protein C due to use of warfarin causes what? - ✔✔skin necrosis in wilson's dz which are the only type of contraceptives recommended? - ✔✔progestin only pill or levoestregel releasing IUD how do u differentiate between amphetamine or cocaine high? - ✔✔time; amphetamine = 4-6 hrs cocaine = 2 hrs. cushings syndrome pts that are not surgical candidates can use what? - ✔✔oral ketoconazole distended neck veins with prominent A or V waves - ✔✔cor pulmonale IgA vasculitis that erupts over skin post URI, manifesting as paplaple lesions and pts also present with hematuria, arthalgia, and abdominal pain and bloody stools. dx: best dx tool: tx: - ✔✔henoch schonlein purpura coag studies: should be NEGATIVE! kidney bx: IgA deposits tx: supportive as dz is self limiting (NSAIDs, bed rest, hydration) which restrictive lung dz has increased serum ACE (angiotensin converting enzyme)? - ✔✔sarcoidosis in pts with orthostatic hypotension, how can you differentiate between autonomic insufficiency or hypovolemia? - ✔✔in autonomic insufficiency there is no compensatory increase in HR which two conditions are associated with: 1. menstrual irregularity 2. androgen exces - hirsutism 3. mood changes 4. insulin resistance - hyperglycemia 5. obesity how can u differentiate the two? - ✔✔PCOS and hypercortisolism ***hypercortisolism has obesity in truncal distribution and is assoc with HTN and inc urinary cortisol. what are the two most common causes of ACUTE renal failure? - ✔✔1. acute tubular necrosis (due to ischemia, shock, sepsis or cardiac arrest or nephrotoxins) 2. prerenal dz (HF or hypovolemia) what is the BUN/Cr ratio like in acute tubular necrosis? - ✔✔normal BUN/Cr ratio only higher in dz with reduced urine outflow = pre/post renal azotemia BUN/Cr ratio is only lower in severe liver dz. beriberi, av fistulas, hyperthyroidism, Paget's dz of bone can all cause what kind of HF? - ✔✔high cardiac output HF. how can you differentiate between inflammatory and non-inflammatory diarrhea? - ✔✔inflammatory diarrhea can be bloody shigella, entameoba, capmhylobacter, salmonella, yersinia are all organisms that are more likely to cause what kind of diarrhea? - ✔✔inflammatory norovirus, rotavirus, e.coli, staph aureus, giardia, crytosproridium are all organisms that cause wht kind of diarrhea? - ✔✔non-inflammatory. in a pt with guillan barre, PMH is significant for recent travel and severe diarrhea (enterocolitis) - what organism can you assume caused this? - ✔✔camphylobacter. which organisms are most likely to cause traveler's diarrhea? - ✔✔e.coli, shigella, camphylobacter which organisms are responsible for causing diarrhea from drinking contaminated water? - ✔✔giardia, cryptosproridium stool immunoassay and micro studies to confirm dx. tx: metronidazole. extraintestinal manifestations of uveitis, erythema nodosum or pyoderma gangrenosum , large joint arthritis, and cholangitis can be seen with what? - ✔✔Ulcerative colitis in addition to heart burn, GERD can cause what sxs? - ✔✔water brash, hoarseness, wheezing, sour taste, sore throat. best test for GERD dx? - ✔✔esophageal pH monitoring how is antiphospholipid antibody syndrome related to pregnancy? - ✔✔recurrent spontaneous abortions. and it can cause preecclampsia. best diagnostic test for someone with charcoat's triad + - ✔✔ERCP unconjugated (INDIRECT) bilirubin is high in what conditions? - ✔✔gilberts's dz, hemolysis, newborn jaundice, resabsorption of hematoma, conjugated (DIRECT) bilirubin is high in what conditions? - ✔✔Dubin johnson, biliary tract obstruction, intrahepatic cholestasis, tumor in liver, cholangitis main cause of primary dysmenorrhea? - ✔✔prostaglandin causing uterine contraction and ischemia in a pt with active upper GI bleed, what test should u perform to dx h.pylori infection? - ✔✔gastric bx. via endoscopy. what is HHS ? who gets it? - ✔✔HHS is Hyperglycemic Hyperosmolar state, middle aged DM pts get it due to infection, AMI, stroke or surgery. - Hyperglycemia = GLU > 600mg/dL - hyperosmolar = serum osmolality > 310 mOsm/kg tx for HHS? - ✔✔1) continuous IV Insulin, granted K+ is > 3.3 mg/dL. If it is not, then K+ has to be replenished first before starting Insulin. 2) start IV fluids. match the circulating antibodies with the correct dz 1. ACH 2. TSH 3. thyroglobulin and thyroid peroxidase 4. anti intrinsic factor antibodies 5. anti ds DNA, and anti SM antibodies - ✔✔1. Myasthenia Gravis 2. Graves (hypertsh) 3. Hashimoto's 4. pernicious anemia 5. SLE what happens in advanced renal dz with reduced glomerular filtration rate? - ✔✔hyperphosphatemia and normocytic normochromic anemia hepatic encephalopathy can be treated with what? - ✔✔Ammonia is usually high 1. oral or rectal lactulose 2. rifampin 3. protein restriction in diet how would u treat ascites? - ✔✔1. spironolactone or furosemide 2. paracentesis. increased ADH secretion seen with low CO systolic HF results in what electrolyte abnormality? - ✔✔hyponatremia IVIG is used in what conditions? (7) - ✔✔1. ITP 2. Kawasaki 3. Guillian Barre 4. MG 5. autoimmune hemolytic anemia 6. pediatric HIV pt 7. antibody deficiency d/o of the following sxs of hepatic failure, which two differentiates acute from chronic? a) jaundice b) bleeding c) ascites d) edema e) portal HTN f) spider angiomas - ✔✔e) and f) are present in chronic liver cirrhosis in a pt with HTN and Hyperglycemia which diseases can u consider? - ✔✔1. DM 2. Pheochromocytoma 3. Hypercortisolism 4. Acromegaly which kind of vertigo (peripheral or central) is assoc with inner ear problems and yields vertigo related to BPPV, or Meniere's dz - ✔✔peripheral what qualities make a HA life threatening? - ✔✔1. sudden onset (SAH) 2. worse with physical strain like valsalva (intercranial hemorrhage) deep excruciating, unilateral HA that is accompanied by tearing, nasal congestion and weakness of the facial muscles on the affected side. - ✔✔cluster HA tx: O2, sumatriptan, octreotide prevent: verapamil, prednisone, lithium. T/F. absence of deep tendon reflexes is normal in otherwise vigorous 80-90 yr olds - ✔✔true mitosis, ptosis, facial anhidrosis - ✔✔Horner's syndrome bronchogenic ca, cluster HA, cerebellar infarction,, dissection of carotid a. -----all can cause what ? - ✔✔Horner's syndrome which of the following is not caused by DM? a) stocking glove sensory loss b) proprioceptive loss c) acquisition of Babinski's reflex - ✔✔Babinski RBBB is most commonly assoc with which congenital heart defect? - ✔✔ASD recurrent numbness and tingling (paresthesias) in fingers, toes, and perioral area are NOT seen in which of the following conditions? a. diabetic polyneuropathy b. lacunar infarct c. vertebrobasilar a. insufficiency d. hypoglycemia/hypocalcemia e. 1* hypoparathyroidism f. lumbar n. compression - ✔✔b. and f. acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia - ✔✔Hemolytic Uremic Syndrome (assoc. with EHEC infection) which dzez cause thrombocytopenia due to autoimmune response (antibody destruction of platelets) ? - ✔✔1. ITP 2. HIT 3. SLE which dzez cause thrombocytopenia due to non-immune causes? - ✔✔1. RMSF 2. DIC 3. Viral Infx 4. B12 or Folate def anemia aside from micronutrient deficiency (Iron, Vitamins (A-E), folate, Calcium, etc.) what is another common complication in pts who underwent Roux-en-Y surgery? - ✔✔cholelithiasis- give prophylactic Ursodeoxycholic acid s/p surgery to prevent this. how to tell the difference diagnostically between perinneal allergic rhinitis (allergy to irritants - dander, pollen, etc), and vasomotor rhinitis (runny nose after eating spicy foods or humidity) ? - ✔✔perinneal allergic rhinitis is assoc with 1. asthma 2. eosinophils on nasal cytology 3. + skin test which anticoag is preferred for Afib pts with valvular heart disease? - ✔✔Heparin (LMWH or UFH) hypokalemia, hypomagnesemia, and hypocalcemia can all cause what on EKG? what kind of abx would make this situation worse? - ✔✔prolonged QT Fluoroquinolones what does lactase deficiency, sorbitol and fructose ingestion have in common? - ✔✔they are poorly absorbed in the intestine causing osmotic diarrhea. BRCA 1 and BRCA2 is associated with which cancers? - ✔✔ca of breast, pancreas and ovaries. dermatitis herpetiformis is a papulovesicular rash assoc with what dz? - ✔✔Celiac disease tx: gluten free diet alk phos and GGT are both elevated in bone or liver dz? - ✔✔liver dz. which of the following is not assoc with 2* adrenal insufficiency? a) weakness b) orthostatic hypotension c) hyperpigmentation d) anorexia - ✔✔c what is the best therapy for allergic rhinitis? - ✔✔intranasal corticosteroids for variant aka prinzmetal angina what do you see on EKG versus what you might see on EKG for AMI caused by ASCVD? - ✔✔variant angina = ST Elevations AMI = Horizontal ST depression how does psoriatic arthritis in distal phalanges look on XR ? - ✔✔Sharpened pencil in a man with a painful rash in his mouth that is violaceous with papules and white streaks which med may be responsible? 1) bactrim 2) lisinopril 3) warfarin 4) cloroquine - ✔✔2. lisinopril man has lichen planus caused by ACE or NSAIDs. left parasternal lift, high JVP, hepatomegaly, ascites, peripheral edema are all signs of ? - ✔✔cor pulmonale - autoimmune destruction of pancreatic B cells - assoc with HLA-DR3 gene - ✔✔Type 1 DM - combo of tissue resistance to insulin and deficiency in response of pancreatic islet cells to glucose - early in dz exaggerated hyperinsulinism - waist to hip fat ratio > 0.9 - ✔✔Type 2 DM which test do u do before starting a pt on probenecid or allorpurinol for recurrent gout? - ✔✔24 hr urinary uric acid should be > 800mg /day serum amylase is NOT elevated in which of the following? (More than one answer) a) ruptured ectopic pregnancy b) mumps c) multiple myeloma d) mesenteric infarction e) renal failure f) diabetes g) diverticulitis - ✔✔f and g what is the best indicator of hypovolemia? - ✔✔orthostatic hypotension what are the absolute CI to giving antithrombolytic therapy? - ✔✔1. active internal bleeding 2. BP > 230/120 3. trauma that caused LOC 4. previous hemorrhagic stroke 5. intracranial malignant neoplasm what is the diff between transudative and exudative? - ✔✔fluid to serum protein and LDH is higher in exudative headaches that occur s/p LP are usually 24-48 hrs after the procedure and located ____________ or ______________. the treatment is bed rest, analgesics or ________________ - ✔✔frontal or occipital epidural blood patch most common infection to occur from recreational water source?