180 Question Advanced PANCE and PANRE Practice Exams

The bones of the vertebral spine are most commonly affected in a patient with osteomyelitis. Organisms reach the well-perfused vertebral body of adults via spinal arteries and quickly spread from the end plate into the disk space and then to the adjacent vertebral body. The infection may originate in the urinary tract and intravenous drug use carries an increased risk of spinal infection

Permethrin 1% cream/shampoo is used to kill the louse and remove the eggs from the hair shafts. And yes, mayonaise does work

The patient in this scenario has clinical signs and symptoms associated with temporal arteritis or giant cell arteritis. The most appropriate course of action is to treat with intravenous steroids and obtain ophthalmology consultation when a patient has visual loss.

Myocardial necrosis can be identified with a great degree of specificity by troponin I, particularly in settings of cocaine use, recent surgery, and chronic renal failure.

Since approximately 50% of calcium is protein bound, total calcium levels should be interpreted relative to albumin levels.

Kussmaul's sign (seen here) is an increase rather than the normal decrease in the CVP during inspiration. It is most often caused by severe right-sided heart failure; it is a frequent finding in patients with constrictive pericarditis or right ventricular infarction.

Rifampin may interfere with the efficacy of the oral contraceptives. Learn More

Direct visualization of the endotracheal tube passing through the vocal cords is the most reliable indicator for endotracheal tube placement. The next most reliable is an end CO2 device .

In this scenario, the patient's sodium level dropped severely and rapidly secondary to excessive water intake. In this setting, patients may present with confusion, muscle cramps, lethargy, anorexia, nausea, seizures, and coma. Other causes of euvolemic hyponatremia include syndrome of inappropriate secretion of antidiuretic hormone (SIADH), renal failure, glucocorticoid deficiency (hypopituitarism), hypothyroidism, and multiple medications such as thiazide diuretics. Learn more

Primary adrenocortical insufficiency (Addison disease) is characterized by inadequate secretion of cortisol, aldosterone, or both most frequently resulting from autoimmune-induced destruction of the adrenal glands. Other causes of Addison disease include tuberculosis, viral infections, carcinomatous destruction of the adrenals, adrenal infarction from arteritis or thrombosis, and adrenal hemorrhage. Laboratory results characteristically include hyperkalemia, hyponatremia, hypochloremia, hypoglycemia, elevated BUN/ creatinine ratio (prerenal azotemia), anemia, decreased 24-hour urinary cortisol, 17-hydroxycorticosteroid, and 17-ketosteroids and increased ACTH (adrenocorticotropic hormone; primary adrenocortical insufficiency).

Vigorous manipulation of the prostate during rectal examination may result in septicemia. This is contraindicated in the presence of fever, irritative voiding symptoms, and perineal/sacral pain.

The endometrial changes seen in the latter half of the cycle are under the influence of both estrogen and progesterone from the corpus luteum. During this phase, the endometrium becomes more vascularized and slightly edematous.

A Hampton hump generally represents a focal area of hemorrhage within the lung or an actual pulmonary infarction. It is a wedge-shaped, dense, consolidated area on the pleural surface of the chest wall. Other more common findings of pulmonary embolism on a chest radiograph include atelectasis, elevated hemidiaphragm, patchy consolidation, and pleural effusions.

Most of the medications listed are a good option for hypertensive emergencies . Sodium nitroprusside is the most widely used/ available, is a rapidly acting arterial and venous dilator, and is the drug of choice for most hypertensive emergences unless there is severe kidney disease. Read More

A hemangioma is a bright red to deep purple vascular nodule or plaque that often develops at birth, may enlarge, and may regress and disappear with aging.

The hallmark of infectious mononucleosis is the presence of lymphocytosis with atypical large lymphocytes seen in the blood smear. These are larger than normal mature lymphocytes, stain more darkly, and frequently show vacuolated, foamy cytoplasm, and dark chromatin in the nucleus.

Carcinoma of the colon is the most common cause of LBOs in adults.

The major predisposing risk factor is cryptorchidism unrepaired until after age two.

Serum creatinine kinase is the most sensitive test to detect rhabdomyolysis, a serious complication of seizures and hyperthermia related to drug abuse. Learn More

The first priority in the management of septic shock is assessment of the airway, oxygenation, and ventilation. Oxygen should be administered at 100% via mask or endotracheal tube. Learn More

The most common etiology of upper GI bleeding (60%) is peptic ulcer disease. This includes gastric, duodenal, and stomal ulcers. Diverticular bleeding usually results from erosion into a penetrating artery of the diverticulum. The GI bleeding associated with diverticular bleeding is usually painless and profuse. Learn More

The low trophic and target hormone levels combined with symptoms of hypogonadism indicate this patient has hypopituitarism. Learn More

Partially chewed meat and esophageal abnormalities such as strictures, esophageal spasms, and Schatzki rings are commonly implicated in adult food bolus impactions.

Tanner stages of sexual maturation categorize the progression of pubertal development in girls according to pubic hair and breast development. Menarche usually occurs 18 to 24 months following the onset of breast development. In female breast development , Tanner Stage I is an absence of breast development; Stage II is a small, raised breast bud; Stage III shows further enlargement/ elevation of breast and alveolar tissue; Stage IV is the areola and papilla forming a secondary mound on breast contour; and Stage V is the mature breast with alveolar area as part of the breast contour. For the stages of pubic hair development, Stage I is prepubertal, an absence of hair; Stage II shows sparse, fine hair, primarily on the border of labia; Stage III is pigmented and curly and increases in quantity on the mons pubis; Stage IV is increased quantity of coarser texture with labia and mons pubis well covered; and Stage V is mature adult distribution with spreading to medial thighs.

Hemophilia B, also known as Christmas disease and factor IX deficiency. Factor IX is activated on the intrinsic side of the coagulation cascade right before the common pathway and the result is an increased aPTT, with a normal prothrombin time, thrombin time, and INR. It does not affect platelets nor bleeding time. Learn More

The diagnosis of rheumatic fever is based on clinical grounds using the modified Jones criteria. Two major manifestations or one major and two minor manifestations in addition to supporting evidence of a preceding streptococcal infection are needed to make the diagnosis of rheumatic fever. The major manifestations are polyarthritis, carditis, erythema marginatum, subcutaneous nodules, and Sydenham chorea. The minor manifestations are fever, arthralgia, previous rheumatic fever or rheumatic heart disease, an elevated sedimentation rate or C-reactive protein, and a prolonged P–R interval . The supporting evidence of a preceding streptococcal infection includes elevated titers of antistreptolysin O or other streptococcal antibodies and positive throat culture for group A beta-hemolytic streptococcus.

The patient's presentation is consistent with a congential qualitative platelet disorder, most likely von Willebrand's Disease, necessitating a bleeding time and evaluation of platelet function.

Regular use of corticosteroid nasal spray and oral inhalers prior to the allergy season is among the best means of preventing allergies.

Coxsackievirus presents with small grayish vesicles and punched-out ulcers in the posterior pharynx.

This patient likely has renovascular disease , which is responsible for her secondary hypertension. Patients with renovascular stenosis have decreased blood flow to one kidney. This ischemic state initiates renin release, which increases the vascular tone in the remaining normal renal artery. Secondary hypertension is also associated with pheochromocytoma, but these patients generally have headaches, palpitations, anxiety attacks, and hyperglycemia as well.