180 Question Advanced PANCE and PANRE Practice Exams

You can see the entire series of these drawings by Lucci Lugee Lieyeung  here. You can also studies these on the Quizlet set here  

Although exercise-induced secondary amenorrhea may seem apparent in this case, it is imperative that pregnancy is ruled out as a cause of the amenorrhea. All amenorrheic women of reproductive age should be assumed to be pregnant until proven otherwise. Therefore, an hCG test is indicated as a first step in the evaluation of this patient. Sudden weight loss and increased physical activity can cause secondary amenorrhea, as can hypothyroidism and hyperprolactinemia. If ordering serum estradiol concentrations, an FSH level should also be ordered. Serum estradiol levels alone are less useful than FSH in deciphering cause of amenorrhea. Decreased estradiol occurs with either hypothalamic–pituitary axis failure or ovarian failure. Decreased FSH indicates hypothalamic– pituitary axis failure whereas elevated FSH indicates ovarian failure.

Generally, infertility is defined as the inability for a couple to conceive after reasonably frequent unprotected intercourse for 1 year. In approaching the diagnostic workup for infertility, with a thorough physical examination and history of both partners, the clinician should establish the following points:

1. Does the woman ovulate? (if not, why not)
2. Does the semen have normal characteristics?
3. Is there a female reproductive tract abnormality? Noninvasive tests should be done the first line. For the male partner, semen analysis is noninvasive and helpful, though not diagnostic. In the initial evaluation of the female partner, noninvasive procedures, such as the measurement of LH and mid-luteal phase progesterone (to determine ovulatory function) and TVUS (to rule out the possibility of fibroids or polycystic ovaries), are first-line investigations. Pelvic ultrasound should also be part of the routine gynecologic evaluation because it allows a more precise evaluation of the position of the uterus within the pelvis and provides more information about its size and irregularities.

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Cyanosis is very common in tetralogy of Fallot.

A Monteggia fracture is a fracture of the proximal ulna with anterior dislocation of the radial head. Study my orthopedic pearls on Quizlet You can view a great set with photos as well here

An indirect inguinal hernia is caused by a patent processus vaginalis and the hernial contents may be felt in the ipsilateral scrotum

The pes anserine bursa underlies the semimembranosus tendon and may become inflamed or painful owing to trauma, overuse, or inflammation. It is a common cause of knee pain and it is often misdiagnosed in adults. Watch Video

Antidiarrheals may cause the development of toxic megacolon when used by patients with active severe inflammatory bowel disease.

Osteoporosis is found in anorexia nervosa due to a lack of calcium intake, decreased estrogen, and an increase in cortisol. Bulimia nervosa has multiple medical complications in the cardiovascular, dental, dermatologic, endocrine, gastrointestinal, and neurologic systems. There are also associated dehydration and electrolyte disorders. Salivary gland hypertrophy, reversible cerebral atrophy, petechial hemorrhages, and hypokalemia are all part of the complications. Watch video explanation

Tangentiality is a disturbance in thought causing the person to start a train of thought, but never getting to the point.

Erythema nodosum produces erythematous red tender nodules, especially on the shins

Anovulatory bleeding is seen in 10% to 15% of all gynecologic patients and is the most common cause of abnormal vaginal bleeding in adolescents. In perimenarchal adolescents , it is caused by an immature hypothalamic– pituitary– ovarian axis. The top five causes of vaginal bleeding in the adolescent are listed by frequency: anovulation, pregnancy , exogenous hormone use, and coagulopathy. The top six causes of vaginal bleeding in the reproductive-aged woman listed by frequency are pregnancy, anovulation, exogenous hormone use, uterine leiomyomas, cervical and endometrial polyps, and thyroid dysfunction. The top four causes of vaginal bleeding in perimenopausal women listed by frequency are anovulation, uterine leiomyomas, cervical and endometrial polyps, and thyroid dysfunction. The top four causes of vaginal bleeding in postmenopausal women listed by frequency are endometrial lesions, exogenous hormone use, atrophic vaginitis, and other tumors.

Hypokalemia is associated with serum potassium levels of less than 3.5 mEq/ L. The ECG findings of hypokalemia include the following: flattened T waves, U waves, and ST-segment depressions. Hyperkalemia relates to serum potassium levels of more than 5.5 mEq/ L. Serum potassium levels in the 6.5 to 7.5 mEq/ L typically result in tall peaked T waves and short QT interval. Prolonged PR interval is seen with 7.5 to 8.0 mEq/ L serum potassium level. QRS widening, flattening of the P wave, is associated with serum potassium levels of 10 to 12 mEq/ L— prolonged QT interval is also associated with hypocalcemia.

Patients who have a phobia realize it is an irrational fear and try to avoid whatever they have the fear of. In attempts to avoid the “problem,” patients can develop anxiety or panic attacks.

A functional ovarian cyst is a much more likely diagnosis than any of the others listed. A follicular cyst develops when an ovarian follicle fails to rupture. The granulosa cells lining the cyst continue to enlarge and fluid continues to accumulate. Symptoms associated with a functional ovarian cyst include mild to moderate unilateral pain and alteration in the menstrual cycle. On occasion, rupture of the follicular cyst causes acute pelvic pain and may need laparoscopic surgery for complete evaluation. In most cases, pain control for 4 to 5 days is what is indicated as well as the consideration of contraception to suppress future ovarian cyst formation.

Bronchiectasis, meaning “dilation of the bronchi,” results from destruction of the airway and poor drainage, often associated with cystic fibrosis, foreign body aspiration, or an infection. It is uncommon in the general population. The presentation may vary from a chronic productive cough to recurrent pneumonia with or without hemoptysis. Persistent rhonchi, rales, and decreased breath sounds are noted over the affected atelectatic area. Watch video explanation

A Babinski test is performed by stroking the lateral aspect of the sole from the heel to the ball of the foot, the great toe dorsiflexes and the other toes fan in a positive test. Watch video

The hallmark of mania is irritability. At times, the patient can have a euphoric mood, which can result in denial of their illness.

Nabothian follicles, or epithelial inclusion cysts, present a characteristic appearance: they contain a dense, yellow, mucoid material . They warrant no further treatment.

Human granulocytic anaplasmosis (formerly known as “ehrlichiosis”) is caused by a rickettsial bacterium and transmitted by the bite of various tick species that often overlap with those that transmit other diseases such as Lyme disease and babesiosis. .

While there are a wide array of factors including biologic factors, gender, age, employment status, education, and psychiatric history, the strongest association identified for substance use is a positive family history of either drug or alcohol abuse.

Loss of position and vibratory sensation are common neurologic findings in pernicious anemia.

Thiazide diuretics can induce electrolyte changes. Principle among those is hypokalemia.

Caput succedaneum is a result of fluid and blood accumulation in the occipitoparietal region of the newborn's scalp due to the vacuum effect of membrane rupture.

Café au lait spots are brown macules that may be found on any part of the body. The presentation of six or more spots greater than 1.5 cm is a sign of neurofibromatosis, a genetic disorder that results in neurofibromas that can develop in any organ/ tissue system.

The typical presentation of pontine hemorrhage is coma, pinpoint reactive pupils, impaired lateral ocular motility, and quadriplegia with decerebrate posturing.

Severe, abrupt chest pain that also may be located between the scapulas is common in aortic dissection. Pain in the anterior chest or back may represent involvement of the ascending or descending aorta. In the setting of symptoms of severe back or abdominal pain accompanied by shock, a dissecting abdominal aneurysm is strongly likely. Rapid onset of stroke, inability to move muscles (except the lateral gaze), and quadriplegia are indicative of basilar artery occlusion. Watch Video

West Nile virus has become the most common mosquito-borne (arthropod-borne or arboviral) infectious disease in the United States since the 2002 epidemic and is far more prevalent than eastern equine encephalitis. Between 2001 and 2004, it spread progressively annually across the United States and is now endemic in most parts of the United States . Read more

Spontaneous pneumothorax most commonly affects tall, thin men, between the ages of 20 and 40 years, who are heavy cigarette smokers. The pain is usually pleuritic and localizes to the affected side. Most patients have decreased breath sounds on the affected side , but few have a significant tachypnea or tachycardia.

The most common mechanism of injury for an anterior shoulder dislocation is abduction, extension, and external rotation. The lateral edge of the acromion process is prominent and the arm is held in slight abduction and external rotation by the opposite extremity. Anterior shoulder dislocations account for 95% to 97% of all glenohumeral dislocations. Falls onto an outstretched hand as mechanism of injury is more common in an older patient population. Watch this to relocate the dislocated shoulder