The Physician Assistant National Certifying Exam (PANCE): the word itself will send the average PA student into instant tachycardia. It’s what you’ve been told about, taught about, and worked for since the very first day of PA school. To add to the stress, you also know that the past 24+ months of hard work and […]

Epiglottitis Patient will be complaining of rapid onset of fever and dysphagia PE will show the patient leaning forward, drooling, inspiratory stridor Imaging will show “thumbprint” sign Most commonly caused by H. influenzae, Streptococcus Treatment is IV antibiotics and airway management Sample question: A 5-year-old boy presents to the emergency department because of difficulty breathing that began a few hours prior to consult. […]

Ottawa Foot and Ankle Rules X-rays required if Patient cannot bear weight for 4 steps Distal 6 cm tibia/fibula tenderness Medial/lateral malleolus tenderness 5th metatarsal tenderness Navicular tenderness Sample question: A 16-year-old boy presents complaining of right ankle pain after injuring himself while playing basketball. He states that he “twisted his ankle” when he landed on […]

Sample question: A 17-year-old boy presents to the clinic with right-hand pain after punching a wall. Physical examination reveals swelling over the dorsum of the right hand with bony tenderness noted with palpation of the fifth metacarpal. What is the most likely diagnosis?

Sample question: You are called to the nursery to examine a newborn boy. He was born at 36 weeks via C section to a 32-year-old G3, P3 mother. APGAR scores were 7 and 9. After six hours, the neonate developed respiratory distress. On examination, respiratory rate is 70, with nasal flaring, expiratory grunting, intercostal retractions, decreased breath sounds, and diminished […]

Transient Tachypnea of the Newborn Patient will be a child shortly after birth Complaining of sudden onset of difficulty breathing PE will show tachypnea, nasal flaring, retractions and hypoxia CXR will show parenchymal infiltrates and fluid in the pulmonary fissures Most commonly caused by residual pulmonary fluid Treatment is supportive, self-resolving within 72 hours Comments: Most common cause of neonatal respiratory distress Sample question: A full-term male […]

Septic Arthritis Patient will be complaining of fever, monoarticular pain with decreased ROM Labs will show WBC > 50,000 with > 75% PMNs Diagnosis is made by arthrocentesis Most commonly caused by: Age < 35: N. gonorrhea, S. aureus overall Treatment is IV ABX, surgical washout Sample question: A 23-year-old man with a history of intravenous heroin use presents to the emergency department with a […]

Sample question: Which muscle is most commonly involved with rotator cuff injuries?

Megaloblastic Anemia Patient will be a vegan or alcoholic Complaining of fatigue, weakness PE will show pallor, glossitis Labs will show MCV > 100 and hypersegmented neutrophils Most commonly caused by vitamin B12 (Cobalamin) or folate deficiency Comments: only vitamin B12 deficiency results in neurological symptoms Sample question: A middle-aged patient in the ED has a hemoglobin of 8.1 g/dL with an MCV of 112 fL. Which of […]

Coarctation of the Aorta PE will show higher blood pressure in the arms than in the legs EKG will show LVH CXR will show notching of ribs Diagnosis is made by echo Treatment is balloon angioplasty with stent placement or surgical correction Comments: associated with Turner syndrome Sample question: A 5-year-old girl with Turner syndrome is found to have systolic hypertension. Further examination […]

Sample question: A 71-year-old man presents to the emergency department after falling on ice outside his home. He complains of neck pain. He has an abrasion to his chin and decreased strength in his bilateral upper extremities. Strength is intact in his lower extremities. Which mechanism of trauma is most consistent with the suspected diagnosis?