PANCE Topics & Exam Review
Questions and Answers
Define the type of shock and give signs on exam:
--Septic Shock - ANS-AKA Distributive shock
--Excess vasodilation and shunting of blood from vital organs to non-vital
--Signs: Inc Cardiac Output, Inc Cap refill, warm skin and Dec SVR
Define the type of shock, common causes and give signs on exam:
--Obstructive Shock - ANS-D/t blockage of blood flow
--Causes: PE, tamponade, tension Pneumo
--Signs: Dec CO, Inc cap wedge, Inc SVR
Define the type of shock, common causes and give signs on exam:
--Cardiogenic Shock - ANS---From pump dysfxn
--Causes: MI, valve pathology
--Signs: Dec CO (cold and clammy), Inc Pulm wedge pressure, Inc SVR
Define the type of shock, common causes and give signs on exam:
--Hemorrhagic Shock - ANS---Blood loss - dissection, bleeding out
--Signs: Dec CO, Inc SVR
Define the type of shock, common causes and give signs on exam:
--Hypovolemic Shock - ANS-Dec fluid status in the body
--Causes: blood loss, GI losses, dehydration
--Dec CO, Inc SVR
The only type of shock that causes inc cardiac output and pt will have warm, flushed
skin and cause vasodilation? - ANS-Septic shock!
Name the bug that causes pneumonia based on the description:
--Gram + cocci in pairs - ANS-Strep pneumo
Name the bug that causes pneumonia based on the description:
--Gram (-) rods (3 options) - ANS---Pseudomonas
--E coli
--H flu
Name the bug that causes pneumonia based on the description:
--Small, obligate intracellular bacterium - ANS-Mycoplasma
--MCC of "walking pna"
,Name the bug that causes pneumonia based on the description:
--Gram (+) cocci in clusters - ANS-Staph aureus
Name the bug that causes pneumonia based on the description:
--Intracellular aerobic bacterium gram (-) rods - ANS-Chlamydia
PNA with thick brown sputum, Inc IgE and Eosinophilia
--What's the cause? - ANS-Aspergillus fumigatus
Encapsulated yeast that can cause PNA and meningitis - ANS-Cryptococcus
neoformans
budding yeast and hyphae that can cause esophagitis, oral thrush, intertrigo, vaginitis,
fungemia and endocarditis.
--name it! - ANS-Candida albicans
Mold that is non-branching hyphae and can present as PNA + sinusitis - ANS-Mucor
indicus
What diuretic is most assoc with gynecomastia?
--What class of diuretic is it in? - ANS-Spironolactone
--K-sparing diuretic - works as aldosterone antagonist and blocks testosterone receptor
HCTZ ADR's:
1 - 2 lytes it lowers
2 - 4 metabolic elevations
3 - Acid / base derangement MC assoc?
4 - Type of allergy to screen for? - ANS-1 - a) HYPOnatremia, b) HYPOkalemia
2 - a) HYPERlipidemia, b) HYPERcalcemia, c) HYPERuricemia, d) HYPERglycemia
3 - Metabolic alkalosis
4 - Sulfa
Acetazolamide:
1 - Type of med
2 - Acid / base derangement it can cause
3 - Dec of what electrolyte
4 - Screen for what allergy - ANS-1 - Diuretic
2 - Metabolic acidosis
3 - HYPOkalemia
4 - Sulfa
8 y/o boy w/ edema, proteinuria and hyperlipidemia
1 - Think what syndrome
2 - MC caused by what in kids
3 - Tx of Choice? - ANS-1 - Nephrotic syndrome
,2 - Minimal change disease
3 - Prednisone
TCA overdose
1 - Signs / sxs (5)
2 - Sodium channel blocking can cause what serious ADR's? - ANS-1 - a) dry skin, b)
dry mouth, c) pupillary dilation, d) dec breath sounds, e) piloerection
2 - Cardiac toxicity and Vent arrhythmias
Name the sign seen on esophagram for the GI issue:
--Achalasia - ANS---Inc LES tone that causes narrowing of the GE junction and pre-
narrowing dilation leading to the "BIRD's BEAK" appearance
Name the sign seen on esophagram for the GI issue:
--Esophageal cancer - ANS---Filling defect around the malignancy
Name the sign seen on esophagram for the GI issue:
--Diffuse esophageal spasm - ANS---Corkscrew appearance - due to strong non-
peristaltic contractions of the esophagus
Name the mechanism for each class of antiarrhythmic:
--Class I
--Class II
--Class III
--Class IV - ANS---Class I = interfere w/ Na channels
--Class II = Anti-sympathetic agents
--Class III = Affect the Efflux of K
--Class IV = Affect Ca channels and AV node
What vessel is assoc with STEMI in leads 2, 3, and aVF? - ANS-R coronary
What leads will you see STEMI on if the R coronary artery is affected? - ANS-2, 3 and
aVF
What are teh CHD risk equivalents - ANS-DM
CKD
AAA
IF you see Q waves on ECG what should you suspect - ANS-Prior MI
What's considered a POSITIVE stress test? - ANS-Downsloping or horizontal ST
depression of 1mm or greater
Agents to use if pt is unable to exercise and needs:
1 - Stress echo
2 - Nuclear stress test - ANS-1 - Dobutamine
, 2 - Lexiscan
GOLD standard for diagnosing CHD? - ANS-Left heart cath
What's a good non-invasive test to assess coronary artery anatomy and level of
stenosis - ANS-CT Coronary angio
First line therapy to reduce anginal frequencies and improve exercise tolerance - ANS-
BB's
4 steps of "Classic ECG" evolution in STEMI - ANS-1 - Peaked T waves
2 - ST elevation
3 - Q wave forming
4 - T wave inversion
Prinzmetal angina:
1 - Due to what
2 - Assoc with ___ and/or ____ usage - ANS-1 - Vasospasm
2 - Tobacco and cocaine
Transient ST elevation during angina think what diagnosis
--What is the preventative first line med class - ANS-Prinzmetal angina
--Acute = nitro
--Preventative = CCB's
ECG showing diffuse ST elevation and PR depression
--LIkely diagnosis
--Order ____ and ____ (2 labs) for baseline and trending over treatment - ANS---
Pericarditis
--CRP and ESR
Pericarditis:
1 - Should never tx with ____
2 - Use high dose ____ and ____ for maintenance therapy - ANS-1 - Steroids
2 - Ibuprofen and Colchicine
Name the risk % for AAA:
1 - > 6cm annual risk
2 - > 7cm annual risk - ANS-1 - 12%
2 - 25%
When you put someone on a statin when should you schedule a follow up and what
should you check? - ANS-6-8 weeks from starting
--Fasting lipid panel
Questions and Answers
Define the type of shock and give signs on exam:
--Septic Shock - ANS-AKA Distributive shock
--Excess vasodilation and shunting of blood from vital organs to non-vital
--Signs: Inc Cardiac Output, Inc Cap refill, warm skin and Dec SVR
Define the type of shock, common causes and give signs on exam:
--Obstructive Shock - ANS-D/t blockage of blood flow
--Causes: PE, tamponade, tension Pneumo
--Signs: Dec CO, Inc cap wedge, Inc SVR
Define the type of shock, common causes and give signs on exam:
--Cardiogenic Shock - ANS---From pump dysfxn
--Causes: MI, valve pathology
--Signs: Dec CO (cold and clammy), Inc Pulm wedge pressure, Inc SVR
Define the type of shock, common causes and give signs on exam:
--Hemorrhagic Shock - ANS---Blood loss - dissection, bleeding out
--Signs: Dec CO, Inc SVR
Define the type of shock, common causes and give signs on exam:
--Hypovolemic Shock - ANS-Dec fluid status in the body
--Causes: blood loss, GI losses, dehydration
--Dec CO, Inc SVR
The only type of shock that causes inc cardiac output and pt will have warm, flushed
skin and cause vasodilation? - ANS-Septic shock!
Name the bug that causes pneumonia based on the description:
--Gram + cocci in pairs - ANS-Strep pneumo
Name the bug that causes pneumonia based on the description:
--Gram (-) rods (3 options) - ANS---Pseudomonas
--E coli
--H flu
Name the bug that causes pneumonia based on the description:
--Small, obligate intracellular bacterium - ANS-Mycoplasma
--MCC of "walking pna"
,Name the bug that causes pneumonia based on the description:
--Gram (+) cocci in clusters - ANS-Staph aureus
Name the bug that causes pneumonia based on the description:
--Intracellular aerobic bacterium gram (-) rods - ANS-Chlamydia
PNA with thick brown sputum, Inc IgE and Eosinophilia
--What's the cause? - ANS-Aspergillus fumigatus
Encapsulated yeast that can cause PNA and meningitis - ANS-Cryptococcus
neoformans
budding yeast and hyphae that can cause esophagitis, oral thrush, intertrigo, vaginitis,
fungemia and endocarditis.
--name it! - ANS-Candida albicans
Mold that is non-branching hyphae and can present as PNA + sinusitis - ANS-Mucor
indicus
What diuretic is most assoc with gynecomastia?
--What class of diuretic is it in? - ANS-Spironolactone
--K-sparing diuretic - works as aldosterone antagonist and blocks testosterone receptor
HCTZ ADR's:
1 - 2 lytes it lowers
2 - 4 metabolic elevations
3 - Acid / base derangement MC assoc?
4 - Type of allergy to screen for? - ANS-1 - a) HYPOnatremia, b) HYPOkalemia
2 - a) HYPERlipidemia, b) HYPERcalcemia, c) HYPERuricemia, d) HYPERglycemia
3 - Metabolic alkalosis
4 - Sulfa
Acetazolamide:
1 - Type of med
2 - Acid / base derangement it can cause
3 - Dec of what electrolyte
4 - Screen for what allergy - ANS-1 - Diuretic
2 - Metabolic acidosis
3 - HYPOkalemia
4 - Sulfa
8 y/o boy w/ edema, proteinuria and hyperlipidemia
1 - Think what syndrome
2 - MC caused by what in kids
3 - Tx of Choice? - ANS-1 - Nephrotic syndrome
,2 - Minimal change disease
3 - Prednisone
TCA overdose
1 - Signs / sxs (5)
2 - Sodium channel blocking can cause what serious ADR's? - ANS-1 - a) dry skin, b)
dry mouth, c) pupillary dilation, d) dec breath sounds, e) piloerection
2 - Cardiac toxicity and Vent arrhythmias
Name the sign seen on esophagram for the GI issue:
--Achalasia - ANS---Inc LES tone that causes narrowing of the GE junction and pre-
narrowing dilation leading to the "BIRD's BEAK" appearance
Name the sign seen on esophagram for the GI issue:
--Esophageal cancer - ANS---Filling defect around the malignancy
Name the sign seen on esophagram for the GI issue:
--Diffuse esophageal spasm - ANS---Corkscrew appearance - due to strong non-
peristaltic contractions of the esophagus
Name the mechanism for each class of antiarrhythmic:
--Class I
--Class II
--Class III
--Class IV - ANS---Class I = interfere w/ Na channels
--Class II = Anti-sympathetic agents
--Class III = Affect the Efflux of K
--Class IV = Affect Ca channels and AV node
What vessel is assoc with STEMI in leads 2, 3, and aVF? - ANS-R coronary
What leads will you see STEMI on if the R coronary artery is affected? - ANS-2, 3 and
aVF
What are teh CHD risk equivalents - ANS-DM
CKD
AAA
IF you see Q waves on ECG what should you suspect - ANS-Prior MI
What's considered a POSITIVE stress test? - ANS-Downsloping or horizontal ST
depression of 1mm or greater
Agents to use if pt is unable to exercise and needs:
1 - Stress echo
2 - Nuclear stress test - ANS-1 - Dobutamine
, 2 - Lexiscan
GOLD standard for diagnosing CHD? - ANS-Left heart cath
What's a good non-invasive test to assess coronary artery anatomy and level of
stenosis - ANS-CT Coronary angio
First line therapy to reduce anginal frequencies and improve exercise tolerance - ANS-
BB's
4 steps of "Classic ECG" evolution in STEMI - ANS-1 - Peaked T waves
2 - ST elevation
3 - Q wave forming
4 - T wave inversion
Prinzmetal angina:
1 - Due to what
2 - Assoc with ___ and/or ____ usage - ANS-1 - Vasospasm
2 - Tobacco and cocaine
Transient ST elevation during angina think what diagnosis
--What is the preventative first line med class - ANS-Prinzmetal angina
--Acute = nitro
--Preventative = CCB's
ECG showing diffuse ST elevation and PR depression
--LIkely diagnosis
--Order ____ and ____ (2 labs) for baseline and trending over treatment - ANS---
Pericarditis
--CRP and ESR
Pericarditis:
1 - Should never tx with ____
2 - Use high dose ____ and ____ for maintenance therapy - ANS-1 - Steroids
2 - Ibuprofen and Colchicine
Name the risk % for AAA:
1 - > 6cm annual risk
2 - > 7cm annual risk - ANS-1 - 12%
2 - 25%
When you put someone on a statin when should you schedule a follow up and what
should you check? - ANS-6-8 weeks from starting
--Fasting lipid panel
