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NCCPA Physician Assistant National
Certifying Exam PANCE 2024 Board
Questions with Answers 100% Pass
Boards Tip: If the question references "ascites" what medication should always be added? - Answer>>Spironolactone Boards: What drug is MOST important drug in reducing M/M for: a) CAD b) CHF - Answer>>CAD = BB CHF = ACE-inhibitor BOARD question: Which cholesterol lab has the GREATEST impact on M/M? (i.e. is the most important) - Answer>>HDL ("garbage truck") **what REMOVES all the "bad cholesterol" BOARD QUESTION: What is the LDL goal in a patient with METABOLIC syndrome? - Answer>>Goal LDL < 70 mg/dL BOARD question: What are the most common complications of HIGH TG? - Answer>>1. Development of CAD = excess TG contribute to production of excess LDL
- Acute pancreatitis BOARD question: What dietary education should you offer someone with HIGH TG?
- Answer>>OMG 3 & 6 are both good for you, HOWEVER, adverse health effects are seen when intake OM6 >>>>> OM
OM6 = vegetable / corn oil, beef, chicken OM3 = fish oil, flax seed, tuna, salmon, walnuts BOARD question: Which of the following is a CONSISTENT predictor of DM, CAD and mortality: a) TG levels b) TC levels c) Total weight d) Waist circumference - Answer>>WAIST CIRCUMFERENCE (highest indicator of M/M) BOARD question: Which group has the HIGHEST prevalence of metabolic syndrome: a) AA b) Caucasians c) Hispanics d) Mexican Americans - Answer>>Mexican americans BOARD question: Which of the following is the MOST SENSITIVE predictor of CAD: a) TC level b) LDL levels c) ratio of TC to HDL d) C-reactive protein - Answer>>Ratio of TC to HDL BOARD question: Use of Niacin is associated with reduction in: a) CVA b) CABG c) CAD d) MI - Answer>>CAD
BOARD question: 65 yo male presents to ER with CP + SOB for last 7 minutes. Initial EKG & cardiac enzymes are negative. What is the most appropriate NEXT step in management: a) admit for ACS and head straight to cath lab b) discharge home with BB + ACEi c) Admit for ACS and schedule for treadmill stress test d) repeat EKG/enzymes in 2 hours - Answer>>Repeat tests in 2 hours BOARD question: Elevation of troponin is indicative of injury to what? a) blood vessels b) pericardium c) myocardium d) smooth muscle - Answer>>elevated troponin indicates = MYOCARDIAL injury BOARD Question: Patients with RCA (inferior MI) typcailly present with WHAT other symptoms besides chest pain: a) visual changes b) hypertension c) hypotension d) epigastric pain - Answer>>Epigastric pain (remember inferior portion of the heart sits on diaphragm) BOARDS: The prevalence of AFIB increases dramatically with: a) cardiac damage b) age c) ETOH intake d) smoking - Answer>>AGE
BOARDS (true or false): The natural tendency of AFIB is to become a CHRONIC condition.... - Answer>>TRUE BOARDS: What is the MOST IMPORTANT diagnostic test to order in a newly diagnosed AFIB patient: a) EKG b) TSH c) ECHO d) Angiogram - Answer>>TSH BOARDS: What is the most appropriate initial test to order in AFIB: a) TEE b) TTE c) CXR d) angiography - Answer>>BUZZ word is INITAL (answer) = TTE Initial = TTE BEST = TEE BOARDS: What agent is the most appropriate to use in a patient with AFIB + RVR secondary to hyperthyroidism: a) CCB b) BB c) Digoxin - Answer>>BB (answer) **remember that: a) AFIB d/t cardiac issue = CCB b) AFIB d/t non-cardiac issue = BB c) AFIB + HF = digoxin
d) Amilodipine - Answer>>Lidocaine **remember that for those who have (+) QT prolongation, they are at the highest risk for unstable cardiac arrhythmias --> so we ADD ventricular anti-arrhythmic (Class 1b) to reduce risk. BOARDS: What cardiac anomaly are you MOST worried about in a patient with history of a eating disorder: a) valvular abnormality b) QT prolongation c) LVH d) ischemia - Answer>>QT prolongation BOARD: In a patient with a new onset of murmur, what test should be ordered initially? a) ECHO b) Cardiac cath c) EKG - Answer>>KEY WORD = "initially" ECHO = INITAL test of choice CATH = DEFINITIVE diagnostic test (usually ordered if echo is inconclusive) BOARDS: A patient presents with sudden onset of angina. In ER they are given "NOBAM" and suddenly collapse. What is the most likely etiology for their syncope: a) MI b) CVA c) Aortic Stenosis d) orthostatic hypotension - Answer>>Aortic stenosis
"NTG makes AS go night-night" BOARDS: What type of MI is usually associated with new-onset of mitral regurgitation: a) Septal b) Lateral c) Inferior - Answer>>Inferior (RCA) BOARDS: A woman who has a history of using Phentermine/Fenfluramine (Phen-fen) is most likely to have which of the following cardiac abnormalities: a) AR b) MR c) TR d) PR - Answer>>TR BOARDS: What is the BEST health maintenance test to order in patients with history of anorexia and/or bulimia: a) CMP b) EKG c) ECHO d) DEXA - Answer>>This one is tricky because all of the following are GOOD tests because these patients are prone to hypocalcemia: -CMP -DEXA -EKG HOWEVER, the best (most critical) test is the annual EKG!! (hypocalcemia = predisposes you to QT prolongation = increased risk of VFIB)
Why? -remember that ACEi are contraindicated in patients with renal artery stenosis -classically if you miss RAS & place them on ACEi they will get worse BOARDS: Which patients have a higher incidence of nitroglycerine induced syncope? a) mitral stenosis b) mitral regurgitation c) aortic regurgitation d) aortic stenosis - Answer>>AS
- these patients RELY on their preload to maintain adequate profusion through the aortic valve... -blood passing out of the aortic valve leaves and supplies the body (including the brain) -NTG reduces preload -Giving NTG to a patient with severe AS, will FURTHER reduce blood flow to the brain (and result in SYNCOPE) BOARDS: This murmur is usually caused by spontaneous chordae tendineae rupture: a) Mitral stenosis b) Mitral regurgitation c) Aortic regurgitation d) Aortic stenosis The MCC of this rupture is a MI of the: a) RCA b) LAD c) Left circumflex - Answer>>Mitral regurgitation LAD
BOARDS:
In this cardiac problem, the RENIN level is elevated and causes an increase in BP: a) VSD b) PDA c) ASD d) Coarctation of aorta - Answer>>Coarctation of aorta BOARDS: Which of the following medications is contraindicated in patient with CAD: a) ATenolol b) Ditalizem c) HTCZ d) Lisinopril e) Sildenafil - Answer>>Sildenafil (viagra) BOARDS: A 85 yo male comes in with HTN + CAD complaining of chest pain. He is given NTG in ER and immediately has a syncopal episode. What is the next step in management? a) Angiogram b) CT scan c) MRI d) Stress test e) ECHO - Answer>>ECHO (most likely as aortic stenosis) BOARDS: Which of the following medications is the MOST important to given a patient with AFIB? a) Atenolol b) Diltazem c) NTG d) ASA
**realize that EBV is also a known cause, HOWEVER, it is not the most common. BOARDS: Elevation of cardiac biomarkers comes from injury to: a) myocardium b) pericardium c) blood vessels - Answer>>MYOCARDIUM (+) elevation w/ myocarditis, ACS (-) elevation w/ pericarditis BOARDS: Which of the following is the most important RF for thoracic & abdominal aortic aneurysms: a) CAD b) Smoking c) Connective tissue disorders d) HTN - Answer>>HTN BOARDS: Which medication has the greatest impact on SLOWING the progression of thoracic and/or abdominal aortic aneurysm: a) ASA b) ACEi c) BB d) NTG - Answer>>BB !!! (all patients should be placed on BB to LOWER BP & prevent further aneurysm enlargement) BOARDS: Which of the following is the MOST specific diagnostic finding related to Pericarditis: a) Sharp CP b) Elevated pulse c) Negative cardiac enzymes
d) ST elevation in all leads e) Pericardial friction rub - Answer>>ST elevation (all leads) BOARDS: In 80% of these patients (new onset) they will present with AFIB + "diastolic opening snap" + accentuated S1: a) MS b) MR c) AR d) AS - Answer>>MS BOARDS: Which is the most common heart abnormality in children: a) VSD b) PDA c) ASD d) Coarctation of aorta - Answer>>VSD BOARDS: A patient with HTN + CAD + AFIB comes in with multiple TIAs over the past 2 weeks and is currently normal. Which of the following tests should be ordered as part of the next step of management: a) INR b) PT c) MRI d) TEE - Answer>>TEE (most likely etiology = patent foramen oval (PFO)) BOARDS: You hear a "machine wash" murmur on PE. What is considered 1st line therapy: a) indomethacin b) high-flow O c) surgery
Patient has = AFIB + RVR Rate control options: a) BB (non-cardiac etiologies) b) CCB (for cardiac etiologies) BOARDS: Which of the following medications is the MOST IMPORTANT to give a patient with AFIB? a) Atenolol b) Ditalizem c) NTG d) ASA e) Coumadin - Answer>>COUMADIN (reduce thromboembolic risk) **remember that for: a) AFIB (non-valvular) = may use alternative agents b) AFIB (valvular) = always use COUMADIN BOARDS: A patient with ovarian cancer comes in with sudden onset of severe sub-sternal CP, which improves when she sits & leans forward. Which of the following is likely the culprit: a) Ketoconazole b) Doxorubicin c) Atenolol d) Metastasis - Answer>>answer = Doxorubicin (chemo agent) **she likely has PERICARDITIS secondary to her chemotherapy drug. BOARDS: Which of the following medications are CONTRAINDICATED during pregnancy:
a) Ampicillin b) Ketoconazole c) Indomethacin d) Tylenol - Answer>>INDOMETHACIN **remember that giving a prostaglandin inhibitor (i.e. NSAID) during pregnancy will cause PREMATURE closure of the ductus arteriosus!! DOC (pregnancy) = TYLENOL BOARDS: A mother brings in her infant complaining that he becomes blue & sweaty with feeding. What is most likely the etiology? a) VSD b) ASD c) TOF d) PDA - Answer>>TOF BOARDS: Which of the following PE findings is MOST SPECIFIC for DVT: a) leg erythema b) leg pain c) leg edema (circumference > 3cm) d) (+) homan's sign - Answer>>Leg edema (circumference > 3cm) BOARDS: Treatment for patient with DVT is using UFH with warfarin started on: a) at discharge b) on 2nd day c) 48hrs after starting heparin d) at the same time you start heparin - Answer>>AT SAME TIME
b) Protein C deficiency c) Protein S deficiency d) Factor V Leiden - Answer>>Factor V Leiden BOARDS: Which of the following tests would yield hte MOST RELIABLE results in diagnosing a PE: a) VQ scan b) CXR c) ABG d) Spiral Ct e) Doppler ultrasound f) D-dimer - Answer>>Spiral CT **but remember that pulmonary angiography (gold standard) BOARDS: A DM patients presents with suspected PE. What medication must be stopped BEFORE you can order the spiral CT: a) Aspirin b) Ace-inhibitor c) Metformin d) Insulin - Answer>>Metformin **remember that Spiral CT requires IV CONTRAST (which is metabolized via kidneys & has potential to be nephrotoxic) **combination of metformin + IV contrast = INCREASES risk of nephrotoxicity (so need to temporarily d/c metformin) BOARDS: Patients receiving Coumadin should have their INR checked every: a) 2 weeks b) 4 weeks c) 6 weeks
d) 8 weeks - Answer>>4 weeks Dabigatran (Pradaxa) is best used for which of the following patietns: a) CVA patient with h/o TIA b) DVT prophylaxis in a patient after hip surgery c) Prophylaxis for emboli in AFIB 2/2 aortic stenosis d) Prophylaxis for emboli in AFIB 2/2 non-valvular cause - Answer>>Prophylaxis for emboli in AFIB 2/2 non-valvular cause **remember: a) AFIB d/t valvular = COUMADIN b) AFIB d/t non-valvular = may use alternative agents BOARDS: Which of the following medications may interact with dabigitran: a) Ciprofloxacin b) Fluoxetine c) Simvastatin d) Carbamazepine - Answer>>CARBAMAZEPINE (remember this drug & antifungals "jack everything up.") BOARDS: What is considered frontline therapy for Thromboangiitis Obliterans: a) ASA b) Amilodipine c) Exercise d) Tobacco cessation - Answer>>Tobacco cessation BOARDS: Which of the below BEST distinguishes Restrictive from Obstructive airway disease: a) Restrictive disease the FEV1/FVC is normal b) Obstructive disease usually presents with chronic cough
