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Alle 15 spørgsmål i overblik

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1. 1. A 72-year-old has a harsh crescendo-decrescendo systolic murmur heard best at the right second intercostal space that radiates to both carotids. The carotid upstroke is slow and weak. Which valve lesion does this describe?

   • A. Mitral regurgitation
   • B. Aortic stenosis
   • C. Aortic regurgitation
   • D. Mitral stenosis
   Vis svar og forklaring

   Svar: B. Aortic stenosis

   Aortic stenosis forces blood through a narrowed outflow tract during systole, so the murmur is systolic, loudest at the right upper sternal border, and carried along the aortic arch to the carotids. The slow, low volume carotid upstroke, often called pulsus parvus et tardus, comes from the same fixed obstruction. Mitral regurgitation is also systolic but blows toward the axilla, while aortic regurgitation and mitral stenosis are diastolic.

2. 2. Which spirometry pattern defines an obstructive ventilatory defect?

   • A. A normal FEV1/FVC ratio with a reduced total lung capacity
   • B. A reduced FVC with a preserved FEV1/FVC ratio
   • C. An increased FEV1 with a normal FVC
   • D. A reduced FEV1/FVC ratio
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   Svar: D. A reduced FEV1/FVC ratio

   Obstruction means air leaves slowly, so the volume exhaled in the first second falls more than the total volume does and the ratio drops. Restriction is the opposite problem, small lungs, so both FEV1 and FVC fall together and the ratio stays normal or even rises while total lung capacity falls. Whether the obstruction improves substantially after a bronchodilator is what separates asthma from fixed disease.

3. 3. Complete the sentence.

   A patient cannot wrinkle the forehead on the affected side, cannot fully close that eye, and cannot lift that corner of the mouth. Because the forehead is involved, the lesion is _____, and the picture fits _____.

   Muligheder for felt 1: central, above the facial nucleus, peripheral, at or distal to the facial nucleus, in the cerebellum

   Muligheder for felt 2: a cortical stroke, Bell palsy, trigeminal neuralgia

   Vis svar og forklaring

   Svar: peripheral, at or distal to the facial nucleus, Bell palsy

   The forehead muscles receive input from both cerebral hemispheres, so a lesion above the facial nucleus spares them and the patient can still wrinkle the brow. Once the forehead goes weak with the rest of the side, the problem is the nerve itself or its nucleus, which is the peripheral pattern seen in Bell palsy. Trigeminal neuralgia is a pain syndrome in the fifth cranial nerve and causes no facial weakness.

4. 4. A patient reports right upper quadrant pain after fatty meals and now has fever and arrest of inspiration when you palpate under the right costal margin. Which imaging study is the best first test?

   • A. Upper endoscopy
   • B. Plain abdominal radiographs
   • C. Right upper quadrant ultrasound
   • D. Barium swallow
   Vis svar og forklaring

   Svar: C. Right upper quadrant ultrasound

   That inspiratory arrest is a positive Murphy sign and points at acute cholecystitis. Ultrasound is first because it is quick, needs no radiation or contrast, and shows the things that matter here: stones, a thickened gallbladder wall and pericholecystic fluid. Most gallstones are not visible on plain films, and endoscopy and barium studies look at the lumen of the gut rather than the biliary tree.

5. 5. Which findings are consistent with primary hypothyroidism?

   Vælg alle, der passer.

   • A. An elevated TSH
   • B. A low free T4
   • C. A delayed relaxation phase of the deep tendon reflexes
   • D. A suppressed TSH with an elevated free T4
   • E. Lid lag and a fine resting tremor
   Vis svar og forklaring

   Svar: A. An elevated TSH, B. A low free T4, C. A delayed relaxation phase of the deep tendon reflexes

   In primary hypothyroidism the thyroid gland itself is failing, so free T4 falls and the pituitary responds by driving TSH up. The slowed metabolic state shows up on exam as the delayed, hung up relaxation phase of the reflexes, along with cold intolerance, constipation and weight gain. A suppressed TSH with a high free T4, lid lag and tremor are the hyperthyroid picture, and TSH is high in the primary form because the feedback loop is intact.

6. 6. Under the Ottawa ankle rules, which finding makes an ankle radiograph series indicated after an acute injury?

   • A. Bone tenderness along the posterior edge or tip of either malleolus
   • B. Any swelling over the lateral ankle
   • C. Pain reproduced by passive inversion of the ankle
   • D. A visible bruise within 24 hours of the injury
   Vis svar og forklaring

   Svar: A. Bone tenderness along the posterior edge or tip of either malleolus

   The Ottawa rules key on bone tenderness at the posterior edge or tip of the medial or lateral malleolus, or an inability to bear weight for four steps both right after the injury and at the time of evaluation. They were built to be highly sensitive, meaning a negative rule is good at ruling a fracture out, so their job is to safely skip films rather than to confirm a fracture. Swelling, bruising and pain with inversion are common in ordinary sprains and do not decide imaging on their own.

7. 7. Complete the sentence.

   An expanding red rash with central clearing at the site of a tick bite is called _____, and it is the classic early sign of infection with _____.

   Muligheder for felt 1: erythema multiforme, erythema migrans, erythema nodosum

   Muligheder for felt 2: Rickettsia rickettsii, Borrelia burgdorferi, Babesia microti

   Vis svar og forklaring

   Svar: erythema migrans, Borrelia burgdorferi

   Erythema migrans is the early localized stage of Lyme disease, which spreads through Ixodes ticks in endemic parts of the country. It matters that the diagnosis at this stage is clinical, because antibodies often have not developed yet and early serology can be falsely negative. Rickettsia rickettsii causes Rocky Mountain spotted fever, whose rash typically starts on the wrists and ankles and moves inward.

8. 8. What distinguishes bipolar I disorder from bipolar II disorder?

   • A. Bipolar I requires psychotic features in every mood episode
   • B. Bipolar II requires a mixed episode
   • C. Bipolar I requires at least one full manic episode
   • D. Bipolar II requires a longer depressive episode
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   Svar: C. Bipolar I requires at least one full manic episode

   Bipolar I is defined by a manic episode, meaning elevated or irritable mood with increased energy that causes marked impairment, needs hospitalization or includes psychosis. Bipolar II requires a hypomanic episode plus at least one major depressive episode, and hypomania is shorter and does not cause that level of impairment. Psychosis can occur in bipolar I but is not required in every episode, and a single manic episode is enough for the bipolar I diagnosis even without a documented depression.

9. 9. Which of the following match current United States Preventive Services Task Force recommendations for average-risk adults?

   Vælg alle, der passer.

   • A. Colorectal cancer screening starting at age 45
   • B. A one-time ultrasound for abdominal aortic aneurysm in men aged 65 to 75 who have ever smoked
   • C. Annual low-dose CT of the chest for adults aged 50 to 80 with a 20 pack-year history who still smoke or quit within the past 15 years
   • D. An annual PSA test for every man starting at age 40
   • E. A routine annual chest radiograph for every adult
   Vis svar og forklaring

   Svar: A. Colorectal cancer screening starting at age 45, B. A one-time ultrasound for abdominal aortic aneurysm in men aged 65 to 75 who have ever smoked, C. Annual low-dose CT of the chest for adults aged 50 to 80 with a 20 pack-year history who still smoke or quit within the past 15 years

   Colorectal screening was moved down to 45 for average-risk adults, AAA screening is a single ultrasound in men 65 to 75 with any smoking history, and lung cancer screening is annual low-dose CT for the 50 to 80 group with a 20 pack-year history. Prostate screening is not a blanket annual test, it is a shared decision with the patient in a defined age band. Routine chest films as general screening have never been supported, because they find little and generate harm through false positives. Task Force recommendations get revised, so check the current version before you quote an age.

10. 10. Why do ACE inhibitors cause a dry cough in some patients?

    • A. They block the breakdown of bradykinin, which then accumulates
    • B. They block angiotensin II at its receptor
    • C. They reduce aldosterone, which raises serum potassium
    • D. They dilate the efferent arteriole in the kidney
    Vis svar og forklaring

    Svar: A. They block the breakdown of bradykinin, which then accumulates

    Angiotensin converting enzyme also acts as kininase II, the enzyme that degrades bradykinin, so blocking it lets bradykinin and substance P build up in the airway and trigger the cough. The same accumulation explains the rarer but far more dangerous angioedema. Angiotensin receptor blockers act downstream at the receptor and leave bradykinin breakdown intact, which is why cough is much less common with them. The potassium rise and the efferent arteriolar dilation are real effects of the class, but they are not what causes the cough.

11. 11. Which urinary sediment finding points to glomerular bleeding rather than bleeding from lower in the urinary tract?

    • A. Muddy brown granular casts
    • B. White blood cell casts
    • C. Calcium oxalate crystals
    • D. Red blood cell casts with dysmorphic red cells
    Vis svar og forklaring

    Svar: D. Red blood cell casts with dysmorphic red cells

    Casts are molded in the renal tubules, so a cast packed with red cells proves the blood entered upstream at the glomerulus rather than from the bladder or ureter. Red cells that squeezed through a damaged glomerular basement membrane come out misshapen, which is the dysmorphic part. Muddy brown granular casts suggest acute tubular necrosis, white cell casts suggest pyelonephritis or interstitial nephritis, and calcium oxalate crystals are common and nonspecific.

12. 12. Which features of a pigmented skin lesion raise concern for melanoma?

    Vælg alle, der passer.

    • A. Asymmetry, so that one half does not mirror the other
    • B. An irregular, notched or poorly defined border
    • C. A change in size, shape or color over recent months
    • D. A single uniform tan color throughout the lesion
    • E. A 2 mm diameter that has been stable for years
    Vis svar og forklaring

    Svar: A. Asymmetry, so that one half does not mirror the other, B. An irregular, notched or poorly defined border, C. A change in size, shape or color over recent months

    The ABCDE list is asymmetry, border irregularity, color variation, diameter greater than about 6 mm, and evolution over time. Evolution carries the most weight in practice, because a lesion that is changing deserves attention even when it does not tick the other boxes. Uniform color and a small, stable size are reassuring features rather than warning signs, and a lesion that simply looks different from all the others on that patient is the ugly duckling sign.

13. 13. A patient reports hearing loss in the left ear. The Weber tuning fork test lateralizes to the left, and on the left the Rinne test shows bone conduction greater than air conduction. What does this pattern indicate?

    • A. Sensorineural hearing loss on the left
    • B. Conductive hearing loss on the left
    • C. Sensorineural hearing loss on the right
    • D. Normal hearing in both ears
    Vis svar og forklaring

    Svar: B. Conductive hearing loss on the left

    Normally air conduction beats bone conduction, so a Rinne with bone greater than air means something is blocking sound on its way in, such as cerumen, fluid or otosclerosis. Weber lateralizes toward the affected ear in conductive loss, because the blocked ear is shielded from room noise and picks up the bone conducted tone better. In sensorineural loss the pattern flips: Weber lateralizes away from the bad ear and air conduction still beats bone conduction on both sides.

14. 14. Complete the sentence.

    In uncomplicated iron deficiency anemia the red cells are typically _____, the serum ferritin is _____, and the total iron binding capacity is high.

    Muligheder for felt 1: microcytic and hypochromic, macrocytic, normocytic and normochromic

    Muligheder for felt 2: high, normal, low

    Vis svar og forklaring

    Svar: microcytic and hypochromic, low

    Without enough iron the marrow cannot fill cells with hemoglobin, so it makes small, pale cells, and ferritin, which reflects stored iron, drops. Transferrin production rises as the body reaches for iron, which is why total iron binding capacity goes up. Anemia of chronic disease can also be microcytic but sits at the other end: ferritin is normal or high because it is an acute phase reactant, and the binding capacity is low.

15. 15. New onset hypertension after 20 weeks of gestation, together with proteinuria or evidence of end organ dysfunction, defines which condition?

    • A. Chronic hypertension
    • B. Gestational diabetes
    • C. Gestational hypertension
    • D. Preeclampsia
    Vis svar og forklaring

    Svar: D. Preeclampsia

    The 20 week line is what separates pregnancy related hypertension from chronic hypertension that was present before pregnancy or appeared early. Gestational hypertension is the same new hypertension without proteinuria and without end organ features, so it becomes preeclampsia the moment those appear. End organ signs include a low platelet count, rising creatinine, elevated liver enzymes, pulmonary edema and new visual or cerebral symptoms, which is why preeclampsia can be diagnosed even when the urine protein is negative.

Hvad PANCE faktisk tester

Physician Assistant National Certifying Exam afholdes af NCCPA, og det er den eksamen, du skal bestå for at bruge titlen PA-C. Det er en computerbaseret multiple choice-eksamen, der afvikles i blokke på tid. Det præcise antal spørgsmål, den tilladte tid per blok, skalascoreintervallet og beståelsesgrænsen fastsættes og offentliggøres af NCCPA, og de har ændret sig gennem årene, så læs de aktuelle eksamenssider på nccpa.net og din egen kandidathåndbog frem for at stole på et tal, du har set i et forum. Det samme gælder, hvor mange forsøg du får, og hvor længe dit tilmeldingsvindue står åbent.

Selve indholdet er offentligt. NCCPA-blueprinten har to akser. Den første er medicinsk indhold efter organsystem, som udgør 94 procent af eksamen: hjerte-kar 11 procent, lunger 9 procent, mave-tarm og ernæring 8 procent, bevægeapparat 8 procent, infektionssygdomme 7 procent, neurologi 7 procent, psykiatri og adfærdsvidenskab 7 procent, reproduktion 7 procent, endokrinologi 6 procent, øjne, ører, næse og hals 6 procent, blodsygdomme 5 procent, nyrer 5 procent, hud 4 procent og urinveje og kønsorganer 4 procent. Professional practice udgør de resterende 6 procent.

Den anden akse er opgavetypen, altså hvad spørgsmålet beder dig gøre med det indhold. De opgaver omfatter at optage anamnese og lave objektiv undersøgelse, at ordinere og tolke diagnostiske undersøgelser og laboratorieprøver, at stille den mest sandsynlige diagnose, sundhedsfremme og forebyggelse, klinisk intervention, farmakologisk behandling, anvendelse af basalfaglige begreber og professional practice. Hvert spørgsmål ligger i krydset mellem ét system og én opgave, og det er derfor, at det at læse efter system alene efterlader huller.

Sådan bruger du smagsprøven

De her 15 spørgsmål er med vilje spredt tyndt ud over blueprinten frem for stablet op på ét system. Du får en klapfejl, et spirometrimønster, en facialisparese, et førstevalg af billeddiagnostik, stofskifteprøver, en beslutningsregel for billeddiagnostik, et flåtbårent udslæt, en psykiatrisk definition, screening af voksne, en mekanisme i en lægemiddelgruppe, urinsediment, en hudforandring, stemmegaffelprøver, jernstatus og en graviditetsdefinition. Pointen er at finde de systemer, hvor dit ræsonnement er tyndt, ikke at simulere en hel eksamen.

Tag den i ét stræk uden noter, og læs så hver eneste forklaring, også dem du svarede rigtigt på af de forkerte grunde. Behandl hvert forkert svar som et emne frem for som et faktum. Gik både spørgsmålet om stemmegaffelprøver og spørgsmålet om urinsediment galt, er det som regel et tegn på, at du lærer fund udenad i stedet for at lære, hvad der frembringer dem, og løsningen er at gå tilbage til mekanismen.

En ærlig begrænsning. De her spørgsmål handler om ræsonnement, mekanismer, klassiske sammenhænge og monitorering, ikke om dosering eller behandlingsprotokoller. Det er med vilje. Intet her er medicinsk vejledning, intet her bør bruges til at behandle en patient, og intet af det er et NCCPA-spørgsmål. Det er eksamenstræning skrevet af StudyPDF-teamet ud fra den offentliggjorte blueprint, og StudyPDF er på ingen måde tilknyttet NCCPA. Kliniske beslutninger hører til hos aktuelle retningslinjer og din superviserende læge.

Sådan bygger StudyPDF fulde øveprøver ud fra dit materiale

Femten spørgsmål kan vise dig, hvor du er svag. De kan ikke gøre dig klar til en så bred blueprint, og en generisk spørgsmålsbank rammer sjældent det, som netop din uddannelse, dine noter fra klinikopholdet eller den repetitionsbog, du faktisk købte, lægger vægt på.

StudyPDF arbejder ud fra dit materiale i stedet. Du uploader din PANCE-repetitionsbog, dine slides fra teoriåret, dine kompendier fra klinikopholdene eller de noter, du tog om et bestemt emne, og Bo, studieagenten, bygger fuldlange øveprøver ud fra præcis de sider. Hvert spørgsmål bygger på dit materiale, og hver forklaring henviser til, hvor svaret kom fra, så når noget ser forkert ud, kan du gå direkte til kilden og tjekke. Du kan lave nye prøver så tit du vil, holde dem på ét system som hjerte-kar eller hormoner, eller på én opgavetype som diagnostiske undersøgelser, og følge med i hvilke begreber du bliver ved med at ramme forkert.

Du behøver ikke et dokument for at komme i gang. Har du ikke noget at uploade, så nævn et emne i stedet, for eksempel mislyde, syre-base-forstyrrelser eller vaccinationsprogrammer for voksne, så skriver Bo en øveprøve ud fra det alene. Gratis at komme i gang.