Rapid Rounds 01: 15 Mixed PANCE Practice Questions

Brian Wallace (0:00)

I talk a lot about active versus passive studying, and I was working with some students this week, and I thought, geez, I need to actually push this even more. And for PA week, I thought it would be really fun to introduce a new sort of show into the feed and see how this goes, and do some active questions right here in the regular podcast feed. So today, we're gonna have 15 We'll see how long it takes. Maybe we'll cut it short, maybe we'll add a couple, but we're looking at 15 mixed practice questions, and let's jump in and just get started. A firefighter is pulled from a burning building with a headache, confusion, and nausea. Pulse Ox reads 99%. What diagnosis must be suspected despite a normal SpO2? Think it through for a second. Firefighter pulled from a burning building, headache, confusion, nausea, Pulse Ox 99 What do you have to consider even though he's got a normal SpO2? Carbon monoxide poisoning. The Pulse Ox can't necessarily tell you how much carbon monoxide is on the heme of it, right? It doesn't know the difference. So here's another question, a follow-up question. How do you treat it? How do you treat carbon monoxide poisoning? It's another good question. It's actually not in my list, but it's 100% oxygen, 100% oxygen. It would be on a non-rebreather, maybe hypobaric, but the idea is just we want to give them as much oxygen as possible to help replace it. A toddler holds the arm flexed and pronated after being pulled by the wrist. What diagnosis should this make you think of?

I did this to my oldest son three different times. This is a radial head subluxation, nursemaids elbow. And it's going to be based on how it happens, right? If you're being, if a howler is being pulled by the wrist, it's a very, I'm not going to say super common, but it does happen.

While we're on it, what's the management here? This does not require an x-ray. This is a clinical diagnosis. Pretty obvious when you've seen it. You're going to reduce with sepination and flexion. I was able to put all three of them back in on my own. A 30-year-old has a sharp pleuritic chest pain that improves leaning forward with diffuse ST elevation and PR depression. What's the diagnosis?

Acute pericarditis. ST elevation in one area is an MI, right? Diffuse ST elevation with PR depression is pericarditis. The leaning forward part is helpful too. A 45-year-old woman has resistant hypertension. A potassium of 2.9 and a metabolic alkalosis or plasma aldosterone to run in ratio is elevated. What's the diagnosis?

Primary hyperaldosteronism. You should think when you see hypertension plus low potassium plus metabolic alkalosis, maybe that's a lot, but you should be thinking aldosterone. The other thing is that the other thing is that the other thing is that the other thing is that the other thing is that the other thing is that the other thing is that the other thing is that the other thing is that the There's a lot, but you really should be thinking Aldosterone. A 50-year-old with chronic back pain develops sudden bilateral leg weakness, saddle anesthesia, and urinary retention. What imaging is needed immediately?

So I'm only thinking one thing when I see saddle anesthesia, right? I don't know that there's anything else that causes that. I don't know, maybe write in and let me know if we can find something else. Only one thing I know causes saddle anesthesia, like in the middle of the night, like emergently, not like a trauma, not like a traumatic event. But you get a phone call with bilateral weakness, saddle anesthesia, I'm thinking cauda equina, right? That's what I'm thinking. So what we need, how do we find that? Well, we need an MRI immediately. And what's the obvious treatment here? Surgery. We're going to go in and decompress the area.

Number six, a patient on unfractionated heparin for DBT develops a platelet count drop from 250,000 to 80,000 on day five of the heparin therapy. What's the most likely diagnosis? I mean, that's sort of straightforward, right? Heparin induced thrombocytopenia. That's just the platelets fall in more than half in five to 10 days after starting heparin. That's the story. A middle-aged patient has painful oral erosions and flaccid blisters on the trunk. Painful oral erosions and flaccid blisters on the trunk. Gentle lateral pressure on uninvolved skin causes the epidermis to shear off. What's the diagnosis?

Pemphigus vulgaris. This is flaccid blisters and in the mouth is probably what you're looking for. What's the sign? What's the sign of a pain in the oral cavity? What's the sign of a pain in the oral cavity? In the mouth is probably what you're looking for. What's the sign? What's the name for the sign that's positive here? The skin shearing off with lateral pressure?