Listen to Podcast Episode 105: Ten PANCE, PANRE, and Rotation Review Questions
If you can’t see the audio player, click here to listen to the full episode.
Welcome to episode 105 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.
Join me today as we cover ten board review questions for your PANCE, PANRE, EOR, and EOC exams.
Links from today’s episode:

* Sign up for the Entire Blueprint Email Series
* Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram
* Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook
* Review systemic lupus erythematosus (SLE)
* Review the diabetes diagnostic guidelines
* Review gestational diabetes screening guidelines
* Review basal cell carcinoma and our comparison tables of the Blueprint dermatologic neoplasms
* Join the Smarty PANCE Member’s Community, then sign up for a study group to get updates about upcoming webinars.

I hope you enjoy this free audio component of the examination portion of this site. Smarty PANCE includes over 2,000 interactive board review questions, along with flashcards, ReelDx cases, integrated Picmonics, and lessons covering every blueprint topic available to all Smarty PANCE members.

* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and all podcasting apps
* You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page.

Interactive exam to complement today’s podcast
1. A 68-year-old male farmer presents with a flesh-colored papule with a rolled border located on the right side of his forehead. As you examine the lesion closely, you notice something else about the lesion. Which of the following physical exam findings would make you more suspicious of malignancy?
A. Telangiectasia
B. Nikolsky sign
C. Hypopigmentation
D. Tenderness to palpation
E.

Listen to Podcast Episode 104: Ten PANCE, PANRE, and Rotation Review Questions


If you can't see the audio player, click here to listen to the full episode.

Welcome to episode 104 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.

Join me today as we cover ten board review questions for your PANCE, PANRE, EOR, and EOC exams.
Links from today's episode:

* Sign up for the Entire Blueprint Email Series
* Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram
* Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook
* Join the Smarty PANCE Member's Community, then sign up for a study group to get updates about upcoming webinars.

I hope you enjoy this free audio component of the examination portion of this site. Smarty PANCE includes over 2,000 interactive board review questions, along with flashcards, ReelDx cases, integrated Picmonics, and lessons covering every blueprint topic available to all Smarty PANCE members.

* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and all podcasting apps
* You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page.

Smarty PANCE is not sponsored or endorsed by, or affiliated with, the National Commission on Certification of Physician Assistants.
Interactive exam to complement today's podcast
When is screening for gestational diabetes done?

A. 16 weeks
B. 22 weeks
C. 24 weeks
D. 32 weeks
E. 34 weeks

Answer and topic summary

The answer is C. 24 weeks

Prenatal care is extremely important. Screening for gestational diabetes is routinely done in pregnant patients at 24 weeks of gestation (typically until 28 weeks). Pregnancy is associated with insulin resistance, mostly because of the placenta’s secretion of human placental lactogen. There are bad consequences of gestational diabetes, so it is critical it is diagnosed and treated adequately.

The initial test is a one-hour 50-gram oral glucose tolerance test (GTT). A positive test >135 mg/dL. If a patient tests positive, they need to undergo the second test, which is a three-hour 100 mg oral GTT. The cut-offs are debated, but generally, the following are positive results: fasting > 95 mg/dL,

Listen to Podcast Episode 103: Ten PANRE & PANRE-LA Intervention Complex Practice Question
If you can’t see the audio player, click here to listen to the full episode.
Welcome to episode 103 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.
Join me today as we cover ten NCCPA-style board review questions for your PANRE and PANRE-LA exams.
Special from today’s episode:

* Take the new PANRE & PANRE-LA (Intervention Complex) Practice Exam: Covers all the topics tested within the new PANRE (Intervention Complex) performance expectation with links to Smarty PANCE lessons.
* PANRE & PANRE-LA Blueprint 8-Week Schedule and Study Planner
* Read The New 2023 PANRE and PANRE-LA: Everything you Need to Know
* Members can try out the newly updated PANRE-LA Smart Search Tool (you must log in to access the search bar)
* Sign up for the Entire Blueprint Email Series to get daily questions for the next 478 days!
* Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram
* Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook
* Join the Smarty PANCE Member’s Community, then sign up for a study group to get updates about upcoming webinars

I hope you enjoy this free audio component of the examination portion of this site. Smarty PANCE includes over 2,000 interactive board review questions, along with flashcards, ReelDx cases, integrated Picmonics, and lessons covering every blueprint topic available to all Smarty PANCE members.

* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps.
* You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page.

Here is an interactive exam to complement today’s podcast
1. A 65-year-old man presents to your office with complaints of constipation for the past six months. He says that he has difficulty passing stools, which are hard and dry. He also reports occasional abdominal pain and bloating. He denies any weight loss, blood in stools, fever, or night sweats. His medical history is significant for hypertension and type 2 diabetes mellitus.

Listen to Podcast Episode 102: Ten PANCE, PANRE, and Rotation Review Questions
If you can’t see the audio player, click here to listen to the full episode.
Welcome to episode 102 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.
Join me today as we cover ten board review questions for your PANCE, PANRE, EOR™, and EOC™ exams.
Special from today’s episode:

* Read The New 2023 PANRE and PANRE-LA: Everything you Need to Know
* Members can try out the newly updated PANRE-LA Smart Search (you must log in to access the search bar)
* Sign up for the Entire Blueprint Email Series
* Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram
* Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook
* Join the Smarty PANCE Member’s Community then sign up for a study group to get updates about upcoming webinars.

I hope you enjoy this free audio component of the examination portion of this site. Smarty PANCE includes over 2,000 interactive board review questions, along with flashcards, ReelDx cases, integrated Picmonics, and lessons covering every blueprint topic available to all Smarty PANCE members.

* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps.
* You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page.

Interactive exam to complement today’s podcast
1. Which of the following is NOT true about a non-ST elevation myocardial infarction?
A. Non-enteric-coated, chewable aspirin 325 mg should be given
B. Troponins are elevated
C. It happens due to a partially occluded epicardial coronary artery
D. Patients need a 12-lead EKG
E. You will always see ST depressions
2. A 22-year-old G1P0 female at 28 weeks gestation with a history of diabetes presents to the clinic with fever, chills, and dysuria. Vitals show tachycardia (115 bpm), tachypnea (22 bpm), and hypotension (90/58 mmHg). Physical exam reveals suprapubic tenderness. Labs reveal leukocytosis, hyponatremia, and hyperglycemia. Urine dipstick is positive for nitrites, blood, glucose, and ketones. Which of the following is the next best step?
A. Send home with oral antibiotics and analgesics
B. Reassurance and oral rehydration solution
C. Admit to hospital for antibiotics, fluids, & insulin
D. Order outpatient CT scan of the abdomen
E.

Welcome to episode 101 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.
Join me today as we cover ten board review questions for your PANCE, PANRE, and rotation exams.
Special from today’s episode:

* Join the Smarty PANCE Member’s Community then sign up for a study group to get updates about upcoming webinars.
* Check out our updated End of Curriculum™ (EOC) Exam Course
* Sign up for the Entire Blueprint Email Series
* Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram
* Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook

I hope you enjoy this free audio component of the examination portion of the Smarty PANCE website. The full board review website includes over 2,000 interactive board review questions, flashcards, and blueprint lessons available to all members of Smarty PANCE.

* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps.
* You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page.

Listen to Podcast Episode 101: Ten PANCE, PANRE, and Rotation Review Questions
If you can’t see the audio player, click here to listen to the full episode.
Interactive exam to complement today’s podcast
1. A 75-year-female smoker with a history of atrial fibrillation and hypertension presents to the ER complaining of a 2-hour history of right-sided weakness and aphasia that has now resolved. Her physical exam and vital signs are completely unremarkable. CT head is unremarkable. Which of the following is the most likely diagnosis?
A. Subarachnoid hemorrhage
B. Transient ischemic attack
C. Cerebral venous sinus thrombosis
D. Multiple sclerosis
E. Complicated migraine
2. A 26-year-old female presents with a history of miscarriages and recurrent pulmonary embolism. She is diagnosed with antiphospholipid syndrome. Which of the following is the mainstay of treatment for this condition?
A. Dual antiplatelet therapy (DAPT)
B. Aspirin and heparin
C. Dabigatran
D. Warfarin
E. Heparin
3. Which of the following is the most common cause of acute bronchitis in the United States?
A. Virus
B. Bacteria
C. Fungus
D. Allergies
E. Tuberculosis
4. A 27-year-old male presents to the clinic with shortness of breath, chest pain, and fatigue. His physical exam is remarkable for a crescendo-decrescendo systolic murmur heard at the apex.

Welcome to episode one hundred of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.
Join me today as we cover atrial fibrillation for the PANCE, PANRE, and EOR™ exams.
Special from today’s episode:

* Join the Smarty PANCE Member’s Community then sign up for the Sunday Funday Study Group. Once you have signed up, you can access the Webinar replay of this episode here
* Check out our updated End of Curriculum™ (EOC) Exam Course (now with orthopedics!)
* Sign up for the Entire Blueprint email series
* Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram
* Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook

Below you will find the audio of today’s podcast.
The Audio PANCE/PANRE and EOR PA Board Review Podcast
I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of Smarty PANCE.

* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps.
* You can listen to all the latest episodes, take interactive quizzes, and download more resources on each episode page.

Listen to Podcast Episode 100: Atrial Fibrillation for the PANCE and PANRE
If you can’t see the audio player, click here to listen to the full episode.

Welcome to episode 99 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.
Join me as I cover ten PANCE, PANRE, and EOR™ review questions from the Smarty PANCE Instagram/Facebook page and the smartypance.com board review website.
Special from today’s episode:

* Join the Smarty PANCE Member’s Community
* Check out our all-new End of Curriculum™ (EOC) Exam Course (still in development)
* Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram
* Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook

Below you will find an interactive exam to complement today’s podcast.
The Audio PANCE/PANRE and EOR PA Board Review Podcast
I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of Smarty PANCE.

* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps.
* You can listen to the latest episode, take an interactive quiz, and download more resources below.

Listen Carefully Then Take the Practice Exam
If you can’t see the audio player, click here to listen to the full episode.
Podcast Episode 99: Ten PANCE/PANRE and EOR Topic Blueprint Questions
1. A 42-year-old male on lithium presents with polyuria, nocturia, and polydipsia. Laboratory findings are remarkable for slightly elevated sodium. Which of the following is the most likely diagnosis?
A. Neurogenic diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Type 2 diabetes mellitus
D. SIADH
E. Adrenal insufficiency
2. A 50-year-old female presents with poor appetite, low energy, poor concentration, and feelings of hopelessness on most days for the past 3 years. She denies suicidal ideation. She has never had a past manic or hypomanic episode. Which of the following is the best treatment option?
A. Haloperidol
B. Fluoxetine
C. Lorazepam
D. Amitriptyline
E. Risperidone
3. An 85-year-old male with a history of chronic kidney disease presents to the ER with muscle cramps. Laboratory studies reveal potassium of 7.8 mEq/L. EKG reveals peaked T waves. Which of the following is the best initial med to give?
A. Insulin
B. Albuterol
C. Furosemide
D. Sodium bicarbonate
E. Calcium gluconate
4. A 28-year-old male with sickle cell disease presents to the ER with chest pain, dyspnea, and a cough for the past day. Vitals are remarkable for SpO2 91% and T 102.2F.

Welcome to episode 98 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.



Join me as I cover ten PANCE, PANRE, and EOR™ review questions from the Smarty PANCE Instagram/Facebook page and the smartypance.com board review website.



Special from today’s episode:



* Join the Smarty PANCE Member’s Community* Check out our all-new End of Curriculum™ (EOC) Exam Course (still in development)* Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram* Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook



Below you will find an interactive exam to complement today’s podcast.



The Audio PANCE/PANRE and EOR PA Board Review Podcast



I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of Smarty PANCE.



* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, and most podcasting apps.* You can listen to the latest episode, take an interactive quiz, and download more resources below.



Listen Carefully Then Take the Practice Exam





If you can’t see the audio player, click here to listen to the full episode.



Podcast Episode 98: Ten PANCE/PANRE and EOR Topic Blueprint Questions



1. An 81-year-old female presents to the ER with acute onset of low back pain. She complains of bowel dysfunction and loss of sensation over her inner thighs. Physical exam reveals decreased lower extremity reflexes. Which of the following is the best diagnostic test for the likely diagnosis?



A. Lumbar radiographsB. MRI of the lumbosacral spineC. CSF fluid analysisD. Scoliosis studiesE. None of the above





2. Which of the following is the most common cause of Cushing syndrome?



A. IatrogenicB. Bronchogenic carcinomaC. Pituitary adenomaD. Adrenal adenomaE. Obesity





3. A 73-year-old female presents with facial flushing, wheezing, and watery diarrhea for a few months. Her symptoms are worsened by certain foods. Which of the following is the best initial diagnostic study to order for the suspected diagnosis?



A. 5-HIAA in urineB. Serum ACE levelsC. Chest radiographD. Upper endoscopyE. Bronchoscopy

Welcome to episode 97 of the Audio PANCE and PANRE PA board review podcast.



Today is a bonus episode rounding out this fabulous five-part podcast series with Joe Gilboy PA-C, all about cardiac murmurs. In this week’s episode, we continue our discussion of cardiac murmurs with ten PANCE and PANRE murmur questions.



We’ll cover the ins and outs of all the NCCPA content blueprint valvular disorders and learn how to identify and differentiate them from one another.



If you haven’t already, make sure to listen to our previous podcast episodes where we covered tricuspid stenosis, aortic valve murmurs, mitral valve murmurs, pulmonic valve murmurs, and HOCM and MVP.



Podcast Episode 97: Murmurs Made Incredibly Easy – 10 PANCE and PANRE Murmur Questions



Below is a transcription of this podcast episode edited for clarity.



* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher, Amazon Music, and most podcasting apps.* You can listen to this latest episode and access even more resources below.



[00:00:00] Welcome back, everybody. This is Joe Gilboy. I work with Stephen Pasquini over there at Smarty PANCE. And today is the most dreaded podcast of all because you know what I’m going to do. That’s right. I’m going to ask cardiac murmur questions.



And I know it’s the most dreaded thing in the world. Let’s do this together because what I want to try to do here is make sense of it all. So, let’s just kind of recap some basic rules before we start going down this thing. You know, the previous lectures, what have I been barking about? What’s Joe been saying? First – inspiration, right? Expiration left.



[00:00:40] Inspiration, right? Expiration left. So, with inspiration, the right-sided murmurs sound louder. So that’s the tricuspid and the pulmonic valve regardless of if it’s stenosis or regurgitation.

Welcome to episode 96 of the Audio PANCE and PANRE PA board review podcast.



Today is part five of this fabulous five-part series with Joe Gilboy PA-C, all about cardiac murmurs. In this week’s episode of the Audio PANCE and PANRE podcast, we continue our discussion of cardiac murmurs with a focus on Mitral Valve Prolapse (MPV) and Hypertrophic Obstructive Cardiomyopathy (HOCM).



We’ll cover the ins and outs of these two NCCPA content blueprint murmurs and learn how to identify and differentiate them from other types of murmurs.



If you haven’t already, make sure to listen to our previous podcast episodes where we covered tricuspid stenosis, aortic valve murmurs, mitral valve murmurs, and pulmonic valve murmurs.



HOCM and MVP (a brief introduction)







Hypertrophic Obstructive Cardiomyopathy (HOCM) is a cardiac abnormality that leads to the muscle in the wall of the heart growing and thickening to the point that it blocks blood flow exiting the heart.



The condition can be mild or severe, and it can lead to a variety of symptoms, including shortness of breath, chest pain, and irregular heartbeat. Complications may include heart failure, an irregular heartbeat, and sudden cardiac death.



HOCM is a hereditary condition, and it is usually diagnosed in adulthood. There is no cure for HOCM, but treatments are available to manage the symptoms and help reduce the risk of complications. With proper care, people with HOCM can live long and healthy lives.



*Hypertrophic cardiomyopathy is covered under the PANCE cardiology content blueprint -> cardiomyopathy -> hypertrophic cardiomyopathy



HOCM is also covered as part of the PAEA EOR pediatric rotation -> cardiovascular topic list -> hypertrophic cardiomyopathy







Mitral Valve Prolapse (MPV) is a condition in which the leaflets of the mitral valve bulge or prolapse back into the left atrium during systole. This may cause blood to flow backward into the left atrium, leading to a heart murmur.



In some cases, MPV may also cause symptoms such as fatigue, dizziness, chest pain, and shortness of breath.



While MPV is usually benign, it can occasionally lead to serious complications such as heart failure or stroke.



Treatment for MPV typically involves lifestyle modification and...

Welcome to episode 95 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.



Join me as I cover ten PANCE, PANRE and EOR review questions from the Smarty PANCE Instagram/Facebook page and the smartypance.com board review website.



Special from today’s episode:



* Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram* Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook



Below you will find an interactive exam to complement today’s podcast.



The Audio PANCE/PANRE and EOR PA Board Review Podcast



I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of Smarty PANCE.



* You can download and listen to past FREE episodes here, on iTunes, Spotify, on Google Podcasts, Stitcher, and most podcasting apps.* You can listen to the latest episode, take an interactive quiz, and download more resources below.



Listen Carefully Then Take the Practice Exam





If you can’t see the audio player, click here to listen to the full episode.



Podcast Episode 95: Ten PANCE/PANRE and EOR Topic Blueprint Questions



1. A 52-year-old patient is admitted with a lower gastrointestinal bleed. He is given 2 units of packed red blood cells. A few hours later the patient develops a fever but has no other symptoms or changes in vital signs. Lab studies reveal no significant changes. Which of the following is the most likely diagnosis?



A. Transfusion-associated circulatory overloadB. Acute immune-mediated hemolytic reactionC. Transfusion-related acute lung injuryD. Febrile non-hemolytic transfusion reactionE. None of the above





2. Which of the following is not a side effect of lithium?



A. HyperparathyroidismB. HypothyroidismC. Cognitive fogD. TremorsE. All are side effects





3. Which of the following best explains the pathophysiology of vasovagal syncope?



A. Increase in parasympathetic signals and withdrawal of sympathetic signalsB. Severe narrowing of the aortic valveC. Drop in blood pressure upon standing due to inadequate peripheral vasoconstrictionD. Occlusion of the pulmonary artery leading to right ventricle dysfunctionE. Blood accumulation in the brain leading to compression of adjacent brain structures





4.

Welcome to episode 94 of the Audio PANCE and PANRE PA board review podcast.



Today is part four of this fabulous five-part series with Joe Gilboy PA-C, all about cardiac murmurs. In this week’s episode of the Audio PANCE and PANRE podcast, we continue our discussion of cardiac murmurs with a focus on the tricuspid valve.



We’ll cover the ins and outs of tricuspid valve stenosis and learn how to identify it and differentiate it from other types of murmurs.



If you haven’t already, make sure to listen to our previous podcast episode where we covered aortic valve murmurs and mitral valve murmurs, and pulmonic valve murmurs.



The Tricuspid Valve







The tricuspid valve, or right atrioventricular valve, is a one-way valve that sits between the right atrium and right ventricle of the heart. It is essential for right ventricular filling and for preventing the backflow of blood from the right ventricle into the right atrium when the right ventricle contracts during systole.



When functioning properly, the tricuspid valve is a passive structure that opens and closes in response to the pressure of the blood flowing through the heart.



The right atrium receives deoxygenated blood from the superior and inferior vena cava. The tricuspid valve which separates the right atrium from the right ventricle opens during ventricular diastole, allowing the deoxygenated blood to flow from the right atrium into the right ventricle, and closes during ventricular systole preventing the backflow of blood from the right ventricle into the right atrium as the right ventricle contracts to pump blood into the lungs out through the pulmonary artery.



Tricuspid Valve Stenosis



Tricuspid stenosis is a narrowing of the tricuspid valve or one of its three leaflets.



If the tricuspid valve is narrowed or stenotic, it will not open properly during diastole, increasing the volume of blood in the right atrium. When the right ventricle contracts the stiffened tricuspid valve also fails to close completely and tricuspid regurgitation develops.



Nearly all cases are caused by rheumatic fever.



Podcast Episode 94: Murmurs Made Incredibly Easy (Part 4 of 5) – Tricuspid Valve Stenosis





Below is a transcription of this podcast episode edited for clarity.



* You can download and listen to past FREE episodes here, on iTunes, Spotify, Go...

Welcome to episode 93 of the Audio PANCE and PANRE physician assistant/associate board review podcast.



Today is part three of this extraordinary five-part series with Joe Gilboy PA-C, all about cardiac murmurs. In this week’s episode of the Audio PANCE and PANRE podcast, we continue our discussion of cardiac murmurs with a focus on the pulmonic valve.



We’ll talk about the different types of murmurs (stenosis and regurgitation) that can occur with the pulmonic valve and how to differentiate them from other types of murmurs. If you haven’t already, make sure to listen to our previous podcast episode where we covered the aortic valve murmurs and mitral valve murmurs.



The Pulmonic Valve



Pulmonic valve stenosis (PVS) and pulmonic valve regurgitation (PVR) are two common heart valve diseases. PVS is a narrowing of the pulmonic valve, while PVR is leakage of blood back through the pulmonic valve. Both conditions can lead to significant heart problems if left untreated.



Pulmonic valve stenosis



PVS is the most common congenital heart disease, affecting approximately 1 in 1000 people. It can lead to right heart failure and/or pulmonary hypertension (high blood pressure in the lung arteries). PVS is caused by an abnormally thickened pulmonic valve or localized stenosis which means that it has a narrowing of the valve. Pulmonic valve stenosis has several different causes including:



* Congenital heart disease – this means that the abnormal valve was present from birth but is often undiagnosed until adulthood. For example, children with Down’s syndrome or Noonan syndrome are more likely to have an undiagnosed congenital heart defect such as PVS. It commonly is a component of tetralogy of Fallot.* Cocaine use in pregnancy – research has shown that there is a link between the use of cocaine in pregnant women and children with PVS, particularly if it is used close to the time of conception or later stages of pregnancy.* Infection during pregnancy can cause an inflammatory response which may lead to heart problems for the baby.* Autoimmune disease – PVS is sometimes associated with other autoimmune diseases, such as lupus.



Symptoms of PVS can vary depending on the type of stenosis that is present and how much it has advanced. Mild cases may not cause any symptoms at all; however, it is common for patients to experience breathlessness, fatigue, chest pain, and palpitations.



Heart sounds include increased splitting of S2 and a harsh crescendo-decrescendo ejection murmur heard best at the left parasternal 2nd or 4th intercostal space when the patient leans forward; the murmur grows louder immediately with Valsalva release and with inspiration.



People with PVS may need to take some medication to ease their symptoms. For example, diuretics can help remove excess fluid; beta-blockers reduce the workload on the heart and therefore lower blood pressure and heart rate, and long-acting calcium channel blockers can reduce the force of contraction of the heart’s left ventricle.

Welcome to episode 92 of the Audio PANCE and PANRE physician assistant/associate board review podcast.







Today is part two of this extraordinary five-part series with Joe Gilboy PA-C, all about cardiac murmurs. In this week’s episode of the Audio PANCE and PANRE podcast, we continue our discussion of cardiac murmurs with a focus on the mitral valve.



We’ll talk about the different types of murmurs (stenosis and regurgitation) that can occur with this valve and how to differentiate them from other types of murmurs. If you haven’t already, make sure to listen to our previous podcast episode where we covered the aortic valve murmurs.



The Mitral Valve



The mitral valve is located between the left atrium and the left ventricle in the heart. It consists of two leaflets (or cusps) and is responsible for preventing blood from flowing back into the atrium when the ventricle contracts.



The mitral valve can have two types of murmurs: stenosis and regurgitation.



* Mitral stenosis is a narrowing (or constriction) of the valve opening, which reduces the amount of blood that can flow through the valve. This type of murmur is of low pitch, rumbling in character, and best heard at the apex with the patient in the left lateral position.* Mitral regurgitation is a leakage (or backflow) of blood from the ventricle into the atrium, caused by weakened or damaged valve leaflets. This type of murmur is a holosystolic (pansystolic) murmur, heard best at the apex with the diaphragm of the stethoscope when the patient is in the left lateral decubitus position.



In addition to auscultation, you can also look for certain signs and symptoms that may indicate mitral stenosis or regurgitation. For example, if a patient presents with chest pain (angina pectoris), this could be from decreased oxygen supply due to poor cardiac output in cases of significant stenosis. On the other hand, if a patient presents with an irregular heart rate (arrhythmia), this could be from increased electrical conduction velocity in cases of significant regurgitation.



Also, keep in mind that mitral valve disease can also occur secondary to rheumatic fever or endocarditis, so you may need to consider these diagnoses if a patient has any of the aforementioned signs and symptoms.



Below is a transcription of this podcast episode edited for clarity.



* You can download and listen to past FREE episodes here, on iTunes, Spotify, Google Podcasts, Stitcher,

Welcome to episode 91 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.



Today is part one of an extraordinary five-part series with Joe Gilboy PA-C, all about cardiac murmurs.



It’s time to throw away everything you have ever learned that made you hate cardiac murmurs (you know those crazy line diagrams) and let Joe hard-wire your brain for success.



I promise you that by the end of this podcast, you will no longer be afraid of murmurs, but you will welcome them into your brain with a whole heart, open arms, and the need to share this podcast with all your classmates.



Below is a transcription of this podcast episode slightly edited for clarity.



* You can download and listen to past FREE episodes here, on iTunes, Spotify, on Google Podcasts, Stitcher, Amazon Music, and most podcasting apps.* You can listen to the latest episode and access even more resources below.





Welcome, everybody. This is Joe Gilboy PA-C, and today is part one of a five-part series on the two most dreaded words that every pa student and recert PA hates. Are you ready for the two words?



Heart murmurs!



Today we’re going to start talking about heart murmurs, and we are going to break this down into a five-part series:



* The first part is going to be on the aortic valve (today’s episode)* The second part will cover the mitral valve* The third will be all about the pulmonic valve* The fourth part will be about the tricuspid valve* And then, in the fifth part of this series, we’re going to wrap this all together



We’re going to cover each valve one at a time. We will look at it and try to really make sense of it all.



Because I know what you did in PA school, you had that little diagram that you made, you know, systolic or diastolic murmurs. You’ve memorized certain things. And then you get to that test question, and you’re completely clueless on it, you’re like, “I have no idea what they just said, Joe, I have no idea.”



And then you’re back to scrambling, looking for some word that’s going to trigger you. And that’s the key point- all the trigger words, all those high-value trigger words, they’re gone. That’s what the creators of the PANCE did about two to three years ago. They took all the trigger words out.



Key point:



* Don’t rely on keywords (trigger words) for your PANCE because they’re gone!



So now, let’s look at this differently. You did it your way.

Welcome to episode 90 of the Audio PANCE and PANRE Physician Assistant/Associate Board Review Podcast.



Join me as I cover ten PANCE, PANRE and EOR review questions from the Smarty PANCE Instagram/Facebook page and the smartypance.com board review website.



Special from today’s episode:



* Follow Smarty PANCE and The Daily PANCE Blueprint on Instagram* Follow Smarty PANCE and The Daily PANCE Blueprint on Facebook



Below you will find an interactive exam to complement today’s podcast.



The Audio PANCE/PANRE and EOR PA Board Review Podcast



I hope you enjoy this free audio component to the examination portion of this site. The full board review course includes over 2,000 interactive board review questions and is available to all members of Smarty PANCE.



* You can download and listen to past FREE episodes here, on iTunes, Spotify, on Google Podcasts, Stitcher, and most podcasting apps.* You can listen to the latest episode, take an interactive quiz, and download more resources below.



Listen Carefully Then Take the Practice Exam





If you can’t see the audio player, click here to listen to the full episode.



Podcast Episode 90: Ten PANCE/PANRE and EOR Blueprint Questions



1. A 32-year-old male presents with acute ascending symmetrical paralysis and diminished reflexes in his bilateral lower extremities. He has a history of bloody diarrhea a few days ago. What did he likely eat that led to his symptoms?



A. Uncooked rice



B. Mayonnaise



C. Uncooked chicken



D. Soft unpasteurized cheese



E. None of the above






2. Which of the following disorders is characterized by a scaly, rough erythematous patch that appears on sun-exposed areas?



A. Seborrheic keratosis



B. Keratosis pilaris



C. Actinic keratosis



D. Lichen planus



E. Pityriasis rosea