 Welcome back to our channel, everybody. Today we have a very special guest yet again, my wife, Andriana. She's joining us yet again for another video. And this video also happens to be sponsored by Board Vitals yet again because Board Vitals is crushing it and we wanna support them. So you all loved my last video when I took sample USMLE questions and I asked at the end of that video if you want me and Andriana to switch me take her PA board questions and she take my USMLE questions. I don't know how she feels about that. I don't know. I kind of roped her into that because you guys wanted it. So that's what we're doing today. All right, let's get into these questions. All right, let's go ahead and get into it. Hit it. So we'll do five question sets. We'll switch off taking turns between me answering the Pan Ray questions, her answering the USMLE Step One questions and I will probably do terrible just like I did last time. And I'll probably do terrible because I never studied for this exam. I mean, Step One is hard even when you do study so good luck. Let's see what residency I'll be getting into. Yeah. So again, I just wanted to thank Board Vitals for sponsoring this video as always. They have amazing question banks and have helped me throughout my entire medical career. If you want to use their question banks they have something for literally every health profession. Use my code Dr.Chalini to get 20% off your purchase. DRChalini. But let's go ahead and get into the Board Vitals question banks right now. All right, so I'll go first starting with the Pan Ray question first. And by the way, we can only do 10 question blocks. So we'll take five of these and grade them at the end. So question number one for me. The four-year-old presents with two-day fever. Also has occasional productive cough and clear rhinorrhea. He has been active in eating well, has passed all the histories under Mark Bull and has immunizations up to date. His oxygen saturation is 96% on room air. His examination of Mark Bull with clear rhinorrhea, bi-Basilar rails, cataract bronchi. Which of the following is the next best step in management? I feel like you know this one. It sounds like it just says a cold, no? Well, he wouldn't have rails. Cold. I'm so bad at this clinical stuff. I don't do this stuff, as you all know. I mean, he's a productive cough with a fever. Oh, productive cough. Productive cough with a fever. His O2 sad is 96%. I don't know if this is just a cold stock. Yeah, this is why I don't do pediatrics. So the question is, what is it? A pneumonia or something? Don't tell me. So I feel like this is a, I'm gonna do with a moxicillin here. No way, augmentin, right? I don't know. I feel like you need to step up the augmentin here. A moxicillin, have you learned anything? Well, which is the next step? Oh, the next step? Yeah. Also, if this was just a cold, they wouldn't just tell you. Yeah, I don't know why I don't talk about that. Oh, but they did say supportive measures as one of your measures. Oh, that's true. So I'm gonna step up the big guns here and go with augmentin E. I feel like this should be a moxicillin, I don't know. Ah, son of a, I'm the worst pediatrician. What is the explanation here? Supportive measures. Oh, this is a viral pneumonia. I guess it could be. I was in no fever. No, you didn't. I don't really know. I don't know if I would. That's a tough one. I guess kids don't get, yeah, I mean, bacterial pneumonia if you're off. It's usually viral. I should have said supportive measure because I'm a bad test taker. I wasn't paying attention. That's why I missed this one. I would have gotten that one. If it was actually bacterial pneumonia, it would have been a moxicillin because that's the most community requires. That's the first treatment of choice. A moxicillin, I'm like augmentin here. And augmentin need to do later on. But it also depends on the age so that they're saying six to five years is a moxicillin. Well, we're off to a great start. Pediatrics, really crushing it. All right, you're doing well. All right. A 13-year-old boy presents at the adolescent clinic complaining of darkening of both axilla over the past nine months. These areas enlarging become rough, raised, and mildly peridic. His father recalls having similar skin fondings at about the same age. His weight and BMI are at the 98th percentile for the age. Physical exam is remarkable for thickened fish with nearly black plaques with velvety texture in the axilla. That looks like acanthosis nigra cancy. So, I mean, if we want to explain this, we definitely know varuca are warts. This does not look like warts. Like in planus, will be purple. The peas, purple peridic. These are definitely not molestum. Yay! This is just derm coming in hot. Yeah, this is not fair. This is like derm, this is rougher alley. I got pediatrics as my first one. All right. Next. I gotta play a little catch up here. All right, let's hit number two here. I might have to agree. Yours was kind of a little bit, a little... Mama's more challenging. Yeah. I guess maybe because you know what? He was active in eating well. But then again, they kind of tricked you with like the 96% of room air, two days of fever. But it's only two days. That was the trick. Not really. All right, I've had enough of that question. Next. Oh, the difficulty level was hard. Oh yeah, the difficulty level was hard. Another... I'm the worst at pediatrics stuff and now I gotta do more. All right. No scrimp for past medical history. It presents with fever, perturbed rash, on some areas of trauma patient. It records sick contact with similar symptoms in school with a patient. Parents are not coughing, shortness of breath, blah, blah, blah. Visitors and playful child, no acute stress, crop of death, school is a similar area of dry and crustal lesion. Oh, I know this one. Yeah. Which of the following is the most appropriate management? I mean, you don't really have to do anything except for if it's painful, right? I mean, she just has a fever. Yeah, so at this point, I don't think acyclovir is gonna help. I don't think getting the vaccine is gonna help and neither will immune globulin. So I'm gonna go with, you don't give aspirin to children. We're doing acetaminophen. Why? What do they get? Ray syndrome. Oh yeah, Ray syndrome. Yeah. Still got it. One for two. Chicken pox. You just do nothing. Chicken pox. This is all supportive treatment. Once they have it, there's nothing you can do. All right, next. For the past two days, a 55 year old man has experienced flame pain and a fever. A physical exam shows that he has a temperature of 38.5 degrees Celsius and a pulse of 80 beats per minute. Respirations, 16 beats per minute. Blood pressure 130 over 80. No protein, glucose, ketones in the urine. Luke's are positive. Some white blood cells, gastro-occasionally seen, which the filing organism is most likely present in this patient's urine. I'm gonna go with E. coli. So, I'm gonna say E. coli because it's the most common. That's what we treat UTIs for. But, the thing is the flame pain could be going into a pilo, but he's not really, cause he has a fever now, on flame pain. So this is kind of a pilo. A pause by E. coli. All right, not too bad. Not too bad. I'm pretty right up my alley. I know, it's time to step it up. All right, number three for me. Which of the following serum profiles is associated with the most likely underlying cause of primary hyperparathyroidism? All right, we can do this. We can do this. You're going to have decreased parathyroid hormone. I can't, this is like my nightmare. I'm trying to think through this. I just can't do it. After working all day, I just can't do it. Primary hyperparathyroidism? All right, you're going to have increased ionized calcium. So I can get rid of all the other ones. And you're going to have, I think it's this, right? Because parathyroid hormones are going to be decreased. Oh wait, no, this is the entries. This should be both, no? It's either B or C. Maybe just pick one. I don't want to be wrong. That's fine, babe. I'll just get another one. Because parathyroid hormone is increased, obviously. Which means calcium is also increased. I feel like it's B, but I'm just going to do it with this. Okay, good. That was way too difficult. So it's obviously over-secretion of parathyroid hormone by like the adenoma or something. And it causes increased PTH and also increased calcium as a result. Let's do the next one because- It's bones, groans, bones, stones, and psychological overtones. Yeah, all those, bones, groans, stones, psychological overtones. Oh, the hypercalcine, yeah. Oh, this is bringing back memories. All right, Andrew has his turn. Question number three. This is you. Ooh. Which of the following is most likely the diagnosis given the following abdominal KUB and neonate with bilious vomiting? All right, so with someone with bilious vomiting, I'm going to go with not a form body. This is definitely not a normal KUB. There's something with like two bubbles. Double bubble sign. You see this in patients with Down syndrome. All right, there's something with- You already clicked it. Oh, okay. I mean, so what's the answer? I'm going to go with D, duodenal atresia. Yes, 100% final answer. Yay. Duodenal atresia? Well, some people say duodenal, some people say duodenal. I know. Who says duodenal and who says duodenal? Some surgeons say duodenum. Yeah, and some people say duodenal. I've always said duodenal. Yeah, same. I've always said duodenal, but then some people say duodenal. I agree. I don't know why. Mine are easier than yours. I know. I'm well aware. Next. Uh-oh. Ella X-ray. Hey, this would be embarrassing if I did this wrong. All right. 35 year old man brought to the emergency department by ambulance after a skiing accident. His chest X-ray is pictured below. Which of the following explains these findings? Oh, I know, hon. Do you? Oh, I see. Oh, so his endotracheal tube is in the right main stem bronchus. So, we'll say that. And that's the reason why his right lung is aerated and his left lung is a little hazy because it's not getting oxygenated like it should. So let's go with, boom. You know I'm not gonna miss the radiology question. I mean, I could, but next. Peeds again? Oh my God, I can't deal with all this peed stuff. A four year old boy presents the pediatric clinic for evaluation of skin bumps. Ooh. The first bump was noted on the ads. It had been a positive three months ago and has since disappeared. Approximately four to five similar legions have appeared over the past two months on the child's chest and back. And we're mildly paridic. Oh, several playmates reported had similar legions over the past six months. The blue exam is remarkable fine around a dome shaped pinkish papules with central obliquations are scattered on the child's chest and back. Oh, man. We're gonna like have this as an answer choice in the last one. Gonna go with melascombe, super common. Yay. This is like her bread and butter in there. So have you got, you haven't missed one yet. You have to miss the next one so we can tie or something. So melascombe, pretty obvious. If we really... Really essential obliquation that like gives it away. Maybe we can put a picture up here or something of one. Got me. And super common in children who go to daycare. Very common. All right. Let's see how the next one is for me. Oh, I knew one. This is pediatric. Did I click like all pediatric? No, I don't think so. I thought I did everything. You did? It's just pediatric day. No, I mean no offense against pediatric. It's just not my cup of tea. All right. So a term newborn male develops respiratory distress immediately after delivery. His respiratory is 30 minutes, blood pressure is low, his or her examination are marked for a decreased right set of breast sounds, a three six considered machinery murmur. I know what that is. Bell sounds are present in the right chest. His abdomen is staphoid. He is acidotic. Heart intent, trachea, shifted, bowel, blah, blah, blah. Solid mass, life-saving permission. The solid mass most likely present. Represent. No, represents. So this is a liver. So basically he has a diaphragmatic hernia but that's rare in that term male. But it sounds like he has a diaphragmatic hernia which means his whole right abdominal stuff contents is in his right chest. So there's a solid mass in his right chest and that's probably the liver that's herniated up. Yeah. Four out of five. Not bad. That's fine. I'm probably gonna get this one wrong. You have to get this one wrong so that we can be equal. All right. Probably will. What a good husband cheering on my way to get it wrong. All right, number five. Last push. Alrighty, so a six-year-old man with a history of prior cerebral vascular accident presents with difficulty comprehending spoken conversation for the past two hours. His speech is fluent but nonsensical and he cannot repeat words or phrases. Which of the following areas of the brain is most likely affected? All right. Some neuro. I'm gonna go with B. Oops. So now we are officially tied. We both got 80% here. Four out of five questions each which makes me feel a little better about myself. Oh, this has broke us with the brain capable producing fluent speech. He had some understanding. Oh, well that's... All right, got that wrong. Knew I was gonna get it wrong. Yeah, okay. So we tied officially which makes me feel a little better about myself. So mark up 80% for both of us here. So we tied this on this day. I will say though, if I didn't get so many pediatric questions I could have made 100%. Yeah, and if I didn't have these biology questions. So that officially concludes this video. Doctor versus PA. Board exam edition. Hope you all enjoyed it. Big thanks to Board Vitals for sponsoring this video once again. Use my code doctorchillini. It's D-R-C-E-L-L-I-N-I. You'll get 20% off your purchase whether you're a nursing student, PA. Med student. Med student, radiologist, pharmacist. You name it. Look down their website boardvitals.com. Use my code doctorchillini to get 20% off. And yeah. So if you enjoyed this video make sure you smash that like and subscribe button and we'll see you on our next video. So fast. Make sure you follow me on TikTok. Just start posting some crazy stuff for there. Follow her on TikTok as well and Instagram for the both of us. Otherwise, we'll see you on the next video. Bye.