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PANCE Practice Exam #1 correctly answered 2023
1. A 52 year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the past few months. During his physical examination, you... [Show More] note a nontender, non-enlarged prostate with an isolated right posterior lobe nodule. Which of the following options is most appropriate? A. order a serum acid phosphatase level B. initiate prazocin and schedule a follow-up appointment in 6 weeks C. refer the patient for an ultrasound of the prostate and order a PSA level D. reassure the patient and schedule a follow-up appointment in six months E. initiate norfloxacin therapy for seven days and schedule follow-up in twoweeks 1. C. This patient has an isolated nodule of the prostate gland — cancer until proven otherwise. You should order an ultrasound and a PSA. BPH will present as diffuse enlargement, and not a discrete nodule. 2. Which term is used to describe the characteristic concave or "spoon-shaped" nails of iron deficiency anemia? A. leukonychia B. koilonychias C. clubbing D. onycholysis E. paronychia 2. B. Koilonychia is a spoon-shaping of the nail itself. Clubbing is a thickening of the nail bed which "lifts" the nail - it is a sign of increased TNF (tissue necrosis factor), most likely occurring in cystic fibrosis, bronchiectasis or lung cancer. A & D are not real words, (onychomycosis is the real term for fungal infection of the nail)..E is paronychia and is an infection of the nailbed. 3. Which of the following is NOT a characteristic feature of the nephotic syndrome? A. proteinuria B. hematuria C. hypoalbuminemia D. hyperlipidemia E. generalized edema 3. B. Hematuria is present in NEPHRITIC syndrome. Nephrotic syndrome characteristically includes proteinuria (>3.5 gm/day), with resulting low serum albumin, hyperlipidemia, hypertension, hypercoagulability, and generalized edema (from oncotic third-spacing) 4. A patient describes a history of recurrent bouts ofuveitis. Her chemistry panel reveals elevated serum calcium and uric acid levels. Her anergy screen is negative. Her chest x-ray deomstrates bilateral hilar adenopathy. Which diagnosis is most likely? A. Silicosis B. Sarcoidosis C. Alpha-1 antitrypsin deficiency D. Histoplasmosis E. Tuberculosis 4. B. Sarcoid typically presents with hilar lymphadenopathy and noncaseating granulomas of the lungs (and other organs). In addition, patients may get eye involvement (uveitis). Elevations of ACE, Calcium and uric acid are frequently seen. 5. A 34 year-old female presents complaining of symmetrical redness and swelling of the small joints of her hands (PIPs and MCPs). She has noted that the symptoms are worst in the morning. Her erythrocyte sedimentation rate is elevated and her rheumatoid factor is negative. Which of the following diagnosis is most likely? A. progressive systemic sclerosis B. CREST syndrome C. osteoarthritis D. rheumatoid arthritis E. ankylosing spondylitis 5. D. In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA characteristically includes small joint symmetrical arthritis, with an elevated ESR (therefore inflammatory, and not OA). 80 of patients with RA will have a positive RF, but 20 will be negative. PSS involves squamous cell thickening and sclerosis causing taut skin of the face and hands and difficulty with esophageal motility. CREST syndrome is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and negative RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine) 6. A 27 year-old nulliparous female presents because she's been trying to get pregnant for two years, but has failed. She relates a history ofamisdiagnosis of appendicitis that lead to abscess formation when she was 14 years old. Which of the following diagnostic studies would be most helpful at this point in her evaluation? A. TSH level B. hysterosalpingogram C. laparoscopy D. PAP smear E. pelvic ultrasound 6. B. While I would disagree that an invasive procedures like HSG should be done first- line, the thing to remember in this question is that the patient has reason to have tubal scarring from adhesions (and there is no better answer listed to choose), so, for a Board exam I would choose this answer. The TSH level would not be indicated (she has not had a pg loss), lap could diagnose the tubal scarring but would be done after an abnormal HSG. Pap smear is screening for cervical cancer and not indicated in this case of infertility; and pelvic US would yield nothing diagnostically about the tubes. 7. A 14 year-old is experiencing a severe asthma attack. Although he is using accessory muscles to breath, auscultation of his chest reveals no audible wheezing. His heart rate is 160 and his respiratory rate is 52. Which of the following arterial blood gases represents the worst prognosis? A. pH = 7.52; pC02 = 28; p02 = 80 B. pH = 7.44; pC02 =38; p02 = 70 C. pH = 7.60; pC02 = 18; p02 = 60 D. pH = 7.40; pC02 = 40; p02 = 60 E. pH = 7.27; pC02 = 62; p02 = 64 7.E. This patient has a RR of 52. If she is ventilating, she is blowing of C02 (an acid) and would be alkalotic and should have a low C02. A pH which is acidic with a pC02 which is elevated means that she is no longer ventilating at all (she needs mechanical ventilation or she will die). 8. A 48 year-old nurse, with a body mass index of 31, presents for an evaluation for back pain. She relates that historically, she had a positive PPD test a year ago and did not follow-up as directed. She has recently been experiencing night sweats and coughing. An x-ray other lumbar spine reveals osteopenia and cortical breakdown of vertebral bodies L4 and L5. Which of the following diagnosis is most suspect? A. compression fractures secondary to obesity B. degenerative joint disease C. Potts disease D. compression fractures secondary to osteoporosis E. spondylolisthesis 8. C. Pott's disease is TB of the spine. She could have any of the other diseases; but the question states that she had a positive PPD and did not take meds.. .that is the clue that she has active TB in the spine. [Show Less]
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60 PANCE Practice Questions with complete solutions 2023
A 52 year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the past few months. During his physical examination, you no... [Show More] te a nontender, non-enlarged prostate with an isolated right posterior lobe nodule. Which of the following options is most appropriate? A. order a serum acid phosphatase level B. initiate prazosin and schedule a follow-up appointment in 6 weeks C. refer the patient for an ultrasound of the prostate and order a PSA level D. reassure the patient and schedule a follow-up appointment in six months E. initiate norfloxacin therapy for 7 days and schedule follow-up in two weeks Answer: C This patient has an isolated nodule of the prostate gland — cancer until proven otherwise. You should order an ultrasound and a PSA. BPH will present as diffuse enlargement, and not a discrete nodule. You are educating a patient that has just been advised that he has "polyps" in his colon. Which of the following statements is FALSE? A. The larger the colonic polyp, the greater the risk of malignant transformation B. Villous adenomas have a 30-70% risk of malignant transformation. C. The greater the number of concomitant colonic polyps, the greater the risk of malignant transformatio D. The majority of colonic polyps are hyperplastic in origin E. The majority of colonic polyps are > 3 cm in size. Answer: E, The majority of colonic polyps are > 3 cm in size. Most polyps are, in fact, quite small. All the rest of these statements are true Which term is used to describe the characteristic concave or "spoon-shaped" nails of iron deficiency anemia? A. leukonychia B. koilonychias C. clubbing D. onycholysis E. paronychia Answer: B. Koilonychia Koilonychia is a spoon-shaping of the nail itself. It is usually a result of iron deficiency anemia. Leukonychia is often associated with hypoalbuminaemia that causes partial or complete white discoloration of the nails. Leukonychia may also appear as a rare side effect of systemic chemotherapy in some oncological patients but may also be present with arsenic poisoning, renal failure pneumonia, or heart disease. Clubbing of the nails is an actual thickening or elevation of the nail bed - it is a sign of release of TNF associated with pulmonary disorders (tissue necrosis factor) typically found in bronchiectasis, lung cancers and cystic fibrosis (the nails are NOT necessarily cyanotic.) Onycholysis is a painless separation of the nail from the nail bed. Several or all nails are usually affected - there are many causes. Paronychia is an infection of the nail bed and nail margin, usually from trauma or more commonly, nail-biting. Which of the following is NOT a characteristic feature of the nephrotic syndrome? A. proteinuria B. hematuria C. hypoalbuminemia D. hyperlipidemia E. generalized edema Answer: B. Hematuria Hematuria is present in NEPHRITIC syndrome. Nephrotic syndrome characteristically includes proteinuria (>3.5 gm/day), with resulting low serum albumin, hyperlipidemia, hypertension, hypercoagulability, and generalized edema (from oncotic third-spacing) A patient describes a history of recurrent bouts of uveitis. Her chemistry panel reveals elevated serum calcium and uric acid levels. Her anergy screen is negative. Her chest x-ray demonstrates bilateral hilar adenopathy. Which diagnosis is most likely? A. Silicosis B. Sarcoidosis C. Alpha-1 antitrypsin deficiency D. Histoplasmosis E. Tuberculosis Answer: B. Sarcoidosis Sarcoid typically presents with hilar lvmphadenopathy and noncaseating granulomas of the lungs (and other organs). In addition, patients may get eye involvement (uveitis). Elevations of ACE, Calcium and uric acid are frequently seen. A 34-old female presents complaining of symmetrical redness and swelling of the small joints of her hands (PIPs and MCPs). She has noted that the symptoms are worst in the morning. Her erythrocyte sedimentation rate is elevated and her rheumatoid factor is negative. Which of the following diagnosis is most likely? A. progressive systemic sclerosis B. CREST syndrome C. osteoarthritis D. rheumatoid arthritis E. ankylosing spondylitis Answer: D Rheumatoid Arthritis In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA characteristically includes small joint symmetrical arthritis, with an elevated ESR (therefore inflammatory, and not OA). 80% of patients with RA will have a positive RF, but 20% will be negative. PSS involves squamous cell thickening and sclerosis causing taut skin of the face and hands and difficulty with esophageal motility. CREST syndrome is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and negative RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine) A 14 year-old is experiencing a severe asthma attack. Although he is using accessory muscles to breath, auscultation of his chest reveals no audible wheezing. His heart rate is 160 and his respiratory rate is 52. Which of the following arterial blood gases represents the worst prognosis? A. pH = 7.52; pC02 = 28; p02 = 80 B. pH = 7.44; pC02 = 38; p02 = 70 C. pH = 7.60; pC02 = 18; p02 = 60 D. pH= 7.40; pC02 = 40; p02 = 60 E. pH = 7.27; pC02 - 62; p02 = 64 Answer: E. pH = 7.27; pC02 - 62; p02 = 64 This patient has a RR of 52. If she is ventilating, she is blowing of C02 (an acid) and would be alkalotic and should have a low C02. A pH which is acidic with a pC02 which is elevated means that she is no longer ventilating at all (she needs mechanical ventilation or she will die). A 27 year-old nulliparous female presents because she's been trying to get pregnant for two years, but has failed. She relates a history of a misdiagnosis of appendicitis that lead to abscess formation when she was 14 years old. Which of the following diagnostic studies would be most helpful at this point in her evaluation? A. TSH level B. hysterosalpingogram C. laparoscopy D. PAP smear E. pelvic ultrasound Answer: B hysterosalpingogram While I would disagree that an invasive procedures like HSG should be done first-line, the thing to remember in this question is that the patient has reason to have tubal scarring from adhesions (and there is no better answer listed to choose), so, for a board exam I would choose this answer. The TSH level would not be indicated (she has not had a pg loss), lap could diagnose the tubal scarring but would be done after an abnormal HSG. Pap smear is screening for cervical cancer and not indicated in this case of infertility; and pelvic US would yield nothing diagnostically about the tubes. 48 year-old nurse, with a body mass index of 31, presents for an evaluation for back pain. She relates that historically, she had a positive PPD test a year ago and did not follow-up as directed. She has recently been experiencing night sweats and coughing. An x-ray of her lumbar spine reveals osteopenia and cortical breakdown of vertebral bodies L4 and L5. Which of the following diagnosis is most suspect? A compression fractures secondary to obesity B degenerative joint disease C Potts disease D compression fractures secondary to osteoporosis E spondylolisthesis Answer: C Potts Disease Pott's disease is TB of the spine. She could have any of the other diseases; but the question states that she had a positive PPD and did not take meds...that is the clue that she has active TB in the spine. While suturing a wound, you opt to use lidocaine with epinephrine. The rationale for your choice is: A an increase in the absorption of the lidocaine. B an increase in the diffusion of the lidocaine into the nerve's myelin sheath. C an increase in the blood flow to the area of injection. D an increase in the duration of anesthesia. E a decrease in the risk of infection at the site of injection. Answer: D Lidocaine with epinephrine both increases duration of anesthesia and decreases blood flow to the area of injection-i.e. penis, nose, fingers, toes An EKG demonstrates a PR interval of 0.16 seconds, a P to QRS relationship of 1:1, a variable heart rate and an R to R interval that is noted to accelerate ad decelerate during the respiratory cycle. What is the diagnosis? A Wenckebach B third degree heart block C atrial fibrillation D sinus arrhythmia E atrial flutter Answer: D Sinus Arrhythmia This is sinus arrhythmia. Wenckebach & third degree AVB would have a non-conducted P wave. A fib would have no P waves and an irregularly irregular rhythm. A flutter would have "flutter waves" or a regular rhythm of 150. Combinations of antimicrobial agents are commonly employed in the treatment of meningitis in infants less than three months old. Ampicillin is commonly an agent included in this regimen. Ampicillin is used empirically for the possible presence of: A Escherichia coli. B Listeria monocytogenes. C Cytomegalovirus. D Herpesvirus. E Hemophilus influenzae. Answer: B Listeria monocytogenes While E. Coli can infect an infant delivered vaginally, AMPICILLIN is given to eliminate Listeria. CMV & HSV are viruses. E. Coli & H. Flu are also typically resistant to amp, and more likely a broader spectrum antibiotic would be used. A 42 year-old female presents after finding a firm, painless bump in her right eyelid. On examination, you note a 6 mm mass within the tarsus of the right eye. The skin is freely movable over the mass. The remainder of the ophthalmoscopic examination is unremarkable. Which of the following is the most likely diagnosis? A pterygium B chalazion C ectropion D external hordeolum E internal hordeolum Answer: B Chalazion A chalazion is a painless chronic mass in the eyelid. Hordeolum are acute and red and painful. Pterygium involves the sclera. Ectropion is when the eyelid sags outwardly and the lid doesn't close well. Which white blood cell disorder is characterized by the presence of the Philadelphia chromosome in 90% of cases? A chronic lymphocytic leukemia (CLL) B acute lymphocytic leukemia (ALL) C chronic myelogenous leukemia (CML) D acute myelogenous leukemia (AML) E multiple myeloma Answer: C Philadelphia Chromosome occurs in CML. ALL occurs in children. AML is associated with Auer rods. Multiple myeloma has Bence-Jones protein. CLL has no clear distinguishing feature except increased lymphocytes. A 22 year-old patient was involved in an automobile accident and is comatose. Which of the following diagnostic modalities would be least useful in this patient's evaluation? A CT scan B skull radiographs C MRI scan D EEG E PET scan Answer: B Skull radiograph Of these choices, the skull film is LEAST useful. Whether or not the skull is fractured, any LOC in a head trauma requires imaging for bleeding. CT would be the imaging test of choice. MRI should be done for a more chronic bleed. EEG would help to establish brain activity. PET scan (while not done often) would establish physiologic function (uptake of glucose). A positive or negative plain film of the skull would supply NO FURTHER INFORMATION. A patient presents complaining of generalized swelling. Her urine is positive for protein. Her serum testing reveals hyperlipidemia and hypoalbuminemia. Which of the following is the most likely diagnosis? A. cirrhosis B. nephrotic syndrome C. congestive heart failure D. cystitits E. pyelonephritis Answer: B, nephrotic syndrome This is a classic presentation of nephrotic syndrome. Question 21 of 60 This papulosquamous eruption is most common in young adults. A single oval patch is generally noted several days before a more generalized, fawn-colored rash erupts. This rash is most prevalent on the trunk, and the proximal upper and lower extremities. The rash spontaneously disappears over 5 to 6 weeks. The diagnosis is: A. pityriasis rosea. B. tinea corporis C. psoriasis. D. atopic dermatitis. E. sporotrichosis Answer: A This is the classic presentation of pityriasis rosea. Remember that the differential diagnosis includes secondary syphilis, so if a positive sexual history - consider ordering a VDRL/RPR. The "herald" patch which is described is pathognomonic for pityriasis. A female in her third trimester of pregnancy developed hypertension, diffuse edema, proteinuria and hyperreflexia. She was treated with intravenous magnesium sulfate and is now hyporeflexic and drowsy. What do you prescribe now? A. calcium B.diazepam C. an amphetamine D. additional magnesium E. oxygen Answer: A, calcium Pre-eclampsia causes hyper-reflexia. Magnesium is the treatment. The sign of Mg toxicity is loss of reflexes...this is treated with Calcium [Show Less]
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PANCE Practice Questions correctly answered rated A+ passed!
b A 24 year old female presents to the ER with chest pain. She reports having upper respiratory symptoms for about two weeks before developing chest pain ... [Show More] this morning which has worsened throughout the day. The pain is worse with deep inspiration and laying flat. On cardiac exam there is an audible friction rub. An EKG obtained shows tachycardia with diffuse ST elevation. A CXR and echocardiogram are normal. What is her most likely diagnosis? a. Acute coronary syndrome b. Acute pericarditis c. Bacterial endocarditis d. Pericardial effusion e. Pulmonary embolism e A 28 year old male presents to the urgent care with shortness of breath. He reports over the last 24 hours he has had right sided chest pain and difficulty catching his breath. His vitals are height 73", weight 180 lbs, temp 98.3, pulse 105, and SpO2 92% on room air. On exam breath sounds are diminished on the right side. What is the most likely diagnosis? a. Atypical pneumonia b. Pleurisy c. Pleural effusion d. Pulmonary embolism e. Spontaneous pneumothorax e Which of the following is the most common cause of respiratory disease in the preterm infant? a. Bronchiolitis b. Bronchiectasis c. Pneumonia d. Restrictive airway disorder e. Respiratory distress syndrome d A 48 year old male has a rash. It started about a month ago with a few isolated lesions on his abdomen. He has since developed new lesions on his arms and legs. His main complaint is itching. On exam, you find anular "coin-shaped" sharply demarcated plaques on his trunk and extremities. What is the most likely diagnosis? a. Erythema multiforme b. Erythema nodosum c. Lichen planus d. Nummular eczema e. Psoriasis e Which of the following is a major Jones criteria for the diagnosis of acute rheumatic fever? a. Fever b. Polyarthralgias c. Prolonged PR interval d. Elevated erythrocyte sedimentation rate e. Carditis d Which vaccine has significantly reduced the incidence of epiglottitis? a. DTaP (diptheria, tetanus, and acellular pertussis) b. PCV13 (pneumococcal conjugate) c. MMR (measles, mumps, and rubella) d. Hib (Haemophilus influenza type B) e. Meningococcal a Which of the following drugs is most likely to have an effect on the INR of a patient taking Warfarin? a. Trimethorpim-Sulfamethoxazole b. Penicillin G c. Clindamycin d. Cefdinir e. Cephalexin b A 1 day old female has excessive secretions, choking, and difficulty feeding. An attempt to pass a catheter ito the stomach is unsuccessful and she is diagnosed with tracheoesophageal fistula. Which congenital abnormality is most commonly associated with this? a. Diaphragmatic hernia b. Esophageal atresia c. Pyloric stenosis d. Hirschsprung disease e. Bowel atresia c A 42 year old woman with a history of asthma is diagnosed with essential hypertension. Which medication should be avoided? a. Lisinopril b. Hydrochlorothiazide c. Propanolol d. Amlodipine e. Losartan d A 4 year old female is admitted to the pediatric hospital unit with pneumonia. What is the most likely pathogen causing her pneumonia? a. Mycoplasma pneumonia b. Staphylococcus pneumoia c. Group B streptococcal pneumonia d. Viral pneumonia e. Haemophilus influenza e A deficiency in which of the following results in night blindness and dry skin? a. Vitamin C b. Biotin c. Vitamin E d. Riboflavin e. Vitamin A d Which of the following antihypertensive drugs reduces mortality after an MI in patients with heart failure? a. Hydrochlorothiazide b. Terazosin c. Amlodipine d. Lisinopril e. Clonidine c A 22 year old female with irregular menses is being evaluated for possible polycystic ovarian syndrome (PCOS). Which of the following would confirm the diagnosis in her case? a. Elevated glucose b. Hyperinsulinemia c. Hyperandrogenism d. Elevated FSH e. Low TSH e A 42 year old woman running a marathon became lightheaded and is transported by medical staff to the ED. IV fluids are started and an electrolyte panel is pending, however she is noted to have a prolonged QT interval o EKG. She suddenly becomes diaphoretic and complains of palpitations. The following rhythm is observed on the monitor: Which of the following medicatios should be administered? a. Amiodarone b. Bicarbonate c. Epinephrine d. Lidocaine e. Magnesium b Which of the following is the most common cause of restrictive cardiomyopathy? a. Alcohol abuse b. Amyloidosis c. Aortic stenosis d. Hypertension e. Sarcoidosis e Which of the following asthma and allergy drugs should be monitored for neuropsychiatric side effects including suicidal ideation? a. Albuterol b. Cetirizine (Zyrtec) c. Famotidine (Allegra) d. Loratidine (Claritin) e. Montelukast (Singulair) a A 54 year old female is diagnosed with DM II and started on Metformin. Despite this and lifestyle modification, after 6 months her HbA1c is still not at goal. Which of the following would be a contraindication for starting her on Victoza (liraglutide)? a. Family hx of medullary thyroid carcinoma b. Family hx of estrogen receptor positive breast cancer c. Personal hx of chronic kidney disease d. Personal hx of heart failure e. Personal hx of medication noncompliance b A 32 year old man is diagnosed with peptic ulcer disease via endoscopy. Despite multiple therapies, he has refractory symptoms. A CT of the abdomen and pelvis reveals a 3 cm mass on the pancreas. Which lab value is likely to be significantly elevated in this patient? a. Cortisol b. Gastrin c. Free T4 d. Insulin e. Testosterone [Show Less]
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Dermatology PANCE Questions with correct answers 2023
A patient presents with a rash, characterized by red macules and edematous papules with a clearing center. This best describes which of the following? A e... [Show More] rythema marginatum B erythema multiforme C varicella D impetigo B Target lesions, also termed iris lesions, are characteristic of erythema multiforme. The rash may be recurrent but typically resolves over 3-6 weeks. In a patient suspected of having seborrheic dermatitis, the most common site of involvement would be the A upper extremities. B thighs C scalp. D feet. C The most common site of involvement of seborrheic dermatitis is the scalp. Other common sites include the eyebrows, eyelids, nasolabial fold, and ears A 26 year-old male complains of intense itching, especially at night and after hot showers, for the past 4 days. On physical examination he has a few red papules and areas of excoriation on his volar wrists, between his fingers, and around his waist. Proper diagnosis should include which of the following tests? A KOH prep B Gram stain C Skin scraping microscopy D Tzanck prep C The history and exam is consistent with a scabies infection. Scrapings from the burrows should be examined for the presence of mites, eggs, and feces. A 35 year-old female who recently returned from a backpacking trip complains of fatigue, malaise, fever, chills, and arthralgias. Physical examination reveals a 6 cm annular lesion with a red border and a clear center on her mid-back. Which of the following laboratory tests would support your diagnosis? A KOH prep of skin scrapings B Blood cultures C RAST testing D Serologic antibody testing D Most people with Lyme Disease will have a positive serologic test after the first few weeks of infection and this would support the diagnosis. A 56 year-old, right hand dominant, carpenter presents to your clinic complaining of a prolonged bruise under his left thumbnail. He states that he first noticed it one year ago. Physical examination reveals a nontender left thumb with a 6 mm macular lesion located under the distal nail bed. It is mixed dark brown and black in color, with irregular borders. The most likely diagnosis is A lentigo. B trauma. C melanoma. D nevus C Acral lentiginous melanoma may occur on the palm, sole, nail bed, or mucus membrane. This lesion is suspicious for a melanoma due to its irregular borders, being variegated in color, and its size. A biopsy is required and will ensure the diagnosis. A mother brings in her 2 year-old child stating that the child has had a 3-day history of a nonproductive cough, thick copious rhinorrhea, conjunctivitis, and a fever to 103 degrees. Physical examination reveals a well-hydrated child, with numerous 1-2 mm white papules on both buccal mucosa, normal heart and breath sounds. This presentation is most consistent with early A rubeola. B rubella. C varicella. D streptococcal pharyngitis A Rubeola (measles) is characterized by cough, coryza, and conjunctivitis, along with a fever as a prodrome. Koplik spots appear prior to the onset of the typical erythematous, maculopapular rash and are pathognomonic for rubeola. A person with atopic dermatitis should be advised to A avoid cutaneous irritants. B take hot water baths or showers C use a high potency glucocorticoid on skin after bathing. D begin a prophylactic antibiotic. A Avoidance of cutaneous irritants, such as wool and other rough clothing, is the cornerstone of therapy for atopic dermatitis. An elderly woman presents to your clinic complaining of unilateral facial pain and painful lesions. She also complains of blurred vision in the ipsilateral eye. On examination she has several vesicles on an erythematous base, some of the lesions with crusts. They are distributed in a dermatomal pattern and involve the skin overlying the maxillary region and the tip of her nose. Which of the following is the next most appropriate intervention in the care of this patient? A KOH prep B Culture for bacteria C Referral to an ophthalmologist D Application of corticosteroids C Immediate referral to an ophthalmologist is needed when herpes keratitis is suspected, as in this case. A fluorescein stain of the eye might reveal the typical dendritic corneal lesion. A 28 year-old female with diabetes mellitus type 2 sustains a partial thickness burn to her left upper arm and her chest when hot grease spilled on her at home. The burn to her arm is circumferential and the estimated total body surface burned is 18%. She has no allergies. The most appropriate treatment of this patient would include A outpatient application of silver sulfadiazine. B debridement of all intact blisters. C IV cefazolin (Ancef, Kefzol). D transfer to a burn center. D Reasons for transfer to a burn center include a partial thickness burn covering greater than 10% of total body surface area. In addition, burns in patients with pre-existing medical conditions, such as diabetes, that could complicate their management, prolong recovery, or affect their outcome, is also a reason for transfer to a burn center. Pharmacologic treatment of a cat bite in the person with no allergies consists of which of the following? A Trimethoprim-sulfamethoxazole (Bactrim) B Cephalexin (Keflex) C Ceftriaxone (Rocephin) D Amoxicillin-clavulanate (Augmentin) D Amoxicillin-clavulanate (Augmentin) has activity against Pasteurella multocida which is the causative agent in the majority of cat bite infections. Which of the following is considered a risk factor for the development of malignant melanoma? A male gender B inability to tan C Japanese ethnicity D brown-haired individuals B Inability to tan and propensity to burn are risk factors for developing malignant melanoma. As a general rule, sutures in the face should be removed in A 2 days B 5 days C 7 days D 10 days B Sutures of the face should be removed in 3-5 days in order to allow for adequate healing and to limit the amount of scarring. A mother brings a 3 month-old infant to the office because she is concerned about a red, vascular, nodular growth on the child's back. It appears to be enlarging slightly and the vessels are slightly dilated. It seems to cause the child no discomfort. The most likely diagnosis is A a hemangioma. B a pigmented nevus. C a salmon patch (stork bite). D a malignant melanoma A A hemangioma is a bright red to deep purple vascular nodule or plaque that often develops at birth, may enlarge, and may regress and disappear with aging. Erythema nodosum is characterized by A subcutaneous red tender nodules. B brown pigmentation on the lower extremities. C tender lymph nodes in the groin. D scaling red macules. A Erythema nodosum produces erythematous red tender nodules, especially on the shins. Which of the following mediators is responsible for initiating the urticaric response? A Cyclic AMP B Prostaglandins C Prednisone D IgE D IgE triggers the release of histamine from mast cells that leads to urticaria. [Show Less]
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PANCE Practice Exam 2 with complete solutions 2023 updated
A 27-year-old woman complains of years of menstrual irregularity and increasing facial and chest hair. PMH: significant for ovarian cyst and left cytectomy... [Show More] . She is a non-smoker and non-drinker. Labs include a negative uCG, elevated LH, and low FSH. She desires fertility and she has not responded to three cycles of clomiphene. What would be the next choice of medication that may return ovulation? A. Insulin B. Metformin C. Dexamethasone D. Spironalactone E. Finasteride The answer is B. EXPLANATION: Dexamethasone, finasteride, and spironalactone all treat symptoms of hirsutism, but do not treat the underlying cause of PCO or improve fertility outcomes. PCO has an underlying insulin resistance that can be treated with oral hypoglycemics and improve sensitivity to insulin. Adding insulin does not improve the resistance. A 2-week-old male infant presents for a routine checkup. The mother complains that he nurses every hour, but vomits (nonbilious) after every time he eats. He has only had three bowel movements since he has been home. On examination, the infant has not gained any weight since leaving the hospital, and the clinician notes gastric peristaltic waves. Which of the following is the treatment of choice for this patient? A. pyloromyotomy B. metoclopramide C. laparotomy D. omeprazole The answer is A. EXPLANATION: This infant is presenting with signs and symptoms of pyloric stenosis. Infants typically have vomiting (projectile at times) after every feeding and it normally starts between the age of 2 and 4 weeks. The infant nurses fervently and is hungry. In addition, there may be dehydration, constipation, weight loss, and apathy. Abdomen may be distended with gastric peristaltic waves. Occasionally, an olive-sized mass can be felt in the right upper quadrant with deep palpation after the child has vomited. Vomitus is typically nonbilious. Diagnosis is confirmed by an upper gastrointestinal series with delayed gastric emptying, enlarged pyloric muscle, and characteristic semilunar impressions on the gastric antrum. In addition, an ultrasound is needed to verify the hypertrophic muscle. The treatment of choice for these patients is pyloromyotomy, which can be done laparoscopically. These patients make full recoveries and have an excellent prognosis. Upon performing a newborn examination, the clinician notes a widened pulse pressure, paradoxical splitting of S2, and a "machine"-like murmur heard best at the second intercostal space, left sternal border, and inferior to the clavicle. Which of the following is the most likely diagnosis? A. tetralogy of Fallot B. ventricular septal defect C. atrial septal defect D. patent ductus arteriosus The answer is D. EXPLANATION: Patent ductus arteriosus (PDA) is an isolated abnormality that occurs in infants. The ductus arteriosus is a normal fetal vessel that joins the aorta and the pulmonary artery and spontaneously closes after 3 to 5 days. Lack of closure results in the audible murmur that is "machine-like" and maximal at the second intercostal space (ICS), at the left sternal border (LSB), and inferior to the clavicle. It is typically a pansystolic murmur with bounding pulses and a widened pulse pressure. There is also a paradoxical splitting of S1 and S2. Echocardiography confirms the PDA, the direction and degree of shunting, and the presence of lesions for which the PDA is needed to keep. If there are no other cardiac malformations requiring the PDA, then if the PDA is large, surgery should be completed before 1 year of age. Symptomatic PDAs that are relatively small may be closed with indomethacin in preterm infants. an ejection type, systolic murmur heard best at the LSB, second ICS with a wide, fixed S2 and normal pulses. atrial septal defect (ASD) a harsh, pansystolic murmur heard best at the third and fourth ICS. With increasing size, heaves, thrills, and lifts are present along with radiation throughout the chest. Ventricular septal defect (VSD) a rough ejection, systolic murmur heard best at the LSB and the third ICS with radiation to the back. Tetralogy of Fallot A 42-year-old woman, with a history of struvite renal calculus, calls the office with a complaint of a urinary tract infection. As part of the interview, she reports intermittent, mild right flank pain for 4 days. Her urine dipstick is positive for microscopic hematuria, and the urine pH is 7.5. The KUB film is positive with two visible stones in the right kidney. Which of the following organisms is most likely to be cultured from the urine specimen? A. Escherichia coli B. Klebsiella C. Proteus D. Chlamydia trachomatis The answer is C. EXPLANATION: This patient has struvite stones. They are frequently associated with recurrent urinary tract infections, visible stones, and high urine pH. These stones are formed by urease-producing organisms including Proteus and Pseudomonas while being caused less commonly by Klebsiella. Struvite stones are not typically caused by E. coli and C. trachomatis. A 33-year-old woman treated with trifluoperazine for the past 3 months is seen in the emergency department because of recent-onset fever, stiffness and tremor, as reported by her accompanying sister. The patient also appears to be mildly confused when asked about location, day, and time. Her temperature is 104.5°F, and her serum creatine kinase (CK) level is markedly elevated. Which of the following has most likely occurred? A. a delayed allergic reaction has occurred with trifluoperazine B. tardive dyskinesia has begun to develop in the patient C. the patient has developed neuroleptic malignant syndrome D. the patient has developed serotonin syndrome E. the patient has overdosed on trifluoperazine The answer is C. EXPLANATION: Neuroleptic malignant syndrome is an uncommon but serious complication with therapeutic doses of antipsychotic drug therapy, particularly the first-generation (typical) class. Cardinal signs and symptoms include a body temperature above 100.4°F, altered state of consciousness, autonomic dysfunction, and rigidity. A 48-year-old man presents to the clinic for a routine employment physical. The patient is asymptomatic. A pre-employment CBC reveals hemoglobin of 13.2g/dl, hematocrit of 39.5%, and MCV of 60.6 fL. Subsequent iron studies, hemoglobin electrophoresis, and sickle cell screening are "normal." After the labs are reviewed, the patient states "they are always normal." Which of the following is the most appropriate management for this patient? A. Bone marrow aspirate B. Ferrous sulfate daily C. Folic acid supplements D. Reassurance E. Refer to an oncologist The answer is D. EXPLANATION: The patient has a mild anemia with pronounced microcytosis consistent with alpha thalassemia minor and requires reassurance. Alpha thalassemia minor hemoglobin electrophoresis reveals normal results. Patients with alpha thalassemia are often inappropriately advised to take iron supplements (B) and don't require iron, folic acid (C) or vitamin B12 supplements unless a coexisting deficiency is confirmed. Referral to an oncologist (E) and a bone marrow aspirate (A) aren't necessary for this patient. white blood cell count (WBC) reveals 14,800 mcL with more than 10% atypical lymphocytes. On physical examination you find significant yellowish-grey pharyngeal exudate, cervical lymphadenopathy as well as an enlarged spleen. Her rapid strep is negative. What should be your treatment of this patient? A. Begin treatment with cephalexin. B. Send out a back-up throat culture and begin treatment with cephalexin pending those results .C. Send out a back-up throat culture and hold treatment pending those results. D. Draw a Monospot test and treat the patient supportively pending the results, insuring that they avoid contact sports until a definitive diagnosis has been made. E. Draw an Epstein-Barr virus (EBV) IgG level and treat the patient supportively if positive. The answer is D. EXPLANATION: With this patient's presentation and a negative rapid strep test, other etiologies beyond group A beta-hemolytic strep should be seriously considered. In light of her symptoms including fatigue, her WBC, and that her significant other is having similar symptoms, infectious mononucleosis is highest on the differential diagnosis. A Monospot test would rule this possibility in or out. She should refrain from contact sports until her infection and any associated splenomegaly has resolved. barking" cough and a low-grade fever. She has some runny nose and her voice is somewhat raspy and hoarse. mild inspiratory stridor. What is the most likely etiology of this child's illness? A. Adenovirus B. Coxsackievirus C. Cytomegalovirus D. Parainfluenza virus E. Respiratory syncytial virus The answer is D. EXPLANATION: This child has the classic presentation for croup. Sixty-five percent of croup is caused by a parinfluenza virus infection. Adenoviruses tend to cause severe pharyngitis/tonsillitis with tender, enlarged cervical nodes (A), while Coxsackievirus is commonly associated with hand-foot-and-mouth disease. (B) Cytomegalovirus causes an infectious-mononucleosis-like picture. (C) RSV is more typically associated with bronchiolitis. (E) Glucose challenge testing to rule out gestational diabetes should be done when? A. Between 12 and 16 weeks gestation B. Between 16 and 20 weeks gestation C. Between 20 and 24 weeks gestation D. Between 24 and 28 weeks gestation E. Between 28 and 32 weeks gestation The answer is D. EXPLANATION: Routine surveillance for gestational diabetes of a pregnant women is between 24 and 28 weeks; it is not modified due to obesity or other risk factors for diabetes. Gestational diabetes is a hormone-mediated intolerance. Surveillance is modified in the presence of pre-existing diabetes A 45-year-old patient came in to see his health care provider today, to discuss the results of his last annual assessment. He was told that he had developed type 2 diabetes mellitus. One of the recommendations from the physician assistant included a visit to an ophthalmologist. The physician assistant was concerned after seeing new capillaries, macular edema, and fibrous tissue within the retina during his funduscopic exam. What type of ocular complication does this patient most likely have at this time? A. Background retinopathy B. Closed angle glaucoma C. Macular degeneration D. Diabetic cataracts E. Proliferative retinopathy The answer is E. The correct choice is E, proliferative retinopathy. The distinguishing factor in the patient's presentation, which signals this disorder, is the development of newly formed vessels. Proliferative retinopathy is the leading cause of blindness in the United States. Up to 20% of patients with type 2 diabetes have retinopathy at the time of diagnosis. Choice A, background retinopathy, or simple retinopathy includes retinal microaneurysms, hemorrhages, exudates, and edema, without new vessel formation. Choice B, closed angle glaucoma, is relatively uncommon in patients with diabetes, except after cataract extraction. Choice C, macular degeneration, is not associated with diabetes mellitus specifically. Choice D, diabetic cataracts, tends to occur in patients with diabetes earlier than the general population, and may correlate with the severity of the disease. A 32-year-old male presents to your office with the complaint of low back pain for 7 months. The patient states he was initially injured on the job while trying to lift a 50-pound barrel off a truck. He denies any paresthesias or bowel/bladder problems associated with the low back pain. The patient states that he had been given NSAIDs and a muscle relaxer, followed by physical therapy treatments. X-rays that were taken 5 months ago were reported as normal. He was placed on light duty at that time. The patient has seen many practitioners who have "not helped him." Another person who works with this patient was at the clinic and stated the patient has had problems with one of his other coworkers. You consider trying the patient on an antidepressant first and then possibly sending him to a pain clinic if there is no success. What is the most likely diagnosis? A. conversion disorder B. hypochondriasis C. drug addiction D. somatoform pain disorder E. schizophreniform The answer is D. EXPLANATION: Somatoform pain disorder is a focus on pain for greater than 6 months. The subjective findings outweigh the objective findings. Pain in the neck, pelvic, or low back areas are frequent sites, as well as headaches. The disorder may be precipitated by an injury. The patient will have a history of seeing multiple providers and possibly many medical and surgical treatments. The patient is unresponsive to treatment. Stressors can aggravate or precipitate the pain. There may be an expectation of secondary gains. Age of onset is around 30s and 40s. Treatment consists of placing the patient on an antidepressant and sending the patient to a pain clinic. [Show Less]
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50 High Yield Pulmonology Questions- Cram the PANCE fully solved 2023
45 y/o AAF present to office w/ persistent nonproductive cough she has had for the past 5 months. On exam you notice violaceous plaques on her nose and ... [Show More] cheeks. Bilateral hilar lymphadenopathy is visualized on chest xray. The 1st line medication for the likely dx in this pt is... oral corticosteroids (sarcoidosis) Which TB med can cause reddish-orange secretions like in the tears and urine? Rifampin Which antibiotics will you use for CAP in an outpatient setting? Fing-MAD that you got CAP -Fluoroquinolones (only in pts w comorbidities or risk factors) -Macrolides -Amoxicillin -Doxycycline A homeless pt present to ER w productive cough, foul smelling sputum, and admits to blacking out a couple nights ago due to excessive alcohol use. On PE you note decreased breath sounds and dullness to percussion in RLL field. Which abx should be considered in this pt for the likely dx? Amoxicillin/Clavulanic acid (Augmentin) - given oral ampicillin/sulbactam - given IV What medications are used in pts with idiopathic pulmonary fibrosis to slow progression of the disease? Pirfenidone Nintedanib TB of the vertebrae is known as... Pots disease Which type of lung cancer is considered the most aggressive and has the lowest 5-year survival rate? Small Cell Lung Cancer 32 y/o F in her 3rd trimester of pregnancy presents to the office c/o SOB, CP worse with deep inspiration. On exam her respirations are rapid and shallow, her vitals reveal a pulse of 122. She admits for the past 4 days she has mostly been on bed rest due to difficulty ambulating in her late stage of pregnancy and due to pain she has had in her LLE. What is the most appropriate test to do for this pt to confirm the most likely dx? V/Q Scan, suspect PE preferred to CT in pregnant pts to decrease radiation exposure A pt who is currently living with his brother who has active TB would have a positive PPD at what size of induration? 5mm or greater - pt is high risk A pt w a hx TB has a CXR that shows diffuse small nodular lesion spread throughout the lungs, which type of TB does this pt likely have? Miliary TB What is the most common bacterial cause of CAP? Strep pneumoniae Define chronic bronchitis productive cough for at least 3 months of the year for 2 consecutive years A 6 y/o boy presents to the ER c/o a sore throat that has gotten worse over the past few days. In addition he has had trouble swallowing and a fever. On exam he is drooling and leaning forward while sitting on his father's lap and refuses to lay down on the exam table. While speaking to you his voice sounds muffles and he is in visible distress What is the first and most important step in management of this pt? Maintain the airways - no tongue depressor! (acute epiglottitis) A 17 y/o M presents to the office today with pharyngitis, nonproductive cough, and an earache. On CXR a patchy infiltrate is visualized. He has no PMH and is not taking any medications What is the likely organism causing this pts symptoms? Mycoplasma pneumoniae Pt with sarcoidosis presents with erythema nodosum, bilateral hilar lymphadenopathy, and polyarthralgia w fever. This syndrome is known as... Lofgren syndrome What tx option is most effective in pts with small cell lung carcinoma? chemo A combination of asthma, nasal polyps with chronic rhinosinusitis, and sensitivity to ASA is known as... Sampter's triad A soft tissue lateral cervical radiograph would show what classic finding in a pt with acute epiglottitis? thumb sign Which type of lung ca is most commonly seen in non-smokers? adenocarcinoma Pt presents with a cavitary lesion in a proximal bronchus visualized on imaging. Labs show an elevation ion serum Ca level. What type of lung malignancy does this pt have? squamous cell carcinoma A 6-month-old boy presents with a harsh barking cough. On PE you notice inspiratory stridor at rest, marked IC retractions, and cyanosis. He is diagnosed with laryngotracheitis (AKA croup). He is started on neb epinephrine to relieve his symptoms. What other therapy should be considered in addition for this pt for relief of his respiratory symptoms? Dexamethasone A pt w coal worker pneumoconiosis would likely have nodules in what part of the lungs? Upper lobes A 42 y/o M presents to the office c/o fever, cough and diarrhea for the past week. He has no PMH and works as a plumber. His labs show elevated hepatic transaminases as well as hyponatremia. What dx should be suspected in this pt? Legionella [Show Less]
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PANCE – HEENT correctly answered already passed 2023
Your 21 year old patient is complaining of a feeling of a "foreign-body sensation" in their eye, but nothing is there. She wears contacts. What is the l... [Show More] ikely dx? (chalazion, corneal abrasion, hordeolum) corneal abrasion This disorder of the eye presents with redness and irritation, fever, sore throat, cough and decreased visual acuity. What is the likely dx? conjunctivitis, uveitis, keratitis keratitis (note the decreased visual acuity is not usu. present in conjunctivitis) What a serious consequence of untreated otitis media in the pediatric patient? (conjunctivitis, meningitis, mastoiditis, sepsis) mastoiditis Usu. caused by minor trauma such as from a fingernail, contact lens, eyelash or foreign body. Patient will present with pain and sensation of a foreign body and it can be accompanied by photophobia, tearing, injection and blepharospam. Corneal abrasion Patient presents w/ a corneal abrasion. What should you do before examining or treating? record visual acuity Slit lamp examination of the eye reveals an epithelial defect but a clear cornea. What is the likely dx? corneal abrasion What is the treatment for a corneal abrasion? topical anesthetic will provice immediate relief, but will retard healing. -saline irrigation - antibiotic ointment (gentamicin) patch for no longer than 24hrs daily f/u Patient presens to your clinic with pain, photophobia an tearing. Examination reveals circumcorneal injection and watery to purulent discharge. Fluorescein staining will reveal a dense corneal infiltrate with overlying epithelial defect. Dx? (corneal abrasian, blehpariits, corneal ulcer) Corneal ulcer How should you treat a corneal ulcer? REFER TO OPTHALMOLOGIST stain lesion and culture Avoid this treatment in a corneal ulcer because they will cause further tissue loss and increase risk of perforation topical steroids This disorder of the eye may be age related or secondary to the toxic effects of drugs such as chloroquine or phenothiazine. It is the leading cause of irreversible central visual loss. Macular degeneration Prevalence of age related macular degeneration increases after what age 50 Cholorquine or phenothiazine are drugs that can cause this disorder of the eye. macular degeneration In macular degeneration, drusten deposits are found in the ____ membrane, leading to degenerative changes, loss of nutritional supply, atrophy and neovascular degeneration. bruchen What is the chief clinical feature of macular degeneration? gradual loss of central vision The phenomenon of wavy or distorted vision and can be measured with an amsler grid. metamorphopsia What is the treatment for macular degeneration? no effective treatment, if detected early laser therapy or intravitreal injections of monoclonal antibody drugs may slow progression These supplments can reduce the progression of macular degeneration. vitamins, antioxidants, zinc, copper and omega 3 fatty acids Defined as an increased intraocular pressure w/ optic nerve damage. Glaucoma Any impediment to the flow of aqeuous humor through the trabecular meshwork and canal of schlemm will increase pressure in the anterior chamber in Glaucoma. T or F T What type of glaucoma is most common? open angle affects ppl > 40 and african americans This is an opthalmic emergency characterized by painful eye and loss of vision. Physical exam will reveal circumlimbal injection, steamy cornea, fixed mid-dilated pupil, decreased visual acuity and tearing. Angle closure glaucoma [Show Less]
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High Yield Endocrine Questions - Cram the PANCE correctly answered 2023
A patient presents to the office with polyuria and polydipsia. He has a family history of diabetes, and he wants to be tested to see if he is diabetic. He ... [Show More] last ate 2 hours ago, and his blood glucose in the office was 156. His A1C comes back and reveals a result of 6.3, and his 2-hour glucose tolerance test revealed a blood glucose of 212. Which of these lab tests can definitively make the diagnosis of diabetes in this patient? 2-hour glucose tolerance test with a blood glucose of 212 Notes: BS in office was non-fasting so >126 criteria cannot be used to diagnose, A1C is elevated but needs to be 6.5 or higher to diagnose diabetes A 66 yo male presents to the office today because his diabetes is out of control lately and he would like some help getting his blood sugars back to normal. He only currently takes Metformin 1000 mg BID. You discuss a few different medications with him including Glipizide, Insulin Glargine, and Empagliflozin. He states his only fear with starting a new medication if low blood sugars. Which one of the medications discussed with the patient is least likely to cause hypoglycemia? Empagliflozin Notes: Glipizide is a sulfonylurea which are notorious as a class for causing low blood sugars, all types of insulin have potential to cause hypoglycemia. Empagliflozin (Jardiance) is an SGLT2 inhibitor which does not usually cause low blood sugar What is the most common type of thyroid cancer? Papillary thyroid carcinoma (roughly 8 out of 10 cases) A nonpregnant adult with Subclinical Hypothyroidism should be treated with thyroid hormone replacement (Levothyroxine) when they TSH reaches what level? TSH of 10 mU/L or higher A 27 yo female with history of bipolar disorder presents to the office complaining of fatigue, constipation, and weight gain. Labs are ordered and it is determined she is biochemically hypothyroid. What medication is this patient likely taking that lead to her diagnosis of hypothyroidism? Lithium Notes: Lithium is first line for bipolar, need TSH levels checked every 6-12 months on lithium since hypothyroidism is so prevalent. Lithium and amiodarone are infamous for causing hypothyroidism A 37 yo female presents to the office complaining that she is having trouble losing weight despite following a strict diet and exercising daily. On physical exam, you note central obesity, thin extremities, oily skin, and striae across her abdomen. A screening test to check for excess of what hormone should be checked in this patient? Serum cortisol Notes: Patient has classic signs of Cushing's (only classic sign missing is "buffalo hump") A patient with secondary hypothyroidism will have an abnormality in which part of the Hypothalamic-Pituitary-Thyroid Axis? Pituitary gland What is the most common cause overall for Cushing's Syndrome? Long-term, high dose use of glucocorticoids In a patient with diabetic ketoacidosis, after checking capillary glucose levels and urine ketones to confirm the diagnosis, what is the first therapeutic intervention that should be started in these patients? Start IV fluids (isotonic saline) A 69 yo male with type II DM over 25 years presents to the office today complaining of early satiety, epigastric discomfort, and post prandial nausea and bloating for many months. What is the likely diagnosis in this patient? Diabetic gastroparesis A patient with nephrogenic diabetes insipidus will likely have what response in urine output after a Desmopressin (ADH) stimulation test is performed? No change, will continue production of large amounts of dilute urine Notes: In nephrogenic DI, there is enough ADH produced but the kidneys are essentially "insensitive" to ADH. If they have central DI, they will improve with administration of Desmopressin. What medication class if given to a patient with a pheochromocytoma before initiating treatment with alpha-adrenergic blockers (phenoxybenzamine) can cause unopposed alpha constriction and lead to a hypertensive crisis? Beta blockers Notes: Unopposed alpha constriction can cause hypertensive crisis if beta blockers are started first What is the most common cause of hypothyroidism in the US? Hashimoto Thyroiditis Notes: US is a iodine sufficient area so autoimmune is most likely cause while iodine deficiency is most common cause worldwide A patient with history of Graves disease presents with bilateral, scaly, non-pitting, induration of the skin of the lower extremities with brown patches spreading throughout. What is the name of the likely diagnosis in this patient? Myxedema (pretibial which is most common) When treating a patient with Graves' Disease, which medication should be used in the first trimester? Propylthiouracil (PTU) Notes: In the first trimester of pregnancy is pretty much the only time PTU is preferred over methimazole, can switch to methimazole after the first trimester A patient develops bladder cancer and is suspected that one of the medications he uses for diabetes is to blame. Which diabetes medication is this patient likely taking? Pioglitazone (TZD class) Notes: Remember "pee-oglitazone" for its relationship with bladder cancer A patient with Cushing's Disease (pituitary) after administration of high dose dexamethasone will likely have what response in their serum cortisol levels? Suppression of serum cortisol Notes: Pituitary causes of Cushing's Disease will be the only cases where you will see suppression with administration of dexamethasone A 47 yo female presents to the office 2 weeks post-op after having a thyroidectomy performed. She complains of muscle cramping and muscle spasms as well as a tingling sensation in her extremities. An ECG is performed and prolongation of the QT interval is visualized. What is the likely cause of her symptoms? Hypocalcemia Notes: Iatrogenic cause of hypoparathyroidism resulting in hypocalcemia A 37 yo female presents to the office today because she has not had her period in 4 months. She is not sexually active and denies any chance of pregnancy. She also complains of headaches and a milky discharge from her breast. What is the first line medication class for the likely diagnosis? Dopamine agonists (cabergoline, bromocriptine) Notes: Patient likely has a prolactinoma which is the most common type of pituitary adenoma, dopamine inhibits prolactin Multiple endocrine neoplasia type I is a rare autosomal dominant disorder characterized by a predisposition to tumors most commonly in what 3 areas of the body? Parathyroid, pancreas, pituitary (3 Ps) A 56 yo male with a history of diabetes presents to the office today to review recent lab results. His labs show he is deficient in vitamin B12. Which medication is he likely taking for his diabetes that caused a deficiency in vitamin B12? Metformin Notes: Metformin can cause B12 deficiency in 5-10% of patients taking it What is the most aggressive type of thyroid cancer Anaplastic thyroid cancer Notes: Median survival time after diagnosis is only 3-7 months How soon after the initiation of thyroid hormone replacement (levothyroxine, etc) in a patient with primary hypothyroidism should the TSH be checked? 4-6 weeks [Show Less]
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PANCE GI correctly answered 2023 updated
Courvoisier's sign painless jaundice with palpable gallbladder -pancreatic CA until proven otherwise MC type of pancreatic CA adenocarcinoma (85%... [Show More] ) 66% in the head Clinically look jaundiced with bilirubin level of...? 3 Scorpion bite can cause... pancreatitis Leading cause of cirrhosis in the US Hep C (26%) -second to alcohol (21%) Barrett's esophagitis normal squamous epithelium--> metaplastic columnar epithelium -found in 10% of reflux pts on endoscopy -can predispose to malignancy (adenocarcinoma) Regurgitation of food several hours after eating Zenker's diverticulum -outpuching of the posterior hypopharynx Esophageal stenosis causes dysphagia for solids/liquids/both? solid foods achalasia -global esophageal motor disorder -decreased peristalsis -decreased LES tone What autoimmune disorder is commonly seen with esophageal dysmotility? scleroderma esophageal neoplasms: MC types SCC and adenocarcinoma esophageal neoplasms: location -adenocarcinoma (assoc with Barrett's) in the distal 1/3 -SCC in the proximal 2/3s Mallory-Weiss tear -linear mucosal tear in the esophagus -typically at GE junction causes of gastritis -Autoimmune -H. pylori -NSAIDs -Stress (surgery, sepsis, burns) -Alcohol PUD: Most common cause H. pylori What is the MCC of nonhemorrhagic GI bleeds PUD If pt has refractory PUD, think... Zollinger-Ellison Syndrome (ZES) Zollinger-Ellison Syndrome: what is it? gastrinoma -fasting gastrin >150pg/mL -do a secretin test, in ZES will make gastrin increase by 200pg/mL MC type of CA worldwide gastric adenocarcinoma -less common in US Gastric adenocarcinoma: epidemiology -MC type of CA worldwide, less in US -2x Men>>Women ->40yo Zollinger-Ellison Syndrome: where is it? typically pancreas or duodenum Gastric adenocarcinoma: strong assoc. with... H. pylori Gastric adenocarcinoma: umbilical nodule Sister-Mary-Joseph nodule Gastric adenocarcinoma: left supraclavicular lymphadenopathy Virchow's node [Show Less]
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PANCE practice test Questions with answers 2023 rated A+
What do pirmented granular "muddy" casts indicate in the setting of oliguria? Acute tubular necrosis How can hyperphosphatemia be treated? aluminu... [Show More] m hydroxide What is the genetic basis for a patient with disproportionately small legs and arms, frontal bossing and mindfacial hypoplasia? autosomal recessive Besides extreme growth what other symptoms can a patient with acromegaly have? headaches, visual field defects, weakness, soft doughy hands, and amenorrhea **kids have giganticism What is the cause of acromegaly? Excess growth hormone How should X-rays be done to diagnosis SCFE (slipped femoral epiphysis)? Frog leg position What are the personality characterisitics of schizoid personality disorder? restricted range of emotion, being a loner, chosing solitary activities What drugs are used to help treat the bradykinesia of Parkinson's? amantadine, levodopa, selective MOAis How do anticholinergics help treat Parkinson's? they help treat the tremor and rigidity What are the findings associated with intussusception? presents 6-18 months of age drawing up of the knees currant jelly stool sausage-shaped mass in upper abdomen Wha tis the most common cause of subacute endocarditis Strep. viridans In adults without significant risk factors how often should fasting lipid profiles be obtained? every 5 years How is Raynaud's disease treated? CCBs What are Janeway's lesions? small hemorrhagic lesions on the skin seen in endocarditis What are Osler's nodes? painful red, raised lesion seen in endocardititis What are Roth's spots? exudative retinal lesions seen in endocarditis A pancytopenia with circulating blasts is characteristic of______________ acute leukemia How is acute myeloid leukemia differentiated from lymphoblastic leukemia? Auer's rods or myeloid enzymes like peroxidase are seen in AML What geene is associated with chronic myeloid leukemia? bcr/abl gene and phildelphia chromosome What are the treatments of acute-closure glaucoma? IV acetazolamide, possibly mannitol if very severe, later topical pilocarpine can be used to reverse underlying angle closure and later surgery iridotomy/iridectomy How does IgA nephropathy present? usually after URI and presents with hematuria and proteinuria Dorsal angulation of the wrist is commonly seen in___________ Colle's fracture What drugs should be avoided in patients with G6PD deficiency? sufa-containing drugs like Bactrim, nirtorfurantoin, because they can cause hemolytic crisis What infection is associated with Guillan Barre? Campylobacter What causes molluscum contagiosum? poxvirus Posterior cerebral artery occlusion can cause what neurological manifestation? Alexia- inability to understand written words Middle cerebral artery occlusion can cause what neurological manifestation? homonymous hemianopia Horner's syndrome is associated with what cerebral artery occlusion? Posterior inferior artery occlusion What is a physical exam test used to help diagnosis thoracic outlet syndrome? Elevated stress test: arm exteneded and externally rotated with the patient opening and closing hands for 3 min When is transphenoidal surgery indicated for a prolactinoma? When the adenoma is >3cm, otherwise Bromocriptine a dopamine agonist is the treatment of choice [Show Less]
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