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PANCE (Physician Assistant National Certifying Examination) 2022/2023 COMPLETE SOLUTION PACKAGE
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PANCE Practice Exam Questions 2022-2023 COMPLETE SOLUTION
PANCE Practice Exam Questions 2022/2023 COMPLETE SOLUTION D. ALS Correct Answer: A 58 year-old male presents complaining of weakness of his grip. Your ... [Show More] examination reveals that the problem is bilateral. During the next few office visits, you note the development of hyperactivity of his DTRs, extensor plantar reflexes and dysarthria. The patient's sensory system remains normal and he denies any urinary symptomatology. Which of the following is the most likely diagnosis? A. multiple sclerosis B. Alzheimer's disease C. Huntington's chorea D. ALS E. myasthenia gravis C. inadequate dietary protein Low dietary Calcium, not protein, is a risk factor for osteoporosis. All of the others are risk factors. Correct Answer: Which of the following is NOT a risk factor for the development of osteoporosis? A. low testosterone levels in men B. low levels of physical activity C. inadequate dietary protein D. cigarette smoking E. chronic corticosteroid use B. metoprolol Of these Beta-blockers (which are usually AVOIDED) in reactive airway disease - metoprolol is the most "cardioselective", so theoretically could be used....although, on an exam, I would avoid beta-blockers in general. Correct Answer: Question 1 CORRECT A patient presents complaining of severe pain and "burning" in an extremity. You note that the extremity is pale and cool to the touch. You cannot appreciate a palpable pulsation. Which of the following diagnostic modalities will identify the source of this patient's problem in approximately 95% of cases? A chest x-ray B echocardiogram aortic angiogram D abdominal flat plate E aortic ultrasound Question 1 Explanation: Angiogram is the "gold standard" for occlusion of an arterial vessel. Question 2 CORRECT A 31 year-old pharmacist complaining of rectal pain. He describes the pain as "a severe tightness that awakens him from sleep." His bowel activity is normal. He denies rectal bleeding and seepage. He adds that sleep interruption is problematic, because with the number of hours he works, every minute of sleep is important. What is the most likely diagnosis? A anal abseess B perianal fistula proctalgia fugax D ulcerative colitis E internal hemorrhoids. Question 2 Explanation: proctalgia (rectal pain) fugax (comes and goes) is the best description. Abscess would be constant, fistula would drain, UC would cause bloody mucousy diarrhea, hemorrhoids would cause no pain, but bleeding. Question 3 CORRECT A 38 year-old chronic smoker presents with shortness of breath and wheezing. He has had several similar episodes in the past. He states that each previous episode began after developing a "cold that moved into his chest." Usually, after treatment with albuterol (VENTOLIN) and several days, the wheezing stops. He adds that he has a chronic cough, productive of mucous, most mornings during the past several years. Which of the following best describes this patient's condition? A chronic emphysema B chronic bronchitis chronic bronchitis with hypersensitive airways (asthmatic bronchitis) D cor pulmonale E bronchiectasis Question 3 Explanation: This is the best descriptor. Question 4 CORRECT A patient is being treated for Tuberculosis. She is experiencing central scotomata, a loss of green-red color perception and decreased visual acuity. Which agent is most likely responsible? A rifampin B isoniazid C streptomycin ethambutol E para-aminosalicylic acid Question 4 Explanation: Ethambutol is the TB drug that causes "E"ye symptoms. I remember it because it begins with an E. Question 5 CORRECT Secondary to a traumatic event, a child complains of pain in the index finger. An x-ray of the digit demonstrates a fracture line through the metaphysis of the proximal aspect of the middle phalanx, ending at the epiphyseal plate. What type of fracture does this child have? A Salter Harris Type I Salter Harris Type II C Salter Harris Type III D Salter Harris Type IV E Salter Harris Type V Question 5 Explanation: Salter I = slight increase in Space between epiphyseal plate and metaphysis Salter II = fx Above the plate (in the metaphysis) Salter III = fx Lower (in the epiphyseal plate) Salter IV = fit Through (both the metaphysic and epiphysis) Salter V = Really bad (comminuted fx compressing the epiphysis) This spells SALTR and may help you remember. 7365546_orig About Jorge Muniz PA-C (Creator of Medcomic) Question 6 CORRECT A 24 year-old male presents complaining of chest pain. He states that it is worse with swallowing and taking a deep breath. It is improved by sitting up and leaning forward. He denies trauma, a cough and shortness of breath. Which of the following tests would be most compatible with your suspected diagnosis? A a hiatal hernia visualized on chest x-ray B a normal erythrocyte sedimentation rate C calcified "popcorn" lesions in the lung fields bilaterally diffuse ST segment elevation on his electrocardiograph E a widened A-a gradient on his arterial blood gas Question 6 Explanation: This is pericarditis (by clinical presentation) which causes diffuse ST segment elevation on ECG (there can be notching of the R wave as well) Question 7 CORRECT A 2 month-old febrile male is brought to your facility to be evaluated for loss of appetite, irritability, and an acute petechial rash. Rectal temperature is 102.8F. Which of the following diagnostic studies is the most important in this child's evaluation? A white blood cell count and differential B urinalysis CSF analysis D serum glucose E chest X-ray (CXR) Question 7 Explanation: Any infant (neonate) with fever and rash should have a lumbar puncture (LP). While I would certainly do a CBC, even if it was normal, I would want the LP. Question 8 CORRECT Your 27 year-old sister is visiting and requests you to provide refills of dexamethasone and homatropine ophthalmic drops for her. What condition is most likely being treated? A conjunctivitis B glaucoma iritis D Herpes keratitis E blepharitis Question 8 Explanation: Iritis is treated with steroid drops (dexamethasone) and miotic drops *homatropine, like atropine (to constrict and fix the pupil to help the pain and open the angle until the iritis is resolved) Question 9 PARTIAL-CREDIT A 58 year-old male presents complaining of weakness of his grip. Your examination reveals that the problem is bilateral. During the next few office visits, you note the development of hyperactivity of his DTRs, extensor plantar reflexes and dysarthria. The patient's sensory system remains normal and he denies any urinary symptomatology. Which of the following is the most likely diagnosis? A multiple sclerosis B Alzheimer's disease Huntington's choreaHint: Huntington's causes a movement disorder with writhing choreiform movements of the body amyotrophic lateral sclerosis E myasthenia gravisHint: Myasthenia causes fatigue of the ocular muscles typically worsening at the end of the day. Question 9 Explanation: ALS (Lou Gehrig's disease) is a progressive bilateral muscle disease which causes fasciculations (lower motor neuron), and hyper-reflexia, plantar reflexes (upper motor neuron) and dysarthria. Sensation is normal as is bladder function. MS may have dysarthria, but reflexes are normal, sensation is impaired and bladder function is frequently affected. Alzheimer's has normal neuro exam with cognitive disability. Huntington's causes a movement disorder with writhing choreiform movements of the body. Myasthenia causes fatigue of the ocular muscles typically worsening at the end of the day. Question 10 CORRECT Which of the following is NOT a characteristic feature of multiple myeloma? A elevated serum calcium B osteoporosis C "punched out" osseous lesions D plasma cell infiltration of bone marrow hypogammaglobulinemia Question 10 Explanation: MM is a HYPERgammaglobulinemia - all of the other findings occur in MM. Question 11 PARTIAL-CREDIT Which of the following is NOT a risk factor for the development of osteoporosis? low testosterone levels in men low levels of physical activity inadequate dietary protein cigarette smoking E chronic corticosteroid use Question 11 Explanation: Low dietary Calcium, not protein, is a risk factor for osteoporosis. All of the others are risk factors. Question 12 A 12 year-old male presents complaining of no appetite for 24 hours and pain near his navel. During the night, the pain moved to the right lower abdomen. He is now nauseated and vomiting and has a low-grade fever. In the operating room, a normal appendix is discovered. What is the most likely diagnosis? A mesenteric ischemia B diverticulitis C mesenteric adenitis D cholecystitis E proctitis Question 13 A patient that must be on a beta-blocking agent has reactive airway disease and commonly experiences central nervous system side effects from medications. Which of the following beta-blockers would most likely be tolerated by this patient? A. atenolol B. metoprolol C. nadfilol D. propranolol E. pindolol E. hypogammaglobulinemia MM is a HYPERgammaglobulinemia - all of the other findings occur in MM Correct Answer: Which of the following is NOT a characteristic feature of multiple myeloma? A. elevated serum calcium B. osteoporosis C. "punched out" osseous lesions D. plasma cell infiltration of bone marrow E. hypogammaglobulinemia (C) Asymptomatic aneurysm 5.5 cm Correct Answer: A 65-year-old female on her routine examina- tion was noted to have a pulsatile abdominal mass. She has been otherwise healthy with history of hypertension with no other history, except family history of father dying of rup-tured AAA. What are the acceptable reasons to operate on abdominal aortic aneurysms in 65-year-old female with 5-cm infrarenal aneurysm? (A) Presence of aneurysm (B) Aneurysm with intramural thrombus (C) Asymptomatic aneurysm 5.5 cm (D) Associated 2-cm iliac aneurysm (E) Patient with splenic artery aneurysm 1.5 cm D. diffuse ST segment elevation on his electrocardiograph This is pericarditis (by clinical presentation) which causes diffuse ST segment elevation on ECG (there can be notching of the R wave as well) Correct Answer: A 24 year-old male presents complaining of chest pain. He states that it is worse with swallowing and taking a deep breath. It is improved by sitting up and leaning forward. He denies trauma, a cough and shortness of breath. Which of the following tests would be most compatible with your suspected diagnosis? A. a hiatal hernia visualized on chest x-ray B. a normal erythrocyte sedimentation rate C. calcified "popcorn" lesions in the lung fields bilaterally D. diffuse ST segment elevation on his electrocardiograph E. a widened A-a gradient on his arterial blood gas C. iritis Iritis is treated with steroid drops (dexamethasone) and miotic drops *homatropine, like atropine (to constrict and fix the pupil to help the pain and open the angle until the iritis is resolved) Correct Answer: Your 27 year-old sister is visiting and requests you to provide refills of dexamethasone and homatropine ophthalmic drops for her. What condition is most likely being treated? A. conjunctivitis B. glaucoma C. iritis D. Herpes keratitis E. blepharitis (B) Ultrasound Although aortography, CT, and MRI can all establish the diagnosis of abdominal aortic aneurysm, ultrasound remains the best screen- ing test. Correct Answer: A middle-aged man is found to have a small pulsating mass at the level of the umbilicus during a routine abdominal examination. What is the best initial test to establish the diagnosis? (A) Aortography (B) Ultrasound (C) Computed tomography (CT) (D) Magnetic resonance imaging (MRI) (E) Plain films of the abdomen (C) Arteriovenous (AV) fistula Correct Answer: A 45-year-old woman undergoes cardiac catheterization through a right femoral approach. Two months later, she complains of right lower extremity swelling and notes the appearance of multiple varicosities. On examination, a bruit is heard over the right groin. What is the most likely diagnosis? (A) Femoral artery thrombosis (B) Superficial venous insufficiency (C) Arteriovenous (AV) fistula (D) Pseudoaneurysm (E) Deep vein insufficiency (B) Pressure-gradient stockings Correct Answer: A middle-age woman has right leg and foot nonpitting edema associated with dermatitis and hyperpigmentation. The diagnosis of chronic venous insufficiency is made. What is the treatment of choice? (A) Vein stripping (B) Pressure-gradient stockings (C) Skin grafting (D) Perforator vein ligation (E) Valvuloplasty (A) Mesenteric embolus Correct Answer: Four days after suffering MI, a 78-year-old woman suddenly develops severe diffuse abdominal pain. Her ECG shows atrial fib. On examination, the abdomen is soft, minimally tender, and slightly distended. Hyperactive bowel sounds are present. What is the most likely diagnosis? (A) Mesenteric embolus (B) Nonocclusive ischemic disease (C) Perforated peptic ulcer (D) Congestive heart failure (CHF) (E) Digoxin toxicity (C) Heart The heart is the origin of about 90% of lower extremity emboli. Correct Answer: A 60-year-old man with a history of atrial fibrilla- tion is found to have a cyanotic, cold right lower extremity. The embolus is most probably originating from which of the following? (A) An atherosclerotic plaque (B) An abdominal aortic aneurysm (C) Heart (D) Lungs (E) Paradoxical embolus (D) Common femoral artery Correct Answer: Which is the most common site at which an arterial embolus lodges? (A) Aortic bifurcation (B) Popliteal artery (C) Tibial arteries (D) Common femoral artery (E) Iliac artery (B) Iliac artery Correct Answer: Stenosis of which of the following vessels is associated with the highest patency rates fol- lowing angioplasty or stenting? (A) Medial circumflex artery (B) Iliac artery (C) Superficial femoral artery (D) Popliteal artery (E) Tibial arteries (C) Zinc deficiency Both zinc and vitamin C (ascarbate) deficiency, impair wound healing. Vitamin A deficiency is also implicated in would heal- ing and supplemental Vitamin A has been shown in experimental studies to prevent radi- ation included defects in wound healing. Incision through the same abdominal wall scar incision actually promotes wound healing, because the initial lag interval after creation of the wound is avoided (unless the whole scar of the incision is removed). Increase in local oxygen tension actually promotes wound healing. Correct Answer: A 68-year-old retired female plastic surgeon underwent laparotomy through a midline abdominal incision. Intestinal infarction was found and a distal 60% small-bowel resection was performed with ileocecal anastomosis. She was placed on hyperalimentation. Seven days after the operation, she underwent a second operation through the same incision. Wound healing is further impaired by which of the following? (A) Incision through the same abdominal wall scar (B) Vitamin A administration (C) Zinc deficiency (D) Increased local oxygen tension (E) Incision through new area of abdominal wall (A) The hernia is more likely to be direct than indirect. [Show Less]
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PANCE Test Prep 2022-2023.
PANCE Test Prep 2022/2023 what vitamin deficiency causes the triad of dermatitis, diarrhea and dementia? – niacin (vitamin B3) deficiency = pel... [Show More] lagra what vitamin deficiency causes bleeding gums, petechiae, poor wound healing, and loose teeth? – vitamin C deficiency = scurvy what is pellagra? – niacin (vit B3) deficiency what is scurvy? – vitamin C deficiency what vitamin deficiency causes night blindness + dry skin? – vitamin A what is the medical term for vitamin D deficiency? – Rickets / osteomalacia what is beriberi? – thiamine (vitamin B1) deficiency what is the medical term for vitamin B1 (thiamine) deficiency? – beriberi what is the treatment of phenylketonuria (PKU)? – low-phenylalanine diet + tyrosine supplementation What is Budd-Chiari syndrome? – hepatic vein thrombosis that causes RUQ pain, ascites, and hepatomegaly DOC for NSAID-induced ulcer disease? – misoprostol "corkscrew" appearance on barium swallow should make you think of what diagnosis? – diffuse esophageal spasm positive Schilling test indicates what? – pernicious anemia what kind of metabolic disturbance occurs in pyloric stenosis? – hypOchloremic, hypOkalemic metabolic alkalosis what is the classic triad for CHRONIC pancreatitis? – pancreatic calcification + steatorrhea+ diabetes mellitus DOC for pruritus in primary biliary cholangitis? – cholestyramine name TWO causes of isolated indirect hyperbilirubinemia. – Gilbert's syndrome, Crigler-Najjar syndrome + IgA endomysial antibody is seen in? – celiac disease + ANCA antibodies are seen in which type of IBD? – ulcerative colitis + ASCA antibodies are seen in which type of IBD? – crohn's MC artery affected in mesenteric ischemia? – SMA how to dx lactose intolerance? – hydrogen breath test Trypanosoma cruzi parasite causes what disease? – Chagas disease what nutritional deficiency causes rickets? – vitamin D deficiency what is the MCC of thiamine deficiency? – chronic ETOH abuse what occupations are associated with berylliosis? – aerospace and nuclear plant workers which TB medication is contraindicated in gout? – pyrazinamide exposure to pigeon droppings may result in pneumonia caused by what organism? – cryptococcus MCC of pneumonia in COPD pts? – Haemophilus influenzae what are the components of carcinoid syndrome? – cutaneous flushing + diarrhea + wheezing + low BP what pulmonary artery pressure is diagnostic for pulmonary hypertension? – > 25 mmHg MC symptom vs. sign in acute PE? – MC symptom = dyspnea MC sign = tachypnea what PCWP is diagnostic for ARDS? – < 18 mmHg what diagnosis should you think of in a young male nonsmoker with emphysema? – alpha1-antitrypsin deficiency what electrolyte must be given with potassium to ensure proper repletion? - magnesium which is more elevated in alcoholic hepatitis, AST or ALT? - AST > ALT which is more elevated in viral hepatitis, AST or ALT? - ALT > AST what's a complication of Hirschsprung disease? - toxic megacolon delayed meconium passage should make you think of what? - Hirschsprung disease name a GI complication associated with Henoch-Schonlein purpura. - intussusception intussusception is a complication of what vaccine? - rotavirus best marker of HBV immunity? - anti-HBs (antibody to HBV surface antigen) DOC for primary prophylaxis of esophageal varices? - propranolol (nonselective beta blocker) which hematologic abnormality is associated with gastritis? - pernicious anemia common cause of osteomyelitis in children with sickle cell disease? - salmonella what is the triad of Wernicke's encephalopathy? - 1. confusion / encephalopathy 2. opthalmoplegia / oculomotor dysfunction 3. ataxia cutaneous manifestation of celiac disease? - dermatitis herpetiformis MC site of pancreatic carcinoma? - head of pancreas name of physical exam finding of sausage-shaped mass in RUQ with emptiness in the RLQ? - Dance's sign (associated w/ intussusception!) liver disease + Parkinson-like symptoms + Kayser-Fleischer rings = __________? - Wilson's disease what vitamin deficiency causes bleeding gums, petechiae, poor wound healing, and loose teeth? and what is this condition called? - vitamin C deficiency = scurvy which antibiotics are used to treat acute diverticulitis? - cipro + flagyl MCC of iron deficiency anemia? - chronic GI bleed MC location of colorectal cancer? - cecum "string sign" on barium swallow indicates what dx? - pyloric stenosis when taking sulfasalazine for IBD, what vitamin should be supplemented? - folic acid (folate) what is the medical term for feeling like there is a lump in your throat? - globus MC location of an anal fissure? - posterior midline DOC for antidromic AVRT (stable)? - procainamide avoid AV nodal blockers (adenosine, beta-blockers, CCBs, digoxin) in orthodromic or antidromic AVRT? - antidromic DOC for primary prophylaxis of esophageal varices? - propranolol (nonselective beta blocker) name of physical exam sign characterized by a loud crunching sound, best heard in LLD? - Hamman's sign (pathognomonic for mediastinal air!) MCC of acute vs. chronic aortic regurgitation? - acute MCC = endocarditis chronic MCC = rheumatic heart disease MCC of tricuspid regurgitation? - increased R heart pressure / RV dilation EKG with characteristic "Salvador Dali mustache"? - digoxin effect fibric acid derivatives (eg, gemfibrozil) are contraindicated in what? - biliary disease MCC of mitral valve prolapse? - myxomatous valve degeneration MCC of tricuspid stenosis? - rheumatic heart disease (TS almost always occurs with MS) which class of diabetes meds are contraindicated in heart failure? - thiazolidinediones (eg, pioglitazone) what medications should be avoided in patients with critical aortic stenosis? - vasodilators and diuretics (b/c these pts are preload-dependent!) "egg-shaped heart" on CXR? - transposition of the great vessels tx of choice (which pharmacologic class) for long QT syndrome? - beta- blockers capture beats and fusion beats confirm the diagnosis of __________? - V-Tach fetus is at risk for what congenital heart problem if maternal Lithium use during pregnancy? - Ebstein's anomaly decrease in SBP (>10mmHg) and weaker pulse during inspiration refers to __________________ - pulsus paradoxus name TWO class IC antiarrhythmics. - flecainide, propafenone digoxin is used to treat what 2 conditions? - CHF & A-Fib triad of claudication + impotence + decreased femoral pulses = ____________ - Leriche syndrome what is the antidote for heparin toxicity? - protamine sulfate [Show Less]
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PANCE Practice Exam 2 (2022-2023) Questions and Answers with Explanation
PANCE Practice Exam 2 (2022/2023) Questions and Answers with Explanation A 27-year-old woman complains of years of menstrual irregularity and increasi... [Show More] ng facial and chest hair. PMH: significant for ovarian cyst and left cytectomy. She is a nonsmoker 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 firstgeneration (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. [Show Less]
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2022-2023 60 PANCE Practice Questions
2022/2023 60 PANCE Practice Questions A 52 year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the past few months... [Show More] . During his physical examination, you 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 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 Correct Answer: *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. Correct Answer: 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 Correct Answer: *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 Correct Answer: *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 Correct Answer: *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 Correct Answer: *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 Correct Answer: 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 Correct Answer: *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 Correct Answer: *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. Correct Answer: *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 Correct Answer: *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. Correct Answer: *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 Correct Answer: *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 Correct Answer: 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 Correct Answer: 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 Correct Answer: 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 Correct Answer: 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 Correct Answer: 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 A 55 year-old male presents complaining of "difficulty wrting" using his dominant hand and some "slurred" speech. He has a h/o hypertension, DM type II, and hypertriglyceridemia. Which of the following would you anticipate to find on a CT scan of his head, as the explanation for his chief complaint? [Show Less]
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PANCE Practice Exam 1 QUESTIONS WITH EXPLAINED ANSWERS 2022-2023
PANCE Practice Exam 1 QUESTIONS WITH EXPLAINED ANSWERS 2022/2023 1. A 52 year-old male presents complaining of urinary frequency, with hesitancy, and no... [Show More] cturia for the past few months. During his physical examination, you 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. 9. While suturing a wound, you opt to use lidocaine with epinephrine. The rationale to 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 mcrease 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. 9. D. Lidocaine with epinephrine both increases duration of anesthesia and decreases blood flow to the area of injection, i.e. penis, nose, fingers, toes 10. An EKG demonstrates a PR interval ofOJ6 seconds, a P to QRS relationship of 1:1, a variable heart rate and an R to R interval that is noted to accelerate and 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 10. D. 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. 11. 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. Herpes virus. E. Hemophilus influenzae. 11. B. 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. 12. A 42 year-old female presents after finding a firm, painless bump in her right eye. On examination you note a 6 mm mass within the tarsus of the right eye. The skin is freely movable over me 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 hourdeolum 12. B. 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. 13. 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. MRIscan D. EEG E. PET scan 13. B. 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. 14. 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 D. acute myelogenous leukemia E. multiple myeloma 14.C. Philadelphia Chromosome occurs in CML. ALL occurs in children. AMLis associated with Auer rods. Multiple myeloma has Bence-Jones protein. CLL has no clear distinguishing feature except increased lymphocytes. 15. Which of the following thyroid profiles is most compatible with a diagnosis of primary hypothyroidism? A. a low TSH (thyroid stimulating hormone) level and a high T4 B. a low TSH level and a normal T4 C. a low TSH level and a low T4 D. a high TSH level and a low T4 E. a high TSH and a high T4 15. D. Low T4 is diagnostic for low thyroid function. If the pituitary is normal (as in primary thyroid disease) the TSH should be high as the pituitary tries to stimulate the failing thyroid gland. 16. All of the following are factors that predispose a patient to the development of gastroesophageal reflux EXCEPT: A. hiatal hernia. B. pregnancy. C. scleroderma. D. an incompetent esophageal sphincter E. pernicious anemia. 16.E. Pernicious anemia has no correlation with GERD. It is an autoimmune destruction of the gastric parietal cells that make intrinsic factor. Signs & symptoms are not present until B12 levels are very low (and include peripheral neuropathies & ataxia) 17. A patient warrants antihypertensive medication use for the duration of her pregnancy. Which of the following is the antihypertensive recommended for such patients? A. alpha-methyldopa B. captopril C. nifedipine D. propranolol E. clonidine 17. A. Methyl Dopa (Aldomet) is indicated in pg. ACEFs (captopril) are contraindicated in pg. B-Blockers can be used but may cause growth restriction. Diuretics are not used in pg. CCB's and centrally acting agents (while not contraindicated) should be avoided. 18. A 6 year-old child falls onto his right arm. An x-ray demonstrates a buckle in the cortices of the distal radius, proximal to the growth plate, without angulation. What is the term used to describe this fracture? A. Salter-Harris Type III B. Salter-Harris Type IV C. Salter-Harris Type V D. torus E. greenstick [Show Less]
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PANCE Practice Exam with Complete Solution (2022-2023)
PANCE Practice Exam with Complete Solution (2022/2023) which type of hypersentitivy rxn is the most severe? requiring emergency tx? Correct Answer: typ... [Show More] e 1 Type IV< III< II < I in an alcoholic pt with global confusion, ataxia (gait imbalance), nystagmus + ocular msl paralysis Correct Answer: wernicke's encephalopathy Tx: IV thiamine which type of hypersensitivity rxn is characterized by antigen -antibody rxns mediated by IgE -- that results in hypotension, shock, urticaria, or angioedema? Correct Answer: type I best diagnostic test for carpal tunnel syndrome ? Correct Answer: electromyogram males with early onset of poor gait that is progressively worsening. Plus pseudohypertrophy of the calves and + Gowers sign (need to lift oneself "climb up" up when getting up) and a positive fam history a Muscle bx to confirm this dx would show: Correct Answer: duchenne muscular dystrophy which tests differentiate between nerve and muscular problems? Correct Answer: electromyogram and nerve conduction studies Cushing's syndrome pt should immediately stop which meds? Correct Answer: steroids. Lambert-Eaton myasthenic syndrome Correct Answer: immune mediated disorder where ACH is not properly released - this causes weakness in scapular and pelvic girdle muscles. and difficulty climbing stairs or impotence. deep tendon reflexes are decreased or absent. overdose cholinesterase inhibitors such as pyridostigmine or neostigmine can cause what ? (usually prescribed for MG) Correct Answer: cholinergic crisis. excessive salivation, lacrimation, emesis, urinary incontinence, gynecomastia, sparse body hair, small soft testes Correct Answer: klinefelters' syndrome (XXY) retinal a. emboli can cause brief episodes of monocular blindness known as Correct Answer: amaruosis fugax inhibition of protein C due to use of warfarin causes what? Correct Answer: skin necrosis in wilson's dz which are the only type of contraceptives recommended? Correct Answer: progestin only pill or levoestregel releasing IUD how do u differentiate between amphetamine or cocaine high? Correct Answer: time; amphetamine = 4-6 hrs cocaine = 2 hrs. cushings syndrome pts that are not surgical candidates can use what? Correct Answer: oral ketoconazole distended neck veins with prominent A or V waves Correct Answer: cor pulmonale IgA vasculitis that erupts over skin post URI, manifesting as paplaple lesions and pts also present with hematuria, arthalgia, and abdominal pain and bloody stools. dx: best dx tool: tx: Correct Answer: henoch schonlein purpura coag studies: should be NEGATIVE! kidney bx: IgA deposits tx: supportive as dz is self limiting (NSAIDs, bed rest, hydration) which restrictive lung dz has increased serum ACE (angiotensin converting enzyme)? Correct Answer: sarcoidosis in pts with orthostatic hypotension, how can you differentiate between autonomic insufficiency or hypovolemia? Correct Answer: in autonomic insufficiency there is no compensatory increase in HR which two conditions are associated with: 1. menstrual irregularity 2. androgen exces - hirsutism 3. mood changes 4. insulin resistance - hyperglycemia 5. obesity how can u differentiate the two? Correct Answer: PCOS and hypercortisolism ***hypercortisolism has obesity in truncal distribution and is assoc with HTN and inc urinary cortisol. what are the two most common causes of ACUTE renal failure? Correct Answer: 1. acute tubular necrosis (due to ischemia, shock, sepsis or cardiac arrest or nephrotoxins) 2. prerenal dz (HF or hypovolemia) what is the BUN/Cr ratio like in acute tubular necrosis? Correct Answer: normal BUN/Cr ratio only higher in dz with reduced urine outflow = pre/post renal azotemia BUN/Cr ratio is only lower in severe liver dz. beriberi, av fistulas, hyperthyroidism, Paget's dz of bone can all cause what kind of HF? Correct Answer: high cardiac output HF. how can you differentiate between inflammatory and non-inflammatory diarrhea? Correct Answer: inflammatory diarrhea can be bloody shigella, entameoba, capmhylobacter, salmonella, yersinia are all organisms that are more likely to cause what kind of diarrhea? Correct Answer: inflammatory norovirus, rotavirus, e.coli, staph aureus, giardia, crytosproridium are all organisms that cause wht kind of diarrhea? Correct Answer: non-inflammatory. in a pt with guillan barre, PMH is significant for recent travel and severe diarrhea (enterocolitis) - what organism can you assume caused this? Correct Answer: camphylobacter. which organisms are most likely to cause traveler's diarrhea? Correct Answer: e.coli, shigella, camphylobacter which organisms are responsible for causing diarrhea from drinking contaminated water? Correct Answer: giardia, cryptosproridium stool immunoassay and micro studies to confirm dx. tx: metronidazole. extraintestinal manifestations of uveitis, erythema nodosum or pyoderma gangrenosum , large joint arthritis, and cholangitis can be seen with what? Correct Answer: Ulcerative colitis in addition to heart burn, GERD can cause what sxs? Correct Answer: water brash, hoarseness, wheezing, sour taste, sore throat. best test for GERD dx? Correct Answer: esophageal pH monitoring how is antiphospholipid antibody syndrome related to pregnancy? Correct Answer: recurrent spontaneous abortions. and it can cause preecclampsia. best diagnostic test for someone with charcoat's triad + Correct Answer: ERCP unconjugated (INDIRECT) bilirubin is high in what conditions? Correct Answer: gilberts's dz, hemolysis, newborn jaundice, resabsorption of hematoma, conjugated (DIRECT) bilirubin is high in what conditions? Correct Answer: Dubin johnson, biliary tract obstruction, intrahepatic cholestasis, tumor in liver, cholangitis main cause of primary dysmenorrhea? Correct Answer: prostaglandin causing uterine contraction and ischemia in a pt with active upper GI bleed, what test should u perform to dx h.pylori infection? Correct Answer: gastric bx. via endoscopy. what is HHS ? who gets it? Correct Answer: HHS is Hyperglycemic Hyperosmolar state, middle aged DM pts get it due to infection, AMI, stroke or surgery. - Hyperglycemia = GLU > 600mg/dL - hyperosmolar = serum osmolality > 310 mOsm/kg tx for HHS? Correct Answer: 1) continuous IV Insulin, granted K+ is > 3.3 mg/dL. If it is not, then K+ has to be replenished first before starting Insulin. 2) start IV fluids. match the circulating antibodies with the correct dz 1. ACH 2. TSH 3. thyroglobulin and thyroid peroxidase 4. anti intrinsic factor antibodies 5. anti ds DNA, and anti SM antibodies Correct Answer: 1. Myasthenia Gravis 2. Graves (hypertsh) 3. Hashimoto's 4. pernicious anemia 5. SLE what happens in advanced renal dz with reduced glomerular filtration rate? Correct Answer: hyperphosphatemia and normocytic normochromic anemia hepatic encephalopathy can be treated with what? Correct Answer: Ammonia is usually high 1. oral or rectal lactulose 2. rifampin 3. protein restriction in diet how would u treat ascites? Correct Answer: 1. spironolactone or furosemide 2. paracentesis. increased ADH secretion seen with low CO systolic HF results in what electrolyte abnormality? Correct Answer: hyponatremia IVIG is used in what conditions? (7) Correct Answer: 1. ITP 2. Kawasaki 3. Guillian Barre 4. MG 5. autoimmune hemolytic anemia 6. pediatric HIV pt 7. antibody deficiency d/o of the following sxs of hepatic failure, which two differentiates acute from chronic? a) jaundice b) bleeding c) ascites d) edema e) portal HTN f) spider angiomas Correct Answer: e) and f) are present in chronic liver cirrhosis in a pt with HTN and Hyperglycemia which diseases can u consider? Correct Answer: 1. DM 2. Pheochromocytoma 3. Hypercortisolism 4. Acromegaly which kind of vertigo (peripheral or central) is assoc with inner ear problems and yields vertigo related to BPPV, or Meniere's dz Correct Answer: peripheral what qualities make a HA life threatening? Correct Answer: 1. sudden onset (SAH) 2. worse with physical strain like valsalva (intercranial hemorrhage) deep excruciating, unilateral HA that is accompanied by tearing, nasal congestion and weakness of the facial muscles on the affected side. Correct Answer: cluster HA tx: O2, sumatriptan, octreotide prevent: verapamil, prednisone, lithium. T/F. absence of deep tendon reflexes is normal in otherwise vigorous 80-90 yr olds Correct Answer: true mitosis, ptosis, facial anhidrosis Correct Answer: Horner's syndrome bronchogenic ca, cluster HA, cerebellar infarction,, dissection of carotid a. -----all can cause what ? Correct Answer: Horner's syndrome which of the following is not caused by DM? a) stocking glove sensory loss b) proprioceptive loss c) acquisition of Babinski's reflex Correct Answer: Babinski RBBB is most commonly assoc with which congenital heart defect? Correct Answer: ASD recurrent numbness and tingling (paresthesias) in fingers, toes, and perioral area are NOT seen in which of the following conditions? a. diabetic polyneuropathy b. lacunar infarct c. vertebrobasilar a. insufficiency d. hypoglycemia/hypocalcemia e. 1* hypoparathyroidism f. lumbar n. compression Correct Answer: b. and f. acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia Correct Answer: Hemolytic Uremic Syndrome (assoc. with EHEC infection) which dzez cause thrombocytopenia due to autoimmune response (antibody destruction of platelets) ? Correct Answer: 1. ITP 2. HIT 3. SLE which dzez cause thrombocytopenia due to non-immune causes? Correct Answer: 1. RMSF 2. DIC 3. Viral Infx 4. B12 or Folate def anemia aside from micronutrient deficiency (Iron, Vitamins (A-E), folate, Calcium, etc.) what is another common complication in pts who underwent Roux-en-Y surgery? Correct Answer: cholelithiasis- give prophylactic Ursodeoxycholic acid s/p surgery to prevent this. how to tell the difference diagnostically between perinneal allergic rhinitis (allergy to irritants - dander, pollen, etc), and vasomotor rhinitis (runny nose after eating spicy foods or humidity) ? Correct Answer: perinneal allergic rhinitis is assoc with 1. asthma 2. eosinophils on nasal cytology 3. + skin test which anticoag is preferred for Afib pts with valvular heart disease? Correct Answer: Heparin (LMWH or UFH) hypokalemia, hypomagnesemia, and hypocalcemia can all cause what on EKG? what kind of abx would make this situation worse? Correct Answer: prolonged QT Fluoroquinolones what does lactase deficiency, sorbitol and fructose ingestion have in common? Correct Answer: they are poorly absorbed in the intestine causing osmotic diarrhea. BRCA 1 and BRCA2 is associated with which cancers? Correct Answer: ca of breast, pancreas and ovaries. dermatitis herpetiformis is a papulovesicular rash assoc with what dz? Correct Answer: Celiac disease tx: gluten free diet alk phos and GGT are both elevated in bone or liver dz? Correct Answer: liver dz. which of the following is not assoc with 2* adrenal insufficiency? a) weakness b) orthostatic hypotension c) hyperpigmentation d) anorexia Correct Answer: c what is the best therapy for allergic rhinitis? Correct Answer: intranasal corticosteroids for variant aka prinzmetal angina what do you see on EKG versus what you might see on EKG for AMI caused by ASCVD? Correct Answer: variant angina = ST Elevations AMI = Horizontal ST depression how does psoriatic arthritis in distal phalanges look on XR ? Correct Answer: Sharpened pencil in a man with a painful rash in his mouth that is violaceous with papules and white streaks which med may be responsible? 1) bactrim 2) lisinopril 3) warfarin 4) cloroquine Correct Answer: 2. lisinopril man has lichen planus caused by ACE or NSAIDs. left parasternal lift, high JVP, hepatomegaly, ascites, peripheral edema are all signs of ? Correct Answer: cor pulmonale - autoimmune destruction of pancreatic B cells - assoc with HLA-DR3 gene Correct Answer: Type 1 DM - combo of tissue resistance to insulin and deficiency in response of pancreatic islet cells to glucose - early in dz exaggerated hyperinsulinism - waist to hip fat ratio > 0.9 Correct Answer: Type 2 DM which test do u do before starting a pt on probenecid or allorpurinol for recurrent gout? Correct Answer: 24 hr urinary uric acid should be > 800mg /day serum amylase is NOT elevated in which of the following? (More than one answer) a) ruptured ectopic pregnancy b) mumps c) multiple myeloma d) mesenteric infarction e) renal failure f) diabetes g) diverticulitis Correct Answer: f and g what is the best indicator of hypovolemia? Correct Answer: orthostatic hypotension [Show Less]
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