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]