PANCE Exam Practice
Questions And Correct
Answers (Verified Answers)
Plus Rationale 2026 Q&A|
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CARDIOVASCULAR
1.
A 64-year-old man presents with crushing substernal chest pain
radiating to his left arm. ECG shows ST-segment elevation in leads II,
III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF is most
commonly caused by right coronary artery occlusion.
2.
A patient with acute pericarditis typically reports chest pain that is
relieved by which maneuver?
A. Lying supine
B. Eating
,C. Sitting forward
D. Performing Valsalva
Rationale: Pericarditis pain classically worsens when supine and
improves when sitting forward.
3.
Which finding is most characteristic of cardiac tamponade?
A. Wide pulse pressure
B. Bounding peripheral pulses
C. Pulsus paradoxus
D. Fixed split S2
Rationale: Pulsus paradoxus, an exaggerated inspiratory decrease in
systolic blood pressure, is a classic finding of tamponade.
4.
A 72-year-old woman has dyspnea, orthopnea, pulmonary crackles,
and bilateral lower-extremity edema. Which medication provides
rapid symptomatic relief by reducing volume overload?
A. Metoprolol
B. Lisinopril
C. Spironolactone
D. Furosemide
Rationale: Loop diuretics such as furosemide rapidly decrease
intravascular volume and relieve congestion in acute decompensated
heart failure.
5.
Which ECG finding is most consistent with atrial fibrillation?
A. Sawtooth flutter waves
B. Regular narrow-complex tachycardia
,C. Irregularly irregular rhythm without distinct P waves
D. Wide QRS complexes with AV dissociation
Rationale: Atrial fibrillation produces chaotic atrial activity and an
irregularly irregular ventricular rhythm.
6.
A patient with stable angina develops predictable chest pain during
exertion that resolves with rest. What is the underlying mechanism?
A. Coronary vasospasm
B. Acute plaque rupture
C. Fixed atherosclerotic coronary obstruction
D. Coronary artery embolism
Rationale: Stable angina results from fixed coronary atherosclerosis
causing demand-related myocardial ischemia.
7.
Which murmur is classically associated with aortic stenosis?
A. Holosystolic murmur at the apex
B. Diastolic murmur at the left sternal border
C. Harsh crescendo-decrescendo systolic murmur radiating to the
carotids
D. Continuous machinery murmur
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic
ejection murmur that radiates to the carotids.
8.
Which physical finding is most characteristic of right-sided heart
failure?
A. Hemoptysis
B. Pulmonary edema
, C. Jugular venous distention
D. Inspiratory stridor
Rationale: Right-sided failure causes systemic venous congestion,
producing JVD, hepatomegaly, and peripheral edema.
9.
A patient has a blood pressure of 220/130 mm Hg with acute
pulmonary edema and altered mental status. What is the
appropriate classification?
A. Hypertensive urgency
B. White-coat hypertension
C. Hypertensive emergency
D. Resistant hypertension
Rationale: Severe hypertension accompanied by acute target-organ
injury constitutes hypertensive emergency.
10.
Which medication should generally be avoided in a patient with
hypertrophic obstructive cardiomyopathy because it can worsen
outflow obstruction?
A. Beta blocker
B. Verapamil
C. Nitrate
D. Disopyramide
Rationale: Reduced preload from nitrates can increase left ventricular
outflow tract obstruction in HOCM.
11.
A 58-year-old patient develops sudden tearing chest pain radiating to
the back. Blood pressure differs between the arms. What diagnosis is
most likely?
Questions And Correct
Answers (Verified Answers)
Plus Rationale 2026 Q&A|
Instant Download Pdf
CARDIOVASCULAR
1.
A 64-year-old man presents with crushing substernal chest pain
radiating to his left arm. ECG shows ST-segment elevation in leads II,
III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF is most
commonly caused by right coronary artery occlusion.
2.
A patient with acute pericarditis typically reports chest pain that is
relieved by which maneuver?
A. Lying supine
B. Eating
,C. Sitting forward
D. Performing Valsalva
Rationale: Pericarditis pain classically worsens when supine and
improves when sitting forward.
3.
Which finding is most characteristic of cardiac tamponade?
A. Wide pulse pressure
B. Bounding peripheral pulses
C. Pulsus paradoxus
D. Fixed split S2
Rationale: Pulsus paradoxus, an exaggerated inspiratory decrease in
systolic blood pressure, is a classic finding of tamponade.
4.
A 72-year-old woman has dyspnea, orthopnea, pulmonary crackles,
and bilateral lower-extremity edema. Which medication provides
rapid symptomatic relief by reducing volume overload?
A. Metoprolol
B. Lisinopril
C. Spironolactone
D. Furosemide
Rationale: Loop diuretics such as furosemide rapidly decrease
intravascular volume and relieve congestion in acute decompensated
heart failure.
5.
Which ECG finding is most consistent with atrial fibrillation?
A. Sawtooth flutter waves
B. Regular narrow-complex tachycardia
,C. Irregularly irregular rhythm without distinct P waves
D. Wide QRS complexes with AV dissociation
Rationale: Atrial fibrillation produces chaotic atrial activity and an
irregularly irregular ventricular rhythm.
6.
A patient with stable angina develops predictable chest pain during
exertion that resolves with rest. What is the underlying mechanism?
A. Coronary vasospasm
B. Acute plaque rupture
C. Fixed atherosclerotic coronary obstruction
D. Coronary artery embolism
Rationale: Stable angina results from fixed coronary atherosclerosis
causing demand-related myocardial ischemia.
7.
Which murmur is classically associated with aortic stenosis?
A. Holosystolic murmur at the apex
B. Diastolic murmur at the left sternal border
C. Harsh crescendo-decrescendo systolic murmur radiating to the
carotids
D. Continuous machinery murmur
Rationale: Aortic stenosis produces a crescendo-decrescendo systolic
ejection murmur that radiates to the carotids.
8.
Which physical finding is most characteristic of right-sided heart
failure?
A. Hemoptysis
B. Pulmonary edema
, C. Jugular venous distention
D. Inspiratory stridor
Rationale: Right-sided failure causes systemic venous congestion,
producing JVD, hepatomegaly, and peripheral edema.
9.
A patient has a blood pressure of 220/130 mm Hg with acute
pulmonary edema and altered mental status. What is the
appropriate classification?
A. Hypertensive urgency
B. White-coat hypertension
C. Hypertensive emergency
D. Resistant hypertension
Rationale: Severe hypertension accompanied by acute target-organ
injury constitutes hypertensive emergency.
10.
Which medication should generally be avoided in a patient with
hypertrophic obstructive cardiomyopathy because it can worsen
outflow obstruction?
A. Beta blocker
B. Verapamil
C. Nitrate
D. Disopyramide
Rationale: Reduced preload from nitrates can increase left ventricular
outflow tract obstruction in HOCM.
11.
A 58-year-old patient develops sudden tearing chest pain radiating to
the back. Blood pressure differs between the arms. What diagnosis is
most likely?
