PANCE Practice Exam Questions 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 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. _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. Hernias, which present in adult life are most often direct and aquired, rather than indirect. They protrude through the transversalis fascia, which forms the medial half of the posterior wall of the inguinal canal and is located medial to the deep inguinal ring and deep epigastric vessels. Strangulation of direct inguinal herniae is uncom- mon, probably because the neck of the sac tends to be wide, rather than narrow and constricting Correct Answer: A 60-year-old male presents with an inguinal hernia of recent onset. Which of the following statements are TRUE? (A) The hernia is more likely to be direct than indirect. (B) Presents through the posterior wall of the inguinal canal, lateral to the deep inguinal ring. (C) Is covered anteriorly by the transversalis fascia. (D) Is more likely than a femoral hernia to strangulate. (E) The sac is congenital. (A) Direct inguinal hernia Correct Answer: A 70-year-old cigarette smoker presents with a right inguinal mass that has enlarged and has caused discomfort in recent months. He com- plains of recent difficulty with micturition and nocturia. The swelling, which does not extend to the scrotum, reduces when resting. What is the likely diagnosis? (A) Direct inguinal hernia (B) Strangulated indirect inguinal hernia (C) Hydrocele (D) Aneurysm of the femoral artery (E) Cyst of the cord (A) The sac is formed by an unobliterated processus vaginalis Correct Answer: A 65-year-old female requires emergency surgery for a strangulated inguinal hernia. Which of the following is correct? (A) The sac is formed by an unobliterated processus vaginalis. (B) The hernia is direct rather than indirect. (C) Such herniae never contain small intestine. (D) Strangulation never results in bowel ischemia and gangrene requiring resection. (E) Indirect inguinal herniae are never found in female patients. (A) Crohn's colitis Correct Answer: A 25-year-old man has recurrent, indolent fistula in ano. He also complains of weight loss, recurrent attacks of diarrhea with blood mixed in the stool, and tenesmus. Proctoscopy revealed a healthy, normal-appearing rectum. What is the most likely diagnosis? (A) Crohn's colitis (B) Ulcerative colitis (C) Amoebic colitis (D) Ischemic colitis (E) Colitis associated with acquired immunodeficiency syndrome (AIDS) (C) Toxic megacolon Correct Answer: A 35-year-old man has known ulcerative colitis. Which of the following is an indication for total proctocolectomy? (A) Occasional bouts of colic and diarrhea (B) Sclerosing cholangitis (C) Toxic megacolon (D) Arthritides (E) Iron deficiency anemia (D) 10-20 years Correct Answer: A 54-year-old man with diarrhea is found to have ulcerative colitis. Colectomy should be advised in patients with ulcerative colitis who have symptoms that persist for more than which of the following? (A) 1 month (B) 6 months (C) 1-5 years (D) 10-20 years (E) More than 25 years A) Toxic megacolon in ulcerative colitis Correct Answer: A 40-year-old man with a long history of bloody diarrhea presents with increased abdominal pain, vomiting, and fever. On examination, he is found to be dehydrated and shows tachycardia and hypotension. The abdomen is markedly tender with guarding and rigidity. What is the most likely cause? (A) Toxic megacolon in ulcerative colitis (B) Small-bowel perforation from regional enteritis (C) Perforated carcinoma of the sigmoid colon (D) Volvulus of the sigmoid colon (E) Acute perforated diverticulitis (A) Wound dehiscence A large amount of seroanguinous drainage from the abdominal wound that occurs 5 to 7 days post-op is usually the result of dehiscence of the abdominal wound closure. A wound infection is heralded by erythema, swelling, and thick pus. Leaks from either enteric suture line would probably be bilious. Ascites is not commonly blood tinged. Correct Answer: A 51-year-old woman underwent a Billroth II subtotal gastrectomy for carcinoma of the stomach 6 days ago. She had been recovering well except for persistent ileus. On morning rounds, you notice a large amount of serosan- guinous drainage on her gown. The most likely diagnosis is: (A) Wound dehiscence (B) Wound infection (C) Leak at the gastrojejunostomy anastomosis (D) Leak from the duodenal stump (E) Ascites A. Aortic stenosis Correct Answer: A 49-yo man presents after he fainted while running on his treadmill at home. He has been having exertional dyspnea and angina for the past several months. Which of the following cardiac diseases is most likely to cause these symptoms? A. Aortic stenosis B. Atrial septal defect C. Mitral incompetence D. Pulmonary stenosis E. Tricuspid incompetence D. Encephalopathy Correct Answer: The hypertensive emergency that is most easily reversible with pharmaceutical management is: A. Acute coronary syndrome B. Aortic dissection C. Eclampsia/preeclampsia D. Encephalopathy E. Intracranial hemorrhage A. Associated with ST-segment depression in V1 Correct Answer: Which of the following statements regarding posterior wall infarction is correct? A. Associated with ST-segment depression in V1 B. ECG shows an inverted T wave in V1 C. ECG shows large S waves in V1 D. Occurs in 5% of all acute MIs E. Results from occlusion of the left anterior descending artery B. β-Blocking agents might improve cardiac output Correct Answer: Regarding treatment of heart failure in patients with diastolic rather than systolic dysfunction: A. Aggressive therapy with diuretics is more effective B. β-Blocking agents might improve cardiac output C. Both are associated with impaired cardiac contractility D. Most patients with CHF have diastolic dysfunction E. Ventricular filling pressures are higher in systolic dysfunction than in diastolic dysfunction E. Reduces the work of breathing Correct Answer: Which of the following statements regarding the use of continuous positive airway pressure therapy in pulmonary edema is correct? A. Decreases left ventricular preload and increases afterload B. Decreases mortality rates C. Increases the effective Fio2 delivered D. Lowers intrathoracic pressure E. Reduces the work of breathing C. Helical CT chest scan Correct Answer: The most specific diagnostic test that can be obtained most rapidly for an emergency department patient to make the initial diagnosis of aortic dissection is: A. 12-lead ECG B. Aortic angiography C. Helical CT chest scan D.Portable chest x-ray E. Transesophageal echocardiography A.Paroxysmal supraventricular tachycardia Correct Answer: Which of the following is the most common ECG abnormality associated with mitral valve prolapse? A.Paroxysmal supraventricular tachycardia B. QT prolongation C. Rapid atrial fibrillation D. ST-segment depression in leads II, III, and aVF E. Ventricular tachycardia