PANCE Practice Exam 1 Q&A 2023

1. A 52 year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the past few months. During his physical examination, you 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 - Answer- 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 - Answer- 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 - Answer- 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