PANCE Practice Exam #2 Exam Prep Questions And Answers (202472025)
You are treating a 20-year-old female with multiple aphthous ulcers. She complains of a moderate
amount of pain. You decide to prescribe "magic mouthwash" for the patient to swish and spit.
Which of the following combinations of medicines is appropriate? - ✔✔A very commonly used
combination of medicines to promote relief of discomfort and healing include liquid
diphenhydramine, antacid, tetracycline, and 2% viscous xylocaine.
A 17-year-old male is brought to your Emergency Department by his girlfriend. She states that he
has been behaving strangely for the last three days, with rapidly fluctuating moods ranging from
euphoric to irritable and paranoid. The patient states that he is fine, just a little nervous about an
upcoming test in school. His pulse is 126 beats per minute, BP 182/106, pupils are widely dilated,
and he is diaphoretic. What is his most likely diagnosis?
A. Acute anxiety
B. Bipolar disorder
C. Cocaine intoxication
D. Heroin intoxication - ✔✔he answer is C.
EXPLANATION: This patient's presentation with tachycardia, hypertension, diaphoresis, and
mydriasis along with the behavioral changes is consistent with cocaine intoxication
cause somnolence and pinpoint pupils - ✔✔Heroin withdrawal
A 67-year-old man presents with pain and stiffness in his shoulders and hips lasting for several
weeks with no history of trauma. He also has complaints of headache, throat pain, and jaw
claudication. It is imperative to diagnose this patient promptly in order to prevent which of the
following complications?
A. anemia
B. cerebral aneurysms
C. mononeuritis multiplex
D. ischemic optic neuropathy
E. respiratory tract complications - ✔✔The answer is D.
EXPLANATION: The most urgent need for diagnosis of a patient with symptoms of polymyalgia
rheumatica (PMR) and giant cell arteritis is to prevent blindness caused by ischemic optic
neuropathy as a result of occlusive arteritis of the ophthalmic artery. Early diagnosis is imperative
,as the neurological damage to the optic nerve is not reversible. Most patients with this diagnosis
will have a normochromic-normocytic anemia, but this does not create urgency in treatment.
Cerebral aneurysms are not common findings with PMR; large vessels such as the subclavian and
aorta may be involved in giant cell arthritis in 15% of patients. Mononeuritis multiplex commonly
presents with painful paralysis of a shoulder, and respiratory tract complications are more
nonclassic findings with the presentation of PMR.
During an ophthalmoscopic exam you notice deep retinal microvascular hemorrhages, and cotton
wool spots. What is the most likely cause of her visual disorder? - ✔✔The answer is D.
Diabetic retinopathy-EXPLANATION: The patient's symptoms suggest a likelihood of diabetes.
Retinal findings can include microaneurysms, deep hemorrhages, a flame-shaped hemorrhage,
exudates, and cotton wool spots.
A newborn male is diagnosed with Christmas factor deficiency. What is the likelihood that he
inherited this disorder from his father?
A. 0%
B. 25%
C. 50% - ✔✔The answer is A.
EXPLANATION: All daughters of a hemophilic male are carriers of hemophilia, whereas all sons
are normal. Hemophilia B (or Christmas factor deficiency) is one of only two sex-linked pattern-
bleeding disorders, and as such the disease occurs almost exclusively in males. Sons of carriers
have a 50% chance of being affected and daughters of carriers have a 50% chance of being carriers
themselves.
A 2-month-old female presents for a well child check. The mother has no concerns and feels that
the child is doing well. On exam, there is no evidence of cyanosis and the peripheral pulses are
normal and equal. However, there is a fixed and widely split S2, a right ventricular heave, and a
systolic ejection murmur present. The murmur is heard best at the left sternal border second
intercostal space. What is the most common abnormality present on an ECG?
A. Atrioventricular heart block
B. Atrial fibrillation
C. Bifasicular block
D. Right axis deviation - ✔✔The answer is D.
,EXPLANATION: The most likely diagnosis is an atrial septal defect, which usually shows right
axis deviation on ECG. The other ECG abnormalities listed do not commonly occur with an atrial
septal defect.
A 28-year-old male smoker presents witha complaint of numbness and pain in his fingers. He
notices thisafter being exposed to the cold. He states that his fingers appearpale or even blue at
times. After warming, his fingers turn redbefore returning to their normal color. What should be
includedin appropriate management of this condition?
A. Counsel the patient to stop smoking
B. Systemic glucocorticoids
C. Take aspirin prior to cold exposure - ✔✔The answer is A.
EXPLANATION: This patient is experiencing Raynaud phenomenon. This is digitalischemia that
can occur after exposure to cold or emotional stress. It is more common in smokers or patients
whose occupation involvesusing vibratory tools. Management includes patient education toinclude
cold avoidance behavior and wearing loose-fitting clothing.Cessation of smoking is imperative.
Drug therapy is used in patientswith progressive and severe Raynaud's.
A 45-year-old woman presents with weight gain, fatigue, dry skin, constipation, and
oligomenorrhea. On physical exam, bradycardia and slow deep tendon reflexes are noted. Her free
T4 is low and TSH is elevated. Which of the following medications may be responsible for her
condition?
A. amiodarone
B. beta-blockers
C. levadopa - ✔✔The answer is A.
EXPLANATION: Hypothyroidism is reported in up to 10% of patients taking amiodarone, an
antiarrhythmic medication. With the high iodine content of the medication and the structural
similarities to thyroxine, thyroid abnormalities occur. Common side effects of amiodarone include
bradycardia and constipation, so laboratory evaluation for thyroid dysfunction must be used.
Common side effects of amiodarone - ✔✔include bradycardia and constipation, so laboratory
evaluation for thyroid dysfunction must be used.
A 3-week-old male infant is brought in by his mother due to his vomiting. The mother notes that
a few days ago her son started vomiting after feeding, and it has become projectile in nature. The
, vomitus is non-bilious and contains no blood. The child seems hungry and nurses regularly, but
the vomiting has become more frequent and is occurring with every feeding now. On physical
examination, an oval mass is palpated in the right upper quadrant. Appropriate imaging is obtained
and confirms the suspected diagnosis. What is the treatment of choice in this patient?
A. Acid supression
B. Dilatation of the lower esophageal sphincter
C. Diverting colostomy
D. Ladd procedure
E. Pyloromyotomy - ✔✔The answer is E.
EXPLANATION: A pyloromyotomy involves an incision along the length of the pylorus, down
to the mucosa, and is the treatment of choice in pyloric stenosis. Acid suppression is the treatment
of choice in cases of peptic ulcer disease. Dilatation of the LES is performed in cases of achalasia
of the esophagus. A diverting colostomy may be used in cases of Hirschsprung disease, after
removal of the aganglionic section of colon. The Ladd procedure is used in surgical treatment of
intestinal malrotation.
The rotator cuff is comprised of which four muscles? - ✔✔Supraspinatus, infraspinatus, teres
minor, subscapularis
The patient has a family history of thyroid cancer. You are concerned that the patient may have
medullary thyroid cancer. Which of the following lab tests would you monitor in this patient after
treatment? - ✔✔serum calcitonin. Both calcitonin and CEA are secreted by medullary thyroid
cancer cells, and are used both in diagnosis and monitoring of patients after treatment.
Alkaline phosphatase, is elevated in disorders of the - ✔✔bone and biliary tract.
serum anti-thyroglobulin antibodies, are most commonly associated with - ✔✔autoimmune
disorders of the thyroid, such as Hashimoto's thyroiditis.
Serum CA-125 has been used to investigate and follow patients with malignancies, such as? -
✔✔ovarian cancer
You are treating a 20-year-old female with multiple aphthous ulcers. She complains of a moderate
amount of pain. You decide to prescribe "magic mouthwash" for the patient to swish and spit.
Which of the following combinations of medicines is appropriate? - ✔✔A very commonly used
combination of medicines to promote relief of discomfort and healing include liquid
diphenhydramine, antacid, tetracycline, and 2% viscous xylocaine.
A 17-year-old male is brought to your Emergency Department by his girlfriend. She states that he
has been behaving strangely for the last three days, with rapidly fluctuating moods ranging from
euphoric to irritable and paranoid. The patient states that he is fine, just a little nervous about an
upcoming test in school. His pulse is 126 beats per minute, BP 182/106, pupils are widely dilated,
and he is diaphoretic. What is his most likely diagnosis?
A. Acute anxiety
B. Bipolar disorder
C. Cocaine intoxication
D. Heroin intoxication - ✔✔he answer is C.
EXPLANATION: This patient's presentation with tachycardia, hypertension, diaphoresis, and
mydriasis along with the behavioral changes is consistent with cocaine intoxication
cause somnolence and pinpoint pupils - ✔✔Heroin withdrawal
A 67-year-old man presents with pain and stiffness in his shoulders and hips lasting for several
weeks with no history of trauma. He also has complaints of headache, throat pain, and jaw
claudication. It is imperative to diagnose this patient promptly in order to prevent which of the
following complications?
A. anemia
B. cerebral aneurysms
C. mononeuritis multiplex
D. ischemic optic neuropathy
E. respiratory tract complications - ✔✔The answer is D.
EXPLANATION: The most urgent need for diagnosis of a patient with symptoms of polymyalgia
rheumatica (PMR) and giant cell arteritis is to prevent blindness caused by ischemic optic
neuropathy as a result of occlusive arteritis of the ophthalmic artery. Early diagnosis is imperative
,as the neurological damage to the optic nerve is not reversible. Most patients with this diagnosis
will have a normochromic-normocytic anemia, but this does not create urgency in treatment.
Cerebral aneurysms are not common findings with PMR; large vessels such as the subclavian and
aorta may be involved in giant cell arthritis in 15% of patients. Mononeuritis multiplex commonly
presents with painful paralysis of a shoulder, and respiratory tract complications are more
nonclassic findings with the presentation of PMR.
During an ophthalmoscopic exam you notice deep retinal microvascular hemorrhages, and cotton
wool spots. What is the most likely cause of her visual disorder? - ✔✔The answer is D.
Diabetic retinopathy-EXPLANATION: The patient's symptoms suggest a likelihood of diabetes.
Retinal findings can include microaneurysms, deep hemorrhages, a flame-shaped hemorrhage,
exudates, and cotton wool spots.
A newborn male is diagnosed with Christmas factor deficiency. What is the likelihood that he
inherited this disorder from his father?
A. 0%
B. 25%
C. 50% - ✔✔The answer is A.
EXPLANATION: All daughters of a hemophilic male are carriers of hemophilia, whereas all sons
are normal. Hemophilia B (or Christmas factor deficiency) is one of only two sex-linked pattern-
bleeding disorders, and as such the disease occurs almost exclusively in males. Sons of carriers
have a 50% chance of being affected and daughters of carriers have a 50% chance of being carriers
themselves.
A 2-month-old female presents for a well child check. The mother has no concerns and feels that
the child is doing well. On exam, there is no evidence of cyanosis and the peripheral pulses are
normal and equal. However, there is a fixed and widely split S2, a right ventricular heave, and a
systolic ejection murmur present. The murmur is heard best at the left sternal border second
intercostal space. What is the most common abnormality present on an ECG?
A. Atrioventricular heart block
B. Atrial fibrillation
C. Bifasicular block
D. Right axis deviation - ✔✔The answer is D.
,EXPLANATION: The most likely diagnosis is an atrial septal defect, which usually shows right
axis deviation on ECG. The other ECG abnormalities listed do not commonly occur with an atrial
septal defect.
A 28-year-old male smoker presents witha complaint of numbness and pain in his fingers. He
notices thisafter being exposed to the cold. He states that his fingers appearpale or even blue at
times. After warming, his fingers turn redbefore returning to their normal color. What should be
includedin appropriate management of this condition?
A. Counsel the patient to stop smoking
B. Systemic glucocorticoids
C. Take aspirin prior to cold exposure - ✔✔The answer is A.
EXPLANATION: This patient is experiencing Raynaud phenomenon. This is digitalischemia that
can occur after exposure to cold or emotional stress. It is more common in smokers or patients
whose occupation involvesusing vibratory tools. Management includes patient education toinclude
cold avoidance behavior and wearing loose-fitting clothing.Cessation of smoking is imperative.
Drug therapy is used in patientswith progressive and severe Raynaud's.
A 45-year-old woman presents with weight gain, fatigue, dry skin, constipation, and
oligomenorrhea. On physical exam, bradycardia and slow deep tendon reflexes are noted. Her free
T4 is low and TSH is elevated. Which of the following medications may be responsible for her
condition?
A. amiodarone
B. beta-blockers
C. levadopa - ✔✔The answer is A.
EXPLANATION: Hypothyroidism is reported in up to 10% of patients taking amiodarone, an
antiarrhythmic medication. With the high iodine content of the medication and the structural
similarities to thyroxine, thyroid abnormalities occur. Common side effects of amiodarone include
bradycardia and constipation, so laboratory evaluation for thyroid dysfunction must be used.
Common side effects of amiodarone - ✔✔include bradycardia and constipation, so laboratory
evaluation for thyroid dysfunction must be used.
A 3-week-old male infant is brought in by his mother due to his vomiting. The mother notes that
a few days ago her son started vomiting after feeding, and it has become projectile in nature. The
, vomitus is non-bilious and contains no blood. The child seems hungry and nurses regularly, but
the vomiting has become more frequent and is occurring with every feeding now. On physical
examination, an oval mass is palpated in the right upper quadrant. Appropriate imaging is obtained
and confirms the suspected diagnosis. What is the treatment of choice in this patient?
A. Acid supression
B. Dilatation of the lower esophageal sphincter
C. Diverting colostomy
D. Ladd procedure
E. Pyloromyotomy - ✔✔The answer is E.
EXPLANATION: A pyloromyotomy involves an incision along the length of the pylorus, down
to the mucosa, and is the treatment of choice in pyloric stenosis. Acid suppression is the treatment
of choice in cases of peptic ulcer disease. Dilatation of the LES is performed in cases of achalasia
of the esophagus. A diverting colostomy may be used in cases of Hirschsprung disease, after
removal of the aganglionic section of colon. The Ladd procedure is used in surgical treatment of
intestinal malrotation.
The rotator cuff is comprised of which four muscles? - ✔✔Supraspinatus, infraspinatus, teres
minor, subscapularis
The patient has a family history of thyroid cancer. You are concerned that the patient may have
medullary thyroid cancer. Which of the following lab tests would you monitor in this patient after
treatment? - ✔✔serum calcitonin. Both calcitonin and CEA are secreted by medullary thyroid
cancer cells, and are used both in diagnosis and monitoring of patients after treatment.
Alkaline phosphatase, is elevated in disorders of the - ✔✔bone and biliary tract.
serum anti-thyroglobulin antibodies, are most commonly associated with - ✔✔autoimmune
disorders of the thyroid, such as Hashimoto's thyroiditis.
Serum CA-125 has been used to investigate and follow patients with malignancies, such as? -
✔✔ovarian cancer
