PANCE Practice Exam #3 Exam Prep Questions And Answers (202472025)
cornea steamy, and the pupil moderately dilated and nonreactive to light. - ✔✔acute bacterial
conjunctivitis
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. What laboratory finding is most
consistent with the suspected diagnosis?
A. Decreased hematocrit
B. Elevated amylase
C. Hyperkalemia
D. Hypochloremic alkalosis - ✔✔The answer is D.
Laboratory findings that are consistent with the suspected diagnosis of pyloric stenosis include
hypochloremic alkalosis with potassium depletion. An elevated hemoglobin and hematocrit can
also be present, and are due to dehydration. Changes in amylase or serum sodium are not present
in cases of pyloric stenosis.
A 39-year-old man presents to the emergency department with massive hematemesis. His physical
examination reveals slight jaundice, palmar erythema, spider angiomas, and marked ascites. Vitals
at the time of presentation are as follows: BP: 85/44 mm Hg, P: 122/min, R: 16/min, oxygen
saturation: 96%, and T: 99.8°F. Which of the following is the most likely cause of the massive
hematemesis?
A. Peptic ulcer disease
B. Mallory-Weiss tear
C. Gastric carcinoma
D. Arteriovenous malformation
E. Esophageal varices - ✔✔The answer is E.
EXPLANATION: The most common cause of massive upper gastrointestinal bleeding in patients
with cirrhosis is esophageal varices. Although 20% of patients with portal hypertension will have
bleeding from other causes (peptic ulcer disease, Mallory-Weiss tears, or gastritis), endoscopic
evaluation in patients with portal hypertension is necessary for diagnosis and initial therapy.
,A two-month-old bottle fed infant female presents with a sharply demarcated scaling red rash on
the face and in the diaper area. The mother reports that her child has been irritable and has had
diarrhea. The primary care provider has treated with hydrocortisone 2.5% ointment bid for two
weeks with no improvement. What should be the next step in confirming the diagnosis?
A. punch biopsy at border of genital rash
B. bacterial culture and viral culture
C. KOH and bacterial culture
D. cbc with diff and Zn level - ✔✔The answer is D.
EXPLANATION: This infant is displaying classic signs of zinc deficiency. This disorder can
occur in infants who are bottle fed. Treatment with topical steroids will not improve the condition
until the zinc level is corrected. A punch biopsy would not help in diagnosing the zinc deficiency
that this patient is exhibiting. Bacterial and viral cultures will not be helpful in establishing the
diagnosis. A KOH is used to diagnose fungal infections. The KOH and bacterial culture will not
be helpful in establishing the diagnosis of zinc deficiency.
A 56-year-old male is diagnosed with an H. pylori associated ulcer. The ulcer was 0.8 mm in size
on endoscopy. He is placed on a proton pump inhibitor, clarithromycin, and amoxicillin. If his
dyspeptic symptoms resolve after starting this regimen, how many days should he take the proton
pump inhibitor to complete the treatment?
A. 5 to 7 days
B. 10 to 14 days
C. 14 to 21 days - ✔✔The answer is B.
EXPLANATION: In an H. pylori associated ulcer that is < 1cm in size and dyspeptic symptoms
resolve with therapy, 10 to 14 days is the recommended length of treatment. For patients with large
or complicated ulcers, antisecretory therapy should be continued for an addition two to four weeks
(duodenal ulcer) or four to six weeks (gastric ulcer) after completion of the antibiotic regimen.
A 26-year-old woman has decreased appetite, weight gain, cold intolerance, hoarse voice,
constipation, and arthralgias. What is the most likely etiology of her condition?
A. autoimmune thyroiditis
B. congenital hypothyroidism
C. dietary iodine deficiency
,D. surgical resection of the thyroid gland - ✔✔The answer is A.
EXPLANATION: Auto immune thyroiditis is the most common cause of hypothyroidism in the
United States. Dietary iodine deficiency is the most common cause in underdeveloped regions of
the world.
A patient is recovering from having a total thyroidectomy two days ago for medullary thyroid
cancer. An extensive neck dissection was required during the surgery. Post-operative lab testing
reveals a low serum calcium level. Which of the following clinical presentations will most likely
occur in this patient?
A. Constipation
B. Anorexia
C. Polyuria
D. Bone pain
E. Paresthesias - ✔✔The answer is E.
The correct choice is E, paresthesias. Circumoral paresthesias are signs of hypocalcemia.
Hypocalcemia can occur after any type of neck surgery that may have resulted in destruction of
the parathyroid glands. Choices A through D are symptoms of hypercalcemia and may be seen in
hyperparathyroidism.
A 51-year-old male patient presents to your family practice office complaining of genital
discomfort with dysuria. His digital rectal exam reveals an enlarged, tender prostate. His prostate-
specific antigen (PSA) returns elevated with a value of 11.1 mg/mL, which you fractionate, and
this reveals approximately 75% free PSA. His urinalysis reveals moderate white cells and trace
blood. What would be your next step in treating this patient?
A. Begin him on 6 weeks of doxycycline to treat his prostatitis and when resolved, repeat his PSA
level.
B. Immediately refer him to a urologist for prostate biopsy to rule out prostate cancer.
C. Immediately refer him to a urologist for cystoscopy to rule out bladder cancer and perform a
computed tomography (CT) scan of the abdomen and pelvis in the interim. - ✔✔The answer is A.
EXPLANATION: This patient has signs and symptoms consistent with prostatitis. Additionally,
while his PSA is elevated, this is common in prostatits as well as prostate cancer, and his free PSA
is of a percentage that prostate cancer is unlikely. However, it would be prudent to recheck his
PSA after treatment and resolution of his symptoms to confirm that an underlying cancer is not
smoldering.
, A 52-year-old female with a past medical history of dyslipidemia, GERD, hypothyroidism, and
osteoarthritis presents with a gradual progression of fatigue and pallor over the last few months.
Initial CBC results show a hemoglobin of 10.7 mg/dL, hematocrit of 33%, an MCV of 117 fL, and
a reticulocyte count of 0.0%. Which of the following medications should be considered as a
potential cause of her anemia?
A. Celecoxib
B. Cholestyramine
C. Levothyroxine
D. Omeprazole
E. Ranitidine - ✔✔The answer is B.
EXPLANATION: Cholestyramine is associated with folate malabsorption and may rarely be a
medication cause for macrocytic anemia.
A 36-year-old male returns to the office for follow up of his heartburn symptoms. He continues to
have heartburn three to four times a week, even though he has been compliant with his proton
pump inhibitor medication since it was prescribed three months ago. He underwent an endoscopy
three weeks ago, which was normal. He denies dysphagia, early satiety, or weight loss. Which of
the following tests is the most appropriate next step in evaluating this patient?
A. Repeat endoscopy
B. Barium esophagography
C. Esophageal manometry
D. Abdominal CT scan
E. Urea breath test - ✔✔The answer is C.
EXPLANATION: Esophageal monometry is the answer, and this is useful in patients who have
persistent symptoms, despite PPI therapy and individuals who have had normal findings on
endoscopy. There is no reason to repeat the endoscopy, as the first one was normal. Barium
esophagography plays a limited role in GERD, and could be helpful if the patient complained of
dysphagia. Abdominal CT is not indicated in this case. Urea breath test is used in the detection of
H. pylori, which is an uncommon cause of dyspepsia in the absence of peptic ulcer disease.
A 77-year-old female has been treated for the last two weeks for a community-acquired
pneumonia. While on oral azithromycin, the patient continues to develop fevers, some as high as
1030F. Her oral intake has decreased, and her effort to breathe continues to be labored. On
cornea steamy, and the pupil moderately dilated and nonreactive to light. - ✔✔acute bacterial
conjunctivitis
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. What laboratory finding is most
consistent with the suspected diagnosis?
A. Decreased hematocrit
B. Elevated amylase
C. Hyperkalemia
D. Hypochloremic alkalosis - ✔✔The answer is D.
Laboratory findings that are consistent with the suspected diagnosis of pyloric stenosis include
hypochloremic alkalosis with potassium depletion. An elevated hemoglobin and hematocrit can
also be present, and are due to dehydration. Changes in amylase or serum sodium are not present
in cases of pyloric stenosis.
A 39-year-old man presents to the emergency department with massive hematemesis. His physical
examination reveals slight jaundice, palmar erythema, spider angiomas, and marked ascites. Vitals
at the time of presentation are as follows: BP: 85/44 mm Hg, P: 122/min, R: 16/min, oxygen
saturation: 96%, and T: 99.8°F. Which of the following is the most likely cause of the massive
hematemesis?
A. Peptic ulcer disease
B. Mallory-Weiss tear
C. Gastric carcinoma
D. Arteriovenous malformation
E. Esophageal varices - ✔✔The answer is E.
EXPLANATION: The most common cause of massive upper gastrointestinal bleeding in patients
with cirrhosis is esophageal varices. Although 20% of patients with portal hypertension will have
bleeding from other causes (peptic ulcer disease, Mallory-Weiss tears, or gastritis), endoscopic
evaluation in patients with portal hypertension is necessary for diagnosis and initial therapy.
,A two-month-old bottle fed infant female presents with a sharply demarcated scaling red rash on
the face and in the diaper area. The mother reports that her child has been irritable and has had
diarrhea. The primary care provider has treated with hydrocortisone 2.5% ointment bid for two
weeks with no improvement. What should be the next step in confirming the diagnosis?
A. punch biopsy at border of genital rash
B. bacterial culture and viral culture
C. KOH and bacterial culture
D. cbc with diff and Zn level - ✔✔The answer is D.
EXPLANATION: This infant is displaying classic signs of zinc deficiency. This disorder can
occur in infants who are bottle fed. Treatment with topical steroids will not improve the condition
until the zinc level is corrected. A punch biopsy would not help in diagnosing the zinc deficiency
that this patient is exhibiting. Bacterial and viral cultures will not be helpful in establishing the
diagnosis. A KOH is used to diagnose fungal infections. The KOH and bacterial culture will not
be helpful in establishing the diagnosis of zinc deficiency.
A 56-year-old male is diagnosed with an H. pylori associated ulcer. The ulcer was 0.8 mm in size
on endoscopy. He is placed on a proton pump inhibitor, clarithromycin, and amoxicillin. If his
dyspeptic symptoms resolve after starting this regimen, how many days should he take the proton
pump inhibitor to complete the treatment?
A. 5 to 7 days
B. 10 to 14 days
C. 14 to 21 days - ✔✔The answer is B.
EXPLANATION: In an H. pylori associated ulcer that is < 1cm in size and dyspeptic symptoms
resolve with therapy, 10 to 14 days is the recommended length of treatment. For patients with large
or complicated ulcers, antisecretory therapy should be continued for an addition two to four weeks
(duodenal ulcer) or four to six weeks (gastric ulcer) after completion of the antibiotic regimen.
A 26-year-old woman has decreased appetite, weight gain, cold intolerance, hoarse voice,
constipation, and arthralgias. What is the most likely etiology of her condition?
A. autoimmune thyroiditis
B. congenital hypothyroidism
C. dietary iodine deficiency
,D. surgical resection of the thyroid gland - ✔✔The answer is A.
EXPLANATION: Auto immune thyroiditis is the most common cause of hypothyroidism in the
United States. Dietary iodine deficiency is the most common cause in underdeveloped regions of
the world.
A patient is recovering from having a total thyroidectomy two days ago for medullary thyroid
cancer. An extensive neck dissection was required during the surgery. Post-operative lab testing
reveals a low serum calcium level. Which of the following clinical presentations will most likely
occur in this patient?
A. Constipation
B. Anorexia
C. Polyuria
D. Bone pain
E. Paresthesias - ✔✔The answer is E.
The correct choice is E, paresthesias. Circumoral paresthesias are signs of hypocalcemia.
Hypocalcemia can occur after any type of neck surgery that may have resulted in destruction of
the parathyroid glands. Choices A through D are symptoms of hypercalcemia and may be seen in
hyperparathyroidism.
A 51-year-old male patient presents to your family practice office complaining of genital
discomfort with dysuria. His digital rectal exam reveals an enlarged, tender prostate. His prostate-
specific antigen (PSA) returns elevated with a value of 11.1 mg/mL, which you fractionate, and
this reveals approximately 75% free PSA. His urinalysis reveals moderate white cells and trace
blood. What would be your next step in treating this patient?
A. Begin him on 6 weeks of doxycycline to treat his prostatitis and when resolved, repeat his PSA
level.
B. Immediately refer him to a urologist for prostate biopsy to rule out prostate cancer.
C. Immediately refer him to a urologist for cystoscopy to rule out bladder cancer and perform a
computed tomography (CT) scan of the abdomen and pelvis in the interim. - ✔✔The answer is A.
EXPLANATION: This patient has signs and symptoms consistent with prostatitis. Additionally,
while his PSA is elevated, this is common in prostatits as well as prostate cancer, and his free PSA
is of a percentage that prostate cancer is unlikely. However, it would be prudent to recheck his
PSA after treatment and resolution of his symptoms to confirm that an underlying cancer is not
smoldering.
, A 52-year-old female with a past medical history of dyslipidemia, GERD, hypothyroidism, and
osteoarthritis presents with a gradual progression of fatigue and pallor over the last few months.
Initial CBC results show a hemoglobin of 10.7 mg/dL, hematocrit of 33%, an MCV of 117 fL, and
a reticulocyte count of 0.0%. Which of the following medications should be considered as a
potential cause of her anemia?
A. Celecoxib
B. Cholestyramine
C. Levothyroxine
D. Omeprazole
E. Ranitidine - ✔✔The answer is B.
EXPLANATION: Cholestyramine is associated with folate malabsorption and may rarely be a
medication cause for macrocytic anemia.
A 36-year-old male returns to the office for follow up of his heartburn symptoms. He continues to
have heartburn three to four times a week, even though he has been compliant with his proton
pump inhibitor medication since it was prescribed three months ago. He underwent an endoscopy
three weeks ago, which was normal. He denies dysphagia, early satiety, or weight loss. Which of
the following tests is the most appropriate next step in evaluating this patient?
A. Repeat endoscopy
B. Barium esophagography
C. Esophageal manometry
D. Abdominal CT scan
E. Urea breath test - ✔✔The answer is C.
EXPLANATION: Esophageal monometry is the answer, and this is useful in patients who have
persistent symptoms, despite PPI therapy and individuals who have had normal findings on
endoscopy. There is no reason to repeat the endoscopy, as the first one was normal. Barium
esophagography plays a limited role in GERD, and could be helpful if the patient complained of
dysphagia. Abdominal CT is not indicated in this case. Urea breath test is used in the detection of
H. pylori, which is an uncommon cause of dyspepsia in the absence of peptic ulcer disease.
A 77-year-old female has been treated for the last two weeks for a community-acquired
pneumonia. While on oral azithromycin, the patient continues to develop fevers, some as high as
1030F. Her oral intake has decreased, and her effort to breathe continues to be labored. On
