PANCE Review Course Part 1: Essential Exam Prep Guide
Coronary artery aneurysm
1. A 3 year-old male presents to the emergency depart-
ment for the evaluation of a persistent fever for five
days, as high as 103F (tympanic). He was seen in an
outpatient clinic three days ago; the diagnosis at that S1
time was viral syndrome. Today, he woke with bilateral
"pink eye," cracked bleeding lips, and peeling skin of
the palms and soles. He has a bright red tongue, bi-
lateral cervical adenopathy, injected conjunctivae and
dry fissured lips. What is the most significant compli-
cation of this condition?
2. A 47 year-old male construction worker was lifting a
75 pound bag of cement when he twisted and injured
his back. He presents complaining of lumbar back
pain with radiating pain into his right lower extremity.
He denies any other trauma. He has never injured his
back before. He denies loss of bladder or bowel func-
tion. He is noted to have decreased sensation over the
heel and lateral border of his right foot. Right lower
extremity strength is measured as follows: quadriceps
5/5, peroneals 3/5, EHL 5/5, EDL 5/5, gastrocnemius
4/5. Based on this assessment, which nerve root is
most likely involved?
, PANCE Review Course Part 1: Essential Exam Prep Guide
3. A 33 year-old male presents with fever, dry cough, and TMP-SMX
progressive dyspnea worsening over the past three
weeks. In addition to the pulmonary complaints he
has noted profound fatigue and a seven pound weight
loss. The patient has known HIV disease; recent CD4
count 170; viral load undetectable. On examination,
his temperature is 102F (oral), heart rate 110, respira-
tions 32, blood pressure 135/90. Examination: tachy-
, PANCE Review Course Part 1: Essential Exam Prep Guide
cardia and scattered crackles noted. A chest X-ray
shows diffuse bilateral interstitial infiltrates. What is
the most appropriate treatment for this patient?
4. A 22 year-old college athlete injured his back while Spondylolisthesis
doing dead lifts in the weight room. For two weeks,
his pain remained localized to the lumbar region and
is aggravated with exercise, specifically movements
that involve extension. The past three days the pain
has started to progressively radiate into his buttocks,
hamstrings and down his right leg. X-rays identify a
30% anterior vertebral displacement of L5 on S1. What
is the correct term to describe the X-ray findings?
5. A 67 year-old male is evaluated for headaches, fatigue S4, R-wave of 14mm in
and difficulty sleeping. His BP is 210/106. He reports lead aVL
that he was prescribed antihypertensive medications
over 10 years ago, but has not been very good about
taking his medicine. What heart sound and ECG find-
ing is most indicative of long-standing, uncontrolled
hypertension?
6. A patient has an echocardiogram performed. The Delayed carotid pulsation
echocardiogram report describes a left ventricle that
is mildly hypertrophic and grades the stenotic lesion
as "high grade." What physical examination finding is
most likely to be identified during the examination of
this patient?
7. A 64 year-old smoker presents to the clinic with a his- Primary polycythemia vera
tory of dyspnea, headache and malaise. CBC reports
Hgb 19.2 (H), Hct 59 (H), platelets 650,000 (H). WBC is
, PANCE Review Course Part 1: Essential Exam Prep Guide
also slightly elevated at 21,000. What is the most likely
diagnosis?
8. A 49 year-old patient with long-standing alcohol use Prednisolone
and cirrhosis is admitted to the hospital with rapid
onset jaundice, nausea and weakness. He admits to
drinking alcohol up until the time of admission. His
transaminases are significantly elevated and INR is
2.5. An abdominal ultrasound shows moderate as-
cites; no masses or biliary obstruction. What interven-
tion would most improve the short-term survival of
this patient?
9. Enlargement of which lymph nodes is most sugges- Posterior cervical
tive that a patient with pharyngitis has infectious
mononucleosis?
10. What is an indication to order a dobutamine cardiac Symptomatic aortic steno-
stress test rather than a treadmill stress test with sis
echocardiogram or treadmill ECG?
11. A G1P0 patient at 32 weeks gestation has been in Vaginal delivery with stim-
labor for 3 days with ruptured membranes. She has ulated labor
been hospitalized on bed rest. Today she develops
a fever (101.2F). A sterile vaginal exam reveals 9 cm
dilation and 50% effacement. What is the best man-
agement option at this time?
12. A 59 year-old female presents inquiring about lung Refer to pulmonology for
cancer screening. She was diagnosed with COPD 8 bronchoscopy and biopsy
years ago and currently using ipratropium/albuterol
and formoterol. On further questioning she discloses
that she has noticed a slight increase in her cough
Coronary artery aneurysm
1. A 3 year-old male presents to the emergency depart-
ment for the evaluation of a persistent fever for five
days, as high as 103F (tympanic). He was seen in an
outpatient clinic three days ago; the diagnosis at that S1
time was viral syndrome. Today, he woke with bilateral
"pink eye," cracked bleeding lips, and peeling skin of
the palms and soles. He has a bright red tongue, bi-
lateral cervical adenopathy, injected conjunctivae and
dry fissured lips. What is the most significant compli-
cation of this condition?
2. A 47 year-old male construction worker was lifting a
75 pound bag of cement when he twisted and injured
his back. He presents complaining of lumbar back
pain with radiating pain into his right lower extremity.
He denies any other trauma. He has never injured his
back before. He denies loss of bladder or bowel func-
tion. He is noted to have decreased sensation over the
heel and lateral border of his right foot. Right lower
extremity strength is measured as follows: quadriceps
5/5, peroneals 3/5, EHL 5/5, EDL 5/5, gastrocnemius
4/5. Based on this assessment, which nerve root is
most likely involved?
, PANCE Review Course Part 1: Essential Exam Prep Guide
3. A 33 year-old male presents with fever, dry cough, and TMP-SMX
progressive dyspnea worsening over the past three
weeks. In addition to the pulmonary complaints he
has noted profound fatigue and a seven pound weight
loss. The patient has known HIV disease; recent CD4
count 170; viral load undetectable. On examination,
his temperature is 102F (oral), heart rate 110, respira-
tions 32, blood pressure 135/90. Examination: tachy-
, PANCE Review Course Part 1: Essential Exam Prep Guide
cardia and scattered crackles noted. A chest X-ray
shows diffuse bilateral interstitial infiltrates. What is
the most appropriate treatment for this patient?
4. A 22 year-old college athlete injured his back while Spondylolisthesis
doing dead lifts in the weight room. For two weeks,
his pain remained localized to the lumbar region and
is aggravated with exercise, specifically movements
that involve extension. The past three days the pain
has started to progressively radiate into his buttocks,
hamstrings and down his right leg. X-rays identify a
30% anterior vertebral displacement of L5 on S1. What
is the correct term to describe the X-ray findings?
5. A 67 year-old male is evaluated for headaches, fatigue S4, R-wave of 14mm in
and difficulty sleeping. His BP is 210/106. He reports lead aVL
that he was prescribed antihypertensive medications
over 10 years ago, but has not been very good about
taking his medicine. What heart sound and ECG find-
ing is most indicative of long-standing, uncontrolled
hypertension?
6. A patient has an echocardiogram performed. The Delayed carotid pulsation
echocardiogram report describes a left ventricle that
is mildly hypertrophic and grades the stenotic lesion
as "high grade." What physical examination finding is
most likely to be identified during the examination of
this patient?
7. A 64 year-old smoker presents to the clinic with a his- Primary polycythemia vera
tory of dyspnea, headache and malaise. CBC reports
Hgb 19.2 (H), Hct 59 (H), platelets 650,000 (H). WBC is
, PANCE Review Course Part 1: Essential Exam Prep Guide
also slightly elevated at 21,000. What is the most likely
diagnosis?
8. A 49 year-old patient with long-standing alcohol use Prednisolone
and cirrhosis is admitted to the hospital with rapid
onset jaundice, nausea and weakness. He admits to
drinking alcohol up until the time of admission. His
transaminases are significantly elevated and INR is
2.5. An abdominal ultrasound shows moderate as-
cites; no masses or biliary obstruction. What interven-
tion would most improve the short-term survival of
this patient?
9. Enlargement of which lymph nodes is most sugges- Posterior cervical
tive that a patient with pharyngitis has infectious
mononucleosis?
10. What is an indication to order a dobutamine cardiac Symptomatic aortic steno-
stress test rather than a treadmill stress test with sis
echocardiogram or treadmill ECG?
11. A G1P0 patient at 32 weeks gestation has been in Vaginal delivery with stim-
labor for 3 days with ruptured membranes. She has ulated labor
been hospitalized on bed rest. Today she develops
a fever (101.2F). A sterile vaginal exam reveals 9 cm
dilation and 50% effacement. What is the best man-
agement option at this time?
12. A 59 year-old female presents inquiring about lung Refer to pulmonology for
cancer screening. She was diagnosed with COPD 8 bronchoscopy and biopsy
years ago and currently using ipratropium/albuterol
and formoterol. On further questioning she discloses
that she has noticed a slight increase in her cough
