PANCE EXAM |ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A 40-year-old woman who actively uses intravenous drugs presents to the ED with fever
and fatigue for the past 3 days. In the ED, her vital signs are BP 126/82 mm Hg, HR 90 bpm,
RR 16/min, SpO2 99% on room air, and T 101.6°F (38.7°C). On exam, a murmur is noted.
Transesophageal echocardiography is ordered. Which of the following valves is most likely
to be affected?
A .Aortic
B .Mitral
C .Pulmonic
D. Tricuspid
CORRECT ANSWER
Tricuspid
dx: bacterial endocarditis.
Bacterial Endocarditis
Risk factors: injection drug use, valvular heart disease
Sx: fever, rash, cough, and myalgias
PE: fever, Roth spots, Osler nodes, murmur, Janeway lesions, anemia, nailbed hemorrhages,
emboli (FROM JANE)
Diagnosis is made by echocardiography and Duke criteria
Most commonly caused by:
IVDA: Staphylococcus aureus, tricuspid
1
,Native valve: Staphylococcus aureus, viridans streptococci (most common in previously
diseased), mitral
Tx: antibiotics
GI malignancy: Streptococcus bovis #Colorectal cancer.
Dental prophylaxis in some cases
Question 2
Which of the following counseling statements should be given regarding tobacco use and
smoking cessation?
ACurrently, there are more active smokers in the U.S. than former smokers
BHeart disease risk is reduced within six months of smoking cessation
CSmoking increases the risk for infertility
DThere is no benefit to smoking cessation over the age of 80
CORRECT ANSWER
Smoking increases the risk for infertility
dx;Tobacco Use and Cessation
Motivational interviewing
Nicotine replacement
Bupropion (avoid with seizure or eating disorders)
Varenicline
Consider combination therapy
USPSTF, Jan 2021: insufficient evidence to recommend for or against pharmacotherapy for
smoking cessation in pregnant people
Nicotine is excreted in breast milk? true
2
,Question 3
A 38-year-old man with a history of heavy alcohol use presents with hematemesis. After
obtaining a history and performing a physical exam, a Mallory-Weiss tear is suspected. The
patient's vital signs are stable with a normal heart rate and blood pressure. Which of the
following is the next best step in caring for this patient?
AAdminister an antiemetic
BObtain intravenous access
CPlace a nasogastric tube
DPrepare the patient for emergent upper endoscopy
CORRECT ANSWER
Obtain intravenous access
Mallory-Weiss Syndrome
History of drinking alcohol and forceful vomiting
Hematemesis
Diagnosis is made by upper endoscopy
Caused by an incomplete tear in the esophagus mucosa and proximal stomach
Tx: acid suppression, endoscopic therapy
Management
• Supportive
• Endoscopic therapy (active bleeding)
• Acid suppression (no active bleeding)
-----------> . Once the patient is stabilized, an esophagoduodenoscopy (EGD) can confirm the
diagnosis and allows for treatment options if the bleeding has not resolved spontaneously.
Epinephrine injection, embolization, or coagulation therapy can be used to stop the bleeding
although most cases resolve spontaneously as the mucosa heals over 48 to 72 hours.
3
, --------------------------------------------------------
Administering an antiemetic (A) is important to prevent further vomiting and subsequent
worsening of the bleeding; however, this is not the most important first step in a patient that
is actively bleeding and has the potential to become hemodynamically unstable.
Preparing the patient for an emergent upper endoscopy (D) may be necessary if the
bleeding is severe and the patient requires the procedure; however, it is not the first step
before obtaining IV access.
Question 4
In addition to stool softeners, which of the following can be used topically in the
management of midline anal fissures?
AFentanyl
BMupirocin
CNitroglycerin
DSucrose
CORRECT ANSWER
Nitroglycerin
Question 5
Its vasodilatory properties increase blood flow to injured tissue, and it also reduces
pressure in the internal anal sphincter, which decreases pain during defecation. The
ointment is applied two to three times daily at the anal opening. Other treatment
modalities include fiber diets, sitz baths, laxatives, botulinum toxin, topical nifedipine (a
calcium channel blocker), and surgery.
Question 6
4
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A 40-year-old woman who actively uses intravenous drugs presents to the ED with fever
and fatigue for the past 3 days. In the ED, her vital signs are BP 126/82 mm Hg, HR 90 bpm,
RR 16/min, SpO2 99% on room air, and T 101.6°F (38.7°C). On exam, a murmur is noted.
Transesophageal echocardiography is ordered. Which of the following valves is most likely
to be affected?
A .Aortic
B .Mitral
C .Pulmonic
D. Tricuspid
CORRECT ANSWER
Tricuspid
dx: bacterial endocarditis.
Bacterial Endocarditis
Risk factors: injection drug use, valvular heart disease
Sx: fever, rash, cough, and myalgias
PE: fever, Roth spots, Osler nodes, murmur, Janeway lesions, anemia, nailbed hemorrhages,
emboli (FROM JANE)
Diagnosis is made by echocardiography and Duke criteria
Most commonly caused by:
IVDA: Staphylococcus aureus, tricuspid
1
,Native valve: Staphylococcus aureus, viridans streptococci (most common in previously
diseased), mitral
Tx: antibiotics
GI malignancy: Streptococcus bovis #Colorectal cancer.
Dental prophylaxis in some cases
Question 2
Which of the following counseling statements should be given regarding tobacco use and
smoking cessation?
ACurrently, there are more active smokers in the U.S. than former smokers
BHeart disease risk is reduced within six months of smoking cessation
CSmoking increases the risk for infertility
DThere is no benefit to smoking cessation over the age of 80
CORRECT ANSWER
Smoking increases the risk for infertility
dx;Tobacco Use and Cessation
Motivational interviewing
Nicotine replacement
Bupropion (avoid with seizure or eating disorders)
Varenicline
Consider combination therapy
USPSTF, Jan 2021: insufficient evidence to recommend for or against pharmacotherapy for
smoking cessation in pregnant people
Nicotine is excreted in breast milk? true
2
,Question 3
A 38-year-old man with a history of heavy alcohol use presents with hematemesis. After
obtaining a history and performing a physical exam, a Mallory-Weiss tear is suspected. The
patient's vital signs are stable with a normal heart rate and blood pressure. Which of the
following is the next best step in caring for this patient?
AAdminister an antiemetic
BObtain intravenous access
CPlace a nasogastric tube
DPrepare the patient for emergent upper endoscopy
CORRECT ANSWER
Obtain intravenous access
Mallory-Weiss Syndrome
History of drinking alcohol and forceful vomiting
Hematemesis
Diagnosis is made by upper endoscopy
Caused by an incomplete tear in the esophagus mucosa and proximal stomach
Tx: acid suppression, endoscopic therapy
Management
• Supportive
• Endoscopic therapy (active bleeding)
• Acid suppression (no active bleeding)
-----------> . Once the patient is stabilized, an esophagoduodenoscopy (EGD) can confirm the
diagnosis and allows for treatment options if the bleeding has not resolved spontaneously.
Epinephrine injection, embolization, or coagulation therapy can be used to stop the bleeding
although most cases resolve spontaneously as the mucosa heals over 48 to 72 hours.
3
, --------------------------------------------------------
Administering an antiemetic (A) is important to prevent further vomiting and subsequent
worsening of the bleeding; however, this is not the most important first step in a patient that
is actively bleeding and has the potential to become hemodynamically unstable.
Preparing the patient for an emergent upper endoscopy (D) may be necessary if the
bleeding is severe and the patient requires the procedure; however, it is not the first step
before obtaining IV access.
Question 4
In addition to stool softeners, which of the following can be used topically in the
management of midline anal fissures?
AFentanyl
BMupirocin
CNitroglycerin
DSucrose
CORRECT ANSWER
Nitroglycerin
Question 5
Its vasodilatory properties increase blood flow to injured tissue, and it also reduces
pressure in the internal anal sphincter, which decreases pain during defecation. The
ointment is applied two to three times daily at the anal opening. Other treatment
modalities include fiber diets, sitz baths, laxatives, botulinum toxin, topical nifedipine (a
calcium channel blocker), and surgery.
Question 6
4
