PANCE EXAM |ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A 15-month-old boy is brought to the emergency department by his parents because he
suddenly turned blue and had difficulty breathing while he was playing in the back yard of
their home. The parents have noticed several times in the previous 2-3 months that he had
developed a bluish discoloration around the lips but did not think much of it, as it was
wintertime. Recently, however, the boy had increasing fatigability and would stop in the
middle of playing to catch his breath by sitting down or squatting. This morning when he
suddenly turned blue and started behaving in a very flustered manner they rushed him to
the emergency department. The parents deny any other significant medical conditions or
allergies to medication. They have a 4-year-old daughter who is in good health. On
physical examination, the patient is in the fifth percentile for height and weight. His lips
and fingertips are bluish in color and he frequ
CORRECT ANSWER
D) Tetralogy of Fallot
Question 2
A 10-year-old girl is brought to the office because of fever and chills for 3 days. She had
been complaining of a headache and feeling tired for 10 days before she developed fever.
The parents had tried giving her acetaminophen, but the child's condition was not
improving. Her past medical history is significant for frequent streptococcal throat
infections over the past 2 years and a new onset heart murmur detected at her last well
child visit 2 months earlier. She is on no medication currently, except for acetaminophen.
Otherwise, she has been wearing dental braces for the past year and had a primary tooth
extracted 2 weeks earlier in the attempt of liberating space for permanent teeth. On
physical examination, the patient is diaphoretic, in moderate distress with a temperature
of 39.0° C (102.2° F), blood pressure of 90/60 mm Hg, pulse of 110/min, and respirations of
24/min. On her fingernails, you note several spl
CORRECT ANSWER
E) Streptococcus viridans
1
,Question 3
A 56-year-old smoker with no previous medical history comes to the emergency
department complaining of chest pain and shortness of breath with exertion. He is
admitted to the hospital for further evaluation. An exercise stress test supports the
diagnosis of coronary artery disease, and the patient undergoes a heart catheterization.
There is diffuse coronary artery disease but no clearly stentable lesions. The cardiologist
decides that medical management of this patient's coronary disease is appropriate at this
time. The patient has no allergies and has no other medical conditions. His blood pressure
and pulse over 3 days are as follows:
Day 1 blood pressure 146/96 mm Hg, pulse 80/min
Day 2 blood pressure 150/90 mm Hg, pulse 86/min
Day 3 blood pressure 140/96 mm Hg, pulse 73/min
Which is the most appropriate blood pressure medication for this patient?
A) Diltiazem (Cardizem, Dilacor, Cartia)
B) Hydrochlorothiazide (M
CORRECT ANSWER
D) Metoprolol
Question 4
A 57-year-old man with hypertension and hyperlipidemia comes to the emergency
department complaining of crushing substernal chest pain, diaphoresis, and nausea for 3
hours. He denies palpitations or shortness of breath. He has no previous history of angina
or myocardial infarction. His temperature is 37.0° C (98.6° F), blood pressure is 82/60 mm
Hg, pulse is 103/min, and respirations are 20/min. Physical examination shows jugular
venous distention, a tachycardic heart that is without murmurs, and clear lungs. An
electrocardiogram is shown.
2
, A right-sided electrocardiogram is also performed that shows ST elevation in V3 and V4.
Which of the following is the most appropriate medical intervention at this time?
A) Dopamine
B) Furosemide (Lasix)
C) Intravenous fluids
D) Metoprolol (Lopressor, Toprol XL)
E) Nitroglycerin
CORRECT ANSWER
C) Intravenous Fluids
Question 5
A 28-year-old man seeks help for progressive edema affecting his right lower extremity. It
first started about 2 years ago but has become much worse in the last 6 months. Physical
examination shows pitting edema from the groin to the toes, as well as very prominent
varicose veins and an area of chronic cellulitis above the medial malleolus. These findings
are confined to the right side and are not present at all on the left. He also is noted to have
a palpable thrill and an audible bruit over the right groin. His resting pulse is 115/min. He
gives a history of having suffered a gunshot wound to his right groin 3 years ago, for which
he had no specific therapy.
Which of the following is the most likely diagnosis?
A) Arteriovenous Fistula
B) Chronic Lymphedema
C) Deep Thrmobophlebitis
D) Postphlebitic Syndrome
E) Superficial saphenous venous insufficiency
CORRECT ANSWER
A) Arteriovenous fistula
3
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A 15-month-old boy is brought to the emergency department by his parents because he
suddenly turned blue and had difficulty breathing while he was playing in the back yard of
their home. The parents have noticed several times in the previous 2-3 months that he had
developed a bluish discoloration around the lips but did not think much of it, as it was
wintertime. Recently, however, the boy had increasing fatigability and would stop in the
middle of playing to catch his breath by sitting down or squatting. This morning when he
suddenly turned blue and started behaving in a very flustered manner they rushed him to
the emergency department. The parents deny any other significant medical conditions or
allergies to medication. They have a 4-year-old daughter who is in good health. On
physical examination, the patient is in the fifth percentile for height and weight. His lips
and fingertips are bluish in color and he frequ
CORRECT ANSWER
D) Tetralogy of Fallot
Question 2
A 10-year-old girl is brought to the office because of fever and chills for 3 days. She had
been complaining of a headache and feeling tired for 10 days before she developed fever.
The parents had tried giving her acetaminophen, but the child's condition was not
improving. Her past medical history is significant for frequent streptococcal throat
infections over the past 2 years and a new onset heart murmur detected at her last well
child visit 2 months earlier. She is on no medication currently, except for acetaminophen.
Otherwise, she has been wearing dental braces for the past year and had a primary tooth
extracted 2 weeks earlier in the attempt of liberating space for permanent teeth. On
physical examination, the patient is diaphoretic, in moderate distress with a temperature
of 39.0° C (102.2° F), blood pressure of 90/60 mm Hg, pulse of 110/min, and respirations of
24/min. On her fingernails, you note several spl
CORRECT ANSWER
E) Streptococcus viridans
1
,Question 3
A 56-year-old smoker with no previous medical history comes to the emergency
department complaining of chest pain and shortness of breath with exertion. He is
admitted to the hospital for further evaluation. An exercise stress test supports the
diagnosis of coronary artery disease, and the patient undergoes a heart catheterization.
There is diffuse coronary artery disease but no clearly stentable lesions. The cardiologist
decides that medical management of this patient's coronary disease is appropriate at this
time. The patient has no allergies and has no other medical conditions. His blood pressure
and pulse over 3 days are as follows:
Day 1 blood pressure 146/96 mm Hg, pulse 80/min
Day 2 blood pressure 150/90 mm Hg, pulse 86/min
Day 3 blood pressure 140/96 mm Hg, pulse 73/min
Which is the most appropriate blood pressure medication for this patient?
A) Diltiazem (Cardizem, Dilacor, Cartia)
B) Hydrochlorothiazide (M
CORRECT ANSWER
D) Metoprolol
Question 4
A 57-year-old man with hypertension and hyperlipidemia comes to the emergency
department complaining of crushing substernal chest pain, diaphoresis, and nausea for 3
hours. He denies palpitations or shortness of breath. He has no previous history of angina
or myocardial infarction. His temperature is 37.0° C (98.6° F), blood pressure is 82/60 mm
Hg, pulse is 103/min, and respirations are 20/min. Physical examination shows jugular
venous distention, a tachycardic heart that is without murmurs, and clear lungs. An
electrocardiogram is shown.
2
, A right-sided electrocardiogram is also performed that shows ST elevation in V3 and V4.
Which of the following is the most appropriate medical intervention at this time?
A) Dopamine
B) Furosemide (Lasix)
C) Intravenous fluids
D) Metoprolol (Lopressor, Toprol XL)
E) Nitroglycerin
CORRECT ANSWER
C) Intravenous Fluids
Question 5
A 28-year-old man seeks help for progressive edema affecting his right lower extremity. It
first started about 2 years ago but has become much worse in the last 6 months. Physical
examination shows pitting edema from the groin to the toes, as well as very prominent
varicose veins and an area of chronic cellulitis above the medial malleolus. These findings
are confined to the right side and are not present at all on the left. He also is noted to have
a palpable thrill and an audible bruit over the right groin. His resting pulse is 115/min. He
gives a history of having suffered a gunshot wound to his right groin 3 years ago, for which
he had no specific therapy.
Which of the following is the most likely diagnosis?
A) Arteriovenous Fistula
B) Chronic Lymphedema
C) Deep Thrmobophlebitis
D) Postphlebitic Syndrome
E) Superficial saphenous venous insufficiency
CORRECT ANSWER
A) Arteriovenous fistula
3
