PANCE Practice Exam 2 Exam Prep Questions And Answers (202472025)
A 27-year-old woman complains of years of menstrual irregularity and increasing facial and chest
hair. PMH: significant for ovarian cyst and left cytectomy. She is a non-smoker and non-drinker.
Labs include a negative uCG, elevated LH, and low FSH. She desires fertility and she has not
responded to three cycles of clomiphene. What would be the next choice of medication that may
return ovulation?
A. Insulin
B. Metformin
C. Dexamethasone
D. Spironalactone
E. Finasteride - ✔✔The answer is B.
EXPLANATION: Dexamethasone, finasteride, and spironalactone all treat symptoms of
hirsutism, but do not treat the underlying cause of PCO or improve fertility outcomes. PCO has an
underlying insulin resistance that can be treated with oral hypoglycemics and improve sensitivity
to insulin. Adding insulin does not improve the resistance.
A 2-week-old male infant presents for a routine checkup. The mother complains that he nurses
every hour, but vomits (nonbilious) after every time he eats. He has only had three bowel
movements since he has been home. On examination, the infant has not gained any weight since
leaving the hospital, and the clinician notes gastric peristaltic waves. Which of the following is the
treatment of choice for this patient?
A. pyloromyotomy
B. metoclopramide
C. laparotomy
D. omeprazole - ✔✔The answer is A.
EXPLANATION: This infant is presenting with signs and symptoms of pyloric stenosis. Infants
typically have vomiting (projectile at times) after every feeding and it normally starts between the
age of 2 and 4 weeks. The infant nurses fervently and is hungry. In addition, there may be
dehydration, constipation, weight loss, and apathy. Abdomen may be distended with gastric
peristaltic waves. Occasionally, an olive-sized mass can be felt in the right upper quadrant with
deep palpation after the child has vomited. Vomitus is typically nonbilious. Diagnosis is confirmed
by an upper gastrointestinal series with delayed gastric emptying, enlarged pyloric muscle, and
characteristic semilunar impressions on the gastric antrum. In addition, an ultrasound is needed to
verify the hypertrophic muscle. The treatment of choice for these patients is pyloromyotomy,
,which can be done laparoscopically. These patients make full recoveries and have an excellent
prognosis.
Upon performing a newborn examination, the clinician notes a widened pulse pressure,
paradoxical splitting of S2, and a "machine"-like murmur heard best at the second intercostal
space, left sternal border, and inferior to the clavicle. Which of the following is the most likely
diagnosis?
A. tetralogy of Fallot
B. ventricular septal defect
C. atrial septal defect
D. patent ductus arteriosus - ✔✔The answer is D.
EXPLANATION: Patent ductus arteriosus (PDA) is an isolated abnormality that occurs in infants.
The ductus arteriosus is a normal fetal vessel that joins the aorta and the pulmonary artery and
spontaneously closes after 3 to 5 days. Lack of closure results in the audible murmur that is
"machine-like" and maximal at the second intercostal space (ICS), at the left sternal border (LSB),
and inferior to the clavicle. It is typically a pansystolic murmur with bounding pulses and a
widened pulse pressure. There is also a paradoxical splitting of S1 and S2. Echocardiography
confirms the PDA, the direction and degree of shunting, and the presence of lesions for which the
PDA is needed to keep. If there are no other cardiac malformations requiring the PDA, then if the
PDA is large, surgery should be completed before 1 year of age. Symptomatic PDAs that are
relatively small may be closed with indomethacin in preterm infants.
an ejection type, systolic murmur heard best at the LSB, second ICS with a wide, fixed S2 and
normal pulses. - ✔✔atrial septal defect (ASD)
a harsh, pansystolic murmur heard best at the third and fourth ICS. With increasing size, heaves,
thrills, and lifts are present along with radiation throughout the chest. - ✔✔Ventricular septal
defect (VSD)
a rough ejection, systolic murmur heard best at the LSB and the third ICS with radiation to the
back. - ✔✔Tetralogy of Fallot
A 42-year-old woman, with a history of struvite renal calculus, calls the office with a complaint of
a urinary tract infection. As part of the interview, she reports intermittent, mild right flank pain for
,4 days. Her urine dipstick is positive for microscopic hematuria, and the urine pH is 7.5. The KUB
film is positive with two visible stones in the right kidney. Which of the following organisms is
most likely to be cultured from the urine specimen?
A. Escherichia coli
B. Klebsiella
C. Proteus
D. Chlamydia trachomatis - ✔✔The answer is C.
EXPLANATION: This patient has struvite stones. They are frequently associated with recurrent
urinary tract infections, visible stones, and high urine pH. These stones are formed by urease-
producing organisms including Proteus and Pseudomonas while being caused less commonly by
Klebsiella. Struvite stones are not typically caused by E. coli and C. trachomatis.
A 33-year-old woman treated with trifluoperazine for the past 3 months is seen in the emergency
department because of recent-onset fever, stiffness and tremor, as reported by her accompanying
sister. The patient also appears to be mildly confused when asked about location, day, and time.
Her temperature is 104.5°F, and her serum creatine kinase (CK) level is markedly elevated. Which
of the following has most likely occurred?
A. a delayed allergic reaction has occurred with trifluoperazine
B. tardive dyskinesia has begun to develop in the patient
C. the patient has developed neuroleptic malignant syndrome
D. the patient has developed serotonin syndrome
E. the patient has overdosed on trifluoperazine - ✔✔The answer is C.
EXPLANATION: Neuroleptic malignant syndrome is an uncommon but serious complication
with therapeutic doses of antipsychotic drug therapy, particularly the first-generation (typical)
class. Cardinal signs and symptoms include a body temperature above 100.4°F, altered state of
consciousness, autonomic dysfunction, and rigidity.
A 48-year-old man presents to the clinic for a routine employment physical. The patient is
asymptomatic. A pre-employment CBC reveals hemoglobin of 13.2g/dl, hematocrit of 39.5%, and
MCV of 60.6 fL. Subsequent iron studies, hemoglobin electrophoresis, and sickle cell screening
are "normal." After the labs are reviewed, the patient states "they are always normal."
Which of the following is the most appropriate management for this patient?
A. Bone marrow aspirate
, B. Ferrous sulfate daily
C. Folic acid supplements
D. Reassurance
E. Refer to an oncologist - ✔✔The answer is D.
EXPLANATION: The patient has a mild anemia with pronounced microcytosis consistent with
alpha thalassemia minor and requires reassurance.
Alpha thalassemia minor hemoglobin electrophoresis reveals normal results. Patients with alpha
thalassemia are often inappropriately advised to take iron supplements (B) and don't require iron,
folic acid (C) or vitamin B12 supplements unless a coexisting deficiency is confirmed. Referral to
an oncologist (E) and a bone marrow aspirate (A) aren't necessary for this patient.
white blood cell count (WBC) reveals 14,800 mcL with more than 10% atypical lymphocytes. On
physical examination you find significant yellowish-grey pharyngeal exudate, cervical
lymphadenopathy as well as an enlarged spleen. Her rapid strep is negative. What should be your
treatment of this patient?
A. Begin treatment with cephalexin.
B. Send out a back-up throat culture and begin treatment with cephalexin pending those results
.C. Send out a back-up throat culture and hold treatment pending those results.
D. Draw a Monospot test and treat the patient supportively pending the results, insuring that they
avoid contact sports until a definitive diagnosis has been made. E. Draw an Epstein-Barr virus
(EBV) IgG level and treat the patient supportively if positive. - ✔✔The answer is D.
EXPLANATION: With this patient's presentation and a negative rapid strep test, other etiologies
beyond group A beta-hemolytic strep should be seriously considered. In light of her symptoms
including fatigue, her WBC, and that her significant other is having similar symptoms, infectious
mononucleosis is highest on the differential diagnosis. A Monospot test would rule this possibility
in or out. She should refrain from contact sports until her infection and any associated
splenomegaly has resolved.
barking" cough and a low-grade fever. She has some runny nose and her voice is somewhat raspy
and hoarse. mild inspiratory stridor.
What is the most likely etiology of this child's illness?
A. Adenovirus
B. Coxsackievirus
A 27-year-old woman complains of years of menstrual irregularity and increasing facial and chest
hair. PMH: significant for ovarian cyst and left cytectomy. She is a non-smoker and non-drinker.
Labs include a negative uCG, elevated LH, and low FSH. She desires fertility and she has not
responded to three cycles of clomiphene. What would be the next choice of medication that may
return ovulation?
A. Insulin
B. Metformin
C. Dexamethasone
D. Spironalactone
E. Finasteride - ✔✔The answer is B.
EXPLANATION: Dexamethasone, finasteride, and spironalactone all treat symptoms of
hirsutism, but do not treat the underlying cause of PCO or improve fertility outcomes. PCO has an
underlying insulin resistance that can be treated with oral hypoglycemics and improve sensitivity
to insulin. Adding insulin does not improve the resistance.
A 2-week-old male infant presents for a routine checkup. The mother complains that he nurses
every hour, but vomits (nonbilious) after every time he eats. He has only had three bowel
movements since he has been home. On examination, the infant has not gained any weight since
leaving the hospital, and the clinician notes gastric peristaltic waves. Which of the following is the
treatment of choice for this patient?
A. pyloromyotomy
B. metoclopramide
C. laparotomy
D. omeprazole - ✔✔The answer is A.
EXPLANATION: This infant is presenting with signs and symptoms of pyloric stenosis. Infants
typically have vomiting (projectile at times) after every feeding and it normally starts between the
age of 2 and 4 weeks. The infant nurses fervently and is hungry. In addition, there may be
dehydration, constipation, weight loss, and apathy. Abdomen may be distended with gastric
peristaltic waves. Occasionally, an olive-sized mass can be felt in the right upper quadrant with
deep palpation after the child has vomited. Vomitus is typically nonbilious. Diagnosis is confirmed
by an upper gastrointestinal series with delayed gastric emptying, enlarged pyloric muscle, and
characteristic semilunar impressions on the gastric antrum. In addition, an ultrasound is needed to
verify the hypertrophic muscle. The treatment of choice for these patients is pyloromyotomy,
,which can be done laparoscopically. These patients make full recoveries and have an excellent
prognosis.
Upon performing a newborn examination, the clinician notes a widened pulse pressure,
paradoxical splitting of S2, and a "machine"-like murmur heard best at the second intercostal
space, left sternal border, and inferior to the clavicle. Which of the following is the most likely
diagnosis?
A. tetralogy of Fallot
B. ventricular septal defect
C. atrial septal defect
D. patent ductus arteriosus - ✔✔The answer is D.
EXPLANATION: Patent ductus arteriosus (PDA) is an isolated abnormality that occurs in infants.
The ductus arteriosus is a normal fetal vessel that joins the aorta and the pulmonary artery and
spontaneously closes after 3 to 5 days. Lack of closure results in the audible murmur that is
"machine-like" and maximal at the second intercostal space (ICS), at the left sternal border (LSB),
and inferior to the clavicle. It is typically a pansystolic murmur with bounding pulses and a
widened pulse pressure. There is also a paradoxical splitting of S1 and S2. Echocardiography
confirms the PDA, the direction and degree of shunting, and the presence of lesions for which the
PDA is needed to keep. If there are no other cardiac malformations requiring the PDA, then if the
PDA is large, surgery should be completed before 1 year of age. Symptomatic PDAs that are
relatively small may be closed with indomethacin in preterm infants.
an ejection type, systolic murmur heard best at the LSB, second ICS with a wide, fixed S2 and
normal pulses. - ✔✔atrial septal defect (ASD)
a harsh, pansystolic murmur heard best at the third and fourth ICS. With increasing size, heaves,
thrills, and lifts are present along with radiation throughout the chest. - ✔✔Ventricular septal
defect (VSD)
a rough ejection, systolic murmur heard best at the LSB and the third ICS with radiation to the
back. - ✔✔Tetralogy of Fallot
A 42-year-old woman, with a history of struvite renal calculus, calls the office with a complaint of
a urinary tract infection. As part of the interview, she reports intermittent, mild right flank pain for
,4 days. Her urine dipstick is positive for microscopic hematuria, and the urine pH is 7.5. The KUB
film is positive with two visible stones in the right kidney. Which of the following organisms is
most likely to be cultured from the urine specimen?
A. Escherichia coli
B. Klebsiella
C. Proteus
D. Chlamydia trachomatis - ✔✔The answer is C.
EXPLANATION: This patient has struvite stones. They are frequently associated with recurrent
urinary tract infections, visible stones, and high urine pH. These stones are formed by urease-
producing organisms including Proteus and Pseudomonas while being caused less commonly by
Klebsiella. Struvite stones are not typically caused by E. coli and C. trachomatis.
A 33-year-old woman treated with trifluoperazine for the past 3 months is seen in the emergency
department because of recent-onset fever, stiffness and tremor, as reported by her accompanying
sister. The patient also appears to be mildly confused when asked about location, day, and time.
Her temperature is 104.5°F, and her serum creatine kinase (CK) level is markedly elevated. Which
of the following has most likely occurred?
A. a delayed allergic reaction has occurred with trifluoperazine
B. tardive dyskinesia has begun to develop in the patient
C. the patient has developed neuroleptic malignant syndrome
D. the patient has developed serotonin syndrome
E. the patient has overdosed on trifluoperazine - ✔✔The answer is C.
EXPLANATION: Neuroleptic malignant syndrome is an uncommon but serious complication
with therapeutic doses of antipsychotic drug therapy, particularly the first-generation (typical)
class. Cardinal signs and symptoms include a body temperature above 100.4°F, altered state of
consciousness, autonomic dysfunction, and rigidity.
A 48-year-old man presents to the clinic for a routine employment physical. The patient is
asymptomatic. A pre-employment CBC reveals hemoglobin of 13.2g/dl, hematocrit of 39.5%, and
MCV of 60.6 fL. Subsequent iron studies, hemoglobin electrophoresis, and sickle cell screening
are "normal." After the labs are reviewed, the patient states "they are always normal."
Which of the following is the most appropriate management for this patient?
A. Bone marrow aspirate
, B. Ferrous sulfate daily
C. Folic acid supplements
D. Reassurance
E. Refer to an oncologist - ✔✔The answer is D.
EXPLANATION: The patient has a mild anemia with pronounced microcytosis consistent with
alpha thalassemia minor and requires reassurance.
Alpha thalassemia minor hemoglobin electrophoresis reveals normal results. Patients with alpha
thalassemia are often inappropriately advised to take iron supplements (B) and don't require iron,
folic acid (C) or vitamin B12 supplements unless a coexisting deficiency is confirmed. Referral to
an oncologist (E) and a bone marrow aspirate (A) aren't necessary for this patient.
white blood cell count (WBC) reveals 14,800 mcL with more than 10% atypical lymphocytes. On
physical examination you find significant yellowish-grey pharyngeal exudate, cervical
lymphadenopathy as well as an enlarged spleen. Her rapid strep is negative. What should be your
treatment of this patient?
A. Begin treatment with cephalexin.
B. Send out a back-up throat culture and begin treatment with cephalexin pending those results
.C. Send out a back-up throat culture and hold treatment pending those results.
D. Draw a Monospot test and treat the patient supportively pending the results, insuring that they
avoid contact sports until a definitive diagnosis has been made. E. Draw an Epstein-Barr virus
(EBV) IgG level and treat the patient supportively if positive. - ✔✔The answer is D.
EXPLANATION: With this patient's presentation and a negative rapid strep test, other etiologies
beyond group A beta-hemolytic strep should be seriously considered. In light of her symptoms
including fatigue, her WBC, and that her significant other is having similar symptoms, infectious
mononucleosis is highest on the differential diagnosis. A Monospot test would rule this possibility
in or out. She should refrain from contact sports until her infection and any associated
splenomegaly has resolved.
barking" cough and a low-grade fever. She has some runny nose and her voice is somewhat raspy
and hoarse. mild inspiratory stridor.
What is the most likely etiology of this child's illness?
A. Adenovirus
B. Coxsackievirus
