PANCE ACTUAL EXAM 2026/2027 TEST | WITH COMPREHENSIVE
QUESTIONS AND VERIFIED ANSWERS | GRADED A+
A patient is brought to the emergency department after a motor vehicle collision. X-ray studies of the
chest show a pleural effusion. A milky fluid drains from the chest tube. Which of the follow structures
is most likely ruptured?
A. Apical bleb
B. Bronchus
C. Diaphragm
D. Esophagus
E. Thoracic duct - ANSWER E. Thoracic duct
Chylothorax commonly caused by leakage of lymph from the thoracic duct into the pleural space. A
chest x-ray will show if there is a buildup of fluid in the pleural space. If a surgical drain or chest tube
is in place and milky white fluid is noted, it can be sent to the laboratory to be tested.
A 72-year-old man with chronic bronchitis undergoes laparotomy for treatment of a bowel
obstruction. Three days after surgery, the patient's wound begins to leak large amounts of clear,
salmon-colored fluid after an episode of coughing. The skin staples are open and the wound is
probed with a sterile-tipped applicator. During this procedure, an open segment of the wound
reaching back to the omentum and intestines is noted. Which of the following is the most
appropriate description of this type of postoperative complication?
A. Dehiscence
B. Fistula
C. Hematoma
D. Seroma
E. Wound Infection - ANSWER A. Dehiscence - The classic "salmon-colored" drainage is concerning
for fascial dehiscence
NOT Seroma - Clear or serous-appearing drainage may represent decompressing seroma
A 35-year-old women is brought to the emergency department by a coworker because she has had
pain in the suprapubic region of her abdomen for the past two hours. The patient says the pain
, developed while she was at work, after she was asked to complete a double shift. She has not
urinated since the beginning of her shift, but she has no symptoms of urinary tract infection. The
patient has a fear of speaking to other people at work and tries to avoid writing in public, even
signing sales receipts when she uses her credit card. She says she did not want to come to the
emergency department, but her coworker was worried and insisted. Physical examination shows
tenderness to palpation over the suprapubic region of the abdomen as well as evidence of distention
of the bladder. Because the patient is unable to urinate, a catheter is inserted, and 1200mL of urine
is removed. Results of renal function studies and urinalysis ar - ANSWER E. Social anxiety disorder
NOT Schizoaffective b/c no symptoms of Schizophrenia (Positive/Negative) + mood disorder (MDD or
Mania)
A 63-year-old man comes to the office because he has had a nontender mass in his abdomen for the
past eight months. He is otherwise healthy and takes no medications. Pulse rate is 88/min,
respirations are 13/min, and blood pressure is 158/94 mmHg. Abdomen examination shows a 7x3-
cm, non-pulsatile mass at the midline. A photograph is shown. Bowel sounds are normoactive, and
no hepatosplenomegaly is noted. Which of the following additional findings on physical examination
of this patient is most likely?
A. Aortic bruit
B. Increase in size of the mass with Valsalva maneuver
C. Increased hepatojugular reflex
D. Involuntary abdominal guarding
E. Venous hum in the right upper quadrant of the abdomen - ANSWER B. Abdominal Hernia -
Increases in size of the mass with Valsalva because the increase in intraabdominal pressure causes
the hernia sac to enlarge and protrude through the anatomic defect.
NOT Aortic bruit because not pulsatile mass.
A 34-year-old women who works as an elementary school teacher has polyarthritis of the proximal
interphalangeal joints of the hands. She has no history of recent illness, has not been traveling, and
currently takes no medications, but recently, some of her students have had erythema infectiosum
(fifth disease). Results of laboratory studies for complete blood cell count, erythrocyte sedimentation
rate, and rheumatoid arthritis show no abnormalities. Which of the following viruses is the most
likely cause of this patient's symptoms?
A. Adenovirus
B. Coxsackievirus
QUESTIONS AND VERIFIED ANSWERS | GRADED A+
A patient is brought to the emergency department after a motor vehicle collision. X-ray studies of the
chest show a pleural effusion. A milky fluid drains from the chest tube. Which of the follow structures
is most likely ruptured?
A. Apical bleb
B. Bronchus
C. Diaphragm
D. Esophagus
E. Thoracic duct - ANSWER E. Thoracic duct
Chylothorax commonly caused by leakage of lymph from the thoracic duct into the pleural space. A
chest x-ray will show if there is a buildup of fluid in the pleural space. If a surgical drain or chest tube
is in place and milky white fluid is noted, it can be sent to the laboratory to be tested.
A 72-year-old man with chronic bronchitis undergoes laparotomy for treatment of a bowel
obstruction. Three days after surgery, the patient's wound begins to leak large amounts of clear,
salmon-colored fluid after an episode of coughing. The skin staples are open and the wound is
probed with a sterile-tipped applicator. During this procedure, an open segment of the wound
reaching back to the omentum and intestines is noted. Which of the following is the most
appropriate description of this type of postoperative complication?
A. Dehiscence
B. Fistula
C. Hematoma
D. Seroma
E. Wound Infection - ANSWER A. Dehiscence - The classic "salmon-colored" drainage is concerning
for fascial dehiscence
NOT Seroma - Clear or serous-appearing drainage may represent decompressing seroma
A 35-year-old women is brought to the emergency department by a coworker because she has had
pain in the suprapubic region of her abdomen for the past two hours. The patient says the pain
, developed while she was at work, after she was asked to complete a double shift. She has not
urinated since the beginning of her shift, but she has no symptoms of urinary tract infection. The
patient has a fear of speaking to other people at work and tries to avoid writing in public, even
signing sales receipts when she uses her credit card. She says she did not want to come to the
emergency department, but her coworker was worried and insisted. Physical examination shows
tenderness to palpation over the suprapubic region of the abdomen as well as evidence of distention
of the bladder. Because the patient is unable to urinate, a catheter is inserted, and 1200mL of urine
is removed. Results of renal function studies and urinalysis ar - ANSWER E. Social anxiety disorder
NOT Schizoaffective b/c no symptoms of Schizophrenia (Positive/Negative) + mood disorder (MDD or
Mania)
A 63-year-old man comes to the office because he has had a nontender mass in his abdomen for the
past eight months. He is otherwise healthy and takes no medications. Pulse rate is 88/min,
respirations are 13/min, and blood pressure is 158/94 mmHg. Abdomen examination shows a 7x3-
cm, non-pulsatile mass at the midline. A photograph is shown. Bowel sounds are normoactive, and
no hepatosplenomegaly is noted. Which of the following additional findings on physical examination
of this patient is most likely?
A. Aortic bruit
B. Increase in size of the mass with Valsalva maneuver
C. Increased hepatojugular reflex
D. Involuntary abdominal guarding
E. Venous hum in the right upper quadrant of the abdomen - ANSWER B. Abdominal Hernia -
Increases in size of the mass with Valsalva because the increase in intraabdominal pressure causes
the hernia sac to enlarge and protrude through the anatomic defect.
NOT Aortic bruit because not pulsatile mass.
A 34-year-old women who works as an elementary school teacher has polyarthritis of the proximal
interphalangeal joints of the hands. She has no history of recent illness, has not been traveling, and
currently takes no medications, but recently, some of her students have had erythema infectiosum
(fifth disease). Results of laboratory studies for complete blood cell count, erythrocyte sedimentation
rate, and rheumatoid arthritis show no abnormalities. Which of the following viruses is the most
likely cause of this patient's symptoms?
A. Adenovirus
B. Coxsackievirus
