PANCE ACTUAL EXAM 2026/2027 TEST | WITH COMPREHENSIVE
QUESTIONS AND VERIFIED ANSWERS | GRADED A+
A 52 year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the
past few months. During his physical examination, you note a nontender, non-enlarged prostate with
an isolated right posterior lobe nodule. Which of the following options is most appropriate?
*A.* order a serum acid phosphatase level
*B.* initiate prazosin and schedule a follow-up appointment in 6 weeks
*C.* refer the patient for an ultrasound of the prostate and order a PSA level
*D.* reassure the patient and schedule a follow-up appointment in six months
*E.* initiate norfloxacin therapy for 7 days and schedule follow-up in two weeks - ANSWER
*ANSWER: C*
This patient has an isolated nodule of the prostate gland — cancer until proven otherwise. You
should order an ultrasound and a PSA. BPH will present as diffuse enlargement, and not a discrete
nodule.
You are educating a patient that has just been advised that he has "polyps" in his colon. Which of the
following statements is FALSE?
A. The larger the colonic polyp, the greater the risk of malignant transformation
B. Villous adenomas have a 30-70% risk of malignant transformation.
C. The greater the number of concomitant colonic polyps, the greater the risk of malignant
transformatio
D. The majority of colonic polyps are hyperplastic in origin
E. The majority of colonic polyps are > 3 cm in size. - ANSWER ANSWER: E, The majority of colonic
polyps are > 3 cm in size.
Most polyps are, in fact, quite small. All the rest of these statements are true
Which term is used to describe the characteristic concave or "spoon-shaped" nails of iron deficiency
anemia?
,A. leukonychia
B. koilonychias
C. clubbing
D. onycholysis
E. paronychia - ANSWER *ANSWER: B. Koilonychia*
Koilonychia is a spoon-shaping of the nail itself. It is usually a result of iron deficiency anemia.
Leukonychia is often associated with hypoalbuminaemia that causes partial or complete white
discoloration of the nails. Leukonychia may also appear as a rare side effect of systemic
chemotherapy in some oncological patients but may also be present with arsenic poisoning, renal
failure pneumonia, or heart disease. Clubbing of the nails is an actual thickening or elevation of the
nail bed - it is a sign of release of TNF associated with pulmonary disorders (tissue necrosis factor)
typically found in bronchiectasis, lung cancers and cystic fibrosis (the nails are NOT necessarily
cyanotic.) Onycholysis is a painless separation of the nail from the nail bed. Several or all nails are
usually affected - there are many causes. Paronychia is an infection of the nail bed and nail margin,
usually from trauma or more commonly, nail-biting.
Which of the following is NOT a characteristic feature of the nephrotic syndrome?
A. proteinuria
B. hematuria
C. hypoalbuminemia
D. hyperlipidemia
E. generalized edema - ANSWER *ANSWER: B. Hematuria*
Hematuria is present in NEPHRITIC syndrome. Nephrotic syndrome characteristically includes
proteinuria (>3.5 gm/day), with resulting low serum albumin, hyperlipidemia, hypertension,
hypercoagulability, and generalized edema (from oncotic third-spacing)
A patient describes a history of recurrent bouts of uveitis. Her chemistry panel reveals elevated
serum calcium and uric acid levels. Her anergy screen is negative. Her chest x-ray demonstrates
bilateral hilar adenopathy. Which diagnosis is most likely?
A. Silicosis
B. Sarcoidosis
C. Alpha-1 antitrypsin deficiency
, D. Histoplasmosis
E. Tuberculosis - ANSWER *ANSWER: B. Sarcoidosis*
Sarcoid typically presents with hilar lvmphadenopathy and noncaseating granulomas of the lungs
(and other organs). In addition, patients may get eye involvement (uveitis). Elevations of ACE,
Calcium and uric acid are frequently seen.
A 34-old female presents complaining of symmetrical redness and swelling of the small joints of her
hands (PIPs and MCPs). She has noted that the symptoms are worst in the morning. Her erythrocyte
sedimentation rate is elevated and her rheumatoid factor is negative. Which of the following
diagnosis is most likely?
A. progressive systemic sclerosis
B. CREST syndrome
C. osteoarthritis
D. rheumatoid arthritis
E. ankylosing spondylitis - ANSWER *ANSWER: D Rheumatoid Arthritis*
In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA characteristically
includes small joint symmetrical arthritis, with an elevated ESR (therefore inflammatory, and not OA).
80% of patients with RA will have a positive RF, but 20% will be negative. PSS involves squamous cell
thickening and sclerosis causing taut skin of the face and hands and difficulty with esophageal
motility. CREST syndrome is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and
negative RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine)
A 14 year-old is experiencing a severe asthma attack. Although he is using accessory muscles to
breath, auscultation of his chest reveals no audible wheezing. His heart rate is 160 and his respiratory
rate is 52. Which of the following arterial blood gases represents the worst prognosis?
A. pH = 7.52; pC02 = 28; p02 = 80
B. pH = 7.44; pC02 = 38; p02 = 70
C. pH = 7.60; pC02 = 18; p02 = 60
D. pH= 7.40; pC02 = 40; p02 = 60
E. pH = 7.27; pC02 - 62; p02 = 64 - ANSWER ANSWER: E. pH = 7.27; pC02 - 62; p02 = 64
QUESTIONS AND VERIFIED ANSWERS | GRADED A+
A 52 year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the
past few months. During his physical examination, you note a nontender, non-enlarged prostate with
an isolated right posterior lobe nodule. Which of the following options is most appropriate?
*A.* order a serum acid phosphatase level
*B.* initiate prazosin and schedule a follow-up appointment in 6 weeks
*C.* refer the patient for an ultrasound of the prostate and order a PSA level
*D.* reassure the patient and schedule a follow-up appointment in six months
*E.* initiate norfloxacin therapy for 7 days and schedule follow-up in two weeks - ANSWER
*ANSWER: C*
This patient has an isolated nodule of the prostate gland — cancer until proven otherwise. You
should order an ultrasound and a PSA. BPH will present as diffuse enlargement, and not a discrete
nodule.
You are educating a patient that has just been advised that he has "polyps" in his colon. Which of the
following statements is FALSE?
A. The larger the colonic polyp, the greater the risk of malignant transformation
B. Villous adenomas have a 30-70% risk of malignant transformation.
C. The greater the number of concomitant colonic polyps, the greater the risk of malignant
transformatio
D. The majority of colonic polyps are hyperplastic in origin
E. The majority of colonic polyps are > 3 cm in size. - ANSWER ANSWER: E, The majority of colonic
polyps are > 3 cm in size.
Most polyps are, in fact, quite small. All the rest of these statements are true
Which term is used to describe the characteristic concave or "spoon-shaped" nails of iron deficiency
anemia?
,A. leukonychia
B. koilonychias
C. clubbing
D. onycholysis
E. paronychia - ANSWER *ANSWER: B. Koilonychia*
Koilonychia is a spoon-shaping of the nail itself. It is usually a result of iron deficiency anemia.
Leukonychia is often associated with hypoalbuminaemia that causes partial or complete white
discoloration of the nails. Leukonychia may also appear as a rare side effect of systemic
chemotherapy in some oncological patients but may also be present with arsenic poisoning, renal
failure pneumonia, or heart disease. Clubbing of the nails is an actual thickening or elevation of the
nail bed - it is a sign of release of TNF associated with pulmonary disorders (tissue necrosis factor)
typically found in bronchiectasis, lung cancers and cystic fibrosis (the nails are NOT necessarily
cyanotic.) Onycholysis is a painless separation of the nail from the nail bed. Several or all nails are
usually affected - there are many causes. Paronychia is an infection of the nail bed and nail margin,
usually from trauma or more commonly, nail-biting.
Which of the following is NOT a characteristic feature of the nephrotic syndrome?
A. proteinuria
B. hematuria
C. hypoalbuminemia
D. hyperlipidemia
E. generalized edema - ANSWER *ANSWER: B. Hematuria*
Hematuria is present in NEPHRITIC syndrome. Nephrotic syndrome characteristically includes
proteinuria (>3.5 gm/day), with resulting low serum albumin, hyperlipidemia, hypertension,
hypercoagulability, and generalized edema (from oncotic third-spacing)
A patient describes a history of recurrent bouts of uveitis. Her chemistry panel reveals elevated
serum calcium and uric acid levels. Her anergy screen is negative. Her chest x-ray demonstrates
bilateral hilar adenopathy. Which diagnosis is most likely?
A. Silicosis
B. Sarcoidosis
C. Alpha-1 antitrypsin deficiency
, D. Histoplasmosis
E. Tuberculosis - ANSWER *ANSWER: B. Sarcoidosis*
Sarcoid typically presents with hilar lvmphadenopathy and noncaseating granulomas of the lungs
(and other organs). In addition, patients may get eye involvement (uveitis). Elevations of ACE,
Calcium and uric acid are frequently seen.
A 34-old female presents complaining of symmetrical redness and swelling of the small joints of her
hands (PIPs and MCPs). She has noted that the symptoms are worst in the morning. Her erythrocyte
sedimentation rate is elevated and her rheumatoid factor is negative. Which of the following
diagnosis is most likely?
A. progressive systemic sclerosis
B. CREST syndrome
C. osteoarthritis
D. rheumatoid arthritis
E. ankylosing spondylitis - ANSWER *ANSWER: D Rheumatoid Arthritis*
In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA characteristically
includes small joint symmetrical arthritis, with an elevated ESR (therefore inflammatory, and not OA).
80% of patients with RA will have a positive RF, but 20% will be negative. PSS involves squamous cell
thickening and sclerosis causing taut skin of the face and hands and difficulty with esophageal
motility. CREST syndrome is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and
negative RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine)
A 14 year-old is experiencing a severe asthma attack. Although he is using accessory muscles to
breath, auscultation of his chest reveals no audible wheezing. His heart rate is 160 and his respiratory
rate is 52. Which of the following arterial blood gases represents the worst prognosis?
A. pH = 7.52; pC02 = 28; p02 = 80
B. pH = 7.44; pC02 = 38; p02 = 70
C. pH = 7.60; pC02 = 18; p02 = 60
D. pH= 7.40; pC02 = 40; p02 = 60
E. pH = 7.27; pC02 - 62; p02 = 64 - ANSWER ANSWER: E. pH = 7.27; pC02 - 62; p02 = 64
