60 PANCE Practice Questions and
Answers A+ Guide(2024 Latest update)
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 - correct answers✅✅*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
,60 PANCE Practice Questions and
Answers A+ Guide(2024 Latest update)
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. - correct
answers✅✅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 - correct answers✅✅*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
,60 PANCE Practice Questions and
Answers A+ Guide(2024 Latest update)
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 - correct answers✅✅*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)
, 60 PANCE Practice Questions and
Answers A+ Guide(2024 Latest update)
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 - correct answers✅✅*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
Answers A+ Guide(2024 Latest update)
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 - correct answers✅✅*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
,60 PANCE Practice Questions and
Answers A+ Guide(2024 Latest update)
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. - correct
answers✅✅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 - correct answers✅✅*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
,60 PANCE Practice Questions and
Answers A+ Guide(2024 Latest update)
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 - correct answers✅✅*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)
, 60 PANCE Practice Questions and
Answers A+ Guide(2024 Latest update)
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 - correct answers✅✅*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
