60 PANCE Practice Questions
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 - ANS>*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. - ANS>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 - ANS>*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 - ANS>*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 - ANS>*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
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 - ANS>*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. - ANS>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 - ANS>*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 - ANS>*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 - ANS>*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
