PANCE EXAM PREP |ACTUAL QUESTIONS AND
VERIFIED ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A 3-week-old male infant is brought in by his mother due to his vomiting. The mother
notes that a few days ago her son started vomiting after feeding, and it has become
projectile in nature. The vomitus is non-bilious and contains no blood. The child seems
hungry and nurses regularly, but the vomiting has become more frequent and is occurring
with every feeding now. On physical examination, an oval mass is palpated in the right
upper quadrant. What laboratory finding is most consistent with the suspected diagnosis?
A. Decreased hematocrit
B. Elevated amylase
C. Hyperkalemia
D. Hypochloremic alkalosis
CORRECT ANSWER
The answer is D.
Laboratory findings that are consistent with the suspected diagnosis of pyloric stenosis
include hypochloremic alkalosis with potassium depletion. An elevated hemoglobin and
hematocrit can also be present, and are due to dehydration. Changes in amylase or serum
sodium are not present in cases of pyloric stenosis.
Question 2
A 39-year-old man presents to the emergency department with massive hematemesis. His
physical examination reveals slight jaundice, palmar erythema, spider angiomas, and
marked ascites. Vitals at the time of presentation are as follows: BP: 85/44 mm Hg, P:
122/min, R: 16/min, oxygen saturation: 96%, and T: 99.8°F. Which of the following is the
most likely cause of the massive hematemesis?
A. Peptic ulcer disease
B. Mallory-Weiss tear
1
,C. Gastric carcinoma
D. Arteriovenous malformation
E. Esophageal varices
CORRECT ANSWER
The answer is E.
EXPLANATION: The most common cause of massive upper gastrointestinal bleeding in
patients with cirrhosis is esophageal varices. Although 20% of patients with portal
hypertension will have bleeding from other causes (peptic ulcer disease, Mallory-Weiss
tears, or gastritis), endoscopic evaluation in patients with portal hypertension is necessary
for diagnosis and initial therapy.
Question 3
A two-month-old bottle fed infant female presents with a sharply demarcated scaling red
rash on the face and in the diaper area. The mother reports that her child has been
irritable and has had diarrhea. The primary care provider has treated with hydrocortisone
2.5% ointment bid for two weeks with no improvement. What should be the next step in
confirming the diagnosis?
A. punch biopsy at border of genital rash
B. bacterial culture and viral culture
C. KOH and bacterial culture
D. cbc with diff and Zn level
CORRECT ANSWER
The answer is D.
EXPLANATION: This infant is displaying classic signs of zinc deficiency. This disorder can occur
in infants who are bottle fed. Treatment with topical steroids will not improve the condition
until the zinc level is corrected. A punch biopsy would not help in diagnosing the zinc
deficiency that this patient is exhibiting. Bacterial and viral cultures will not be helpful in
establishing the diagnosis. A KOH is used to diagnose fungal infections. The KOH and
bacterial culture will not be helpful in establishing the diagnosis of zinc deficiency.
2
,Question 4
A 56-year-old male is diagnosed with an H. pylori associated ulcer. The ulcer was 0.8 mm
in size on endoscopy. He is placed on a proton pump inhibitor, clarithromycin, and
amoxicillin. If his dyspeptic symptoms resolve after starting this regimen, how many days
should he take the proton pump inhibitor to complete the treatment?
A. 5 to 7 days
B. 10 to 14 days
C. 14 to 21 days
CORRECT ANSWER
The answer is B.
EXPLANATION: In an H. pylori associated ulcer that is < 1cm in size and dyspeptic symptoms
resolve with therapy, 10 to 14 days is the recommended length of treatment. For patients
with large or complicated ulcers, antisecretory therapy should be continued for an addition
two to four weeks (duodenal ulcer) or four to six weeks (gastric ulcer) after completion of
the antibiotic regimen.
Question 5
A 26-year-old woman has decreased appetite, weight gain, cold intolerance, hoarse voice,
constipation, and arthralgias. What is the most likely etiology of her condition?
A. autoimmune thyroiditis
B. congenital hypothyroidism
C. dietary iodine deficiency
D. surgical resection of the thyroid gland
CORRECT ANSWER
The answer is A.
EXPLANATION: Auto immune thyroiditis is the most common cause of hypothyroidism in the
United States. Dietary iodine deficiency is the most common cause in underdeveloped
regions of the world.
3
, Question 6
A patient is recovering from having a total thyroidectomy two days ago for medullary
thyroid cancer. An extensive neck dissection was required during the surgery. Post-
operative lab testing reveals a low serum calcium level. Which of the following clinical
presentations will most likely occur in this patient?
A. Constipation
B. Anorexia
C. Polyuria
D. Bone pain
E. Paresthesias
CORRECT ANSWER
The answer is E.
The correct choice is E, paresthesias. Circumoral paresthesias are signs of hypocalcemia.
Hypocalcemia can occur after any type of neck surgery that may have resulted in destruction
of the parathyroid glands. Choices A through D are symptoms of hypercalcemia and may be
seen in hyperparathyroidism.
Question 7
A 51-year-old male patient presents to your family practice office complaining of genital
discomfort with dysuria. His digital rectal exam reveals an enlarged, tender prostate. His
prostate-specific antigen (PSA) returns elevated with a value of 11.1 mg/mL, which you
fractionate, and this reveals approximately 75% free PSA. His urinalysis reveals moderate
white cells and trace blood. What would be your next step in treating this patient?
A. Begin him on 6 weeks of doxycycline to treat his prostatitis and when resolved, repeat his
PSA level.
B. Immediately refer him to a urologist for prostate biopsy to rule out prostate cancer.
C. Immediately refer him to a urologist for cystoscopy to rule out bladder cancer and
perform a computed tomography (CT) scan of the abdomen and pelvis in the interim.
CORRECT ANSWER
The answer is A.
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VERIFIED ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
A 3-week-old male infant is brought in by his mother due to his vomiting. The mother
notes that a few days ago her son started vomiting after feeding, and it has become
projectile in nature. The vomitus is non-bilious and contains no blood. The child seems
hungry and nurses regularly, but the vomiting has become more frequent and is occurring
with every feeding now. On physical examination, an oval mass is palpated in the right
upper quadrant. What laboratory finding is most consistent with the suspected diagnosis?
A. Decreased hematocrit
B. Elevated amylase
C. Hyperkalemia
D. Hypochloremic alkalosis
CORRECT ANSWER
The answer is D.
Laboratory findings that are consistent with the suspected diagnosis of pyloric stenosis
include hypochloremic alkalosis with potassium depletion. An elevated hemoglobin and
hematocrit can also be present, and are due to dehydration. Changes in amylase or serum
sodium are not present in cases of pyloric stenosis.
Question 2
A 39-year-old man presents to the emergency department with massive hematemesis. His
physical examination reveals slight jaundice, palmar erythema, spider angiomas, and
marked ascites. Vitals at the time of presentation are as follows: BP: 85/44 mm Hg, P:
122/min, R: 16/min, oxygen saturation: 96%, and T: 99.8°F. Which of the following is the
most likely cause of the massive hematemesis?
A. Peptic ulcer disease
B. Mallory-Weiss tear
1
,C. Gastric carcinoma
D. Arteriovenous malformation
E. Esophageal varices
CORRECT ANSWER
The answer is E.
EXPLANATION: The most common cause of massive upper gastrointestinal bleeding in
patients with cirrhosis is esophageal varices. Although 20% of patients with portal
hypertension will have bleeding from other causes (peptic ulcer disease, Mallory-Weiss
tears, or gastritis), endoscopic evaluation in patients with portal hypertension is necessary
for diagnosis and initial therapy.
Question 3
A two-month-old bottle fed infant female presents with a sharply demarcated scaling red
rash on the face and in the diaper area. The mother reports that her child has been
irritable and has had diarrhea. The primary care provider has treated with hydrocortisone
2.5% ointment bid for two weeks with no improvement. What should be the next step in
confirming the diagnosis?
A. punch biopsy at border of genital rash
B. bacterial culture and viral culture
C. KOH and bacterial culture
D. cbc with diff and Zn level
CORRECT ANSWER
The answer is D.
EXPLANATION: This infant is displaying classic signs of zinc deficiency. This disorder can occur
in infants who are bottle fed. Treatment with topical steroids will not improve the condition
until the zinc level is corrected. A punch biopsy would not help in diagnosing the zinc
deficiency that this patient is exhibiting. Bacterial and viral cultures will not be helpful in
establishing the diagnosis. A KOH is used to diagnose fungal infections. The KOH and
bacterial culture will not be helpful in establishing the diagnosis of zinc deficiency.
2
,Question 4
A 56-year-old male is diagnosed with an H. pylori associated ulcer. The ulcer was 0.8 mm
in size on endoscopy. He is placed on a proton pump inhibitor, clarithromycin, and
amoxicillin. If his dyspeptic symptoms resolve after starting this regimen, how many days
should he take the proton pump inhibitor to complete the treatment?
A. 5 to 7 days
B. 10 to 14 days
C. 14 to 21 days
CORRECT ANSWER
The answer is B.
EXPLANATION: In an H. pylori associated ulcer that is < 1cm in size and dyspeptic symptoms
resolve with therapy, 10 to 14 days is the recommended length of treatment. For patients
with large or complicated ulcers, antisecretory therapy should be continued for an addition
two to four weeks (duodenal ulcer) or four to six weeks (gastric ulcer) after completion of
the antibiotic regimen.
Question 5
A 26-year-old woman has decreased appetite, weight gain, cold intolerance, hoarse voice,
constipation, and arthralgias. What is the most likely etiology of her condition?
A. autoimmune thyroiditis
B. congenital hypothyroidism
C. dietary iodine deficiency
D. surgical resection of the thyroid gland
CORRECT ANSWER
The answer is A.
EXPLANATION: Auto immune thyroiditis is the most common cause of hypothyroidism in the
United States. Dietary iodine deficiency is the most common cause in underdeveloped
regions of the world.
3
, Question 6
A patient is recovering from having a total thyroidectomy two days ago for medullary
thyroid cancer. An extensive neck dissection was required during the surgery. Post-
operative lab testing reveals a low serum calcium level. Which of the following clinical
presentations will most likely occur in this patient?
A. Constipation
B. Anorexia
C. Polyuria
D. Bone pain
E. Paresthesias
CORRECT ANSWER
The answer is E.
The correct choice is E, paresthesias. Circumoral paresthesias are signs of hypocalcemia.
Hypocalcemia can occur after any type of neck surgery that may have resulted in destruction
of the parathyroid glands. Choices A through D are symptoms of hypercalcemia and may be
seen in hyperparathyroidism.
Question 7
A 51-year-old male patient presents to your family practice office complaining of genital
discomfort with dysuria. His digital rectal exam reveals an enlarged, tender prostate. His
prostate-specific antigen (PSA) returns elevated with a value of 11.1 mg/mL, which you
fractionate, and this reveals approximately 75% free PSA. His urinalysis reveals moderate
white cells and trace blood. What would be your next step in treating this patient?
A. Begin him on 6 weeks of doxycycline to treat his prostatitis and when resolved, repeat his
PSA level.
B. Immediately refer him to a urologist for prostate biopsy to rule out prostate cancer.
C. Immediately refer him to a urologist for cystoscopy to rule out bladder cancer and
perform a computed tomography (CT) scan of the abdomen and pelvis in the interim.
CORRECT ANSWER
The answer is A.
4
