PANCE EXAM |ACTUAL QUESTIONS AND VERIFIED
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
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 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.
Question 2
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.
1
,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 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
Question 3
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 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 -
2
, there are many causes. Paronychia is an infection of the nail bed and nail margin, usually
from trauma or more commonly, nail-biting.
Question 4
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 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)
Question 5
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
3
, E. Tuberculosis
CORRECT 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.
Question 6
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
CORRECT 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)
4
ANSWERS|BRAND NEW 2026-2027
UPDATE|GRADED A+
Question 1
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 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.
Question 2
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.
1
,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 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
Question 3
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 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 -
2
, there are many causes. Paronychia is an infection of the nail bed and nail margin, usually
from trauma or more commonly, nail-biting.
Question 4
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 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)
Question 5
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
3
, E. Tuberculosis
CORRECT 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.
Question 6
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
CORRECT 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)
4
