PANCE Practice Questions AND ANSWERS GRADED A | 60 Q & A
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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. or...
pance practice questions and answers graded a | 60 q amp a
52 year old male presents complaining of urinary frequency
and nocturia for the past few months during his physical
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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 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.
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. 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
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 - 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 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 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.
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)
, 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?
This patient has a RR of 52. If she is ventilating, she is blowing of C02 (an acid) and would be alkalotic
and should have a low C02. A pH which is acidic with a pC02 which is elevated means that she is no
longer ventilating at all (she needs mechanical ventilation or she will die).
A 27 year-old nulliparous female presents because she's been trying to get pregnant for two years, but
has failed. She relates a history of a misdiagnosis of appendicitis that lead to abscess formation when
she was 14 years old. Which of the following diagnostic studies would be most helpful at this point in
her evaluation?
A. TSH level
B. hysterosalpingogram
C. laparoscopy
D. PAP smear
E. pelvic ultrasound Correct Answer: *Answer: B hysterosalpingogram*
While I would disagree that an invasive procedures like HSG should be done first-line, the thing to
remember in this question is that the patient has reason to have tubal scarring from adhesions (and
there is no better answer listed to choose), so, for a board exam I would choose this answer. The TSH
level would not be indicated (she has not had a pg loss), lap could diagnose the tubal scarring but would
be done after an abnormal HSG. Pap smear is screening for cervical cancer and not indicated in this case
of infertility; and pelvic US would yield nothing diagnostically about the tubes.
48 year-old nurse, with a body mass index of 31, presents for an evaluation for back pain. She relates
that historically, she had a positive PPD test a year ago and did not follow-up as directed. She has
recently been experiencing night sweats and coughing. An x-ray of her lumbar spine reveals osteopenia
and cortical breakdown of vertebral bodies L4 and L5. Which of the following diagnosis is most suspect?
A compression fractures secondary to obesity
B degenerative joint disease
C Potts disease
D compression fractures secondary to osteoporosis
E spondylolisthesis Correct Answer: *Answer: C Potts Disease*
Pott's disease is TB of the spine. She could have any of the other diseases; but the question states that
she had a positive PPD and did not take meds...that is the clue that she has active TB in the spine.
While suturing a wound, you opt to use lidocaine with epinephrine. The rationale for your choice is:
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