PANCE Practice Exam #1 questions and answers

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 prazocin 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 seven days and schedule follow-up in twoweeks 1. 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. 2. 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 2. B. Koilonychia is a spoon-shaping of the nail itself. Clubbing is a thickening of the nail bed which "lifts" the nail - it is a sign of increased TNF (tissue necrosis factor), most likely occurring in cystic fibrosis, bronchiectasis or lung cancer. A & D are not real words, (onychomycosis is the real term for fungal infection of the nail)..E is paronychia and is an infection of the nailbed. 00:31 01:36 3. Which of the following is NOT a characteristic feature of the nephotic syndrome? A. proteinuria B. hematuria C. hypoalbuminemia D. hyperlipidemia E. generalized edema 3. B. 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) 4. A patient describes a history of recurrent bouts ofuveitis. Her chemistry panel reveals elevated serum calcium and uric acid levels. Her anergy screen is negative. Her chest x-ray deomstrates bilateral hilar adenopathy. Which diagnosis is most likely? A. Silicosis B. Sarcoidosis C. Alpha-1 antitrypsin deficiency D. Histoplasmosis E. Tuberculosis 4. B. Sarcoid typically presents with hilar lymphadenopathy 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. 5. A 34 year-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 5. D. 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) 6. 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 ofamisdiagnosis 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 6. B. 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. 7. 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? A. pH = 7.52; pC02 = 28; p02 = 80 B. pH = 7.44; pC02 =38; p02 = 70 C. pH = 7.60; pC02 = 18; p02 = 60 D. pH = 7.40; pC02 = 40; p02 = 60 E. pH = 7.27; pC02 = 62; p02 = 64 7.E. 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). 8. A 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 other 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 8. C. 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. 9. While suturing a wound, you opt to use lidocaine with epinephrine. The rationale to your choice is: A. an increase in the absorption of the lidocaine. B. an increase in the diffusion of the lidocaine into the nerve's myelin sheath C. an mcrease in the blood flow to the area of injection. D. an increase in the duration of anesthesia. E. a decrease in the risk of infection at the site of injection. 9. D. Lidocaine with epinephrine both increases duration of anesthesia and decreases blood flow to the area of injection, i.e. penis, nose, fingers, toes 10. An EKG demonstrates a PR interval ofOJ6 seconds, a P to QRS relationship of 1:1, a variable heart rate and an R to R interval that is noted to accelerate and decelerate during the respiratory cycle. What is the diagnosis? A. Wenckebach B. third degree heart block C. atrial fibrillation D. sinus arrhythmia E. atrial flutter 10. D. This is sinus arrhythmia. Wenckebach & third degree AVB would have a non- conducted P wave. A fib would have no P waves and an irregularly irregular rhythm. A flutter would have "flutter waves" or a regular rhythm of 150. 11. Combinations of antimicrobial agents are commonly employed in the treatment of meningitis in infants less than three months old. Ampicillin is commonly an agent included in this regimen. Ampicillin is used empirically for the possible presence of: A. Escherichia coli. B. Listeria monocytogenes. C. Cytomegalovirus. D. Herpes virus. E. Hemophilus influenzae. 11. B. While E. Coli can infect an infant delivered vaginally, AMPICILLIN is given to eliminate Listeria. CMV & HSV are viruses. E. Coli & H. Flu are also typically resistant to amp, and more likely a broader spectrum antibiotic would be used. 12. A 42 year-old female presents after finding a firm, painless bump in her right eye. On examination you note a 6 mm mass within the tarsus of the right eye. The skin is freely movable over me mass. The remainder of the ophthalmoscopic examination is unremarkable. Which of the following is the most likely diagnosis? " A. pterygium B. chalazion C. ectropion D. external hordeolum E. internal hourdeolum 12. B. A chalazion is a painless chronic mass in the eyelid. Hordeolum are acute and red and painful. Pterygium involves the sclera. Ectropion is when the eyelid sags outwardly and the lid doesn't close well.