60 PANCE Practice Questions well answered(completed)

Original 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 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. 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 00:56 01:36 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 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 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 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 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? 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 Answer: E. pH = 7.27; pC02 - 62; p02 = 64 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 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 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: 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 increase 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. Answer: D Lidocaine with epinephrine both increases duration of anesthesia and decreases blood flow to the area of injection-i.e. penis, nose, fingers, toes An EKG demonstrates a PR interval of 0.16 seconds, a P to QRS relationship of 1:1, a variable heart rate and an R to R interval that is noted to accelerate ad 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 Answer: D Sinus Arrhythmia 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. 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 Herpesvirus. E Hemophilus influenzae. Answer: B Listeria monocytogenes 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.