PANCE Practice Exam Questions
COMPLETE SOLUTION
D. ALS Correct Answer: A 58 year-old male presents complaining of weakness of
his grip. Your examination reveals that the problem is bilateral. During the next
few office visits, you note the development of hyperactivity of his DTRs, extensor
plantar reflexes and dysarthria. The patient's sensory system remains normal and
he denies any urinary symptomatology. Which of the following is the most likely
diagnosis?
A. multiple sclerosis
B. Alzheimer's disease
C. Huntington's chorea
D. ALS
E. myasthenia gravis
C. inadequate dietary protein
Low dietary Calcium, not protein, is a risk factor for osteoporosis. All of the others
are risk factors. Correct Answer: Which of the following is NOT a risk factor for
the development of osteoporosis?
A. low testosterone levels in men
B. low levels of physical activity
C. inadequate dietary protein
D. cigarette smoking
E. chronic corticosteroid use
B. metoprolol
Of these Beta-blockers (which are usually AVOIDED) in reactive airway disease -
metoprolol is the most "cardioselective", so theoretically could be used....although,
on an exam, I would avoid beta-blockers in general. Correct Answer: Question 1
CORRECT
A patient presents complaining of severe pain and "burning" in an extremity. You
note that the extremity is pale and cool to the touch. You cannot appreciate a
palpable pulsation. Which of the following diagnostic modalities will identify the
source of this patient's problem in approximately 95% of cases?
A chest x-ray
B echocardiogram
,aortic angiogram
D abdominal flat plate
E aortic ultrasound
Question 1 Explanation: Angiogram is the "gold standard" for occlusion of an
arterial vessel.
Question 2 CORRECT
A 31 year-old pharmacist complaining of rectal pain. He describes the pain as "a
severe tightness that awakens him from sleep." His bowel activity is normal. He
denies rectal bleeding and seepage. He adds that sleep interruption is problematic,
because with the number of hours he works, every minute of sleep is important.
What is the most likely diagnosis?
A anal abseess
B perianal fistula
proctalgia fugax
D ulcerative colitis
E internal hemorrhoids.
Question 2 Explanation: proctalgia (rectal pain) fugax (comes and goes) is the best
description. Abscess would be constant, fistula would drain, UC would cause
bloody mucousy diarrhea, hemorrhoids would cause no pain, but bleeding.
Question 3 CORRECT
A 38 year-old chronic smoker presents with shortness of breath and wheezing. He
has had several similar episodes in the past. He states that each previous episode
began after developing a "cold that moved into his chest." Usually, after treatment
with albuterol (VENTOLIN) and several days, the wheezing stops. He adds that he
has a chronic cough, productive of mucous, most mornings during the past several
years. Which of the following best describes this patient's condition?
A chronic emphysema
B chronic bronchitis
chronic bronchitis with hypersensitive airways (asthmatic bronchitis)
D cor pulmonale
E bronchiectasis
Question 3 Explanation: This is the best descriptor.
Question 4 CORRECT
A patient is being treated for Tuberculosis. She is experiencing central scotomata,
a loss of green-red color perception and decreased visual acuity. Which agent is
most likely responsible?
A rifampin
B isoniazid
C streptomycin
ethambutol
,E para-aminosalicylic acid
Question 4 Explanation: Ethambutol is the TB drug that causes "E"ye symptoms. I
remember it because it begins with an E.
Question 5 CORRECT
Secondary to a traumatic event, a child complains of pain in the index finger. An x-
ray of the digit demonstrates a fracture line through the metaphysis of the proximal
aspect of the middle phalanx, ending at the epiphyseal plate. What type of fracture
does this child have?
A Salter Harris Type I
Salter Harris Type II
C Salter Harris Type III
D Salter Harris Type IV
E Salter Harris Type V
Question 5 Explanation: Salter I = slight increase in Space between epiphyseal
plate and metaphysis Salter II = fx Above the plate (in the metaphysis) Salter III =
fx Lower (in the epiphyseal plate) Salter IV = fit Through (both the metaphysic
and epiphysis) Salter V = Really bad (comminuted fx compressing the epiphysis)
This spells SALTR and may help you remember. 7365546_orig About Jorge
Muniz PA-C (Creator of Medcomic)
Question 6 CORRECT
A 24 year-old male presents complaining of chest pain. He states that it is worse
with swallowing and taking a deep breath. It is improved by sitting up and leaning
forward. He denies trauma, a cough and shortness of breath. Which of the
following tests would be most compatible with your suspected diagnosis?
A a hiatal hernia visualized on chest x-ray
B a normal erythrocyte sedimentation rate
C calcified "popcorn" lesions in the lung fields bilaterally
diffuse ST segment elevation on his electrocardiograph
E a widened A-a gradient on his arterial blood gas
Question 6 Explanation: This is pericarditis (by clinical presentation) which causes
diffuse ST segment elevation on ECG (there can be notching of the R wave as
well)
Question 7 CORRECT
A 2 month-old febrile male is brought to your facility to be evaluated for loss of
appetite, irritability, and an acute petechial rash. Rectal temperature is 102.8F.
Which of the following diagnostic studies is the most important in this child's
evaluation?
A white blood cell count and differential
B urinalysis
CSF analysis
, D serum glucose
E chest X-ray (CXR)
Question 7 Explanation: Any infant (neonate) with fever and rash should have a
lumbar puncture (LP). While I would certainly do a CBC, even if it was normal, I
would want the LP.
Question 8 CORRECT
Your 27 year-old sister is visiting and requests you to provide refills of
dexamethasone and homatropine ophthalmic drops for her. What condition is most
likely being treated?
A conjunctivitis
B glaucoma
iritis
D Herpes keratitis
E blepharitis
Question 8 Explanation: Iritis is treated with steroid drops (dexamethasone) and
miotic drops *homatropine, like atropine (to constrict and fix the pupil to help the
pain and open the angle until the iritis is resolved)
Question 9 PARTIAL-CREDIT
A 58 year-old male presents complaining of weakness of his grip. Your
examination reveals that the problem is bilateral. During the next few office visits,
you note the development of hyperactivity of his DTRs, extensor plantar reflexes
and dysarthria. The patient's sensory system remains normal and he denies any
urinary symptomatology. Which of the following is the most likely diagnosis?
A multiple sclerosis
B Alzheimer's disease
Huntington's choreaHint: Huntington's causes a movement disorder with writhing
choreiform movements of the body
amyotrophic lateral sclerosis
E myasthenia gravisHint: Myasthenia causes fatigue of the ocular muscles
typically worsening at the end of the day.
Question 9 Explanation: ALS (Lou Gehrig's disease) is a progressive bilateral
muscle disease which causes fasciculations (lower motor neuron), and hyper-
reflexia, plantar reflexes (upper motor neuron) and dysarthria. Sensation is normal
as is bladder function. MS may have dysarthria, but reflexes are normal, sensation
is impaired and bladder function is frequently affected. Alzheimer's has normal
neuro exam with cognitive disability. Huntington's causes a movement disorder
with writhing choreiform movements of the body. Myasthenia causes fatigue of the
ocular muscles typically worsening at the end of the day.
Question 10 CORRECT
Which of the following is NOT a characteristic feature of multiple myeloma?
COMPLETE SOLUTION
D. ALS Correct Answer: A 58 year-old male presents complaining of weakness of
his grip. Your examination reveals that the problem is bilateral. During the next
few office visits, you note the development of hyperactivity of his DTRs, extensor
plantar reflexes and dysarthria. The patient's sensory system remains normal and
he denies any urinary symptomatology. Which of the following is the most likely
diagnosis?
A. multiple sclerosis
B. Alzheimer's disease
C. Huntington's chorea
D. ALS
E. myasthenia gravis
C. inadequate dietary protein
Low dietary Calcium, not protein, is a risk factor for osteoporosis. All of the others
are risk factors. Correct Answer: Which of the following is NOT a risk factor for
the development of osteoporosis?
A. low testosterone levels in men
B. low levels of physical activity
C. inadequate dietary protein
D. cigarette smoking
E. chronic corticosteroid use
B. metoprolol
Of these Beta-blockers (which are usually AVOIDED) in reactive airway disease -
metoprolol is the most "cardioselective", so theoretically could be used....although,
on an exam, I would avoid beta-blockers in general. Correct Answer: Question 1
CORRECT
A patient presents complaining of severe pain and "burning" in an extremity. You
note that the extremity is pale and cool to the touch. You cannot appreciate a
palpable pulsation. Which of the following diagnostic modalities will identify the
source of this patient's problem in approximately 95% of cases?
A chest x-ray
B echocardiogram
,aortic angiogram
D abdominal flat plate
E aortic ultrasound
Question 1 Explanation: Angiogram is the "gold standard" for occlusion of an
arterial vessel.
Question 2 CORRECT
A 31 year-old pharmacist complaining of rectal pain. He describes the pain as "a
severe tightness that awakens him from sleep." His bowel activity is normal. He
denies rectal bleeding and seepage. He adds that sleep interruption is problematic,
because with the number of hours he works, every minute of sleep is important.
What is the most likely diagnosis?
A anal abseess
B perianal fistula
proctalgia fugax
D ulcerative colitis
E internal hemorrhoids.
Question 2 Explanation: proctalgia (rectal pain) fugax (comes and goes) is the best
description. Abscess would be constant, fistula would drain, UC would cause
bloody mucousy diarrhea, hemorrhoids would cause no pain, but bleeding.
Question 3 CORRECT
A 38 year-old chronic smoker presents with shortness of breath and wheezing. He
has had several similar episodes in the past. He states that each previous episode
began after developing a "cold that moved into his chest." Usually, after treatment
with albuterol (VENTOLIN) and several days, the wheezing stops. He adds that he
has a chronic cough, productive of mucous, most mornings during the past several
years. Which of the following best describes this patient's condition?
A chronic emphysema
B chronic bronchitis
chronic bronchitis with hypersensitive airways (asthmatic bronchitis)
D cor pulmonale
E bronchiectasis
Question 3 Explanation: This is the best descriptor.
Question 4 CORRECT
A patient is being treated for Tuberculosis. She is experiencing central scotomata,
a loss of green-red color perception and decreased visual acuity. Which agent is
most likely responsible?
A rifampin
B isoniazid
C streptomycin
ethambutol
,E para-aminosalicylic acid
Question 4 Explanation: Ethambutol is the TB drug that causes "E"ye symptoms. I
remember it because it begins with an E.
Question 5 CORRECT
Secondary to a traumatic event, a child complains of pain in the index finger. An x-
ray of the digit demonstrates a fracture line through the metaphysis of the proximal
aspect of the middle phalanx, ending at the epiphyseal plate. What type of fracture
does this child have?
A Salter Harris Type I
Salter Harris Type II
C Salter Harris Type III
D Salter Harris Type IV
E Salter Harris Type V
Question 5 Explanation: Salter I = slight increase in Space between epiphyseal
plate and metaphysis Salter II = fx Above the plate (in the metaphysis) Salter III =
fx Lower (in the epiphyseal plate) Salter IV = fit Through (both the metaphysic
and epiphysis) Salter V = Really bad (comminuted fx compressing the epiphysis)
This spells SALTR and may help you remember. 7365546_orig About Jorge
Muniz PA-C (Creator of Medcomic)
Question 6 CORRECT
A 24 year-old male presents complaining of chest pain. He states that it is worse
with swallowing and taking a deep breath. It is improved by sitting up and leaning
forward. He denies trauma, a cough and shortness of breath. Which of the
following tests would be most compatible with your suspected diagnosis?
A a hiatal hernia visualized on chest x-ray
B a normal erythrocyte sedimentation rate
C calcified "popcorn" lesions in the lung fields bilaterally
diffuse ST segment elevation on his electrocardiograph
E a widened A-a gradient on his arterial blood gas
Question 6 Explanation: This is pericarditis (by clinical presentation) which causes
diffuse ST segment elevation on ECG (there can be notching of the R wave as
well)
Question 7 CORRECT
A 2 month-old febrile male is brought to your facility to be evaluated for loss of
appetite, irritability, and an acute petechial rash. Rectal temperature is 102.8F.
Which of the following diagnostic studies is the most important in this child's
evaluation?
A white blood cell count and differential
B urinalysis
CSF analysis
, D serum glucose
E chest X-ray (CXR)
Question 7 Explanation: Any infant (neonate) with fever and rash should have a
lumbar puncture (LP). While I would certainly do a CBC, even if it was normal, I
would want the LP.
Question 8 CORRECT
Your 27 year-old sister is visiting and requests you to provide refills of
dexamethasone and homatropine ophthalmic drops for her. What condition is most
likely being treated?
A conjunctivitis
B glaucoma
iritis
D Herpes keratitis
E blepharitis
Question 8 Explanation: Iritis is treated with steroid drops (dexamethasone) and
miotic drops *homatropine, like atropine (to constrict and fix the pupil to help the
pain and open the angle until the iritis is resolved)
Question 9 PARTIAL-CREDIT
A 58 year-old male presents complaining of weakness of his grip. Your
examination reveals that the problem is bilateral. During the next few office visits,
you note the development of hyperactivity of his DTRs, extensor plantar reflexes
and dysarthria. The patient's sensory system remains normal and he denies any
urinary symptomatology. Which of the following is the most likely diagnosis?
A multiple sclerosis
B Alzheimer's disease
Huntington's choreaHint: Huntington's causes a movement disorder with writhing
choreiform movements of the body
amyotrophic lateral sclerosis
E myasthenia gravisHint: Myasthenia causes fatigue of the ocular muscles
typically worsening at the end of the day.
Question 9 Explanation: ALS (Lou Gehrig's disease) is a progressive bilateral
muscle disease which causes fasciculations (lower motor neuron), and hyper-
reflexia, plantar reflexes (upper motor neuron) and dysarthria. Sensation is normal
as is bladder function. MS may have dysarthria, but reflexes are normal, sensation
is impaired and bladder function is frequently affected. Alzheimer's has normal
neuro exam with cognitive disability. Huntington's causes a movement disorder
with writhing choreiform movements of the body. Myasthenia causes fatigue of the
ocular muscles typically worsening at the end of the day.
Question 10 CORRECT
Which of the following is NOT a characteristic feature of multiple myeloma?
