PANCE Practice Questions And Answers| graded A ( 30 PAGES 113 QUESTIONS)

PANCE Practice Questions And Answers| graded A ( 30 PAGES 113 QUESTIONS) b Correct Answer: A 24 year old female presents to the ER with chest pain. She reports having upper respiratory symptoms for about two weeks before developing chest pain this morning which has worsened throughout the day. The pain is worse with deep inspiration and laying flat. On cardiac exam there is an audible friction rub. An EKG obtained shows tachycardia with diffuse ST elevation. A CXR and echocardiogram are normal. What is her most likely diagnosis? a. Acute coronary syndrome b. Acute pericarditis c. Bacterial endocarditis d. Pericardial effusion e. Pulmonary embolism e Correct Answer: A 28 year old male presents to the urgent care with shortness of breath. He reports over the last 24 hours he has had right sided chest pain and difficulty catching his breath. His vitals are height 73", weight 180 lbs, temp 98.3, pulse 105, and SpO2 92% on room air. On exam breath sounds are diminished on the right side. What is the most likely diagnosis? a. Atypical pneumonia b. Pleurisy c. Pleural effusion d. Pulmonary embolism e. Spontaneous pneumothorax e Correct Answer: Which of the following is the most common cause of respiratory disease in the preterm infant? a. Bronchiolitis b. Bronchiectasis c. Pneumonia d. Restrictive airway disorder e. Respiratory distress syndrome d Correct Answer: A 48 year old male has a rash. It started about a month ago with a few isolated lesions on his abdomen. He has since developed new lesions on his arms and legs. His main complaint is itching. On exam, you find anular "coin-shaped" sharply demarcated plaques on his trunk and extremities. What is the most likely diagnosis? a. Erythema multiforme b. Erythema nodosum c. Lichen planus d. Nummular eczema e. Psoriasis e Correct Answer: Which of the following is a major Jones criteria for the diagnosis of acute rheumatic fever? a. Fever b. Polyarthralgias c. Prolonged PR interval d. Elevated erythrocyte sedimentation rate e. Carditis d Correct Answer: Which vaccine has significantly reduced the incidence of epiglottitis? a. DTaP (diptheria, tetanus, and acellular pertussis) b. PCV13 (pneumococcal conjugate) c. MMR (measles, mumps, and rubella) d. Hib (Haemophilus influenza type B) e. Meningococcal a Correct Answer: Which of the following drugs is most likely to have an effect on the INR of a patient taking Warfarin? a. Trimethorpim-Sulfamethoxazole b. Penicillin G c. Clindamycin d. Cefdinir e. Cephalexin b Correct Answer: A 1 day old female has excessive secretions, choking, and difficulty feeding. An attempt to pass a catheter ito the stomach is unsuccessful and she is diagnosed with tracheoesophageal fistula. Which congenital abnormality is most commonly associated with this? a. Diaphragmatic hernia b. Esophageal atresia c. Pyloric stenosis d. Hirschsprung disease e. Bowel atresia c Correct Answer: A 42 year old woman with a history of asthma is diagnosed with essential hypertension. Which medication should be avoided? a. Lisinopril b. Hydrochlorothiazide c. Propanolol d. Amlodipine e. Losartan d Correct Answer: A 4 year old female is admitted to the pediatric hospital unit with pneumonia. What is the most likely pathogen causing her pneumonia? a. Mycoplasma pneumonia b. Staphylococcus pneumoia c. Group B streptococcal pneumonia d. Viral pneumonia e. Haemophilus influenza e Correct Answer: A deficiency in which of the following results in night blindness and dry skin? a. Vitamin C b. Biotin c. Vitamin E d. Riboflavin e. Vitamin A d Correct Answer: Which of the following antihypertensive drugs reduces mortality after an MI in patients with heart failure? a. Hydrochlorothiazide b. Terazosin c. Amlodipine d. Lisinopril e. Clonidine c Correct Answer: A 22 year old female with irregular menses is being evaluated for possible polycystic ovarian syndrome (PCOS). Which of the following would confirm the diagnosis in her case? a. Elevated glucose b. Hyperinsulinemia c. Hyperandrogenism d. Elevated FSH e. Low TSH e Correct Answer: A 42 year old woman running a marathon became lightheaded and is transported by medical staff to the ED. IV fluids are started and an electrolyte panel is pending, however she is noted to have a prolonged QT interval o EKG. She suddenly becomes diaphoretic and complains of palpitations. The following rhythm is observed on the monitor: Which of the following medicatios should be administered? a. Amiodarone b. Bicarbonate c. Epinephrine d. Lidocaine e. Magnesium b Correct Answer: Which of the following is the most common cause of restrictive cardiomyopathy? a. Alcohol abuse b. Amyloidosis c. Aortic stenosis d. Hypertension e. Sarcoidosis e Correct Answer: Which of the following asthma and allergy drugs should be monitored for neuropsychiatric side effects including suicidal ideation? a. Albuterol b. Cetirizine (Zyrtec) c. Famotidine (Allegra) d. Loratidine (Claritin) e. Montelukast (Singulair) a Correct Answer: A 54 year old female is diagnosed with DM II and started on Metformin. Despite this and lifestyle modification, after 6 months her HbA1c is still not at goal. Which of the following would be a contraindication for starting her on Victoza (liraglutide)? a. Family hx of medullary thyroid carcinoma b. Family hx of estrogen receptor positive breast cancer c. Personal hx of chronic kidney disease d. Personal hx of heart failure e. Personal hx of medication noncompliance b Correct Answer: A 32 year old man is diagnosed with peptic ulcer disease via endoscopy. Despite multiple therapies, he has refractory symptoms. A CT of the abdomen and pelvis reveals a 3 cm mass on the pancreas. Which lab value is likely to be significantly elevated in this patient? a. Cortisol b. Gastrin c. Free T4 d. Insulin e. Testosterone a Correct Answer: A 42 year old woman has a 2 month history of generalized fatigue, muscle aches, and weakness. She works as a mail carrier and has difficulty carrying and delivering mail and packages. Prior to onset of symptoms, she reports a patchy, purple discoloration to her face and back of her hands. On exam she has purple discoloration to her eyelids with periorbital edema, as well as flat-topped raised nonpruritic lesions over the dorsum of the MCP, PIP, and DIP joints. She has a V-shaped rash o her neck and trunk. What is her most likely diagnosis? a. Dermatomyositis b. Myasthenia gravis c. Polymyalgia rheumatica d. Rheumatoid arthritis e. Systemic lupus erythematosus c Correct Answer: A 14-year old male comes to the clinic to discuss options for acne treatment. On exam he has non-inflammatory open and closed comedomes o his cheeks, forehead, and chin. Currently he is washing his face once a day with antibacterial soap and water. What is the best first-line treatment? a. Oral isotrenitoin b. Oral tetracycline c. Topical benzoyl peroxide d. Topical triamcinolone e. Topical clindamycin c Correct Answer: A 72 year old male nursing home resident with a history of DM II and CAD is transferred to the ED with altered mental status. Labs reveal serum Na 126 (normal 135-145), Cl 92 (normal 96-106), CO2 21 (normal 23-29), and serum glucose 920 (normal 70-130). Urinalysis was positive for 500 glucose and small ketones present. On exam the patient is confused, mucous membranes are dry and there is decreased skin turgor. What is his most likely diagnosis? a. Diabetic insipidus b. Diabetic ketoacidosis c. Hyperglycemic hyperosmolar syndrome d. Syndrome of inappropriate antidiuretic hormone secretion c Correct Answer: A 19 year old G0P0 female presents to urgent care with 1 week of yellow vaginal discharge, vaginal itching and irritation. She is sexually active and does not use condoms consistently. On exam, there is a malodorous, frothy discharge and the cervix is noted to have tiny erythematous punctate lesions. Which finding on microscopic evaluation helps confirm the suspected diagnosis? a. Branching hyphae b. WBCs c. Flagellated motile organisms d. RBCs e. Squamous epithelial cells b Correct Answer: A 44 year old man fell from a two story rooftop and is transported to the ED. On arrival, is GCS is 12. Vital signs are HR 120, RR 35, BP 90/70, and SpO2 80%. On exam, lung sounds are absent on the right, diminished on the left, and heart sounds are muffled. A tension pneumothorax is suspected. Which of the following is the next best step in the treatment of this patient? a. Needle decompression on the left b. Needle decompression on the right c. Place a chest tube on the left d. Place a chest tube on the right e. Obtain STAT CXR c Correct Answer: A 13 year ol