PANCE NCCPA Review Questions and
Answers.
A patient is brought to the emergency department after a motor vehicle collision. X-ray
studies of the chest show a pleural effusion. A milky fluid drains from the chest tube.
Which of the follow structures is most likely ruptured?
A. Apical bleb
B. Bronchus
C. Diaphragm
D. Esophagus
E. Thoracic duct -
\E. Thoracic duct
Chylothorax commonly caused by leakage of lymph from the thoracic duct into the
pleural space. A chest x-ray will show if there is a buildup of fluid in the pleural space. If
a surgical drain or chest tube is in place and milky white fluid is noted, it can be sent to
the laboratory to be tested.
A 72-year-old man with chronic bronchitis undergoes laparotomy for treatment of a
bowel obstruction. Three days after surgery, the patient's wound begins to leak large
amounts of clear, salmon-colored fluid after an episode of coughing. The skin staples
are open and the wound is probed with a sterile-tipped applicator. During this
procedure, an open segment of the wound reaching back to the omentum and intestines
is noted. Which of the following is the most appropriate description of this type of
postoperative complication?
A. Dehiscence
B. Fistula
C. Hematoma
D. Seroma
E. Wound Infection -
\A. Dehiscence - The classic "salmon-colored" drainage is concerning for fascial
dehiscence
NOT Seroma - Clear or serous-appearing drainage may represent decompressing
seroma
A 35-year-old women is brought to the emergency department by a coworker because
she has had pain in the suprapubic region of her abdomen for the past two hours. The
patient says the pain developed while she was at work, after she was asked to complete
a double shift. She has not urinated since the beginning of her shift, but she has no
symptoms of urinary tract infection. The patient has a fear of speaking to other people at
work and tries to avoid writing in public, even signing sales receipts when she uses her
, credit card. She says she did not want to come to the emergency department, but her
coworker was worried and insisted. Physical examination shows tenderness to
palpation over the suprapubic region of the abdomen as well as evidence of distention
of the bladder. Because the patient is unable to urinate, a catheter is inserted, and
1200mL of urine is removed. Results of renal function studies and urinalysis ar -
\E. Social anxiety disorder
NOT Schizoaffective b/c no symptoms of Schizophrenia (Positive/Negative) + mood
disorder (MDD or Mania)
A 63-year-old man comes to the office because he has had a nontender mass in his
abdomen for the past eight months. He is otherwise healthy and takes no medications.
Pulse rate is 88/min, respirations are 13/min, and blood pressure is 158/94 mmHg.
Abdomen examination shows a 7x3-cm, non-pulsatile mass at the midline. A
photograph is shown. Bowel sounds are normoactive, and no hepatosplenomegaly is
noted. Which of the following additional findings on physical examination of this patient
is most likely?
A. Aortic bruit
B. Increase in size of the mass with Valsalva maneuver
C. Increased hepatojugular reflex
D. Involuntary abdominal guarding
E. Venous hum in the right upper quadrant of the abdomen -
\B. Abdominal Hernia - Increases in size of the mass with Valsalva because the
increase in intraabdominal pressure causes the hernia sac to enlarge and protrude
through the anatomic defect.
NOT Aortic bruit because not pulsatile mass.
A 34-year-old women who works as an elementary school teacher has polyarthritis of
the proximal interphalangeal joints of the hands. She has no history of recent illness,
has not been traveling, and currently takes no medications, but recently, some of her
students have had erythema infectiosum (fifth disease). Results of laboratory studies for
complete blood cell count, erythrocyte sedimentation rate, and rheumatoid arthritis show
no abnormalities. Which of the following viruses is the most likely cause of this patient's
symptoms?
A. Adenovirus
B. Coxsackievirus
C. Echovirus
D. Parvovirus
E. Rotavirus -
\D. Parvovirus
A 21-year-old man who does not use illicit drugs had sudden onset of pain in the
anterior aspect of his chest one hour ago. He says the pain is worse when he inhales
Answers.
A patient is brought to the emergency department after a motor vehicle collision. X-ray
studies of the chest show a pleural effusion. A milky fluid drains from the chest tube.
Which of the follow structures is most likely ruptured?
A. Apical bleb
B. Bronchus
C. Diaphragm
D. Esophagus
E. Thoracic duct -
\E. Thoracic duct
Chylothorax commonly caused by leakage of lymph from the thoracic duct into the
pleural space. A chest x-ray will show if there is a buildup of fluid in the pleural space. If
a surgical drain or chest tube is in place and milky white fluid is noted, it can be sent to
the laboratory to be tested.
A 72-year-old man with chronic bronchitis undergoes laparotomy for treatment of a
bowel obstruction. Three days after surgery, the patient's wound begins to leak large
amounts of clear, salmon-colored fluid after an episode of coughing. The skin staples
are open and the wound is probed with a sterile-tipped applicator. During this
procedure, an open segment of the wound reaching back to the omentum and intestines
is noted. Which of the following is the most appropriate description of this type of
postoperative complication?
A. Dehiscence
B. Fistula
C. Hematoma
D. Seroma
E. Wound Infection -
\A. Dehiscence - The classic "salmon-colored" drainage is concerning for fascial
dehiscence
NOT Seroma - Clear or serous-appearing drainage may represent decompressing
seroma
A 35-year-old women is brought to the emergency department by a coworker because
she has had pain in the suprapubic region of her abdomen for the past two hours. The
patient says the pain developed while she was at work, after she was asked to complete
a double shift. She has not urinated since the beginning of her shift, but she has no
symptoms of urinary tract infection. The patient has a fear of speaking to other people at
work and tries to avoid writing in public, even signing sales receipts when she uses her
, credit card. She says she did not want to come to the emergency department, but her
coworker was worried and insisted. Physical examination shows tenderness to
palpation over the suprapubic region of the abdomen as well as evidence of distention
of the bladder. Because the patient is unable to urinate, a catheter is inserted, and
1200mL of urine is removed. Results of renal function studies and urinalysis ar -
\E. Social anxiety disorder
NOT Schizoaffective b/c no symptoms of Schizophrenia (Positive/Negative) + mood
disorder (MDD or Mania)
A 63-year-old man comes to the office because he has had a nontender mass in his
abdomen for the past eight months. He is otherwise healthy and takes no medications.
Pulse rate is 88/min, respirations are 13/min, and blood pressure is 158/94 mmHg.
Abdomen examination shows a 7x3-cm, non-pulsatile mass at the midline. A
photograph is shown. Bowel sounds are normoactive, and no hepatosplenomegaly is
noted. Which of the following additional findings on physical examination of this patient
is most likely?
A. Aortic bruit
B. Increase in size of the mass with Valsalva maneuver
C. Increased hepatojugular reflex
D. Involuntary abdominal guarding
E. Venous hum in the right upper quadrant of the abdomen -
\B. Abdominal Hernia - Increases in size of the mass with Valsalva because the
increase in intraabdominal pressure causes the hernia sac to enlarge and protrude
through the anatomic defect.
NOT Aortic bruit because not pulsatile mass.
A 34-year-old women who works as an elementary school teacher has polyarthritis of
the proximal interphalangeal joints of the hands. She has no history of recent illness,
has not been traveling, and currently takes no medications, but recently, some of her
students have had erythema infectiosum (fifth disease). Results of laboratory studies for
complete blood cell count, erythrocyte sedimentation rate, and rheumatoid arthritis show
no abnormalities. Which of the following viruses is the most likely cause of this patient's
symptoms?
A. Adenovirus
B. Coxsackievirus
C. Echovirus
D. Parvovirus
E. Rotavirus -
\D. Parvovirus
A 21-year-old man who does not use illicit drugs had sudden onset of pain in the
anterior aspect of his chest one hour ago. He says the pain is worse when he inhales
