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.
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.
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.
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.
