Master the PANCE Exam: Essential
Practice Questions
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
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
Practice Questions
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
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
