Sample PANCE Questions- NCCPA
For the past three weeks, a 47-year-old man has had the feeling of heaviness in his
chest while pushing his lawn mower. He says he has never been treated for similar
symptoms and has no symptoms now. He smoked one pack of cigarettes daily for 20
years but quit smoking seven years ago. Findings on physical examination are normal.
Electrocardiography shows no
abnormalities. Which of the following is the most appropriate initial diagnostic study?
A. Coronary arteriography
B. Echocardiography
C. Exercise stress test
D. 24-Hour ambulatory cardiac monitoring
E. Myocardial perfusion scan -
\exercise stress test
exercise stress test, is correct because it is the most appropriate initial step in the
workup of a patient with recent chest pain because the test is noninvasive, inexpensive,
convenient, and sensitive in this type of patient.
The most definitive diagnostic test for a patient with coronary artery disease is Option
(A), coronary arteriography, but this test is not the most appropriate initial test in an
asymptomatic patient with no abnormal findings on electrocardiography. Option (B),
echocardiography, is a valuable tool for examining valvular structures, cardiac size,
ejection fraction, as well as other anatomic features. However, echocardiography is not
routinely indicated for evaluating ischemia resulting from coronary artery disease and is,
therefore, incorrect. Option (D), 24-hour ambulatory cardiac monitoring, is also
incorrect. Twenty-four-hour ambulatory cardiac monitoring is used primarily for
evaluating disturbances of rate and rhythm and it is able to detect ST-segment
depression, but it is less effective than exercise stress testing in confirming a diagnosis
of coronary artery disease in the initial workup of a patient. This patient's
electrocardiogram shows no abnormalities, and therefore, Option (E), myocardial
perfusion scan, is incorrect. This option would only be correct if the results of resting
electrocardiography were abnormal, making it difficult to interpret an exercise stress tes
A 32-year-old woman has had a rash on her legs for the past three weeks. There are no
known infectious contacts. One month ago, she had a bladder infection and was treated
with trimethoprim-sulfamethoxazole. Physical examination shows a diffuse rash on the
shins, the left medial ankle, and the right medial calf. The rash is tender, diffuse, and
recurs in the same
areas. A few of the lesions have the appearance of bruising. Which of the following is
the most
likely diagnosis?
A. Erythema multiforme
, B. Erythema nodosum
C. Lichen planus
D. Lichen simplex
E. Nummular eczema -
\B. Erythema nodosum
Option (B), erythema nodosum, because this type of rash may be antibiotic-related,
occurs on the lower extremities below the knees, and has the appearance of bruising.
All of these symptoms are present in this clinical scenario. Options (A), erythema
multiforme, and (C), lichen planus, can also result from an allergic reaction to a sulfa
antibiotic, but the presentation of this patient's rash is not consistent with either of these
conditions. Options (D), lichen simplex, and (E), nummular eczema, are chronic
conditions that result in scaling. Therefore, given the time frame and the presentation of
this patient's rash, these two options are incorrect.
A 41-year-old woman has a nine-month history of nausea, constipation, dyspepsia,
general fatigue, arthralgia, and increasing memory loss. She has no history of illness
other than her present complaints, and her menses have been regular. Physical
examination shows no abnormalities. Laboratory findings include the following levels:
Serum Albumin 4.9 g/dL
Calcium 13.0 mg/dL
Chloride 111 mEq/L
Creatinine 1.0 mg/dL
Phosphate 0.3 mg/dL
Blood urea nitrogen 17 mg/dL
Which of the following is the most likely diagnosis?
A. Cushing syndrome
B. Hyperparathyroidism
C. Hypopituitarism
D. Malabsorption
E. Multiple myeloma -
\B. Hyperparathyroidism
Option (B), hyperparathyroidism, is the correct answer. The patient has the classic signs
of this condition, which include gastrointestinal, musculoskeletal, and neurologic
abnormalities. Additionally, the laboratory values clearly show hypercalcemia and
hypophosphatemia, both of which indicate hyperparathyroidism. Option (A), Cushing
syndrome, is incorrect because the patient does not have the typical symptoms of
Cushing syndrome, which include oligomenorrhea or amenorrhea and a host of
changes to the body habitus. Option (C), hypopituitarism, is incorrect because the
patient does not have severe metabolic, growth, and menstrual abnormalities as a result
of a decrease in pituitary hormone levels. Option (D), malabsorption, is incorrect
because there is no indication in the patient's history of weight loss, other illness, or
abnormal menses. In addition, the laboratory values do not support a diagnosis of
malabsorption. Option (E), multiple myeloma, is incorrect because the patient does not
For the past three weeks, a 47-year-old man has had the feeling of heaviness in his
chest while pushing his lawn mower. He says he has never been treated for similar
symptoms and has no symptoms now. He smoked one pack of cigarettes daily for 20
years but quit smoking seven years ago. Findings on physical examination are normal.
Electrocardiography shows no
abnormalities. Which of the following is the most appropriate initial diagnostic study?
A. Coronary arteriography
B. Echocardiography
C. Exercise stress test
D. 24-Hour ambulatory cardiac monitoring
E. Myocardial perfusion scan -
\exercise stress test
exercise stress test, is correct because it is the most appropriate initial step in the
workup of a patient with recent chest pain because the test is noninvasive, inexpensive,
convenient, and sensitive in this type of patient.
The most definitive diagnostic test for a patient with coronary artery disease is Option
(A), coronary arteriography, but this test is not the most appropriate initial test in an
asymptomatic patient with no abnormal findings on electrocardiography. Option (B),
echocardiography, is a valuable tool for examining valvular structures, cardiac size,
ejection fraction, as well as other anatomic features. However, echocardiography is not
routinely indicated for evaluating ischemia resulting from coronary artery disease and is,
therefore, incorrect. Option (D), 24-hour ambulatory cardiac monitoring, is also
incorrect. Twenty-four-hour ambulatory cardiac monitoring is used primarily for
evaluating disturbances of rate and rhythm and it is able to detect ST-segment
depression, but it is less effective than exercise stress testing in confirming a diagnosis
of coronary artery disease in the initial workup of a patient. This patient's
electrocardiogram shows no abnormalities, and therefore, Option (E), myocardial
perfusion scan, is incorrect. This option would only be correct if the results of resting
electrocardiography were abnormal, making it difficult to interpret an exercise stress tes
A 32-year-old woman has had a rash on her legs for the past three weeks. There are no
known infectious contacts. One month ago, she had a bladder infection and was treated
with trimethoprim-sulfamethoxazole. Physical examination shows a diffuse rash on the
shins, the left medial ankle, and the right medial calf. The rash is tender, diffuse, and
recurs in the same
areas. A few of the lesions have the appearance of bruising. Which of the following is
the most
likely diagnosis?
A. Erythema multiforme
, B. Erythema nodosum
C. Lichen planus
D. Lichen simplex
E. Nummular eczema -
\B. Erythema nodosum
Option (B), erythema nodosum, because this type of rash may be antibiotic-related,
occurs on the lower extremities below the knees, and has the appearance of bruising.
All of these symptoms are present in this clinical scenario. Options (A), erythema
multiforme, and (C), lichen planus, can also result from an allergic reaction to a sulfa
antibiotic, but the presentation of this patient's rash is not consistent with either of these
conditions. Options (D), lichen simplex, and (E), nummular eczema, are chronic
conditions that result in scaling. Therefore, given the time frame and the presentation of
this patient's rash, these two options are incorrect.
A 41-year-old woman has a nine-month history of nausea, constipation, dyspepsia,
general fatigue, arthralgia, and increasing memory loss. She has no history of illness
other than her present complaints, and her menses have been regular. Physical
examination shows no abnormalities. Laboratory findings include the following levels:
Serum Albumin 4.9 g/dL
Calcium 13.0 mg/dL
Chloride 111 mEq/L
Creatinine 1.0 mg/dL
Phosphate 0.3 mg/dL
Blood urea nitrogen 17 mg/dL
Which of the following is the most likely diagnosis?
A. Cushing syndrome
B. Hyperparathyroidism
C. Hypopituitarism
D. Malabsorption
E. Multiple myeloma -
\B. Hyperparathyroidism
Option (B), hyperparathyroidism, is the correct answer. The patient has the classic signs
of this condition, which include gastrointestinal, musculoskeletal, and neurologic
abnormalities. Additionally, the laboratory values clearly show hypercalcemia and
hypophosphatemia, both of which indicate hyperparathyroidism. Option (A), Cushing
syndrome, is incorrect because the patient does not have the typical symptoms of
Cushing syndrome, which include oligomenorrhea or amenorrhea and a host of
changes to the body habitus. Option (C), hypopituitarism, is incorrect because the
patient does not have severe metabolic, growth, and menstrual abnormalities as a result
of a decrease in pituitary hormone levels. Option (D), malabsorption, is incorrect
because there is no indication in the patient's history of weight loss, other illness, or
abnormal menses. In addition, the laboratory values do not support a diagnosis of
malabsorption. Option (E), multiple myeloma, is incorrect because the patient does not
