Essential NCCPA-PANCE Practice Exam
You are treating a 20-year-old female with multiple aphthous ulcers. She complains of a
moderate amount of pain. You decide to prescribe "magic mouthwash" for the patient to
swish and spit. Which of the following combinations of medicines is appropriate? -
\A very commonly used combination of medicines to promote relief of discomfort and
healing include liquid diphenhydramine, antacid, tetracycline, and 2% viscous xylocaine.
A 17-year-old male is brought to your Emergency Department by his girlfriend. She
states that he has been behaving strangely for the last three days, with rapidly
fluctuating moods ranging from euphoric to irritable and paranoid. The patient states
that he is fine, just a little nervous about an upcoming test in school. His pulse is 126
beats per minute, BP 182/106, pupils are widely dilated, and he is diaphoretic. What is
his most likely diagnosis?
A. Acute anxiety
B. Bipolar disorder
C. Cocaine intoxication
D. Heroin intoxication -
\he answer is C.
EXPLANATION: This patient's presentation with tachycardia, hypertension, diaphoresis,
and mydriasis along with the behavioral changes is consistent with cocaine intoxication
cause somnolence and pinpoint pupils -
\Heroin withdrawal
A 67-year-old man presents with pain and stiffness in his shoulders and hips lasting for
several weeks with no history of trauma. He also has complaints of headache, throat
pain, and jaw claudication. It is imperative to diagnose this patient promptly in order to
prevent which of the following complications?
A. anemia
B. cerebral aneurysms
C. mononeuritis multiplex
D. ischemic optic neuropathy
E. respiratory tract complications -
\The answer is D.
EXPLANATION: The most urgent need for diagnosis of a patient with symptoms of
polymyalgia rheumatica (PMR) and giant cell arteritis is to prevent blindness caused by
ischemic optic neuropathy as a result of occlusive arteritis of the ophthalmic artery.
Early diagnosis is imperative as the neurological damage to the optic nerve is not
reversible. Most patients with this diagnosis will have a normochromic-normocytic
anemia, but this does not create urgency in treatment. Cerebral aneurysms are not
common findings with PMR; large vessels such as the subclavian and aorta may be
involved in giant cell arthritis in 15% of patients. Mononeuritis multiplex commonly
,presents with painful paralysis of a shoulder, and respiratory tract complications are
more nonclassic findings with the presentation of PMR.
During an ophthalmoscopic exam you notice deep retinal microvascular hemorrhages,
and cotton wool spots. What is the most likely cause of her visual disorder? -
\The answer is D.
Diabetic retinopathy-EXPLANATION: The patient's symptoms suggest a likelihood of
diabetes. Retinal findings can include microaneurysms, deep hemorrhages, a flame-
shaped hemorrhage, exudates, and cotton wool spots.
A newborn male is diagnosed with Christmas factor deficiency. What is the likelihood
that he inherited this disorder from his father?
A. 0%
B. 25%
C. 50% -
\The answer is A.
EXPLANATION: All daughters of a hemophilic male are carriers of hemophilia, whereas
all sons are normal. Hemophilia B (or Christmas factor deficiency) is one of only two
sex-linked pattern-bleeding disorders, and as such the disease occurs almost
exclusively in males. Sons of carriers have a 50% chance of being affected and
daughters of carriers have a 50% chance of being carriers themselves.
A 2-month-old female presents for a well child check. The mother has no concerns and
feels that the child is doing well. On exam, there is no evidence of cyanosis and the
peripheral pulses are normal and equal. However, there is a fixed and widely split S2, a
right ventricular heave, and a systolic ejection murmur present. The murmur is heard
best at the left sternal border second intercostal space. What is the most common
abnormality present on an ECG?
A. Atrioventricular heart block
B. Atrial fibrillation
C. Bifasicular block
D. Right axis deviation -
\The answer is D.
EXPLANATION: The most likely diagnosis is an atrial septal defect, which usually
shows right axis deviation on ECG. The other ECG abnormalities listed do not
commonly occur with an atrial septal defect.
A 28-year-old male smoker presents witha complaint of numbness and pain in his
fingers. He notices thisafter being exposed to the cold. He states that his fingers
appearpale or even blue at times. After warming, his fingers turn redbefore returning to
their normal color. What should be includedin appropriate management of this
condition?
A. Counsel the patient to stop smoking
B. Systemic glucocorticoids
C. Take aspirin prior to cold exposure -
\The answer is A.
,EXPLANATION: This patient is experiencing Raynaud phenomenon. This is
digitalischemia that can occur after exposure to cold or emotional stress. It is more
common in smokers or patients whose occupation involvesusing vibratory tools.
Management includes patient education toinclude cold avoidance behavior and wearing
loose-fitting clothing.Cessation of smoking is imperative. Drug therapy is used in
patientswith progressive and severe Raynaud's.
A 45-year-old woman presents with weight gain, fatigue, dry skin, constipation, and
oligomenorrhea. On physical exam, bradycardia and slow deep tendon reflexes are
noted. Her free T4 is low and TSH is elevated. Which of the following medications may
be responsible for her condition?
A. amiodarone
B. beta-blockers
C. levadopa -
\The answer is A.
EXPLANATION: Hypothyroidism is reported in up to 10% of patients taking amiodarone,
an antiarrhythmic medication. With the high iodine content of the medication and the
structural similarities to thyroxine, thyroid abnormalities occur. Common side effects of
amiodarone include bradycardia and constipation, so laboratory evaluation for thyroid
dysfunction must be used.
Common side effects of amiodarone -
\include bradycardia and constipation, so laboratory evaluation for thyroid dysfunction
must be used.
A 3-week-old male infant is brought in by his mother due to his vomiting. The mother
notes that a few days ago her son started vomiting after feeding, and it has become
projectile in nature. The vomitus is non-bilious and contains no blood. The child seems
hungry and nurses regularly, but the vomiting has become more frequent and is
occurring with every feeding now. On physical examination, an oval mass is palpated in
the right upper quadrant. Appropriate imaging is obtained and confirms the suspected
diagnosis. What is the treatment of choice in this patient?
A. Acid supression
B. Dilatation of the lower esophageal sphincter
C. Diverting colostomy
D. Ladd procedure
E. Pyloromyotomy -
\The answer is E.
EXPLANATION: A pyloromyotomy involves an incision along the length of the pylorus,
down to the mucosa, and is the treatment of choice in pyloric stenosis. Acid suppression
is the treatment of choice in cases of peptic ulcer disease. Dilatation of the LES is
performed in cases of achalasia of the esophagus. A diverting colostomy may be used
in cases of Hirschsprung disease, after removal of the aganglionic section of colon. The
Ladd procedure is used in surgical treatment of intestinal malrotation.
The rotator cuff is comprised of which four muscles? -
, \Supraspinatus, infraspinatus, teres minor, subscapularis
The patient has a family history of thyroid cancer. You are concerned that the patient
may have medullary thyroid cancer. Which of the following lab tests would you monitor
in this patient after treatment? -
\serum calcitonin. Both calcitonin and CEA are secreted by medullary thyroid cancer
cells, and are used both in diagnosis and monitoring of patients after treatment.
Alkaline phosphatase, is elevated in disorders of the -
\bone and biliary tract.
serum anti-thyroglobulin antibodies, are most commonly associated with -
\autoimmune disorders of the thyroid, such as Hashimoto's thyroiditis.
Serum CA-125 has been used to investigate and follow patients with malignancies,
such as? -
\ovarian cancer
A 76 year-old woman with steroid dependent chronic obstructive pulmonary disease is
hospitalized with fever, chills, and a productive cough. The sputum gram stain shows
many WBCs and small, pleomorphic gram-negative rods. Which of the following is the
most likely causative agent?
A. Chlamydia pneumoniae
B. Haemophilus influenzae
C. Mycoplasma pneumoniae -
\The answer is B.
EXPLANATION: Haemophilus influenzae (B) is a gram-negative pleomorphic
coccobacillus. Strep pneumonia (E) and Staph aureus (D) are gram positive organisms.
Mycoplasma pneumonia (C) and Chlamydia pneumoniae (A) aren't visible on gram
stain.
An 8-month-old baby boy is brought in by his mother after noticing redness and swelling
around his penis, which she retracted his foreskin to clean after a diaper change. She
states the swelling has been increasing over the past 2 hours. His past medical history
is unremarkable and he is uncircumcised. On physical examination you see the
following:
Considering your suspected diagnosis, what would be the management of this patient?
A. Observation until the swelling decreases
B. Attempt manual reduction and get emergent urologic consultation
C. IV fluids and analgesics
D. Dorsal penile nerve block with lidocaine and epinephrine -
\he answer is B.
EXPLANATION: Paraphimosis occurs when a tight ring of foreskin is retracted proximal
to the glans of the penis and becomes trapped in the retracted position. Impaired
venous and lymphatic draining can cause swelling and is a true urologic emergency.
Immediate attempt with manual reduction should be done and if unsuccessful an
You are treating a 20-year-old female with multiple aphthous ulcers. She complains of a
moderate amount of pain. You decide to prescribe "magic mouthwash" for the patient to
swish and spit. Which of the following combinations of medicines is appropriate? -
\A very commonly used combination of medicines to promote relief of discomfort and
healing include liquid diphenhydramine, antacid, tetracycline, and 2% viscous xylocaine.
A 17-year-old male is brought to your Emergency Department by his girlfriend. She
states that he has been behaving strangely for the last three days, with rapidly
fluctuating moods ranging from euphoric to irritable and paranoid. The patient states
that he is fine, just a little nervous about an upcoming test in school. His pulse is 126
beats per minute, BP 182/106, pupils are widely dilated, and he is diaphoretic. What is
his most likely diagnosis?
A. Acute anxiety
B. Bipolar disorder
C. Cocaine intoxication
D. Heroin intoxication -
\he answer is C.
EXPLANATION: This patient's presentation with tachycardia, hypertension, diaphoresis,
and mydriasis along with the behavioral changes is consistent with cocaine intoxication
cause somnolence and pinpoint pupils -
\Heroin withdrawal
A 67-year-old man presents with pain and stiffness in his shoulders and hips lasting for
several weeks with no history of trauma. He also has complaints of headache, throat
pain, and jaw claudication. It is imperative to diagnose this patient promptly in order to
prevent which of the following complications?
A. anemia
B. cerebral aneurysms
C. mononeuritis multiplex
D. ischemic optic neuropathy
E. respiratory tract complications -
\The answer is D.
EXPLANATION: The most urgent need for diagnosis of a patient with symptoms of
polymyalgia rheumatica (PMR) and giant cell arteritis is to prevent blindness caused by
ischemic optic neuropathy as a result of occlusive arteritis of the ophthalmic artery.
Early diagnosis is imperative as the neurological damage to the optic nerve is not
reversible. Most patients with this diagnosis will have a normochromic-normocytic
anemia, but this does not create urgency in treatment. Cerebral aneurysms are not
common findings with PMR; large vessels such as the subclavian and aorta may be
involved in giant cell arthritis in 15% of patients. Mononeuritis multiplex commonly
,presents with painful paralysis of a shoulder, and respiratory tract complications are
more nonclassic findings with the presentation of PMR.
During an ophthalmoscopic exam you notice deep retinal microvascular hemorrhages,
and cotton wool spots. What is the most likely cause of her visual disorder? -
\The answer is D.
Diabetic retinopathy-EXPLANATION: The patient's symptoms suggest a likelihood of
diabetes. Retinal findings can include microaneurysms, deep hemorrhages, a flame-
shaped hemorrhage, exudates, and cotton wool spots.
A newborn male is diagnosed with Christmas factor deficiency. What is the likelihood
that he inherited this disorder from his father?
A. 0%
B. 25%
C. 50% -
\The answer is A.
EXPLANATION: All daughters of a hemophilic male are carriers of hemophilia, whereas
all sons are normal. Hemophilia B (or Christmas factor deficiency) is one of only two
sex-linked pattern-bleeding disorders, and as such the disease occurs almost
exclusively in males. Sons of carriers have a 50% chance of being affected and
daughters of carriers have a 50% chance of being carriers themselves.
A 2-month-old female presents for a well child check. The mother has no concerns and
feels that the child is doing well. On exam, there is no evidence of cyanosis and the
peripheral pulses are normal and equal. However, there is a fixed and widely split S2, a
right ventricular heave, and a systolic ejection murmur present. The murmur is heard
best at the left sternal border second intercostal space. What is the most common
abnormality present on an ECG?
A. Atrioventricular heart block
B. Atrial fibrillation
C. Bifasicular block
D. Right axis deviation -
\The answer is D.
EXPLANATION: The most likely diagnosis is an atrial septal defect, which usually
shows right axis deviation on ECG. The other ECG abnormalities listed do not
commonly occur with an atrial septal defect.
A 28-year-old male smoker presents witha complaint of numbness and pain in his
fingers. He notices thisafter being exposed to the cold. He states that his fingers
appearpale or even blue at times. After warming, his fingers turn redbefore returning to
their normal color. What should be includedin appropriate management of this
condition?
A. Counsel the patient to stop smoking
B. Systemic glucocorticoids
C. Take aspirin prior to cold exposure -
\The answer is A.
,EXPLANATION: This patient is experiencing Raynaud phenomenon. This is
digitalischemia that can occur after exposure to cold or emotional stress. It is more
common in smokers or patients whose occupation involvesusing vibratory tools.
Management includes patient education toinclude cold avoidance behavior and wearing
loose-fitting clothing.Cessation of smoking is imperative. Drug therapy is used in
patientswith progressive and severe Raynaud's.
A 45-year-old woman presents with weight gain, fatigue, dry skin, constipation, and
oligomenorrhea. On physical exam, bradycardia and slow deep tendon reflexes are
noted. Her free T4 is low and TSH is elevated. Which of the following medications may
be responsible for her condition?
A. amiodarone
B. beta-blockers
C. levadopa -
\The answer is A.
EXPLANATION: Hypothyroidism is reported in up to 10% of patients taking amiodarone,
an antiarrhythmic medication. With the high iodine content of the medication and the
structural similarities to thyroxine, thyroid abnormalities occur. Common side effects of
amiodarone include bradycardia and constipation, so laboratory evaluation for thyroid
dysfunction must be used.
Common side effects of amiodarone -
\include bradycardia and constipation, so laboratory evaluation for thyroid dysfunction
must be used.
A 3-week-old male infant is brought in by his mother due to his vomiting. The mother
notes that a few days ago her son started vomiting after feeding, and it has become
projectile in nature. The vomitus is non-bilious and contains no blood. The child seems
hungry and nurses regularly, but the vomiting has become more frequent and is
occurring with every feeding now. On physical examination, an oval mass is palpated in
the right upper quadrant. Appropriate imaging is obtained and confirms the suspected
diagnosis. What is the treatment of choice in this patient?
A. Acid supression
B. Dilatation of the lower esophageal sphincter
C. Diverting colostomy
D. Ladd procedure
E. Pyloromyotomy -
\The answer is E.
EXPLANATION: A pyloromyotomy involves an incision along the length of the pylorus,
down to the mucosa, and is the treatment of choice in pyloric stenosis. Acid suppression
is the treatment of choice in cases of peptic ulcer disease. Dilatation of the LES is
performed in cases of achalasia of the esophagus. A diverting colostomy may be used
in cases of Hirschsprung disease, after removal of the aganglionic section of colon. The
Ladd procedure is used in surgical treatment of intestinal malrotation.
The rotator cuff is comprised of which four muscles? -
, \Supraspinatus, infraspinatus, teres minor, subscapularis
The patient has a family history of thyroid cancer. You are concerned that the patient
may have medullary thyroid cancer. Which of the following lab tests would you monitor
in this patient after treatment? -
\serum calcitonin. Both calcitonin and CEA are secreted by medullary thyroid cancer
cells, and are used both in diagnosis and monitoring of patients after treatment.
Alkaline phosphatase, is elevated in disorders of the -
\bone and biliary tract.
serum anti-thyroglobulin antibodies, are most commonly associated with -
\autoimmune disorders of the thyroid, such as Hashimoto's thyroiditis.
Serum CA-125 has been used to investigate and follow patients with malignancies,
such as? -
\ovarian cancer
A 76 year-old woman with steroid dependent chronic obstructive pulmonary disease is
hospitalized with fever, chills, and a productive cough. The sputum gram stain shows
many WBCs and small, pleomorphic gram-negative rods. Which of the following is the
most likely causative agent?
A. Chlamydia pneumoniae
B. Haemophilus influenzae
C. Mycoplasma pneumoniae -
\The answer is B.
EXPLANATION: Haemophilus influenzae (B) is a gram-negative pleomorphic
coccobacillus. Strep pneumonia (E) and Staph aureus (D) are gram positive organisms.
Mycoplasma pneumonia (C) and Chlamydia pneumoniae (A) aren't visible on gram
stain.
An 8-month-old baby boy is brought in by his mother after noticing redness and swelling
around his penis, which she retracted his foreskin to clean after a diaper change. She
states the swelling has been increasing over the past 2 hours. His past medical history
is unremarkable and he is uncircumcised. On physical examination you see the
following:
Considering your suspected diagnosis, what would be the management of this patient?
A. Observation until the swelling decreases
B. Attempt manual reduction and get emergent urologic consultation
C. IV fluids and analgesics
D. Dorsal penile nerve block with lidocaine and epinephrine -
\he answer is B.
EXPLANATION: Paraphimosis occurs when a tight ring of foreskin is retracted proximal
to the glans of the penis and becomes trapped in the retracted position. Impaired
venous and lymphatic draining can cause swelling and is a true urologic emergency.
Immediate attempt with manual reduction should be done and if unsuccessful an
