PANCE Practice Exam – With COMPLETE SOLUTION
300 Questions with 100% Correct Answers
A 27-year-old woman complains of years of menstrual irregularity and increasing facial and chest hair.
PMH: significant for ovarian
...
PANCE Practice Exam – With COMPLETE SOLUTION
300 Questions with 100% Correct Answers
A 27-year-old woman complains of years of menstrual irregularity and increasing facial and chest hair.
PMH: significant for ovarian cyst and left cytectomy. She is a non-smoker and non-drinker. Labs include
a negative uCG, elevated LH, and low FSH. She desires fertility and she has not responded to three cycles
of clomiphene. What would be the next choice of medication that may return ovulation?
A. Insulin
B. Metformin
C. Dexamethasone
D. Spironalactone
E. Finasteride - ✔✔The answer is B.
EXPLANATION: Dexamethasone, finasteride, and spironalactone all treat symptoms of hirsutism, but do
not treat the underlying cause of PCO or improve fertility outcomes. PCO has an underlying insulin
resistance that can be treated with oral hypoglycemics and improve sensitivity to insulin. Adding insulin
does not improve the resistance.
A 2-week-old male infant presents for a routine checkup. The mother complains that he nurses every
hour, but vomits (nonbilious) after every time he eats. He has only had three bowel movements since he
has been home. On examination, the infant has not gained any weight since leaving the hospital, and
the clinician notes gastric peristaltic waves. Which of the following is the treatment of choice for this
patient?
A. pyloromyotomy
B. metoclopramide
C. laparotomy
D. omeprazole - ✔✔The answer is A.
EXPLANATION: This infant is presenting with signs and symptoms of pyloric stenosis. Infants typically
have vomiting (projectile at times) after every feeding and it normally starts between the age of 2 and 4
weeks. The infant nurses fervently and is hungry. In addition, there may be dehydration, constipation,
weight loss, and apathy. Abdomen may be distended with gastric peristaltic waves. Occasionally, an
olive-sized mass can be felt in the right upper quadrant with deep palpation after the child has vomited.
Vomitus is typically nonbilious. Diagnosis is confirmed by an upper gastrointestinal series with delayed
gastric emptying, enlarged pyloric muscle, and characteristic semilunar impressions on the gastric
antrum. In addition, an ultrasound is needed to verify the hypertrophic muscle. The treatment of choice
for these patients is pyloromyotomy, which can be done laparoscopically. These patients make full
recoveries and have an excellent prognosis.
Upon performing a newborn examination, the clinician notes a widened pulse pressure, paradoxical
splitting of S2, and a "machine"-like murmur heard best at the second intercostal space, left sternal
border, and inferior to the clavicle. Which of the following is the most likely diagnosis?
A. tetralogy of Fallot
B. ventricular septal defect
C. atrial septal defect
D. patent ductus arteriosus - ✔✔The answer is D.
EXPLANATION: Patent ductus arteriosus (PDA) is an isolated abnormality that occurs in infants. The
ductus arteriosus is a normal fetal vessel that joins the aorta and the pulmonary artery and
spontaneously closes after 3 to 5 days. Lack of closure results in the audible murmur that is "machinelike" and maximal at the second intercostal space (ICS), at the left sternal border (LSB), and inferior to
the clavicle. It is typically a pansystolic murmur with bounding pulses and a widened pulse pressure.
There is also a paradoxical splitting of S1 and S2. Echocardiography confirms the PDA, the direction and
degree of shunting, and the presence of lesions for which the PDA is needed to keep. If there are no
other cardiac malformations requiring the PDA, then if the PDA is large, surgery should be completed
before 1 year of age. Symptomatic PDAs that are relatively small may be closed with indomethacin in
preterm infants.
an ejection type, systolic murmur heard best at the LSB, second ICS with a wide, fixed S2 and normal
pulses. - ✔✔atrial septal defect (ASD)
a harsh, pansystolic murmur heard best at the third and fourth ICS. With increasing size, heaves, thrills,
and lifts are present along with radiation throughout the chest. - ✔✔Ventricular septal defect (VSD)
a rough ejection, systolic murmur heard best at the LSB and the third ICS with radiation to the back. -
✔✔Tetralogy of Fallot
A 42-year-old woman, with a history of struvite renal calculus, calls the office with a complaint of a
urinary tract infection. As part of the interview, she reports intermittent, mild right flank pain for 4 days.
Her urine dipstick is positive for microscopic hematuria, and the urine pH is 7.5. The KUB film is positive
with two visible stones in the right kidney. Which of the following organisms is most likely to be cultured
from the urine specimen?
A. Escherichia coli
B. Klebsiella
C. Proteus
D. Chlamydia trachomatis - ✔✔The answer is C.
EXPLANATION: This patient has struvite stones. They are frequently associated with recurrent urinary
tract infections, visible stones, and high urine pH. These stones are formed by urease-producing
organisms including Proteus and Pseudomonas while being caused less commonly by Klebsiella. Struvite
stones are not typically caused by E. coli and C. trachomatis.
A 33-year-old woman treated with trifluoperazine for the past 3 months is seen in the emergency
department because of recent-onset fever, stiffness and tremor, as reported by her accompanying
sister. The patient also appears to be mildly confused when asked about location, day, and time. Her
temperature is 104.5°F, and her serum creatine kinase (CK) level is markedly elevated. Which of the
following has most likely occurred?
A. a delayed allergic reaction has occurred with trifluoperazine
B. tardive dyskinesia has begun to develop in the patient
C. the patient has developed neuroleptic malignant syndrome
D. the patient has developed serotonin syndrome
E. the patient has overdosed on trifluoperazine - ✔✔The answer is C.
EXPLANATION: Neuroleptic malignant syndrome is an uncommon but serious complication with
therapeutic doses of antipsychotic drug therapy, particularly the first-generation (typical) class. Cardinal
signs and symptoms include a body temperature above 100.4°F, altered state of consciousness,
autonomic dysfunction, and rigidity.
A 48-year-old man presents to the clinic for a routine employment physical. The patient is
asymptomatic. A pre-employment CBC reveals hemoglobin of 13.2g/dl, hematocrit of 39.5%, and MCV
of 60.6 fL. Subsequent iron studies, hemoglobin electrophoresis, and sickle cell screening are "normal."
After the labs are reviewed, the patient states "they are always normal."
Which of the following is the most appropriate management for this patient?
A. Bone marrow aspirate
B. Ferrous sulfate daily
C. Folic acid supplements
D. Reassurance
E. Refer to an oncologist - ✔✔The answer is D.
EXPLANATION: The patient has a mild anemia with pr
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