PANCE PANRE Fast Track Exam 1 †Questions 1-30

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Question 1A patient presents complaining of severe pain and "burning" in an extremity.   You note that the extremity is pale and cool to the touch. You cannot appreciate a palpable pulsation. Which of the following diagnostic modalities will identify the source of this patient's problem in approximately 95% of cases? Achest x-rayBechocardiogramCangiogramDabdominal flat plateEaortic ultrasoundQuestion 1 Explanation: An angiogram is the "gold standard" for occlusion of an arterial vessel. Arterial embolism/thrombosis  is covered as part of the  PANCE Cardiology Blueprint. Question 2A 31-year-old pharmacist complaining of rectal pain. He describes the pain as "a severe tightness that awakens him from sleep." His bowel activity is normal. He denies rectal bleeding and seepage. He adds that sleep interruption is problematic because, with the number of hours he works, every minute of sleep is important. What is the most likely diagnosis? Aanal abseessHint: Abscess would be constantBperianal fistulaHint: fistula would drainCproctalgia fugax Dulcerative colitisHint: UC would cause bloody mucousy diarrheaEinternal hemorrhoids.Hint: hemorrhoids would cause no pain, but bleeding.Question 2 Explanation: proctalgia (rectal pain) fugax (comes and goes) is the best description. An abscess would be constant, fistula would drain, UC would cause bloody mucousy diarrhea, hemorrhoids would cause no pain, but bleeding. Disorders of the Anus and Rectum  are covered as part of the  PANCE GI and Nutrition Blueprint. Question 3A 38-year-old chronic smoker presents with shortness of breath and wheezing. He has had several similar episodes in the past. He states that each previous episode began after developing a "cold that moved into his chest." Usually, after treatment with albuterol (VENTOLIN) and several days, the wheezing stops. He adds that he has a chronic cough, productive of mucous, most mornings during the past several years. Which of the following best describes this patient's condition? Achronic emphysemaBchronic bronchitisCchronic bronchitis with hypersensitive airways (asthmatic bronchitis)Dcor pulmonaleEbronchiectasisQuestion 3 Explanation: This is the best descriptor. Chronic bronchitis  is covered as part of the  PANCE Pulmonary Blueprint. Question 4A patient is being treated for Tuberculosis. She is experiencing central scotomata, a loss of green-red color perception and decreased visual acuity. Which agent is most likely responsible? ArifampinBisoniazidCstreptomycinDethambutolEpara-aminosalicylic acidQuestion 4 Explanation: Ethambutol is the TB drug that causes eye symptoms. It's helpul to remember "E" for Ethambutol causes "E"ye symptoms. Tuberculosis is covered as part of the  PANCE Infectious Disease Blueprint. Question 5Secondary to a traumatic event, a child complains of pain in the index finger. An x-ray of the digit demonstrates a fracture line through the metaphysis of the proximal aspect of the middle phalanx, ending at the epiphyseal plate. What type of fracture does this child have? ASalter Harris Type IHint: Salter I = slight increase in Space between epiphyseal plate and metaphysisBSalter Harris Type IICSalter Harris Type IIIHint: Salter III = fx Lower (in the epiphyseal plate) DSalter Harris Type IVHint: Salter IV = fit Through (both the metaphysis and epiphysis) ESalter Harris Type VHint: Salter V = Really bad (comminuted fx compressing the epiphysis) This spells SALTR and may help you remember.Question 5 Explanation: Salter I = slight increase in Space between epiphyseal plate and metaphysis Salter II = fx Above the plate (in the metaphysis) Salter III = fx Lower (in the epiphyseal plate) Salter IV = fit Through (both the metaphysis and epiphysis) Salter V = Really bad (comminuted fx compressing the epiphysis) This spells SALTR and may help you remember. Types of fractures and Salter-Harris classification are covered as part of the PANCE Musculoskeletal Blueprint Question 6A 24-year-old male presents complaining of chest pain. He states that it is worse with swallowing and taking a deep breath. It is improved by sitting up and leaning forward. He denies trauma, a cough, and shortness of breath. Which of the following tests would be most compatible with your suspected diagnosis? Aa hiatal hernia visualized on chest x-rayBa normal erythrocyte sedimentation rateCcalcified "popcorn" lesions in the lung fields bilaterallyDdiffuse ST segment elevation on his electrocardiographEa widened A-a gradient on his arterial blood gasQuestion 6 Explanation: This is pericarditis (by clinical presentation) which causes diffuse ST-segment elevation on ECG (there can be notching of the R wave as well). Acute pericarditis is covered as part of the PANCE Cardiology Blueprint. Any infant (neonate) with fever and rash should have a lumbar puncture (LP). While I would certainly do a CBC, even if it was normal, I would want the LP. Question 8Your 27-year-old sister is visiting and requests you to provide refills of  dexamethasone and  homatropine ophthalmic drops for her. What condition is most likely being treated? Aconjunctivitis BglaucomaCiritisDHerpes keratitisEblepharitisQuestion 8 Explanation: Iritis is treated with steroid drops (dexamethasone) and miotic drops *homatropine, like atropine (to constrict and fix the pupil to help the pain and open the angle until the iritis is resolved). Iritis and  disorders of the Eye (PEARLS)  are covered as part of the PANCE EENT Blueprint. Question 9A 58-year-old male presents complaining of weakness of his grip. Your  examination reveals that the problem is bilateral. During the next few office visits, you note the development of hyperactivity of his DTRs, extensor plantar reflexes and dysarthria. The patient's sensory system remains normal and he denies any urinary symptomatology. Which of the following is the most likely diagnosis? Amultiple sclerosisHint: MS may have dysarthria, but reflexes are normal, sensation is impaired and bladder function is frequently affectedBAlzheimer's diseaseHint: Alzheimer's has normal neuro exam with cognitive disability. CHuntington's choreaHint: Huntington's causes a movement disorder with writhing choreiform movements of the bodyDamyotrophic lateral sclerosisEmyasthenia gravisHint: Myasthenia causes fatigue of the ocular muscles typically worsening at the end of the day.Question 9 Explanation: ALS (Lou Gehrig's disease) is a progressive bilateral muscle disease which causes fasciculations (lower motor neuron), and hyperreflexia, plantar reflexes (upper motor neuron) and dysarthria. Sensation is normal as is bladder function. MS may have dysarthria, but reflexes are normal, sensation is impaired and bladder function is frequently affected. Alzheimer's has normal neuro exam with cognitive disability. Huntington's causes a movement disorder with writhing choreiform movements of the body. Myasthenia causes fatigue of the ocular muscles typically worsening at the end of the day. Question 10Which of the following is NOT a characteristic feature of multiple myeloma? Aelevated serum calciumBosteoporosisC"punched out" osseous lesionsDplasma cell infiltration of bone marrowEhypogammaglobulinemiaQuestion 10 Explanation: Multiple myeloma is a HYPERgammaglobulinemia - all of the other findings occur in multiple myeloma. Multiple myeloma is covered as part of the  PANCE Hematology Blueprint. Question 11Which of the following is NOT a risk factor for the development of osteoporosis? ALow testosterone levels in menBLow levels of physical activityCInadequate dietary proteinDCigarette smokingEChronic corticosteroid useQuestion 11 Explanation: Low dietary Calcium, not protein, is a risk factor for osteoporosis. All of the others are risk factors. Osteoporosis  is covered as part of the  PANCE Musculoskeletal Blueprint. Question 12A 12-year-old male presents complaining of no appetite for 24 hours and pain  near his navel. During the night, the pain moved to the right lower abdomen. He is now nauseated and vomiting and has a low-grade fever. In the operating room, a normal appendix is discovered. What is the most likely diagnosis? Amesenteric ischemiaBdiverticulitisCmesenteric adenitisDcholecystitisEproctitisQuestion 12 Explanation: Mesenteric adenitis (lymphadenopathy of the mesentery - usually from a virus) can mimic appendicitis and usually occurs in kids. There is usually no way to diagnose it pre-operatively, except perhaps with a CT of the abdomen (usually done nowadays before going to the OR). Review  Diseases of the Small Intestine and Colon (PEARLS) from the  PANCE GI and Nutrition Blueprint Question 13A patient that must be on a beta-blocking agent has reactive airway disease and commonly experiences central nervous system side effects from medications. Which of the following beta-blockers would most likely be tolerated by this patient? AatenololBmetoprololCnadololDpropranololEpindololQuestion 13 Explanation: This is a picky question for the Boards. Of these Beta-blockers (which are usually AVOIDED) in reactive airway disease - metoprolol is the most "cardioselective", so theoretically could be used.... although, on an exam, I would avoid beta-blockers in general. Asthma  is covered as part of the PANCE Pulmonary Blueprint Question 14A polarized light microscopic study of joint fluid demonstrates negative birefringent crystals. What is the diagnosis? Arheumatoid arthritisBseptic arthritisCpseudogout goutHint: Calcium Pyrophosphate (pseudogout) is Prism-shaped crystals with Positive birefringence - To remember this think "P"seudogout has "P"rism shaped crystals and "P"ositive birefringence.Daseptic arthritisEgoutQuestion 14 Explanation: Uric acid (gout) is "Needle-shaped crystals with Negative birefringence). Calcium Pyrophosphate (pseudogout) is Prism-shaped crystals with Positive birefringence - To remember this think "P"seudogout has "P"rism shaped crystals and "P"ositive birefringence. Gout/pseudogout are covered as part of the PANCE Musculoskeletal Blueprint Question 15Which of the following agents is most appropriate in the treatment of a pregnant patient infected with Chlamydia? AtetracyclineHint: Tetracyclines (A Azithromycin 1 g orally in a single dose is both safe and effective - it is now considered first-line treatment by the CDC for use in pregnancy. Of the choices above, erythromycin is best and is considered an alternative regimen. PCN does not work for Chlamydia. Tetracyclines (A & E) should be avoided. Quinolones (norfloxacin) are contraindicated. Note: Erythromycin estolate is contraindicated during pregnancy because of drug-related hepatotoxicity. So you would use either Erythromycin base or Erythromycin ethylsuccinate. Chlamydia  is covered as part of the PANCE Infectious Disease Blueprint. Question 16Typically, it produces a local burning, followed in 3 to 4 hours by a white area of vasoconstriction. Subsequently, a bleb forms at the bite site, darkens, and is followed over hours to days by tissue necrosis. Which of the following inflicts this envenomation? Abrown recluse spiderBblack widow spiderCscorpion DDermacentor andersoni tickEthe centipedeQuestion 16 Explanation: This is a brown recluse spider bite. Spider bites  are covered as part of the  PANCE Dermatology Blueprint Question 17A patient with acute renal failure provides a urine specimen that demonstrates normal osmolality and sodium content. The urine contains no casts, but RBCs are present. Which of the following is the most likely etiology of this patient's acute renal failure? Aprerenal causeHint: In pre-renal ARF, the sodium content of the urine would be decreased (because the patient is volume depleted, so the kidneys try to retain Na - less is in the urine)Bintrarenal — glomerulonephritisCintrarenal — acute tubular necrosisHint: In intrarenal disease, the urine would contain casts. Dintrarenal — interstitial nephritisEpostrenal causeQuestion 17 Explanation: In pre-renal ARF, the sodium content of the urine would be decreased (because the patient is volume depleted, so the kidneys try to retain Na - less is in the urine). In intrarenal disease, the urine would contain casts. So, this is postrenal disease (usually a big prostate or stones) which would cause normal urine with rbc's. Acute renal failure  is covered as part of the PANCE Genitourinary Blueprint. Question 18All of the following, when administered to the physically dependent opiate abuser, can precipitate withdrawal symptoms EXCEPT: AnaloxoneBpentazocineCnalbuphineDmethadoneEbuprenorphineQuestion 18 Explanation: That is why we use methadone when weaning folks from opiates (like heroin). Substance Use Disorders are covered as part of the  PANCE Psychiatry Blueprint. Question 19During a sports 'screening physical' examination, a 15-year-old male is noted to have a murmur. You perform bedside maneuvers in an attempt to delineate which type of murmur you are auscultating. Which of the following would be the finding associated with the highest risk of sudden death for this patient? Athe intensity of the murmur increases during a valsalva maneuverBthe intensity of the murmur decreases during standingCthe murmur does not change while the patient squatDthe intensity of the murmur decreases during exerciseEelevation of the legs while the patient is supine increases the intensity of the murmurQuestion 19 Explanation: Hypertrophic cardiomyopathy (most common cause of sudden cardiac death in this age individual) would have a systolic ejection murmur which would INCREASE with Valsalva (decreased preload causing a smaller LV volume and an increase in the obstruction) The murmur would DECREASE with squat or elevating the legs (increase preload, make the LV volume larger and decrease the obstruction). Hypertrophic Cardiomyopathy  is covered as part of the PANCE Cardiology Blueprint. Question 20A 44-year-old male presents with a fever, a cough productive of brownish sputum,  rigors and lethargy for seven days. A chest x-ray reveals a right middle lobe infiltrate and a right-sided pleural effusion. A thoracentesis is performed. Which of the following results from the pleural fluid analysis would be most characteristic of acute pneumonia? Apleural fluid: serum LDH ratio >0.6Bpleural fluid specific gravity Cpleural fluid without proteinDpleural fluid without LDHEpleural fluid:serum protein ratio Question 20 Explanation: The question suggests bacterial pneumonia. The pleural fluid should have high LDH (pleural > serum), a high specific gravity (lots of "stuff' in the fluid), a large amount of protein (WBC's, bacteria, and "stuff"). Bacterial pneumonia  is covered as part of the  PANCE Pulmonary Blueprint. Question 21A patient presents with severe diarrhea described as watery and bloody. He states he ate some chicken at a farm and wasn't sure if it was cooked well enough. His stool demonstrates many WBC's and S-shaped gram-neg rods. Which of the following antimicrobial agent of choice should be used to treat this patient? AmetronidazoleBerythromycinCampicillinDciprofloxacinEdoxycyclineQuestion 21 Explanation: Campylobacter = erythromycin. Infectious and Noninfectious Diarrhea  is covered as part of the  PANCE GI and Nutrition Blueprint. Question 22An 82-year-old man presents with acute, atraumatic left flank pain which is constant. He denies fever. Since its onset, the pain has moved from the flank to the central abdomen and also radiates into the left inguinal area. Of the following, which diagnosis do you suspect? Aacute bacterial prostatitisBspigelian herniaCcalyceal obstructionDacute biliary colicEdissecting aortic aneurysmQuestion 22 Explanation: This is CONSTANT pain, so not colicky (like colic, C & D). It is in the abdomen, and not perineal (like BPH), and I have no idea what a Spigelian hernia is.... but in this older gentleman, the most important thing to r/o is AAA which is dissecting. Aortic aneurysm/dissection  is covered as part of the  PANCE Cardiology Blueprint. Question 23A 32-year-old female presents with an acute narrow-complex tachycardia noted on her twelve lead EKG. Her blood pressure is 110/72. Her heart rate is 156. She denies chest pain and dyspnea. What do you order next for this patient? Abretylium 500 mg intravenouslyBverapamil 5 mg intravenouslyCadenosine 6 mg intravenouslyDdigoxin 0.5 mg intravenouslyElidocaine 100 mg intravenouslyQuestion 23 Explanation: The treatment for SVT (regular narrow complex tachycardia in a young healthy patient) could be valsalva or carotid massage, and then adenosine 6 mgm. IV bolus. Supraventricular tachycardia  is covered as part of the  PANCE Cardiology Blueprint. Question 24A 56-year-old male presents complaining of night sweats, weight loss, a cough and shortness of breath. A urinalysis demonstrates hematuria. The patient had a positive PPD skin test six months ago but was never treated. You order a chest x-ray and expect to find pathology in which area of the lung? Athe anterior aspect of the lung basesBthe lingual of the left lungCthe right middle lobeDthe posterior aspect of the lung basesEthe apices of the lungsQuestion 24 Explanation: TB reactivated typically appears in the apices of the lung fields. Tuberculosis  is covered as part of the  PANCE Pulmonary Blueprint. Question 25A mother brings her nine-year-old son to your office, along with the snake that bit him 20 minutes earlier. Which of the following, if identified during your examination of the snake, is most suggestive that the snake is poisonous? Aelliptical pupilsBa rounded headCa double row of caudal platesDthe length of the snakeEthe presence of a black band next to a red bandQuestion 25 Explanation: There are two families of poisonous snakes: Viperidae is pit vipers, rattlesnakes, water moccasins, copperheads. They are distinguished by elliptical pupils vs. round in non-venomous snakes. Elapidae contains cobras, mambas, taipan and coral snakes. There are differentiated by their color bands, "red on yellow kills a fellow", "red on black, venom lack". Most poisonous snakes in the US - coral snakes. Mambas are the most poisonous in the world; cobras are hooded at the neck and are next most poisonous but neither of these is found in the U.S. Animal  and insect bites are covered as part of the  PANCE Infectious Disease Blueprint. Question 26Which of the following vaccines can prevent cancer? Arubella vaccineBrubeola vaccineChepatitis B vaccineDinfluenza vaccineEtetanus vaccineQuestion 26 Explanation: Think of Hep B and Hep C as carcinogens. We don't have a Hep C vaccine yet, but we DO have a Hep B vaccine. Since chronic Hep B and Hep C infection cause liver cancer, a vaccine can "prevent" it. Acute and chronic hepatitis  are covered as part of the  PANCE Genitourinary Blueprint. Question 27A 51-year-old male who has smoked for 32 years, presents complaining of a  persistent cough. His chest x-ray is unremarkable. The cough began shortly after he started a new medication. Which medication do you suspect as the cause? AverapamilBdigoxinCcaptoprilDacetaminophenElovastatinQuestion 27 Explanation: ACEI's cause chronic cough. Captopril is the prototypical ACEI. Ace inhibitors and other cardiac medications are  covered as part of the  PANCE Cardiology Blueprint Question 28Which of the following is associated with a reduced risk of ovarian cancer? Adelivering the first child at an age greater than 40 years oldBa positive family history of ovarian cancerCpresent age greater than 50 years oldDbeing nulliparousEoral contraceptive useQuestion 28 Explanation: OCP's protect (reduce risk by 40% for a decade after one year of use). Ovarian Neoplasms  are covered as part of the  PANCE Reproductive System Blueprint. Question 29A patient is given a new product for an acute migraine headache. Shortly after the injection, the patient complains of significant chest tightness. Which of the following medications do you suspect this patient received? ApromethazineBmetoclopramideCsumitriptanDtrimethobenzamideEketorolacQuestion 29 Explanation: Sumatriptan (Imitrex) and all triptans can cause chest tightness as it is a potent vasoconstrictor. You must use it with caution in a patient with risk factors for coronary disease and in uncontrolled hypertension. Migraine  headaches are covered as part of the  PANCE Neurology Blueprint. Question 30Which of the following does NOT increase the likelihood of infection in a cancer patient? AthrombocytopeniaBmalnutritionCthe presence of catheters or shunts for therapeutic interventionDneutropeniaEsplenectomyQuestion 30 Explanation: Decreased platelets could predispose the patient to bleeding, the others would increase his risk for infection. Thrombocytopenia  is covered as part of the  PANCE Hematology Blueprint. Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results There are 30 questions to complete. List Return Shaded items are complete. 123456789101112131415161718192021222324252627282930End Return You have completed questions question Your score is Correct Wrong Partial-Credit You have not finished your quiz. If you leave this page, your progress will be lost. Correct Answer You Selected Not Attempted Final Score on Quiz Attempted Questions Correct Attempted Questions Wrong Questions Not Attempted Total Questions on Quiz Question Details Results Date Score Hint Time allowed minutes seconds Time used Answer Choice(s) Selected Question Text All doneNeed more practice!Keep trying!Not bad!Good work!Perfect!