PANCE Practice Exam 2 300 Actual Questions and

PANCE Practice Exam #2 300 Actual Questions and Answers 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? - Answer 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?

• Acute anxiety
• Bipolar disorder
• Cocaine intoxication
• Heroin intoxication - Answer 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 - Answer 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?

• anemia
• cerebral aneurysms
• mononeuritis multiplex
• ischemic optic neuropathy
• respiratory tract complications - Answer The answer is D. 1 / 4

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? - Answer 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?

• 0%

B. 25%

• 50% - Answer 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?

• Atrioventricular heart block 2 / 4

• Atrial fibrillation
• Bifasicular block
• Right axis deviation - Answer 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?

• Counsel the patient to stop smoking
• Systemic glucocorticoids
• Take aspirin prior to cold exposure - Answer 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?

• amiodarone
• beta-blockers
• levadopa - Answer 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 - Answer include bradycardia and constipation, so laboratory evaluation for thyroid dysfunction must be used. 3 / 4

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?

• Acid supression
• Dilatation of the lower esophageal sphincter
• Diverting colostomy
• Ladd procedure
• Pyloromyotomy - Answer 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? - Answer 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? - Answer 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 - Answer bone and biliary tract.

serum anti-thyroglobulin antibodies, are most commonly associated with - Answer autoimmune disorders of the thyroid, such as Hashimoto's thyroiditis.

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