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PANCE EXAM 2 2024/2025 WITH 100% ACCURATE SOLUTIONS
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PANCE EXAM 2 2024/2025 WITH 100% ACCURATE SOLUTIONS
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PANCE EXAM 2 2024/2025 WITH 100%ACCURATE SOLUTIONS
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 - Precise Answer ✔✔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 - Precise Answer ✔✔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 - Precise Answer ✔✔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 "machine-like" 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. - Precise Answer ✔✔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. - Precise Answer ✔✔Ventricular septal defect
(VSD)
a rough ejection, systolic murmur heard best at the LSB and the third
ICS with radiation to the back. - Precise Answer ✔✔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 - Precise Answer ✔✔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
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