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Rosh Review PANCE practice exam 2024/2025 with 100% correct answers
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five-year-old boy presents to the emergency department with nasal bleeding lasting greater than two hours. In the emergency department, the nurse applied pressure for 20 minutes without successful resolution. The patient appears well and has a normal heart rate and blood pressure. The patient's mot...

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  • November 2, 2024
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  • 2024/2025
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Rosh Review PANCE practice

five-year-old boy presents to the emergency department with nasal bleeding lasting greater than two
hours. In the emergency department, the nurse applied pressure for 20 minutes without successful
resolution. The patient appears well and has a normal heart rate and blood pressure. The patient's
mother reports that the child's father has a bleeding disorder for which he occasionally uses a nasal
spray. The patient has never had testing, and this is his first physician encounter for bleeding. Which lab
abnormality would you expect to find for the child's inherited condition? correct answers*increased
bleeding time*



Pt has Von Willebrand disease (VWD). It is the most common hereditary bleeding disorder.



vWF = causes the platelets to stick together, contributes to fibrin clot formation (carries factor viii)



will have normal platelets, normal PT/INR, aPTT (unless very deficient in factor 8 than can be prolonged)



tx with desmopressin



A 32-year-old woman presents to the clinic with acute vertigo that began 12 hours ago and has been
constant. She complains of nausea, vomiting and difficulty ambulating but denies tinnitus or change in
hearing. Past medical history is significant for a recent viral illness. Physical exam reveals horizontal
nystagmus and a negative Dix-Hallpike maneuver. Which of the following is the most likely diagnosis?



A Benign paroxysmal positional vertigo

B Ménière's diseaseYour Answer

C Vestibular migraine

D Vestibular neuronitis correct answersD



A 58-year-old woman with a history of previous cerebrovascular accident presents to the emergency
department by ambulance due to concern for possible overdose. According to her husband, at home she
was vomiting and complaining of nausea and ringing in her ears. The patient is confused and unable to
answer questions upon arrival. Her blood pressure is 90/57 mm Hg, heart rate is 112 beats/minute,

,respiratory rate is 28 breaths/minute, and temperature is 103.1°F. Which of the following interventions
should be avoided if possible?



A Administration of intravenous fluids

B Arterial blood gas analysis

C Endotracheal intubation

D Hemodialysis correct answersC

Providers need to be aware that airway management can worsen the condition of patients with aspirin
overdose. The brief moment of apnea that occurs in preparation for intubation can cause acute and
significant worsening of the patient's respiratory alkalosis. Intubation of patients exhibiting tachypnea in
aspirin overdose has resulted in death and should be reserved for patients with hypoventilation and
severe respiratory distress.



aspirin overdose includes aggressive volume resuscitation with intravenous fluids (A), especially in those
who are hypotensive due to fluid loss and inappropriate systemic vasodilation. Frequent laboratory
testing is done to assess clinical status and response to treatment. Arterial blood gas analysis (B) is
critical and should be drawn every 1-2 hours to monitor acid-base status in patients with a salicylate
overdose. Salicylate removal can be improved with the use of hemodialysis (D). Indications for
hemodialysis include altered mental status, renal insufficiency, cerebral or pulmonary edema, serum
salicylate concentration > 100 mg/dL (in acute overdose) and > 50 mg/dL (in chronic overdose), and
clinical deterioration despite aggressive resuscitation.



Rifampin known s/e correct answersRifampin is an integral drug in standard combination treatment of
active M. tuberculosis disease and can be used as an alternative to isoniazid (INH) in the treatment of
latent tuberculosis infection in children who cannot tolerate INH. All rifamycins including rifampin can
turn urine and other secretions (e.g., tears, saliva, stool, sputum) orange. The rifamycins inhibit the DNA-
dependent RNA polymerase of mycobacteria, resulting in decreased RNA synthesis.



clinical presentation for anterior vs posterior hip dislocations correct answersposterior = leg will be
shortened, adducted, INTERNALLY ROTATED



anterior = markedly abducted, EXTERNALLY rotated



*posterior much more common*

, 3 main types of polyps (colon) correct answers1. hyperplastic (no risk of malignant transformation)



2. adenomatous ("tubular adenomas") (most common; possible risk of malignant transformation) ->
repeat colonoscopy in 5 to 10 years



3. malignant



Pt presents with refractory dyspesia. On rinitidine and ompeprazole and no improvement - thinking of
Zollinger-Ellison syndrome - what is this? correct answers- Gastrin secreting tumor, causes peptic ulcer
disease

- Found in duodenum, pancreas

- Often malignant

- Patient will complain of abdominal pain, chronic diarrhea, weight loss

- Exam will show epigastric tenderness of palpation

- Labs will show elevated serum gastrin level (>1000 pg/mL)

Treat with H2 blockers, PPI, surgery

Associated with MEN I



what test can be used to confirm lactose intolerance? correct answersbreath hydrogen test will show a
rise in breath hydrogen >20 ppm within 90 min of ingestion of 50 g of lactose and is positive for lactase
deficiency. This test is positive in 90% of patients with lactose malabsorption. Common causes of false-
negative results are recent use of oral antibiotics or recent high colonic enema. The diagnosis can usually
be made on the basis of the history and improvement with dietary manipulation. Lactose intolerance is a
prototypical carbohydrate malabsorption disorder. Individuals with the condition may experience
diarrhea, cramps, abdominal pain, and flatus following ingestion of milk products.



<25% of white adults being lactose intolerant but >85% of Asian Americans and >60% of African
Americans having some form of lactose intolerance.



treatment of choice for torsades de pointes correct answersUnstable: defibrillation

Stable: intravenous magnesium sulfate and stopping the offending drug

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