PANCE Practice Exam with Complete Solution (2022/2023).

PANCE Practice Exam with Complete Solution (2022/2023) which type of hypersentitivy rxn is the most severe? requiring emergency tx? Correct Answer: type 1 Type IV< III< II < I in an alcoholic pt with global confusion, ataxia (gait imbalance), nystagmus + ocular msl paralysis Correct Answer: wernicke's encephalopathy Tx: IV thiamine which type of hypersensitivity rxn is characterized by antigen -antibody rxns mediated by IgE -- that results in hypotension, shock, urticaria, or angioedema? Correct Answer: type I best diagnostic test for carpal tunnel syndrome ? Correct Answer: electromyogram males with early onset of poor gait that is progressively worsening. Plus pseudohypertrophy of the calves and + Gowers sign (need to lift oneself "climb up" up when getting up) and a positive fam history a Muscle bx to confirm this dx would show: Correct Answer: duchenne muscular dystrophy which tests differentiate between nerve and muscular problems? Correct Answer: electromyogram and nerve conduction studies Cushing's syndrome pt should immediately stop which meds? Correct Answer: steroids. Lambert-Eaton myasthenic syndrome Correct Answer: immune mediated disorder where ACH is not properly released - this causes weakness in scapular and pelvic girdle muscles. and difficulty climbing stairs or impotence. deep tendon reflexes are decreased or absent. overdose cholinesterase inhibitors such as pyridostigmine or neostigmine can cause what ? (usually prescribed for MG) Correct Answer: cholinergic crisis. excessive salivation, lacrimation, emesis, urinary incontinence, gynecomastia, sparse body hair, small soft testes Correct Answer: klinefelters' syndrome (XXY) retinal a. emboli can cause brief episodes of monocular blindness known as Correct Answer: amaruosis fugax inhibition of protein C due to use of warfarin causes what? Correct Answer: skin necrosis in wilson's dz which are the only type of contraceptives recommended? Correct Answer: progestin only pill or levoestregel releasing IUD how do u differentiate between amphetamine or cocaine high? Correct Answer: time; amphetamine = 4-6 hrs cocaine = 2 hrs. cushings syndrome pts that are not surgical candidates can use what? Correct Answer: oral ketoconazole distended neck veins with prominent A or V waves Correct Answer: cor pulmonale IgA vasculitis that erupts over skin post URI, manifesting as paplaple lesions and pts also present with hematuria, arthalgia, and abdominal pain and bloody stools. dx: best dx tool: tx: Correct Answer: henoch schonlein purpura coag studies: should be NEGATIVE! kidney bx: IgA deposits tx: supportive as dz is self limiting (NSAIDs, bed rest, hydration) which restrictive lung dz has increased serum ACE (angiotensin converting enzyme)? Correct Answer: sarcoidosis in pts with orthostatic hypotension, how can you differentiate between autonomic insufficiency or hypovolemia? Correct Answer: in autonomic insufficiency there is no compensatory increase in HR which two conditions are associated with: 1. menstrual irregularity 2. androgen exces - hirsutism 3. mood changes 4. insulin resistance - hyperglycemia 5. obesity how can u differentiate the two? Correct Answer: PCOS and hypercortisolism ***hypercortisolism has obesity in truncal distribution and is assoc with HTN and inc urinary cortisol. what are the two most common causes of ACUTE renal failure? Correct Answer: 1. acute tubular necrosis (due to ischemia, shock, sepsis or cardiac arrest or nephrotoxins) 2. prerenal dz (HF or hypovolemia) what is the BUN/Cr ratio like in acute tubular necrosis? Correct Answer: normal BUN/Cr ratio only higher in dz with reduced urine outflow = pre/post renal azotemia BUN/Cr ratio is only lower in severe liver dz. beriberi, av fistulas, hyperthyroidism, Paget's dz of bone can all cause what kind of HF? Correct Answer: high cardiac output HF. how can you differentiate between inflammatory and non-inflammatory diarrhea? Correct Answer: inflammatory diarrhea can be bloody shigella, entameoba, capmhylobacter, salmonella, yersinia are all organisms that are more likely to cause what kind of diarrhea? Correct Answer: inflammatory norovirus, rotavirus, , staph aureus, giardia, crytosproridium are all organisms that cause wht kind of diarrhea? Correct Answer: non-inflammatory. in a pt with guillan barre, PMH is significant for recent travel and severe diarrhea (enterocolitis) - what organism can you assume caused this? Correct Answer: camphylobacter. which organisms are most likely to cause traveler's diarrhea? Correct Answer: , shigella, camphylobacter which organisms are responsible for causing diarrhea from drinking contaminated water? Correct Answer: giardia, cryptosproridium stool immunoassay and micro studies to confirm dx. tx: metronidazole. extraintestinal manifestations of uveitis, erythema nodosum or pyoderma gangrenosum , large joint arthritis, and cholangitis can be seen with what? Correct Answer: Ulcerative colitis in addition to heart burn, GERD can cause what sxs? Correct Answer: water brash, hoarseness, wheezing, sour taste, sore throat. best test for GERD dx? Correct Answer: esophageal pH monitoring how is antiphospholipid antibody syndrome related to pregnancy? Correct Answer: recurrent spontaneous abortions. and it can cause preecclampsia. best diagnostic test for someone with charcoat's triad + Correct Answer: ERCP unconjugated (INDIRECT) bilirubin is high in what conditions? Correct Answer: gilberts's dz, hemolysis, newborn jaundice, resabsorption of hematoma, conjugated (DIRECT) bilirubin is high in what conditions? Correct Answer: Dubin johnson, biliary tract obstruction, intrahepatic cholestasis, tumor in liver, cholangitis main cause of primary dysmenorrhea? Correct Answer: prostaglandin causing uterine contraction and ischemia in a pt with active upper GI bleed, what test should u perform to dx i infection? Correct Answer: gastric bx. via endoscopy. what is HHS ? who gets it? Correct Answer: HHS is Hyperglycemic Hyperosmolar state, middle aged DM pts get it due to infection, AMI, stroke or surgery. - Hyperglycemia = GLU > 600mg/dL - hyperosmolar = serum osmolality > 310 mOsm/kg tx for HHS? Correct Answer: 1) continuous IV Insulin, granted K+ is > 3.3 mg/dL. If it is not, then K+ has to be replenished first before starting Insulin. 2) start IV fluids. match the circulating antibodies with the correct dz 1. ACH 2. TSH 3. thyroglobulin and thyroid peroxidase 4. anti intrinsic factor antibodies 5. anti ds DNA, and anti SM antibodies Correct Answer: 1. Myasthenia Gravis 2. Graves (hypertsh) 3. Hashimoto's 4. pernicious anemia 5. SLE what happens in advanced renal dz with reduced glomerular filtration rate? Correct Answer: hyperphosphatemia and normocytic normochromic anemia hepatic encephalopathy can be treated with what? Correct Answer: Ammonia is usually high 1. oral or rectal lactulose 2. rifampin 3. protein restriction in diet how would u treat ascites? Correct Answer: 1. spironolactone or furosemide 2. paracentesis. increased ADH secretion seen with low CO systolic HF results in what electrolyte abnormality? Correct Answer: hyponatremia IVIG is used in what conditions? (7) Correct Answer: 1. ITP 2. Kawasaki 3. Guillian Barre 4. MG 5. autoimmune hemolytic anemia 6. pediatric HIV pt 7. antibody deficiency d/o of the following sxs of hepatic failure, which two differentiates acute from chronic? a) jaundice b) bleeding c) ascites d) edema e) portal HTN f) spider angiomas Correct Answer: e) and f) are present in chronic liver cirrhosis in a pt with HTN and Hyperglycemia which diseases can u consider? Correct Answer: 1. DM 2. Pheochromocytoma 3. Hypercortisolism 4. Acromegaly which kind of vertigo (peripheral or central) is assoc with inner ear problems and yields vertigo related to BPPV, or Meniere's dz Correct Answer: peripheral what qualities make a HA life threatening? Correct Answer: 1. sudden onset (SAH) 2. worse with physical strain like valsalva (intercranial hemorrhage) deep excruciating, unilateral HA that is accompanied by tearing, nasal congestion and weakness of the facial muscles on the affected side. Correct Answer: cluster HA tx: O2, sumatriptan, octreotide prevent: verapamil, prednisone, lithium. T/F. absence of deep tendon reflexes is normal in otherwise vigorous 80-90 yr olds Correct Answer: true mitosis, ptosis, facial anhidrosis Correct Answer: Horner's syndrome bronchogenic ca, cluster HA, cerebellar infarction,, dissection of carotid a. -----all can cause what ? Correct Answer: Horner's syndrome which of the following is not caused by DM? a) stocking glove sensory loss b) proprioceptive loss c) acquisition of Babinski's reflex Correct Answer: Babinski RBBB is most commonly assoc with which congenital heart defect? Correct Answer: ASD recurrent numbness and tingling (paresthesias) in fingers, toes, and perioral area are NOT seen in which of the following conditions? a. diabetic polyneuropathy b. lacunar infarct c. vertebrobasilar a. insufficiency d. hypoglycemia/hypocalcemia e. 1* hypoparathyroidism f. lumbar n. compression Correct Answer: b. and f. acute renal failure, microangiopathic hemolytic anemia, and thrombocytopenia Correct Answer: Hemolytic Uremic Syndrome (assoc. with EHEC infection) which dzez cause thrombocytopenia due to autoimmune response (antibody destruction of platelets) ? Correct Answer: 1. ITP 2. HIT 3. SLE which dzez cause thrombocytopenia due to non-immune causes? Correct Answer: 1. RMSF 2. DIC 3. Viral Infx 4. B12 or Folate def anemia aside from micronutrient deficiency (Iron, Vitamins (A-E), folate, Calcium, etc.) what is another common complication in pts who underwent Roux-en-Y surgery? Correct Answer: cholelithiasis- give prophylactic Ursodeoxycholic acid s/p surgery to prevent this. how to tell the difference diagnostically between perinneal allergic rhinitis (allergy to irritants - dander, pollen, etc), and vasomotor rhinitis (runny nose after eating spicy foods or humidity) ? Correct Answer: perinneal allergic rhinitis is assoc with 1. asthma 2. eosinophils on nasal cytology 3. + skin test which anticoag is preferred for Afib pts with valvular heart disease? Correct Answer: Heparin (LMWH or UFH) hypokalemia, hypomagnesemia, and hypocalcemia can all cause what on EKG? what kind of abx would make this situation worse? Correct Answer: prolonged QT Fluoroquinolones what does lactase deficiency, sorbitol and fructose ingestion have in common? Correct Answer: they are poorly absorbed in the intestine causing osmotic diarrhea. BRCA 1 and BRCA2 is associated with which cancers? Correct Answer: ca of breast, pancreas and ovaries. dermatitis herpetiformis is a papulovesicular rash assoc with what dz? Correct Answer: Celiac disease tx: gluten free diet alk phos and GGT are both elevated in bone or liver dz? Correct Answer: liver dz. which of the following is not assoc with 2* adrenal insufficiency? a) weakness b) orthostatic hypotension c) hyperpigmentation d) anorexia Correct Answer: c what is the best therapy for allergic rhinitis? Correct Answer: intranasal corticosteroids for variant aka prinzmetal angina what do you see on EKG versus what you might see on EKG for AMI caused by ASCVD? Correct Answer: variant angina = ST Elevations AMI = Horizontal ST depression how does psoriatic arthritis in distal phalanges look on XR ? Correct Answer: Sharpened pencil in a man with a painful rash in his mouth that is violaceous with papules and white streaks which med may be responsible? 1) bactrim 2) lisinopril 3) warfarin 4) cloroquine Correct Answer: 2. lisinopril man has lichen planus caused by ACE or NSAIDs. left parasternal lift, high JVP, hepatomegaly, ascites, peripheral edema are all signs of ? Correct Answer: cor pulmonale - autoimmune destruction of pancreatic B cells - assoc with HLA-DR3 gene Correct Answer: Type 1 DM - combo of tissue resistance to insulin and deficiency in response of pancreatic islet cells to glucose - early in dz exaggerated hyperinsulinism - waist to hip fat ratio > 0.9 Correct Answer: Type 2 DM which test do u do before starting a pt on probenecid or allorpurinol for recurrent gout? Correct Answer: 24 hr urinary uric acid should be > 800mg /day serum amylase is NOT elevated in which of the following? (More than one answer) a) ruptured ectopic pregnancy b) mumps c) multiple myeloma d) mesenteric infarction e) renal failure f) diabetes g) diverticulitis Correct Answer: f and g what is the best indicator of hypovolemia? Correct Answer: orthostatic hypotension