A patient presents with a recurrent history of swelling on the right side of the jaw that begins while eating and subsides within two hours postprandially. You suspect: A. hypochondriasis B. sialolithiasis C. parotitis. D. an abscessed tooth. E. conjunctivitis manibularis. Â Answer:Â B, sialolithiasis Sialo(salivary gland) lithiasis (stone) is described in this question. Parotitis would be […]
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The Daily PANCE & PANRE Question 65
Secondary to a traumatic even, a child complains of pain in the index finger. An x-ray of the digit demonstrates a fracture line through the metaphysic of the proximal aspect of the middle phalanx, ending at the epiphyseal plate. What type of fracture does this child have? A. Salter Harris Type I B. Salter Harris […]
The Daily PANCE & PANRE Question 40
A 51 year-old male with renal artery stenosis and an elevated BUN and creatinine, is newly diagnosed as hypertensive. Which of the following agents should be avoided? A. hydrochlorothiazide-triamterene B. prazosin C. nifedipine D. verapamil E. furosemide Answer:Â A, hydrochlorothiazide-triamterene This is a potassium sparing diuretic and should be avoided in anyone with renal disease. ACEI […]
The Daily PANCE & PANRE Question 59
Which of the following is the earliest manifestation of diabetic nephropathy? A. proteinuria B. a progressive decline in the creatinine clearance C. an elevated serum haptoglobin D. renal insufficiency E. microalbuminuria  Answer: E, microalbuminuria Tiny amounts of albumin (microalbumin) show up first – but need a special test ordered to detect it. Intervention at this point […]
The Daily PANCE & PANRE Question 66
A 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 sitting up and leaning forward. He denies trauma, a cough and shortness of breath. Which of the following test would be most compatible with your suspected diagnosis? A. a hiatal […]
The Daily PANCE & PANRE Question 25
A patient with AIDS develops severe headaches. A CT scan demonstrates multiple ring-enhancing lesions of the brain. What diagnosis is most likely? A. Toxoplasmosis B. Histoplasmosis C. lymphoma D. Cytomegalovirus E. Herpes encephalitis Answer: A Toxo occurs commonly in HTV, and is a parasitic infection causing ring-enhancing lesions (but lots of things can cause ring-enhancing […]
The Daily PANCE & PANRE Question 41
A patient at a Christmas party on a cruise ship develops a terrible headache. His blood pressure is 224/158 mm Hg. Which of the following agents is this patient most likely taking regularly? A. tricyclic antidepressants B. barbiturates C. benzodiazepines D. monoamine oxidase inhibitors E. phenothiazines Answer:Â D, monoamine oxidase inhibitors This is a typical scenario […]
The Daily PANCE & PANRE Question 60
Fluid from a thoracentesis is grossly purulent. The effusion from which this fluid was aspirated is best described as a(n): A. loculated effusion B. chylothorax. C. empyema. D. hydrothorax. E. hemothorax. Â Answer:Â C, empyema. A grossly purulent tap would suggest staph (empyema). Loculated effusion does not describe either a trans or exudative effusion. Chylo and hydro […]
The Daily PANCE & PANRE Question 26
A Caucasian male has a history of a meconium ileus as a newborn, steatorrhea and a positive sweat test. What is the most likely diagnosis? A. Von Gierke’s disease B. Hurler’s syndrome C. Cystic fibrosis D. Hunter’s syndrome E. Cri du chat syndrome Answer: C, Cystic fibrosis This is the classic presentation of Cystic fibrosis […]
The Daily PANCE & PANRE Question 42
A patient with known hyperlipidemia, taking clofibrate, presents to your office complaining of severe myalgias and weakness. He has noted a dark color to his urine. The laboratory calls with a panic value CPK of 8500. He was recently started on a new medication, four days earlier. Which of the following is most likely the […]
The Daily PANCE & PANRE Question 63
A 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 […]
The Daily PANCE & PANRE Question 68
Your 27 year-old sister is visiting and requests you to provide refills of dexamethasone and homotropine ophthalmic drops for her. What condition is most likely being treated? A. conjunctivitis B. glaucoma C. iritis D. Herpes keratitis E. blepharitis Answer:Â C, iritis Iritis is treated with steroid drops (dexamethasone) and miotic drops *homotropine, like atropine (to constrict […]
The Daily PANCE & PANRE Question 27
A 32 year-old male presents with dyspnea and a nonproductive cough. His is tachycardic, tachypneic and febrile. Auscultation of his chest reveals scattered rhonchi. His chest x-ray demonstrates a diffuse interstitial infiltrate. His ABG demonstrates moderate hypoxemia and his LDH is elevated. What is the most likely diagnosis? A. Â Streptococcal pneumoniae pneumonia B. Â Mycoplasma pneumoniae […]
The Daily PANCE & PANRE Question 43
A female patient presents for an evaluation for primary amenorrhea. She is noted to be short of stature and have short fourth metacarpals. What diagnosis do you suspect? A. XO B. XXY C. XXX D. XXXY E. Trisomy 21 Answer:Â A, XO This is the genotype for Turner’s syndrome. XXY is the genotype for Klinefelter’s (which […]
The Daily PANCE & PANRE Question 64
A 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? A. rifampin B. isoniazid C. streptomycin D. ethambutol E. para-aminosalicylic acid Answer, D Ethambutol is the TB drug that causes “E”ye symptoms. I remember it because it […]
The Daily PANCE & PANRE Question 69
A 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 […]
The Daily PANCE & PANRE Question 28
A patient describes a history of a “curtain being brought down over my right eye it stayed there for a few minutes then was lifted back up.” In which of the following arteries is the etiology of this complaint located? A. anterior cerebral B. middle cerebral C. posterior cerebral D. internal carotid E. external carotid […]
The Daily PANCE & PANRE Question 44
An 18 year-old female presents after completing her freshman year at college. Two months ago, she developed “bronchitis” which has persisted. She has become increasingly tired and has frequent night sweats. A chest x-ray today reveals a left mediastinal mass. What is the next step in her evaluation? A. repeat the chest x-ray in six […]
The Daily PANCE & PANRE Question 65
Secondary to a traumatic even, a child complains of pain in the index finger. An x-ray of the digit demonstrates a fracture line through the metaphysic of the proximal aspect of the middle phalanx, ending at the epiphyseal plate. What type of fracture does this child have? A. Salter Harris Type I B. Salter Harris […]
The Daily PANCE & PANRE Question 70
Which of the following is NOT a characteristic feature of multiple myeloma? A. elevated serum calcium B. osteoporosis C. “punched out” osseous lesions D. plasma cell infiltration of bone marrow E. hypogammaglobulinemia Answer:Â E. hypogammaglobulinemia MM is a HYPERgammaglobulinemia – all of the other findings occur in MM Help Support The Physician Assistant Life for […]
The Daily PANCE & PANRE Question 29
Upon review of an EKG you notice periodic, repetitively absent QRS complexes and “grouped beating.” Which of the following is the explanation? A. Third degree heart block B. Mobitz Type II heart block C. Mobitz Type I heart block D. first degree heart block E. sinus tachycardia Answer: C, Mobitz Type I heart block I […]
The Daily PANCE & PANRE Question 48
A 14 month-old female is brought to your office with a 1 day history of a fever of 101 degrees rectally. Suddenly, today, the parent noted small red spots that became bumps and are now blisters. The majority of the lesions are on the thorax. Each vesicle resides on its own erythematous base. A. shingles. […]
The Daily PANCE & PANRE Question 66
A 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 sitting up and leaning forward. He denies trauma, a cough and shortness of breath. Which of the following test would be most compatible with your suspected diagnosis? A. a hiatal […]
The Daily PANCE & PANRE Question 71
Which of the following is NOT a risk factor for the development of osteoporosis? A. low testosterone levels in men B. low levels of physical activity C. inadequate dietary protein D. cigarette smoking E. chronic corticosteroid use Answer:Â C, inadequate dietary protein Low dietary Calcium, not protein, is a risk factor for osteoporosis. All of the […]
The Daily PANCE & PANRE Question 30
A 14 month-old female is brought to your office with a 3-day history of a fever of 104 degrees rectally. Suddenly, today, the fever stopped and a rash developed. Examination reveals a diffuse, fine, maculopapular rash. Presently, the child does not appear ill. The most likely diagnosis is: A. Rubella B. Rubeola C. erythema infectiosum […]
The Daily PANCE & PANRE Question 49
A 35 year-old male complains of acute left eye pain immediately after he struck a nail with a hammer. On examination, you note that the left pupil is elliptical. What diagnostic test/procedure will most likely confirm your diagnostic suspicion? A. flourescein staining of the ey B. pressing on the globe to assess intraocular pressure C. […]
The Daily PANCE & PANRE Question 68
Your 27 year-old sister is visiting and requests you to provide refills of dexamethasone and homotropine ophthalmic drops for her. What condition is most likely being treated? A. conjunctivitis B. glaucoma C. iritis D. Herpes keratitis E. blepharitis Answer:Â C, iritis Iritis is treated with steroid drops (dexamethasone) and miotic drops *homotropine, like atropine (to constrict […]
The Daily PANCE & PANRE Question 72
A 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? A. […]
The Daily PANCE & PANRE Question 31
The most common cause of curable blindness in the United States is: A. macular degeneration. B. cataracts. C. retinal detachments. D. glaucoma. E. trauma. Answer: D, glaucoma Again, the wording is difficult in this question. Macular degeneration, retinal detachments and trauma are not preventable. Cataracts are “curable”, but the cataract itself is probably not […]
The Daily PANCE & PANRE Question 50
This drug causes gingival hyperplasia and hirsutism. At high doses it can cause nystagmus, ataxia and diplopia. Which drug is best described by these statements A. aspirin B. acetaminophen C. acyclovir D. phenytoin E. valproic acid Answer:Â D, phenytoin Dilantin (phenytoin) causes these typical symptoms Help Support The Physician Assistant Life for FREE! This is […]