An EKG demonstrates a PR interval of 0.16 seconds, a P to QRS relationship of 1:1, a variable heart rate and an R to R interval that is noted to accelerate ad decelerate during the respiratory cycle. What is the diagnosis? A Wenckebach B third degree heart block C atrial fibrillation D sinus arrhythmia E […]
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The Daily PANCE & PANRE Question 12
A 42 year-old female presents after finding a firm, painless bump in her right eyelid. On examination, you note a 6 mm mass within the tarsus of the right eye. The skin is freely movable over the mass. The remainder of the ophthalmoscopic examination is unremarkable. Which of the following is the most likely diagnosis? […]
The Daily PANCE and PANRE Fast Track – Question 34
A 46 year-old patient with chronic hypertension, suddenly discontinues the use of his antihypertensive agent. This patient presents to your office with a blood pressure of 198/116 in the left arm. The patient denies chest pain and shortness of breath. You note no evidence of acute end-organ changes on physical examination. His laboratory studies and […]
The Daily PANCE and PANRE Fast Track – Question 49
A 65 year-old female is referred to your office by her rheumatologist, complaining of a severe, unilateral headache of a piercing quality. You examine the patient and cannot appreciate any pulsation of the temporal artery on the side of her head, ipsilateral to her cephalgia. While awaiting consultation of the appropriate specialist, you prescribe prednisone. […]
The Daily PANCE & PANRE Question 14
Which white blood cell disorder is characterized by the presence of the Philadelphia chromosome in 90% of cases? A chronic lymphocytic leukemia (CLL) B acute lymphocytic leukemia (ALL) C chronic myelogenous leukemia (CML) D acute myelogenous leukemia (AML) E multiple myeloma Answer: C Philadelphia Chromosome occurs in CML. ALL occurs in children. AML is associated […]
The Daily PANCE and PANRE Fast Track – Question 50
A 59 year-old, heavy smoker, presents for the evaluation of facial swelling. Upon examination, you note swelling, not only of the face, but also of the neck and upper extremities. You appreciate diminished breath sounds and tactile fremitus in the right upper lobe. Which of the following diagnosis is most likely? A. Pancoast tumor B. […]
The Daily PANCE and PANRE Fast Track – Question 1
A 31 year-old pharmacist complaining of rectal pain. He describes the pain as “a severe tightness that awakens him from sleep.” His bowel activity is normal. He denies rectal bleeding and seepage. He adds that sleep interruption is problematic, because with the number of hours he works, every minute of sleep is important. What is […]
The Daily PANCE & PANRE Question 15
Which of the following thyroid profiles is most compatible with a diagnosis of primary hypothyroidism? A a low TSH (thyroid stimulating hormone) level and a high T4 B a low TSH level and a normal T4 C a low TSH level and a low T4 D a high TSH level and a low T4 E […]
The Daily PANCE and PANRE Fast Track – Question 57
A patient is started on a new antipsychotic medication for his disorder. Three days later he develops altered consciousness, lead-pipe rigidity, diaphoresis and catatonia. Vital signs reveal respiratory rate of 20, temperature of 105.6 degrees F, and pulse oximetry of 95% room air. Which of the following would be the most appropriate initial intervention in […]
The Daily PANCE & PANRE Question 16
All of the following are factors that predispose a patient to the development of gastroesophageal reflux EXCEPT: A hiatal hernia. B pregnancy C scleroderma. D an incompetent esophageal sphincter E pernicious anemia. Answer: E Pernicious anemia has no correlation with GERD. It is an autoimmune destruction of the gastric parietal cells that make intrinsic factor. […]
The Daily PANCE and PANRE Question 23
A patient is experiencing an acute exacerbation of asthma. Which of the following drugs would be the least useful in the management of this asthma attack? A. albuterol B. cromolyn sodium C. prednisone D. theophylline E. epinephrine Answer: B Cromolyn sodium Cromolyn is a mast cell stabilizer and must be present in the system PRIOR […]
The Daily PANCE & PANRE Fast Track – Question 6
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 […]
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The Daily PANCE & PANRE Question 18
A 6 year-old child falls onto his right arm. An x-ray demonstrates a buckle in the cortices of the distal radius, proximal to the growth plate, without angulation. What is the term used to describe this fracture? A Salter-Harris Type III B Salter Harris Type IV C Salter Harris Type V D torus E greenstick […]
The Daily PANCE & PANRE Question 3
Which of the following is NOT a characteristic feature of the nephritic syndrome? A. proteinuria B. hematuria C. hypoalbuminemia D. hyperlipidemia E. generalized edema Answer: B. Hematuria Hematuria is present in NEPHRITIC syndrome. Nephrotic syndrome characteristically includes proteinuria (>3.5 gm/day), with resulting low serum albumin, hyperlipidemia, hypertension, hypercoagulability, and generalized edema (from oncotic third-spacing) […]
The Daily PANCE & PANRE Question 19
A 55 year-old male presents complaining of “difficulty wrtiing” using his dominant hand and some “slurred” speech. He has a h/o hypertension, DM type II, and hypertriglyceridemia. Which of the following would you anticipate to find on a CT scan of his head, as the explanation for his chief complaint? A. hemorrhage in the distribution […]
The Daily PANCE & PANRE Question 20
A female in her third trimester of pregnancy developed hypertension, diffuse edema, proteinuria and hyperreflexia. She was treated with intravenous magnesium sulfate and is now hyporeflexic and drowsy. What do you prescribe now? A. calcium B. diazepam C. an amphetamine D. additional magnesium E. oxygen Answer: A, calcium Pre-eclampsia causes hyper-reflexia. Magnesium is the treatment. […]
The Daily PANCE & PANRE Question 5
A 34-old female presents complaining of symmetrical redness and swelling of the small joints of her hands (PIPs and MCPs). She has noted that the symptoms are worst in the morning. Her erythrocyte sedimentation rate is elevated and her rheumatoid factor is negative. Which of the following diagnosis is most likely? A. progressive systemic sclerosis […]
The Daily PANCE & PANRE Question 12
A 42-year-old female presents after finding a firm, painless bump in her right eyelid. On examination, you note a 6 mm mass within the tarsus of the right eye. The skin is freely movable over the mass. The remainder of the ophthalmoscopic examination is unremarkable. Which of the following is the most likely diagnosis? pterygium […]
The Daily PANCE & PANRE Fast Track – Question 12
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 21
This papulosquamous eruption is most common in young adults. A single oval patch is generally noted several days before a more generalized, fawn-colored rash erupts. This rash is most prevalent on the trunk, and the proximal upper and lower extremities. The rash spontaneously disappears over 5 to 6 weeks. The diagnosis is: A. pityriasis rosea. […]
The Daily PANCE & PANRE Question 6
A 27 year-old nulliparous female presents because she’s been trying to get pregnant for two years, but has failed. She relates a history of a misdiagnosis of appendicitis that lead to abscess formation when she was 14 years old. Which of the following diagnostic studies would be most helpful at this point in her evaluation? […]
The Daily PANCE & PANRE Question 22
A patient presents complaining of generalized swelling. Her urine is positive for protein. Her serum testing reveals hyperlipidemia and hypoalbuminemia. Which of the following is the most likely diagnosis? A. cirrhosis B. nephrotic syndrome C. congestive heart failure D. cystitits E. pyelonephritis Answer: B, nephrotic syndrome This is a classic presentation of nephrotic syndrome. […]
The Daily PANCE & PANRE Question 14
Which white blood cell disorder is characterized by the presence of the Philadelphia chromosome in 90% of cases? chronic lymphocytic leukemia (CLL) acute lymphocytic leukemia (ALL) chronic myelogenous leukemia (CML) acute myelogenous leukemia (AML) multiple myeloma Answer: C Chronic Myeloid Leukemia (CML) – (Philadelphia CreaM cheese) Philadelphia Chromosome occurs in CML. ALL occurs in children. […]