FREE PANCE/PANRE Practice Exam

An angiogram is the "gold standard" for occlusion of an arterial vessel. Arterial embolism/thrombosis is covered as part of the PANCE Cardiology Blueprint.

proctalgia (rectal pain) fugax (comes and goes) is the best description. An abscess would be constant, fistula would drain, UC would cause bloody mucousy diarrhea, hemorrhoids would cause no pain, but bleeding. Disorders of the Anus and Rectum are covered as part of the PANCE GI and Nutrition Blueprint.

This is the best descriptor. Chronic bronchitis is covered as part of the PANCE Pulmonary Blueprint.

Ethambutol is the TB drug that causes eye symptoms. It's helpful to remember "E" for Ethambutol causes "E"ye symptoms. Tuberculosis is covered as part of the PANCE Infectious Disease Blueprint.

• Salter I = slight increase in Space between epiphyseal plate and metaphysis
• Salter II = fx Above the plate (in the metaphysis)
• Salter III = fx Lower (in the epiphyseal plate)
• Salter IV = fit Through (both the metaphysis and epiphysis)
• Salter V = Really bad (comminuted fx compressing the epiphysis) This spells SALTR and may help you remember.

Types of fractures and Salter-Harris classification are covered as part of the PANCE Musculoskeletal Blueprint

This is pericarditis (by clinical presentation) which causes diffuse ST-segment elevation on ECG (there can be notching of the R wave as well). Acute pericarditis is covered as part of the PANCE Cardiology Blueprint.

Any infant (neonate) with fever and rash should have a lumbar puncture (LP). While I would certainly do a CBC, even if it was normal, I would want the LP.

Iritis is treated with steroid drops (dexamethasone) and miotic drops *homatropine, like atropine (to constrict and fix the pupil to help the pain and open the angle until the iritis is resolved). Iritis and disorders of the Eye (PEARLS) are covered as part of the PANCE EENT Blueprint.

ALS (Lou Gehrig's disease) is a progressive bilateral muscle disease which causes fasciculations (lower motor neuron), and hyperreflexia, plantar reflexes (upper motor neuron) and dysarthria. Sensation is normal as is bladder function.

• MS may have dysarthria, but reflexes are normal, sensation is impaired and bladder function is frequently affected.
• Alzheimer's has normal neuro exam with cognitive disability.
• Huntington's causes a movement disorder with writhing choreiform movements of the body.
• Myasthenia causes fatigue of the ocular muscles typically worsening at the end of the day.

Multiple myeloma is a HYPERgammaglobulinemia - all of the other findings occur in multiple myeloma. Multiple myeloma is covered as part of the PANCE Hematology Blueprint.

Low dietary Calcium, not protein, is a risk factor for osteoporosis. All of the others are risk factors. Osteoporosis is covered as part of the PANCE Musculoskeletal Blueprint.

Mesenteric adenitis (lymphadenopathy of the mesentery - usually from a virus) can mimic appendicitis and usually occurs in kids. There is usually no way to diagnose it pre-operatively, except perhaps with a CT of the abdomen (usually done nowadays before going to the OR). Review Diseases of the Small Intestine and Colon (PEARLS) from the PANCE GI and Nutrition Blueprint

This is a picky question for the Boards. Of these Beta-blockers (which are usually AVOIDED) in reactive airway disease - metoprolol is the most "cardioselective", so theoretically could be used.... although, on an exam, I would avoid beta-blockers in general. Asthma is covered as part of the PANCE Pulmonary Blueprint

Uric acid (gout) is "Needle-shaped crystals with Negative birefringence). Calcium Pyrophosphate (pseudogout) is Prism-shaped crystals with Positive birefringence - To remember this think "P"seudogout has "P"rism shaped crystals and "P"ositive birefringence. Gout/pseudogout are covered as part of the PANCE Musculoskeletal Blueprint

Azithromycin 1 g orally in a single dose is both safe and effective - it is now considered first-line treatment by the CDC for use in pregnancy. Of the choices above, erythromycin is best and is considered an alternative regimen. PCN does not work for Chlamydia. Tetracyclines (A & E) should be avoided. Quinolones (norfloxacin) are contraindicated. Note: Erythromycin estolate is contraindicated during pregnancy because of drug-related hepatotoxicity. So you would use either Erythromycin base or Erythromycin ethylsuccinate. Chlamydia is covered as part of the PANCE Infectious Disease Blueprint.

This is a brown recluse spider bite. Spider bites are covered as part of the PANCE Dermatology Blueprint

In pre-renal ARF, the sodium content of the urine would be decreased (because the patient is volume depleted, so the kidneys try to retain Na - less is in the urine). In intrarenal disease, the urine would contain casts. So, this is postrenal disease (usually a big prostate or stones) which would cause normal urine with rbc's. Acute renal failure is covered as part of the PANCE Genitourinary Blueprint.

That is why we use methadone when weaning folks from opiates (like heroin). Substance Use Disorders are covered as part of the PANCE Psychiatry Blueprint.

Hypertrophic cardiomyopathy (most common cause of sudden cardiac death in this age individual) would have a systolic ejection murmur which would INCREASE with Valsalva (decreased preload causing a smaller LV volume and an increase in the obstruction) The murmur would DECREASE with squat or elevating the legs (increase preload, make the LV volume larger and decrease the obstruction). Hypertrophic Cardiomyopathy is covered as part of the PANCE Cardiology Blueprint.

The question suggests bacterial pneumonia. The pleural fluid should have high LDH (pleural > serum), a high specific gravity (lots of "stuff' in the fluid), a large amount of protein (WBC's, bacteria, and "stuff"). Bacterial pneumonia is covered as part of the PANCE Pulmonary Blueprint.

Campylobacter = erythromycin. Infectious and Noninfectious Diarrhea is covered as part of the PANCE GI and Nutrition Blueprint.

This is CONSTANT pain, so not colicky (like colic, C & D). It is in the abdomen, and not perineal (like BPH), and I have no idea what a Spigelian hernia is.... but in this older gentleman, the most important thing to r/o is AAA which is dissecting. Aortic aneurysm/dissection is covered as part of the PANCE Cardiology Blueprint.

The treatment for SVT (regular narrow complex tachycardia in a young healthy patient) could be valsalva or carotid massage, and then adenosine 6 mgm. IV bolus. Supraventricular tachycardia is covered as part of the PANCE Cardiology Blueprint.

TB reactivated typically appears in the apices of the lung fields. Tuberculosis is covered as part of the PANCE Pulmonary Blueprint.

There are two families of poisonous snakes: Viperidae is pit vipers, rattlesnakes, water moccasins, copperheads. They are distinguished by elliptical pupils vs. round in non-venomous snakes. Elapidae contains cobras, mambas, taipan and coral snakes. There are differentiated by their color bands, "red on yellow kills a fellow", "red on black, venom lack". Most poisonous snakes in the US - coral snakes. Mambas are the most poisonous in the world; cobras are hooded at the neck and are next most poisonous but neither of these is found in the U.S. Animal and insect bites are covered as part of the PANCE Infectious Disease Blueprint.

Think of Hep B and Hep C as carcinogens. We don't have a Hep C vaccine yet, but we DO have a Hep B vaccine. Since chronic Hep B and Hep C infection cause liver cancer, a vaccine can "prevent" it. Acute and chronic hepatitis are covered as part of the PANCE Genitourinary Blueprint.

ACEI's cause chronic cough. Captopril is the prototypical ACEI. Ace inhibitors and other cardiac medications are covered as part of the PANCE Cardiology Blueprint

OCP's protect (reduce risk by 40% for a decade after one year of use). Ovarian Neoplasms are covered as part of the PANCE Reproductive System Blueprint.

Sumatriptan (Imitrex) and all triptans can cause chest tightness as it is a potent vasoconstrictor. You must use it with caution in a patient with risk factors for coronary disease and in uncontrolled hypertension. Migraine headaches are covered as part of the PANCE Neurology Blueprint.

Decreased platelets could predispose the patient to bleeding, the others would increase his risk for infection. Thrombocytopenia is covered as part of the PANCE Hematology Blueprint.