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PANCE Flashcards

7 cards from real PANCE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 55-year-old male presents with sudden onset of severe 'tearing' chest pain radiating to the back. BP is 180/100 mmHg in the right arm and 160/90 in the left. Which diagnosis is most likely?

    Answer: Aortic dissection

    Aortic dissection classically presents with tearing chest pain radiating to the back and a blood pressure differential between arms.

  2. A patient on warfarin presents with an INR of 8.0 and active bleeding. What is the most appropriate immediate treatment?

    Answer: Administer 4-factor PCC and IV vitamin K

    Life-threatening bleeding with supratherapeutic INR requires 4-factor prothrombin complex concentrate (PCC) plus IV vitamin K for rapid reversal.

  3. A 30-year-old woman presents with polyuria, polydipsia, and a serum sodium of 155 mEq/L. Urine osmolality remains low after water deprivation but rises with desmopressin administration. What is the diagnosis?

    Answer: Central diabetes insipidus

    Response to desmopressin confirms central diabetes insipidus, as ADH deficiency is corrected by exogenous desmopressin.

  4. Which murmur is best heard at the left sternal border and increases with inspiration?

    Answer: Tricuspid regurgitation

    Tricuspid regurgitation is heard at the left lower sternal border and increases with inspiration (Carvallo's sign) due to increased venous return.

  5. A 4-year-old child presents with a barky cough, stridor, and low-grade fever. X-ray shows the 'steeple sign.' What is the most likely diagnosis?

    Answer: Croup (laryngotracheobronchitis)

    Croup (viral laryngotracheobronchitis) causes subglottic narrowing seen as the steeple sign on AP neck X-ray.

  6. A 62-year-old male with a history of gout presents with acute swollen red first MTP joint. Synovial fluid analysis reveals negatively birefringent needle-shaped crystals. What is the treatment of choice for the acute attack?

    Answer: Indomethacin or colchicine

    Acute gout attacks are treated with NSAIDs (e.g., indomethacin) or colchicine; urate-lowering therapy like allopurinol should not be started during an acute attack.

  7. A 28-year-old female presents with amenorrhea, galactorrhea, and headaches. Labs show elevated prolactin. MRI reveals a pituitary mass. What is the first-line treatment?

    Answer: Bromocriptine or cabergoline

    Dopamine agonists (bromocriptine or cabergoline) are first-line therapy for prolactinomas, as they effectively shrink the tumor and normalize prolactin.