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PANCE Evaluation 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.

Read the first 7 PANCE Evaluation flashcards as text

  1. A 58-year-old male presents with exertional chest pain radiating to the left arm for the past 3 weeks. EKG shows ST-segment depression in leads V4-V6. Which is the most appropriate next step?

    Answer: Admit and obtain serial troponins with cardiology consult

    New onset exertional chest pain with EKG changes warrants inpatient evaluation with serial cardiac biomarkers to rule out ACS.

  2. A 34-year-old woman presents with a 2-week history of fatigue, weight gain, cold intolerance, and constipation. Which lab finding would you expect?

    Answer: High TSH, low free T4

    Primary hypothyroidism causes elevated TSH (pituitary compensation) and low free T4 due to decreased thyroid output.

  3. A 6-year-old child is brought in for evaluation of a 3-day sore throat, fever of 38.9°C, and enlarged anterior cervical lymph nodes. No cough is present. What is the Centor score and recommended management?

    Answer: Score 3 — perform rapid strep test or empirically treat

    Exudate, tender anterior cervical lymphadenopathy, fever, and absence of cough each score 1 point (age <15 adds 1), giving a score of 3-4, warranting strep testing or empiric treatment.

  4. On auscultation, a patient has a harsh systolic murmur that increases in intensity with the Valsalva maneuver. Which condition is most likely?

    Answer: Hypertrophic obstructive cardiomyopathy (HOCM)

    HOCM murmurs increase with Valsalva (decreased preload worsens outflow obstruction), distinguishing it from most other murmurs.

  5. A 45-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and ophthalmoplegia. Which treatment should be administered immediately?

    Answer: Thiamine 100 mg IV before glucose

    Wernicke encephalopathy requires immediate thiamine before glucose to prevent precipitating or worsening the condition.

  6. A 72-year-old woman has a T-score of -2.7 on DEXA scan with no prior fracture. She is currently taking calcium and vitamin D. What is the most appropriate additional therapy?

    Answer: Oral bisphosphonate (e.g., alendronate)

    A T-score ≤ -2.5 meets WHO criteria for osteoporosis, and bisphosphonates are the first-line pharmacologic treatment.

  7. A 22-year-old college student presents with fever, severe headache, nuchal rigidity, and a petechial rash. Which organism is the most likely cause?

    Answer: Neisseria meningitidis

    Neisseria meningitidis causes bacterial meningitis with a classic petechial/purpuric rash due to septicemia, particularly in young adults.