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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 55-year-old diabetic patient presents with a painless foot ulcer over the plantar surface of the first metatarsal head. Pulses are intact. What is the primary etiology?

    Answer: Peripheral neuropathy

    Neuropathic ulcers in diabetics occur at pressure points (plantar metatarsal heads) due to loss of protective sensation from peripheral neuropathy.

  2. A 28-year-old woman at 10 weeks gestation presents with severe nausea, vomiting, and a uterus larger than expected for gestational age. β-hCG is markedly elevated. Ultrasound shows a 'snowstorm' pattern. What is the diagnosis?

    Answer: Complete hydatidiform mole

    A complete hydatidiform mole presents with markedly elevated β-hCG, uterine size larger than dates, and a classic snowstorm ultrasound pattern.

  3. A 40-year-old male with chronic kidney disease stage 3 presents with lab values: sodium 138, potassium 5.8, bicarbonate 18, BUN 42, creatinine 2.4. Which acid-base disturbance is present?

    Answer: Anion gap metabolic acidosis

    CKD causes accumulation of uremic acids (phosphate, sulfate, urate) creating an elevated anion gap metabolic acidosis.

  4. A 16-year-old male presents with unilateral testicular swelling, nausea, and severe pain of 4 hours duration. The testicle is high-riding with a horizontal lie. What is the most appropriate immediate action?

    Answer: Emergent urologic consultation for surgical exploration

    Testicular torsion requires emergent surgical exploration within 6 hours; delay leads to irreversible ischemia and testicular loss.

  5. Which physical exam finding best differentiates cellulitis from necrotizing fasciitis?

    Answer: Crepitus, wooden-hard texture of tissue, and disproportionate pain

    Crepitus (gas in tissues), a wooden-hard texture to palpation, and pain out of proportion to appearance indicate necrotizing fasciitis requiring emergent surgical debridement.

  6. A 66-year-old woman has a blood pressure of 158/96 mmHg at two separate visits. She has a history of type 2 diabetes and microalbuminuria. Which antihypertensive is most appropriate as first-line therapy?

    Answer: Lisinopril

    ACE inhibitors (e.g., lisinopril) are first-line in diabetic patients with hypertension and microalbuminuria because they provide renoprotection beyond blood pressure lowering.

  7. A chest X-ray shows a unilateral pleural effusion. Thoracentesis fluid analysis reveals: LDH 320 U/L (serum LDH 180 U/L), protein 4.2 g/dL (serum protein 6.8 g/dL). How is this effusion classified?

    Answer: Exudate — pleural LDH > 2/3 upper limit of normal serum LDH

    By Light's criteria, pleural LDH > 2/3 the upper limit of normal serum LDH (or pleural/serum LDH ratio > 0.6) classifies the effusion as an exudate.