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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 45-year-old woman presents with acute onset of right upper quadrant pain, fever, and jaundice. Her labs show elevated total bilirubin, alkaline phosphatase, and WBC of 18,000. What is the most likely diagnosis?

    Answer: Ascending cholangitis

    Charcot's triad (RUQ pain, fever, jaundice) is classic for ascending cholangitis, indicating biliary obstruction with infection.

  2. A 55-year-old male with a 40-pack-year smoking history presents with hemoptysis, weight loss, and a hilar mass on CXR. His serum calcium is 11.8 mg/dL. Which lung cancer type is most likely?

    Answer: Squamous cell carcinoma

    Squamous cell carcinoma is centrally located, associated with smoking, and classically causes hypercalcemia via PTHrP secretion.

  3. A 19-year-old female presents with amenorrhea for 4 months, fatigue, and cold intolerance. She has a BMI of 16.5 and excessive exercise. Labs: low LH, low FSH, low estradiol, normal TSH. Which diagnosis explains these findings?

    Answer: Hypothalamic amenorrhea

    Low GnRH from hypothalamic suppression (due to low body weight/excessive exercise) leads to low LH, FSH, and estradiol with normal thyroid function.

  4. A 68-year-old male presents with polyuria, polydipsia, and blurred vision. Random plasma glucose is 380 mg/dL. HbA1c is 11.2%. He has no ketones. Which management is most appropriate at this time?

    Answer: Insulin therapy plus metformin

    Symptomatic hyperglycemia with HbA1c >10% warrants insulin therapy at diagnosis, often combined with metformin, to achieve timely glycemic control.

  5. A 42-year-old woman is found to have a blood pressure of 176/108 mmHg. She reports episodic severe headaches, diaphoresis, and palpitations. 24-hour urine shows elevated metanephrines. What is the first step in management after diagnosis?

    Answer: Start alpha-blocker (phenoxybenzamine) first, then add beta-blocker if needed

    In pheochromocytoma, alpha-blockade must precede beta-blockade to prevent unopposed alpha-mediated hypertensive crisis.

  6. A 50-year-old male presents with gradually worsening low back pain and bilateral lower extremity pain that is relieved by leaning forward or sitting. MRI shows narrowing of the spinal canal. What is the most likely diagnosis?

    Answer: Lumbar spinal stenosis

    Lumbar spinal stenosis causes neurogenic claudication with bilateral leg pain relieved by flexion (sitting or leaning forward), which opens the canal.

  7. A 5-year-old child presents with periorbital edema, frothy urine, and hypoalbuminemia. Urinalysis shows 4+ protein but no blood. What is the most common histologic finding on renal biopsy in this age group?

    Answer: Minimal change disease

    Minimal change disease accounts for ~90% of nephrotic syndrome in children aged 1-8 years and shows effacement of podocyte foot processes on electron microscopy.