PANCE PANCE Evaluation 2

Question 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?

Accepted Answer

Admit and obtain serial troponins with cardiology consult

Answer

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

Question 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?

Accepted Answer

High TSH, low free T4

Answer

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

Question 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?

Accepted Answer

Score 3 — perform rapid strep test or empirically treat

Answer

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.

Question 4

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

Accepted Answer

Hypertrophic obstructive cardiomyopathy (HOCM)

Answer

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

Question 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?

Accepted Answer

Thiamine 100 mg IV before glucose

Answer

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

PANCE Test Practice Test

PANCE Test Practice Test

PANCE PANCE Evaluation 2