PANCE PANCE Evaluation 5

Question 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?

Accepted Answer

Ascending cholangitis

Answer

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

Question 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?

Accepted Answer

Squamous cell carcinoma

Answer

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

Question 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?

Accepted Answer

Hypothalamic amenorrhea

Answer

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

Question 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?

Accepted Answer

Insulin therapy plus metformin

Answer

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

Question 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?

Accepted Answer

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

Answer

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

PANCE Test Practice Test

PANCE Test Practice Test

PANCE PANCE Evaluation 5