PANCE / PANRE Practice Test Review Questions Answer): National Commission on Certification of Physician Assistants (NCCPA) administered the Physician Assistant National Certifying Examination (PANCE) and Physician Assistant National Recertifying Examination (PANRE) Examinations.
(A) Symmetrical tapering of the subglottic portion of the trachea
(B) An abnormality in the bronchi
(C) Enlargement of the adenoids
(D) Inflammation of the vocal cords
View Answer
Answer: (A)
Explanation: The “steeple sign” refers to subglottic edema, which creates a symmetrically tapered configuration in the subglottic portion of the trachea when imaged in a frontal soft tissue X-ray of the neck. This is consistent with croup.
Q2. A 3-year-old male child is woken in the middle of the night with a barking seal-like cough and signs and symptoms consistent with croup. On examination, the child’s respirations are 35/min and oxygen saturation is 95% on room air. There is no evidence of stridor on examination and his lungs are clear. What is the recommended treatment for this patient?
(A) Immediate hospitalization
(B) Supportive care, fluids, and observation at home
(C) Antibiotics
(D) Inhaled corticosteroids
View Answer
Answer: (B)
Explanation: The recommended treatment for this patient includes supportive care, fluids, and observation at home. If oxygen saturation is low, oxygen therapy is indicated. In all cases, inhalable racemic epinephrine by nebulizer is warranted.
Q3. What if the child presented with stridor on examination?
(A) Administer albuterol nebulizer
(B) Immediate intubation
(C) Administer dexamethasone 0.6 mg/kg IM one-time dose
(D) Oral antihistamines
View Answer
Answer: (C)
Explanation: If the child presented with stridor, the appropriate treatment would include administering dexamethasone 0.6 mg/kg IM one-time dose along with all the other therapies mentioned above.
Q4. A 34-year-old woman wakes up with a history of sudden onset of fever, body aches, malaise, chills, cough, and a sore throat. She reports that several other members at home have the same symptoms, as do some of her coworkers. On examination, her temperature is 101°F, pulse 100, respiratory rate 18, and BP 122/86. Her throat appears to be moist without any abnormalities, lungs are clear, and the rest of the examination is unremarkable. What is the most probable cause of this illness?
(A) Common cold
(B) Bacterial pharyngitis
(C) Influenza
(D) Allergic rhinitis
View Answer
Answer: (C)
Explanation: The symptoms of sudden onset fever, body aches, malaise, chills, cough, and sore throat with similar cases among family members and coworkers are indicative of influenza.
Q5. Which strain of influenza is considered to cause more pandemic outbreaks?
(A) Influenza A
(B) Influenza B
(C) Influenza C
(D) Influenza D
View Answer
Answer: (A)
Explanation: Influenza A is known to cause more pandemic outbreaks due to its ability to undergo significant antigenic shifts and drifts.
Q6. Which syndrome can be caused by an outbreak of influenza B virus?
(A) Guillain-Barre syndrome
(B) Reye’s syndrome
(C) Stevens-Johnson syndrome
(D) Toxic shock syndrome
View Answer
Answer: (B)
Explanation: Reye’s syndrome is a rare but serious condition that can occur in children and teenagers recovering from a viral infection, such as influenza B, particularly if they have taken aspirin.
Q7. What is the main method of transmission for the influenza virus?
(A) Bloodborne transmission
(B) Vector-borne transmission
(C) Aerosol by cough and sneeze and hand-to-hand contact
(D) Foodborne transmission
View Answer
Answer: (C)
Explanation: Influenza virus primarily spreads via aerosol by cough and sneeze and through hand-to-hand contact.
Q8. What is the most common type of pneumonia seen in influenza patients?
(A) Bacterial pneumonia
(B) Fungal pneumonia
(C) Viral pneumonia
(D) Aspiration pneumonia
View Answer
Answer: (C)
Explanation: The most common type of pneumonia seen in influenza patients is viral pneumonia. However, secondary bacterial pneumonia can also occur, caused by Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae.
Q9. What method is used to detect a positive influenza illness?
(A) Blood culture
(B) Throat, nasopharyngeal, or sputum samples with a rapid influenza A or B test
(C) Chest X-ray
(D) Urinalysis
View Answer
Answer: (B)
Explanation: Rapid influenza diagnostic tests (RIDTs) are used to detect influenza virus antigens in throat, nasopharyngeal, or sputum samples.
Q10. What is the treatment of choice for a patient with influenza B virus?
(A) Amoxicillin
(B) Oseltamivir or Zanamivir
(C) Acyclovir
(D) Metronidazole
View Answer
Answer: (B)
Explanation: The treatment of choice for influenza B virus is oseltamivir orally or zanamivir inhaled. These antiviral medications must be started within 24 to 48 hours of onset of illness to be effective.
Q11. Name some other therapies that are helpful in symptomatic relief of an influenza illness:
(A) Antibiotics and corticosteroids
(B) Supportive care, fluids, analgesics such as acetaminophen, and a cough suppressant with or without codeine
(C) Antifungal therapy
(D) Bronchodilators
View Answer
Answer: (B)
Explanation: Supportive care with fluids, analgesics such as acetaminophen for body aches, myalgias, and fever, and a cough suppressant with or without codeine are helpful in symptomatic relief of influenza illness.
Q12. Which patients should be vaccinated with the influenza vaccine?
(A) Only the elderly
(B) Only healthcare workers
(C) Children between 6 and 59 months, pregnant women, individuals with chronic cardiovascular and pulmonary disorders, nursing home residents, and healthcare workers
(D) Only individuals traveling to endemic areas
View Answer
Answer: (C)
Explanation: Influenza vaccination is recommended for children between 6 and 59 months, pregnant women, individuals with chronic cardiovascular and pulmonary disorders, nursing home residents, and healthcare workers.
Q13. What age group is usually afflicted by pertussis?
(A) Adults older than 50 years
(B) Infants younger than 2 years
(C) Teenagers
(D) Middle-aged adults
View Answer
Answer: (B)
Explanation: Pertussis, or whooping cough, most commonly affects infants younger than 2 years of age.
Q14. What are some of the hallmark symptoms of a patient with pertussis?
(A) Severe headache and photophobia
(B) Initial common cold symptoms, progressing to paroxysmal coughing fits with a whooping sound and posttussive vomiting
(C) High fever and rash
(D) Abdominal pain and diarrhea
View Answer
Answer: (B)
Explanation: Pertussis initially presents with common cold symptoms. Within 1-2 weeks, it progresses to paroxysmal coughing fits with a whooping sound and may include posttussive vomiting.
Q15. What is the main pathway for infection leading to pneumonia?
(A) Hematogenous spread
(B) Direct inoculation
(C) Aspiration via the oropharynx
(D) Contaminated water
View Answer
Answer: (C)
Explanation: The main pathway for infection leading to pneumonia is aspiration via the oropharynx.
Q16. Describe the different presentations of bacterial and viral pneumonia:
(A) Bacterial pneumonia: Sudden onset, pleurisy, high fever, productive cough. Viral pneumonia: Gradual onset, no pleurisy, general malaise, nonproductive cough
(C) Bacterial pneumonia: No fever, clear lungs. Viral pneumonia: High fever, pleuritic pain
(D) Bacterial pneumonia: No cough, no fever. Viral pneumonia: Productive cough, high fever
View Answer
Answer: (A)
Explanation: Bacterial pneumonia typically presents with a sudden onset of symptoms, including pleurisy, fever, chills, productive cough, tachypnea, and tachycardia. Viral pneumonia presents with a gradual onset of symptoms, no pleurisy, chills, or high fever, general malaise, and a nonproductive cough.
Q17. What is the leading identifiable cause of acute community-acquired pneumonia in adults?
(A) Mycoplasma pneumoniae
(B) Streptococcus pneumoniae
(C) Haemophilus influenzae
(D) Staphylococcus aureus
View Answer
Answer: (B)
Explanation: Streptococcus pneumoniae is the leading identifiable cause of acute community-acquired pneumonia in adults.
Q18. Name the risk factors for community-acquired pneumonia:
(A) Obesity, diabetes, hypertension
(B) Alcoholism, asthma, immunosuppression, ≥70 years of age
(C) Sedentary lifestyle, high cholesterol, smoking
(D) Anemia, hyperthyroidism, vegetarian diet
View Answer
Answer: (B)
Explanation: Risk factors for community-acquired pneumonia include alcoholism, asthma, immunosuppression, and being ≥70 years of age.
Q19. Name the risk factors for pneumococcal pneumonia:
(A) Dementia, seizure disorder, alcoholism, smoking, COPD, and HIV
(D) Sedentary lifestyle, high cholesterol, vegetarian diet
View Answer
Answer: (A)
Explanation: Risk factors for pneumococcal pneumonia include dementia, seizure disorder, alcoholism, smoking, COPD, and HIV.
Q20. A young infant patient who you suspect has pneumonia is ordered to have a chest X-ray performed. When you view the results, you note the presence of pneumatoceles on the film. What pathogen is likely responsible for this type of finding?
(A) Streptococcus pneumoniae
(B) Haemophilus influenzae
(C) Mycoplasma pneumoniae
(D) Staphylococcus aureus
View Answer
Answer: (D)
Explanation: Staphylococcus aureus is likely responsible for pneumatoceles, which are air-filled cystic spaces in the lungs seen on X-ray in young infants with pneumonia.
Q21. A 24-year-old male patient has had fevers, chills, and a productive cough with dark green sputum for the last week. On physical examination, his temperature is 101.3°F, P 90, R 22, and BP 124/85. There is coryza with moist mucous membranes and a regular rhythm on cardiac examination. Lung sounds reveal an area of crackles with a mild expiratory wheeze at the right lower base of the lung fields. Based on this history and physical examination, what is the treatment of choice for this patient?
(A) Amoxicillin
(B) Macrolide antibiotic (clarithromycin or azithromycin)
(C) Antiviral therapy
(D) Corticosteroids
View Answer
Answer: (B)
Explanation: A macrolide antibiotic, such as clarithromycin or azithromycin, is the treatment of choice for community-acquired pneumonia in this patient.
Q22. If this patient required inpatient treatment of pneumonia but without ICU admission, what is the class of antibiotics that would be indicated? What if the patient needed to be in the ICU?
(A) Amoxicillin for non-ICU patients; vancomycin for ICU patients
(B) Fluoroquinolone for non-ICU patients; ceftriaxone, ampicillin-sulbactam, plus azithromycin or fluoroquinolone for ICU patients
(C) Tetracycline for non-ICU patients; clindamycin for ICU patients
(D) Metronidazole for non-ICU patients; doxycycline for ICU patients
View Answer
Answer: (B)
Explanation: Fluoroquinolone (moxifloxacin, levofloxacin, or gemifloxacin) is indicated for non-ICU patients. For ICU patients, ceftriaxone, ampicillin-sulbactam, plus azithromycin or fluoroquinolone are recommended.
Q23. What are some of the more common complications associated with community-acquired pneumonia?
(A) Hyperglycemia, dehydration, anemia
(B) Respiratory failure, shock, worsening of comorbid diseases, metastatic infection, lung abscess, and complicated pleural effusion
(C) Deep vein thrombosis, pulmonary embolism, myocardial infarction
(D) Seizures, stroke, renal failure
View Answer
Answer: (B)
Explanation: Common complications of community-acquired pneumonia include respiratory failure, shock, worsening of comorbid diseases, metastatic infection, lung abscess, and complicated pleural effusion.
Q24. Which bacterial pneumonias frequently cause frank hemoptysis?
(A) Streptococcus pneumoniae and Mycoplasma pneumoniae
(B) Pseudomonas aeruginosa, Klebsiella pneumoniae, and Staphylococcus aureus
(C) Haemophilus influenzae and Legionella pneumoniae
(D) Escherichia coli and Chlamydia pneumoniae
View Answer
Answer: (B)
Explanation: Pseudomonas aeruginosa, Klebsiella pneumoniae, and Staphylococcus aureus are bacterial pneumonias frequently associated with frank hemoptysis.
Q25. What bacteria are associated with pneumonia following influenza?
(A) Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae
(B) Mycoplasma pneumoniae and Chlamydia pneumoniae
(C) Pseudomonas aeruginosa and Klebsiella pneumoniae
(D) Legionella pneumoniae and Escherichia coli
View Answer
Answer: (A)
Explanation: Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae are bacteria commonly associated with pneumonia following influenza.
Q26. What two underlying medical conditions are associated with Haemophilus influenzae pneumonia?
(A) Diabetes and hypertension
(B) Chronic obstructive lung disease and HIV infection
(C) Chronic kidney disease and anemia
(D) Asthma and rheumatoid arthritis
View Answer
Answer: (B)
Explanation: Chronic obstructive lung disease and HIV infection are two underlying medical conditions commonly associated with Haemophilus influenzae pneumonia.
Q27. What is the most common etiologic agent of atypical pneumonia?
(A) Legionella pneumoniae
(B) Mycoplasma pneumoniae
(C) Chlamydia pneumoniae
(D) Coxiella burnetii
View Answer
Answer: (B)
Explanation: Mycoplasma pneumoniae is the most common etiologic agent of atypical pneumonia.
Q28. What is considered to be the second most common cause of atypical pneumonia?
(A) Mycoplasma pneumoniae
(B) Chlamydia pneumoniae
(C) Legionella pneumoniae
(D) Coxiella burnetii
View Answer
Answer: (B)
Explanation: Chlamydia pneumoniae is considered to be the second most common cause of atypical pneumonia.
Q29. Of the following organisms, which is commonly spread by person-to-person contact: Legionella pneumoniae or Mycoplasma pneumoniae?
(A) Legionella pneumoniae
(B) Mycoplasma pneumoniae
(C) Both
(D) Neither
View Answer
Answer: (B)
Explanation: Mycoplasma pneumoniae is commonly spread by person-to-person contact, unlike Legionella pneumoniae which is typically spread through water sources.
Q30. What three X-ray findings are associated with a poor outcome in patients with pneumonia?
(A) Ground-glass opacities, air bronchograms, and pulmonary nodules
(B) Multilobar involvement, cavitary lesions, and pleural effusions
(C) Reticular pattern, honeycombing, and pleural plaques
(D) Hilar lymphadenopathy, miliary pattern, and peribronchial cuffing
View Answer
Answer: (B)
Explanation: Multilobar involvement, cavitary lesions, and pleural effusions on X-ray are associated with a poor outcome in patients with pneumonia.
