PANCE / PANRE PreTest 2023 (Review Question Answer)

For the past three weeks, a 47-year-old man has had the feeling of heaviness in his chest while pushing his lawn mower. He says he has never been treated for similar symptoms and has no symptoms now. He smoked one pack of cigarettes daily for 20 years but quit smoking seven years ago. Findings on physical examination are normal. Electrocardiography shows no abnormalities. Which of the following is the most appropriate initial diagnostic study?

A 32-year-old woman has had a rash on her legs for the past three weeks. There are no known infectious contacts. One month ago, she had a bladder infection and was treated with trimethoprim-sulfamethoxazole. Physical examination shows a diffuse rash on the shins, the left medial ankle, and the right medial calf. The rash is tender, diffuse, and recurs in the same areas. A few of the lesions have the appearance of bruising. Which of the following is the most likely diagnosis?

A 41-year-old woman has a nine-month history of nausea, constipation, dyspepsia, general fatigue, arthralgia, and increasing memory loss. She has no history of illness other than her present complaints, and her menses have been regular. Physical examination shows no abnormalities. Laboratory findings include the following levels

Serum
Albumin 4.9 g/dL
Calcium 13.0 mg/dL
Chloride 111 mEq/L
Creatinine 1.0 mg/dL
Phosphate 0.3 mg/dL
Blood urea nitrogen 17 mg/dL

Which of the following is the most likely diagnosis?

A 40-year-old man is being examined because he feels weak and tired and has had symptoms of sexual dysfunction. His blood pressure is 100/60 mmHg. Physical examination shows decreased facial, axillary, and pubic hair. Laboratory studies show decreased serum levels of luteinizing and follicle-stimulating hormones, thyroxine, and testosterone; serum thyroid- stimulating hormone level is within normal limits. Which of the following is the most likely diagnosis?

A previously healthy 15-month-old boy becomes anxious and begins crying and drooling copiously. A few minutes earlier he had been calmly playing with his toys. Temperature is 36.7°C (98.1°F), pulse rate is 84/min, and respirations are 18/min. On physical examination, the posterior pharynx is mildly injected but otherwise clear. The lungs are clear to auscultation and percussion. Findings on chest x-ray study are normal. Within an hour he is calmer, but he continues to drool heavily. Which of the following is the most appropriate next step?

Six days ago, a 2-year-old boy had a temperature of 40.0°C (104.0°F). No specific cause was found. His fever has persisted, and he now has injected conjunctivae, strawberry tongue, dry fissured lips, erythema and desquamation of his hands and feet, and bilateral cervical adenopathy. Which of the following is the most likely complication of this condition?

A 22-year-old woman is brought to the emergency department for evaluation three hours after falling backward out of a chair and striking her head on a carpeted floor. She has tenderness over the back of her head but does not report loss of consciousness. Physical examination, including neurologic and musculoskeletal evaluation, shows no abnormalities except a 2-cm area of swelling and minimal abrasion overlying the left occiput. Which of the following is the most appropriate next step?

A 46-year-old woman wanders into the clinic, rambling incoherently. When questioned, she has some difficulty remembering what she was asked. She exhibits some perceptual disturbances and is not oriented to time. Which of the following is the most likely diagnosis?

A 31-year-old African American woman has had worsening malaise, dyspnea, and low-grade fever for the past four weeks. She was recently treated for iritis. On physical examination, red nodules over the anterior lower legs and mild hepatomegaly are noted. Chest x-ray study shows bilateral hilar adenopathy. Which of the following is the most likely diagnosis?

A 33-year-old woman at 35 weeks’ gestation has constant pelvic pain. She says that she had a small amount of dark red vaginal bleeding after sexual intercourse. Her blood pressure is 80/50 mmHg, and she has tachycardia. The uterus is firm and tender to palpation. Which of the following is the most likely diagnosis?

In a randomized, double-blind, placebo-controlled clinical trial, which of the following assists the reader of the study in determining whether the results are statistically significant?

A 39-year-old woman has been undergoing in vitro fertilization treatments using her extracted eggs and sperm from her husband. The patient has a 15% chance of successful conception. While reviewing the patient’s records, the physician assistant discovers that the patient was inadvertently implanted with a fertilized embryo from another couple 24 hours ago. Which of the following is the most appropriate course of action for the physician assistant?

The supervising physician examines a patient who had just been examined by the physician assistant because of pain in the knees. The physician instructs the physician assistant to add findings on McMurray test to the patient’s chart, and the physician assistant realizes that this pertinent part of the physical examination had been missed. The patient has not yet left the examination room. Which of the following is the most appropriate next step by the physician assistant?

A 55-year-old man comes to the emergency department because he has had pressure-like pain in the substernal region of his chest for the past 20 minutes. The patient says the pain radiates to his left arm. He is nauseated and sweating profusely. Medical history includes long-standing hypertension that is well controlled with diuretics. On the basis of this patient’s history and symptoms, which of the following pathologic processes is most likely to have occurred first?

A 67-year-old woman comes to the clinic for routine physical examination. Medical history includes hypertension, type 2 diabetes mellitus, and dyslipidemia, which are well managed with medications. As the patient walks into the examination room, she describes an aching pain behind her sternum that radiates to her left breast. She says she has never had this type of pain before, and the pain does not worsen when she changes positions. The patient has shortness of breath and is slightly diaphoretic. Pulse rate is 105/min and regular, respirations are 24/min, and blood pressure is 146/91 mmHg. Oxygen saturation is 97% on room air. Which of the following is the most likely cause of this patient’s symptoms?

A 57-year-old woman comes to the office because she has had pain in the left side of her chest for the past hour. The patient says the pain worsened as she crossed the parking lot to the office. During the past three months, she has had pain in her left shoulder and breast that worsens with exertion and is relieved with rest. She also has had fatigue during this time. Medical history includes hypertension and chronic obstructive pulmonary disease, which are well controlled. The patient smokes one pack of cigarettes daily. Height is 170.2 cm (5 ft 7 in), and weight is 99.8 kg (220 lb). Pulse rate is 112/min, respirations are 24/min, and blood pressure is 180/76 mmHg. Oxygen saturation is 96% on room air. On physical examination, palpation of the chest does not worsen the pain. Which of the following is the most appropriate next step?

A 22-year-old woman presents with abdominal pain and fever of 2 days’ duration. During the digital pelvic examination, she experiences exquisite pain when the cervix is moved. This suggests a diagnosis of

A painless testicular mass is found in an otherwise normal 29-year-old. Which of the following diagnoses should be pursued?

The diagnosis of congenital hip dislocation is made

An obese 45-year-old woman presents with acute genital pain. Upon examination, a 2- to 3-cm soft mass is found in the right labia majora. This is most likely

Which of the following is NOT a sign of major depressive disorder?

A 19-year-old unconscious motorcycle accident victim with suspected multiple trauma is brought to the emergency department. The most significant physical findings usually will result from

A 71-year-old female with long history of heavy tobacco use and COPD presents with increasing dyspnea on exertion, abdominal fullness, and lower extremity edema. The physical examination reveals elevated jugular venous pressure, a right ventricular heave, S3 gallop, holosystolic murmur at the lower LSB, RUQ tenderness with hepatomegaly, and bilateral peripheral edema. ECG demonstrates right axis deviation, right ventricular hypertrophy without significant ST-T abnormalities, and peaked P waves. What is her likely diagnosis?

27-year-old male with remote history of endocarditis secondary to intravenous drug use presents with complaints of abdominal fullness and edema. On examination, he has jugular venous distention, hepatic congestion, and peripheral edema. A blowing holosystolic murmur is heard along the lower left sternal border than is intensified with inspiration. What is this murmur?

A 68-year-old man presents to the emergency department with fatigue, dyspnea, and generalized weakness that has been getting worse over the past month or so. He has faint heart sounds with weak pulses and bradycardia on physical examination. His ECG demonstrates sinus bradycardia with low-voltage QRS and T wave flattening. His chest x-ray demonstrates enlarged cardiac silhouette with a globular appearance and pleural effusions. What is his most likely underlying diagnosis?