Free PANCE: Physician Assistant National Certifying Exam Questions and Answers

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?

• AA. Coronary arteriography
• BB. Echocardiography
• CC. Exercise stress test
• DD. 24-Hour ambulatory cardiac monitoring
• EE. Myocardial perfusion scan

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?

• AA. Erythema multiforme
• BB. Erythema nodosum
• CC. Lichen planus
• DD. Lichen simplex
• EE. Nummular eczema

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?

• AA. Cushing syndrome
• BB. Hyperparathyroidism
• CC. Hypopituitarism
• DD. Malabsorption
• EE. Multiple myeloma

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?

• AA. Diabetes insipidus
• BB. Diabetes mellitus
• CC. Hyperprolactinemia
• DD. Hypopituitarism
• EE. Hypothyroidism

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?

• AA. Administration of syrup of ipecac
• BB. Barium swallow x-ray study
• CC. Chest physiotherapy
• DD. Esophagogastroduodenoscopy
• EE. Insertion of a nasogastric tube

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?

• AA. Chorea
• BB. Heart failure
• CC. Coronary artery aneurysm
• DD. Mesenteric arteritis
• EE. Valvular heart disease

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?

• AA. Anteroposterior and lateral x-ray studies of the skull
• BB. CT scan
• CC. Discharge and observation by family or friends
• DD. Hospital admission for observation
• EE. MRI

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?

• AA. Bipolar disorder
• BB. Delirium
• CC. Major neurocognitive disorder
• DD. Paranoid personality disorder
• EE. Schizophrenia

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?

• AA. Lymphoma
• BB. Mesothelioma
• CC. Sarcoidosis
• DD. Tuberculosis
• EE. Wegener granulomatosis

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?

• AA. Abruptio placentae
• BB. Cervical laceration
• CC. Placenta previa
• DD. Preterm labor
• EE. Vasa previa