PANCE Prep

Ocular examination is performed on a patient during a routine medical check-up. Retinal examination demonstrates a generalized retinal arteriolar constriction. The light reflex on the arterioles is broad and dull. Two areas of flame-shaped hemorrhages and multiple cotton wool spots are also seen.

These findings are most suggestive of which of the following?

• Central Retinal Artery Occlusion

• Central Retinal Vein Occlusion

• Hypertensive Retinopathy

• Non-proliferative Diabetic Retinopathy

• Proliferative Diabetic Retinopathy

A 65-year-old woman is admitted to the hospital for constant, severe abdominal pain that has worsened over the previous week. She has no other associated symptoms, such as nausea or vomiting, but has noticed that her daily urine output has sharply decreased. She has had a constant desire to urinate, but when she tries, only a small amount of bloody urine is discharged. The patient is a long-time smoker, having smoked 3 packs per day for 45+ years, though she claims to have quit 2 days ago. Bladder ultrasound in the emergency department reveals a large mass consistent with bladder cancer, as well as significant urinary retention.

Which of the following is most likely to be detected upon imaging the patient's genitourinary system?

• Bilateral hydronephrosis

• Bladder dilation

• Bladder dyskinesis

• Unilateral hydronephrosis

• Ureteral dilation

A 29-year-old man comes to the clinic with a 2-day history of severe left-sided scrotal pain and swelling. He is sexually active and has multiple sexual partners. He has no history of sexually transmitted diseases. His temperature is 38.2°C (100.8°F), blood pressure 120/70 mm Hg, and pulse 80/min. Examination shows unilateral intra-scrotal tenderness and swelling. Raising the testicle makes the pain less intense.

Which of the following is the most likely diagnosis?

• Epididymitis

• Prostatitis

• Testicular torsion

• Urethritis

• Varicocele

A 27-year-old-man with no significant past medical history comes to the health care provider for an infertility evaluation. He and his wife have been trying to conceive for 2 years without success. A complete infertility workup of his wife found no abnormalities. History reveals that the patient had normal childhood development but late puberty. He had problems throughout his life in school secondary to what counselors told him was a moderate learning disability. Physical examination reveals a tall man with long legs and arms that seem out of proportion to the rest of the body. His testes are small, and moderate gynecomastia is present.

Which of the following findings is consistent with this patient's condition?

• Decreased luteinizing hormone, follicle stimulating hormone, and testosterone

• Elevated prolactin level

• Increased luteinizing hormone to follicle stimulating hormone level

• Karyotype 47, XXY

• 21-Hydroxylase deficiency

A 53-year-old woman with no past medical history complains of incontinence. She thinks that she must have "a small bladder capacity" because she has to go to the restroom so frequently. She also complains that she tends to lose her urine when she coughs or laughs. Particularly embarrassing is the fact that when she goes to the gym, she has to wear an undergarment while she does light weightlifting so she does not lose her urine in public. A recent urinalysis and urine culture she had at her employee health center were unremarkable. She denies recent back or head injury, neurologic dysfunction, and renal, bladder/urethral/ureteral disorder. She denies any psychological disorder and appears well-adjusted. She only takes oral contraceptive pills regularly; she does not drink or smoke but admits to drinking 3 cups of coffee a day.

Which of the following is the most likely diagnosis?

• Drug-induced incontinence

• Functional incontinence

• Overflow incontinence

• Stress incontinence

• Urge incontinence

Fluid from a thoracentesis is grossly purulent. The effusion from which this fluid was aspired is best described as a(n):

• Loculated effusion

• Chylothorax

• Empyema

• Hydrothorax

• Hemothorax

Which of the following is the earliest manifestation of diabetic nephropathy?

• Proteinuria

• A progressive decline in the creatinine clearance

• An elevated serum haptoglobin

• Renal insufficiency

• Microalbuminuria

A 2-year-old girl is brought to the emergency department because she looked "unwell" and has not wanted to get out of bed for 24 hours. She had a diarrheal illness 1 week ago marked by fever and bloody diarrhea, from which she had recovered. Two days ago, however, she developed reduced appetite and lethargy. She has had only 2 wet diapers in the last 36 hours. She was previously a well child and at the regular clinic visits normal growth and development were noted. Examination shows an irritable, pale child who has petechiae and edema. Vital signs reveal the blood pressure 102/74 mm Hg, pulse 136/min, and respirations 26/min. Lung and abdominal examinations are normal. Laboratory studies show:

Hemoglobin7.1g/dL

WBCs222 x 109/L (normal 5,000-10,000)

Differential:

Polymorphs38%

Lymphocytes52%

Monocytes8%

Platelets80 x 109/L

Blood filmFragmented red blood cells

Prothrombin time12.1 sec

Partial thromboplastin time32 sec

Serum sodium132 mEq/L

Serum potassium6.3 mEq/L

Serum chloride106 mEq/L

Serum bicarbonate16 mEq/L

Blood urea nitrogen32 mg/dL

Serum creatinine3.1 mg/dL

• Administer a normal saline bolus of 20gmL/k

• Administer methylprednisolone

• Begin dialysis

• Begin plasmapheresis

• Transfuse red blood cells

An 8-year-old boy has left leg pain and a high fever, and has been refusing to walk since yesterday. On physical examination, his temperature is 39.8ordmC (103.6ordmF), blood pressure 122/68 mm Hg, pulse 102/min, and respirations 20/min. The left femur is tender to palpation 3 cm above the left knee and there is marked soft-tissue swelling. Radiograph of the left leg is normal. Bone scan shows increased uptake around the metaphysis of the left femur.

Which of the following is the most likely pathogen?

• Escherichia Coli

• Haemophilus Influenzae

• Salmonella

• Staphylococcus Aureus

• Streptococcus Pneumoniae

5-year-old boy is brought to the clinic because his parents have noticed swelling around his eyes for the past 3 days. The child was previously well and was last seen for an annual well-child visit 1 month ago when his weight was 18.5 kg (40.8 lb). He has been urinating less than usual but he is otherwise well. No change in the urine color was noticed and there was no fever, diarrhea, or vomiting. Examination reveals an alert and active child. Blood pressure is 98/66 mm Hg. There is periorbital edema as well as pitting edema of the ankles. Lung and abdominal examinations are normal and there is no skin rash. Laboratory studies show:

• Albumin infusion

• Cyclophosphamide (Cytoxan)

• Furosemide (Lasix)

• High protein diet

• Prednisone