ALL THINGS PA-C | FREE PRACTICE QUIZ Questions
Questions
1. A 12-year-old male is struck in the face with a baseball. He presents with pain and swelling of the left
orbit. On exam you notice limitation of upward gaze in his left eye. What is the cause of this symptom?
A. A hyphema
B. Damage to the supraorbital nerve
C. Injury to the medial canthal ligament
D. Orbital emphysema
E. Entrapment of the inferior rectus muscle
2. A 54-year-old male with a history of hypertension and tobacco dependence has substernal chest pain
he describes as severe pressure lasting 45 minutes. Paramedics administer oxygen by nasal cannula
and give him sublingual nitrogen in route to the hospital which alleviates some of his pain. Upon arrival
to the emergency department his vital signs are within normal limits and an EKG obtained shows
normal sinus rhythm. Which of the following should be done next?
A. Coronary angiography
B. Aspirin
C. Exercise stress test
D. Beta blocker
E. Echocardiogram
3. A 61-year-old female has dyspnea with exertion for several weeks. Until recently she walked 20
minutes a day, but now she gets lightheaded and short of breath after walking down her driveway. The
last few nights she’s had to sleep on two pillows to keep from getting short of breath. On exam, she is
afebrile, blood pressure 118/88, HR 92 and RR 16. You hear mild bibasilar inspiratory crackles on lung
exam and find 2+ pitting edema to bilateral lower extremities. What is the best test to evaluate your
suspected diagnosis?
A. Chest xray
B. Brain Natriuretic Peptide (BNP)
C. Echocardiogram
D. Serum electrolytes
E. EKG
Your go-to resource for PANCE study questions & PA resources Page 1 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Questions
4. A 49-year-old female with a history of rheumatic fever has a loud S1 with a mid diastolic rumble best
heard at the apex in the left lateral decubitus position. What type of valve disorder does she have?
A. Aortic regurgitation
B. Aortic stenosis
C. Mitral regurgitation
D. Mitral stenosis
E. Tricuspid regurgitation
5. Trimethoprim-sulfamethoxasole (Bactrim) utilizes which of the following mechanism of action?
A. Inhibits or disrupts cell wall growth
B. Inhibits protein synthesis
C. Inhibits DNA or RNA synthesis
D. Inhibits folic acid synthesis
E. Destabilizes cell membranes
6. Which of the following is the most common opportunistic infection in AIDS patients?
A. Pneumocystosis (PCP)
B. Histoplasmosis
C. Candidiasis
D. Cytomegalovirus
E. Mycobacterium avium
7. A 27-year-old G1P0 presents with complaint of vaginal bleeding. She is estimated at 12 weeks
gestation based on a definite LMP and early ultrasonography at 8 weeks. During the exam, fetal heart
tones are detected. Transvaginal ultrasonography confirms a viable intrauterine pregnancy with cardiac
activity. Pelvic exam reveals a closed cervix. Which of the following describes this presentation?
A. Missed abortion
B. Threatened abortion
C. Blighted ovum
D. Inevitable abortion
E. None of the above
Your go-to resource for PANCE study questions & PA resources Page 2 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Questions
8. Which of the following symptoms is NOT consistent with rheumatoid arthritis?
A. PIPs and MCPs are often affected
B. Incidence increases with age
C. RF is positive in most cases
D. Joint swelling is symmetric
E. Elevated ESR
9. A 25-year-old male presents with 2 days of scrotal pain he describes as a dull ache 7/10 in severity.
He denies fever or chills. On exam the epididymis is markedly swollen and tender to touch. The pain is
relieved with scrotal elevation. Urinalysis reveal + leukocyte esterase and + bacteria. What is the most
likely pathogen causing his illness?
A. E. coli
B. staphylococcus aureus
C. psuedomonas aeruginosa
D. chlamydia trachomatis
E. klebsiealla pneumonia
10. An adult female presents with decreased hearing in the right ear. On exam, you identify a large
cerumen impaction. What are you likely to find on examination?
A. Weber lateralized to the right ear
B. Rinne air conduction > bone conduction in the right ear
C. Diminished high frequency sounds
D. A dull and bulging tympanic membrane
E. None of the above
11. A 60-year-old male has new anemia present on a screening CBC. Labs indicated hemoglobin of 11 (L),
hematocrit 37 (L), serum iron 28 (L), plasma ferritin 15 (L), and increased TIBC 500 (H). Which of the
following should be done next?
A. Initiate oral iron supplement and repeat labs in 12 weeks
B. Refer to hematology for a bone marrow aspiration and biopsy
C. Hemoglobin electrophoresis
D. Fecal occult blood test
E. Check a vitamin B12 and folate level
Your go-to resource for PANCE study questions & PA resources Page 3 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Questions
12. A patient has progressively worsening dysphagia. She describes difficulty with both solids and liquids.
She occasionally regurgitates her food and has been having intermittent episodes of chest pain.
Manometry confirms increased lower esophageal sphincter pressure. What would you expect to find
on a barium swallow study?
A. Shatzki’s ring (smooth, circumferential strictures in the distal esophagus)
B. “bird’s beak” in the distal esophagus (dilated esophagus tapering distally)
C. Zenker diverticulum (outpouching of the posterior hypopharynx)
D. Esophageal web (ballooning of esophagus above a small thick infolding of mucosa)
E. No abnormality on barium
13. A 24-year-old female presents with general complaints of restlessness, anxiety, and 10 pound weight
loss. Exam findings include an enlarged thyroid, hyperreflexia, and exophthalmos. Which of the
following is NOT a potential complication of her likely diagnosis?
A. Atrial fibrillation
B. Hypocalcemia
C. Osteoporosis
D. Thyroid storm
E. Decreased libido
14. A 12-year-old female is brought into the emergency department by her parents at the request of her
athletic trainer after being kicked in the head during a soccer game. Initially on the sidelines, she
complained of headache and nausea, and had trouble remembering today’s date. On examination
she has some tenderness over the back of her head where she was struck but exam is otherwise
unremarkable including neurologic exam. Which of the following is the next appropriate step?
A. CT of the head
B. Observation overnight in the hospital
C. Discharge home and have them wake her up every 2 hours overnight
D. Council parents she can return to play if she is still asymptomatic after 48 hours
E. Discharge home and refer to primary care for follow up prior to return to play
Your go-to resource for PANCE study questions & PA resources Page 4 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Questions
15. Which of the following is NOT a structural abnormality in Tetralogy of Fallot?
A. Ventricular septal defect
B. Pulmonary stenosis
C. Patent ductus arteriosus
D. Overriding aorta
E. Right ventricular hypertrophy
16. A 45-year-old male sustained severe burns while pouring gasoline on a bonfire. He has second degree
burns to both arms, and the entire front of his torso. What is the surface area of his injury?
A. 18%
B. 27%
C. 36%
D. 45%
E. 54%
17. A 22-year-old veteran complains of insomnia and frequent nightmares. When he tries to sleep, he can’t
stop thinking of his combat tour. He is easily startled and his wife is concerned that he isn’t spending
time with her and their children. What is the first line treatment for his suspected diagnosis?
A. sertraline
B. quetiapine
C. risperidone
D. diazepam
E. amytriptiline
18. A 21-year-old female presents with a rash to her neck and chest. She works as a lifeguard and although
the rash doesn’t bother her, she is embarrassed and feels it’s getting worse. On exam you identify large
hypopigmented macular lesions that coalesce in some areas. What is the most appropriate treatment?
A. Oral doxycycline
B. Oral fluconazole
C. Topical selenium sulfide
D. Topical permethrin
E. Topical triamcinolone
Your go-to resource for PANCE study questions & PA resources Page 5 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Questions
19. A 58-year-old male has sudden onset of fever, chills, low back and perineal pain. He has had increased
urinary frequency and dysuria for the last 3 days. Which of the following is the most appropriate
treatment?
A. macrobid bid for 7 days
B. ciprofloxacin bid for 6 weeks
C. NSAIDS and alpha blocker for 1-2 weeks
D. urgent referral to urology
E. await results of urine culture to determine best course of action
20. A 45-year-old male falls from his roof while cleaning gutters. He had a brief loss of consciousness,
however when paramedics arrived he was alert and talking to them. Upon arrival to the emergency
department he loses consciousness again and begins deteriorating. Which diagnosis is most likely?
A. Hemorrhagic stroke
B. Epidural hematoma
C. Subdural hematoma
D. Basilar skull fracture
E. Concussion
Your go-to resource for PANCE study questions & PA resources Page 6 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Answers
Answers
1. E. Entrapment of the inferior rectus muscle
A significant consequence of an orbital floor or “blowout” fracture is entrapment of the inferior
rectus muscle which can cause ischemia and subsequent loss of muscle function. These injuries are
commonly associate with small round objects such as a baseball striking the eye. X-ray imaging is not
very sensitive and a CT should be ordered if an orbital fracture is suspected. A hyphema is bleeding
into the anterior chamber of the eye and can be caused by trauma. Damage to the supraorbital nerve
may cause numbness to the forehead. Orbital epmhysema and injury to the medial canthal ligament
can be caused by orbital injury, but would not affect extraocular eye movements
HENT; history taking and physical examination
2. B. Aspirin
Initial EKG and cardiac enzyme studies can be normal during an acute MI. If acute coronary syndrome
is at all suspected, oxygen, nitroglycerin and aspirin should be administered. Aspirin decreases
mortality in acute coronary syndrome. In this case, serial EKG and cardiac enzymes are needed to rule
out acute coronary syndrome.
Cardiovascular system; using diagnostic and laboratory studies, managing patients (clinical
intervention)
3. C. Echocardiogram
The patient in this question is presenting with classic signs of heart failure. An echocardiogram is the
single most useful test in the evaluation of congestive heart failure. It measures size of the ventricles,
contractility of the left ventricle, estimates ejection fraction, examinse valve function and can diagnose
a myopathy. A BNP has low specificity but high sensitivity for CHF. It is useful in determining whether
the source of dyspnea is cardiac or pulmonary (BNP >200 suggest CHF vs pulmonary). A chest
xray may show cardiomegaly, pulmonary effusions, or interstitial edema and can be helpful as an
initial diagnostic study. An EKG may show nonspecific changes and serum electrolytes can identify
abnormalities such as hyperkalemia and hyponatremia, but would not be the BEST test to evaluate
heart failure.
Cardiovascular system; formulating most likely diagnosis; using diagnostic and laboratory studies
Your go-to resource for PANCE study questions & PA resources Page 7 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Answers
4. D. Mitral stenosis
Rheumatic heart disease is a late sequela of acute rheumatic fever and can occur many years after
the original illness. Most cases of mitral stenosis in adults are secondary to rheumatic heart disease.
The mitral valve is most frequently involved and thickening, fibrosis and calcifications lead to valvular
stenosis. The murmur is described as a low-pitched diastolic rumble after the opening snap, heard
best at the apex with the bell of the stethoscope.
Cardiovascular system; formulating most likely diagnosis; history taking and performing physical
examination; mitral stenosis
5. D. Inhibits folic acid synthesis
Trimethoprim-sulfamethoxasole works by inhibiting folic acid synthesis. Beta-lactams (PCN,
cephalosporins, cabapenems), monobactams (aztreonam) and glycopeptides (vancomycin) all inhibit
or disrupt cell wall growth. Macrolides, ketolides, lincosamide, oxazolidinoes, aminoglycosides,
tetracyclines, glycylcyclines) all inhibit protein synthesis. Fluroquinolones, rifampin and metronidazole
inhibit DNA or RNA synthesis. Cyclic lipoproteins destabilize cell membranes.
Managing patients; pharmaceutical therapeutics
6. A. Pneumocystosis (PCP)
Pneumocystosis (PCP) caused by pneumocystis jiroveci is the most common opportunistic infection
in AIDS patients and common with CD4 counts <200. CD4 counts <200 require prophylaxis. Patients
present with fever, dyspnea, a non productive cough and the exam does not always correlate with
the degree of hypoxemia. Treat with trimethoprim-sulfa (TMP-SMX). The remaining choices can be
opportunistic in immunocompromised hosts but are not the most common infection in AIDS patients.
Infectious disease; formulating most likely diagnosis; pneumonia, HIV related
7. B. Threatened abortion
Threatened abortion is defined as bleeding with or without cramping with a closed cervix. Inevitable
abortion is bleeding with dilation of the cervix. With a missed abortion the embryo or fetus dies but
the products of conception are retained. A Blighted ovum or anembryonic pregnancy is when a
fertilized egg implants in the uterus but does not develop into an embryo.
Reproductive system; applying basic scientific concepts; threatened abortion
Your go-to resource for PANCE study questions & PA resources Page 8 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Answers
8. B. Incidence increases with age
Onset of RA is typically 20-40 years old and affects females 3:1 compared to males. Joint swelling is
symmetric and PIPs, MCPs, knees ankles and toes are often affected. ESR is often elevated and RF is
positive in 80% of cases. The incidence of osteoarthritis increases with age.
Musculoskeletal system; using diagnostic and laboratory studies; history taking and performing
physical examination; formulating most likely diagnosis; rheumatoid arthritis
9. D. Chlamydia trachomatis
Chlamydia and gonococcal are the most common organisms causing epididymitis in men younger
than 35. In men older than 35, E. coli is the most common. Epididymitis presents as scrotal pain,
with or without fever and symptoms of urethritis or cystitis. Swelling and marked tenderness of the
epididymis are present and pain is often reduced with testicular elevation (Prehn’s sign). Treatment
should include coverage against chlamydia and gonococcal infections such as ceftriaxone 250mg IM
plus doxycycline 100mg bid for 10 days
Genitourinary system (male); formulating most likely diagnosis, managing patients (pharmaceutical
therapeutics); epididymitis
10. A. Weber lateralized to the right ear
Obstruction from cerumen impaction causes conductive hearing loss. With CHL, you would expect
to find sound lateralizing to the affected ear with Weber, and bone conduction > air conduction with
Rinne. Impairment of high frequency sounds is typically associated with sensorineural hearing loss.
Serous otitis media can cause conductive hearing loss, but was not described in the patient above.
ENT; History taking and physical examination; conductive hearing loss
Your go-to resource for PANCE study questions & PA resources Page 9 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Answers
11. D. Fecal occult blood test
In adults, GI blood loss must be ruled out as bleeding from peptic ulcer disease or colon cancer
is a likely cause. A fecal occult blood test is fast and easy. Referral to GI for further evaluation with
and EGD and colonoscopy may be warranted. Iron supplementation is used to treat iron deficiency
anemia however the cause must be determined first. Hemoglobin electrophoresis can be used to rule
out a thalassemia if iron deficiency and anemia of chronic inflammation are excluded. Evaluation for
folate and B12 deficiency should be completed for macrocytic anemia.
Hematology; Using diagnostic and laboratory studies; iron deficiency anemia
12. B. “bird’s beak” in the distal esophagus (dilated esophagus tapering distally)
This presentation is consistent with achalasia, a motility disorder that often presents with progressive
dysphagia of solids and liquids, episodic regurgitation and chest pain. Manometry confirms a
diagnosis. The “bird’s beak” can be seen on esophagram.
Gastrointestinal system; Using diagnostic and laboratory studies; achalasia
13. B. Hypocalcemia
Graves disease is the most common cause of hyperthyroidism. It affects women more than men
(8:1), at an average age of 20-40 years old and has a familial tendency. Complications include atrial
fibrillation, HYPERcalcemia, osteoporosis, and decreased libido. Thyroid storm is a rare but life-
threatening complication of untreated extreme hyperthyroidism.
Endrocrinology; History taking and performing physical exam; formulating most likely diagnosis;
hyperthyrodism
14. E. Discharge home and refer to primary care for follow up prior to return to play
The patient likely sustained a concussion. There are no red flags such as loss of consciousness so
CT imaging is not warranted and would cause unnecessary radiation. Observation in the hospital is
not required for minor closed head injuries. It is no longer recommended to keep patients awake or
wake them up periodically after a head injury. In order to return to play, patients should be examined
and released by someone versed in concussion management which can typically be done through a
concussion clinic or primary care office.
Neurologic system; Managing patients (clinical intervention); head injury
Your go-to resource for PANCE study questions & PA resources Page 10 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Answers
15. C. Patent ductus arteriosus
Tetralogy of Fallot consist of 1. VSD 2. Pulmonary stenosis 3. Overriding aorta and 4. Right
ventricular hypertrophy. Patent ductus arteriosus is present in fetal life and allows blood from the
pulmonary artery to flow to the aorta, bypassing the nonaerated fetal lungs. Normally it closes
spontaneously in normal term infants by 4 days of age. If not, surgical closure may be warranted or
indomethacin can be used in preemies
Cardiovascular system (pediatrics); Applying basic scientific concepts
16. C. 36%
Using the rule of nines, each arm represents 9% and the front of the torso represents 18% for a total
of 36% for this patient. The head would represents 9%, the front of each leg is 9% and the back of
each leg is 9%. The back of the torso is 18%.
Surgery; burn
17. A. Sertraline (Zoloft)
This patient likely has posttraumatic stress disorder which results from exposure to physiologically or
psychologically traumatic events that are not common for most people and typically include threat of
death, serious injury or violence towards themselves or witnessed to others. Symptoms include sense
of helplessness and fear. Individuals may relive the event, have intrusive memories or dreams, or
experience distress when exposed to triggers. SSRIs are considered first line therapy.
Psychiatry/behavioral; Formulating most likely diagnosis; Managing patients (pharmaceutical
therapeutics); PTSD
Your go-to resource for PANCE study questions & PA resources Page 11 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
ALL THINGS PA-C | FREE PRACTICE QUIZ Answers
18. C. Topical selenium sulfide
The rash described is consistent with tinea versicolor (pityriasis versicolor), caused by Malassezia
furfur which is normally colonized on the skin. It consists of hypo or hyperpigmented macules that
do not tan in areas of overgrowth, and is frequently noticed in the summer months for this reason.
Scrapings will show a hyphae and spores “spaghetti and meatball” appearance with KOH prep.
Treatment is selenium sulfide shampoo left on for 15 minutes and washed off for one wee. Oral
ketoconazole can also be used.
Dermatology; Formulating most likely diagnosis; Managing patients (pharmaceutical therapeutics);
Tinea versicolor
19. B. ciprofloxacin bid for 6 weeks
This patient has acute prostatitis likely caused by gram-negative rods. A fluoroquinolone or
trimethoprim-sulfamethoxasole for 6 weeks should be utilized to ensure adequate treatment. If fever
does not resolve within 1-2 days, referral to a urologist to rule out a postatic abscess is warranted.
NSAIDs and alpha blockers can be utilized if lower urinary tract symptoms are present but antibiotics
should be initiated immediately and should not wait on culture and sensitivity in the setting of acute
illness.
Renal/reproductive system; Managing patients (clinical intervention/pharmaceutical therapies);
Prostatitis
20. B. Epidural hematoma
Epidural hematomas are usually caused by injury to the middle meningeal artery which causes
bleeding between the dura and the skull. Patients can experience loss of consciousness followed by
a lucid period before mass effect and brain herniation occurs. Treatment is emergent craniotomy
Surgery; Formulating most likely diagnosis; Epidural hematoma
Your go-to resource for PANCE study questions & PA resources Page 12 of 12
instagram all_things_pa_c | facebook allthingspa | allthingspac.com ©2019 All Things PA-C. All rights reserved.
