The PANCE exam is a fairly straightforward test – the questions are generally not designed to trick the student and the idea is to test fundamental knowledge. That said, the exam does cover a very wide range of topics, so it’s challenging simply in scope.
While we suggest signing up for our question bank here for 1800 practice questions, we also suggest the PANRE practice exams. There’s a strong correlation with the number of practice questions you complete and a passing score.
Below are a couple of PANCE practice questions from our question bank:
Question 1. Pediatrics QID 29232
A 15-year-old male with a recent history of camping presents after 5 days of flatulence and greasy, foul-smelling diarrhea. The patient also reports nausea, weight loss, and abdominal cramps which precedes the sudden diarrhea. He denies tenesmus, urgency, or bloody diarrhea. What is the patient most likely to report about his camping activities?
A. Collecting water from a stream, without boiling or chemical treatment
B. Recent antibiotic prescription
C. Symptoms have been going on for months
D. The patient camped as a side-excursion from a cruise ship
E. The patient camped in Mexico
Answer: A. Collecting water from a stream, without boiling or chemical treatment.
Giardiasis is an infection of Giardia lamblia, a protozoan parasite that can cause epidemic or sporadic diarrhea. The major site of infection is the small intestine. While the exact etiology is uncertain, diarrhea may be a result of both intestinal malabsorption and hypersecretion. The small intestine is the site of the major structural and functional abnormalities associated with giardiasis. 
While G. lamblia occurs worldwide, it is particularly common in areas with limited water treatment and poor sanitary conditions. Giardia cysts are transmitted by food, water, and fecal-oral interactions.  High risk groups include infants and young children and those with compromised immune systems. Travelers make up about 40% of giardiasis cases.
Water is an important source of giardiasis transmission.  Giardia cysts are resistant to the chlorination process and survive in streams due to their tolerance of cold temperatures. Some water-dwelling animals may serve as ongoing environmental sources of contamination. As with this patient, Giardia lamblia is a significant cause of diarrhea in hikers and campers in wilderness areas, who drink water that has not been adequately boiled or filtered.
The most common symptoms of acute giardiasis are the sudden onset of diarrhea, malaise, foul-smelling fatty stools, abdominal cramps, flatulence, nausea, and weight loss. Vomiting and fever are less common symptoms. Symptoms usually present after a 7-14 day incubation period and may last from 2-4 weeks. Complete recovery can take many weeks, even after clearance of the parasite. 
B – Incorrect. Clostridium difficile can cause colitis by colonizing the intestinal tract, often once normal gut flora have been affected by antibiotics.
C – Incorrect. The primary characteristics of irritable bowel syndrome are the combination of chronic lower abdominal pain and altered bowel habits.
D – Incorrect. Noroviruses are often suspected when outbreaks of gastroenteritis are widespread. With norovirus-induced gastroenteritis, stools are non-bloody, lack mucous, and may be watery or loose. Symptoms typically last two to three days.
E – Incorrect. Travelers’ diarrhea (TD) is a common illness in travelers to the developing world from wealthier countries. Most patients experience symptoms for 1-5 days.
Reference: 1. Kappus K, Lundgren R Jr, Juranek D, et al. Intestinal parasitism in the United States: update on a continuing problem. Am J Trop Med Hyg 1994; 50:705. 2. Musher D, Musher B. Contagious acute gastrointestinal infections. N Engl J Med 2004; 351:2417. 3. Hopkins R, Juranek D. Acute giardiasis: an improved clinical case definition for epidemiologic studies. Am J Epidemiol 1991; 133:402.
Question 2. Cardiovascular System QID 31850
67 year-old male who was recently diagnosed with colorectal cancer presents with fever and shortness of breath that started 2 days prior to presentation. Patient also noticed that his hands are “more red than usual” and there are painful lesions on his fingers. Cardiovascular examination is remarkable for a holosytolic, “blowing” murmur best heard in the mitral area which was not present during prior examinations. Preliminary results of the blood culture is positive for a gram positive cocci. Which of the following organism is most likely responsible for patient’s disease?
A. Staphylococcus aureus
B. Streptococcus viridians
C. Staphyloccus epidermidis
D. Streptococcus bovis
E. Eikenella corrodens
Answer: D. Streptococcus bovis.
The hand erythema is likely Janeway lesions (erythematous non-tender lesions on palms and soles) and the tender lesions on the fingers are Osler’s nodes. Given the above findings and a new murmur on physical examination, the most likely diagnosis for this patient is infective endocarditis. Endocarditis is inflammation of the endocardium that lines the surface of cardiac valves; usually due to bacterial infection. Streptococci and staphylococci account for majority (80%) of cases of infective endocarditis. Common organisms responsible for infective endocarditis include the following:
Streptococcus viridians (Choice B) is the most common overall cause. It is a low-virulence organism that infects previously damaged valves (e.g. chronic rheumatic heart disease and prolapsed mitral valve).
Staphylococcus aureus (choice A) is the most common cause in IV drug abusers. S. aureus is a high-virulence organism that infects normal valves, most commonly the tricuspid valve.
Staphyloccus epidermidis (choice C) is associated with endocarditis of prosthetic valves.
Streptococcus bovis (Choice D) is associated with endocarditis in patients with underlying colorectal carcinoma. Given our patient was recently diagnosed with colorectal cancer, the most likely causative organism is S. bovis.
HACEK organisms (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella) are associated with endocarditis with negative blood cultures.
Reference: Nesseler N, Launey Y, Malledant Y. Infective endocarditis. The New England journal of medicine. Aug 22 2013;369(8):784-785. Mahroo OA, Graham EM. Images in clinical medicine. Roth spots in infective endocarditis. The New England journal of medicine. Jun 19 2014;370(25):e38.
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