Physician Assistant Exam For Dummies
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These practice questions give you a sense of what to expect of hematology and oncology questions on the Physician Assistant Exam (PANCE). They also address important subject areas you need to be familiar with, without regard to the test.

Example PANCE Questions

  1. You’re evaluating a 43-year-old man who presents to the ER with an abnormal complete blood count (CBC). The white blood cell count is 6.3 mg/dL, the hemoglobin is 7.4 mg/dL, and the platelet count is 40 mg/dL. You order a peripheral smear, and there are schistocytes. The LDH level is 2,500. Plasmapheresis isn’t available at your hospital facility. What would be your next immediate step?

    (A) Platelet transfusion

    (B) Intravenous steroids

    (C) Intravenous immunoglobulin (IVIG)

    (D) Fresh frozen plasma (FFP) transfusion

    (E) Splenectomy

  2. Which of the following is an example of a macrocytic anemia?

    (A) Anemia of kidney disease

    (B) Chronic liver disease

    (C) Myelophthisic anemia

    (D) Multiple myeloma

    (E) Pure red cell aplasia

  3. You’re evaluating a patient with anemia. During the course of your examination, you note that the patient has a positive monoclonal spike on a serum protein electrophoresis. You’re not sure of the significance of this. Which one of the following tests would you order next?

    (A) CT scan of thorax, abdomen, and pelvis

    (B) Nuclear medicine bone scan

    (C) A radiographic skeletal survey

    (D) MRI spine survey with gadolinium

    (E) CT scan of the spine with intravenous contrast

  4. What is the most common cause of a hypercoagulable state?

    (A) Prothrombin gene mutation

    (B) Factor V Leiden mutation

    (C) Nephrotic syndrome

    (D) Antiphospholipid antibody syndrome

    (E) Antithrombin III deficiency

  5. You are evaluating a 23-year-old woman who presents with recurrent epistaxis. She also experiences some bleeding from her gums when she brushes her teeth. Other past medical history is unremarkable, and the patient denies taking any medications, including NSAIDs. On examination, there is no splenomegaly. The CBC shows a WBC of 7.4 mg/dL, hemoglobin of 11.3 mg/dL, and a platelet count of 220,000. What would be your next step?

    (A) Obtain an abdominal ultrasound to be sure splenomegaly is not present.

    (B) Order a bone marrow biopsy.

    (C) Test for von Willebrand disease.

    (D) Obtain stat creatinine to evaluate kidney function.

    (E) Send peripheral blood for flow stat creatinine.

  6. Which one of the following tumor markers and its association is correct?

    (A) CA125 — breast cancer

    (B) CA19-9 — ovarian cancer

    (C) Alpha-fetoprotein — hepatocellular carcinoma (HCC)

    (D) Prostate-specific antigen (PSA) — testicular cancer

    (E) Carcinoembryonic antigen (CEA) level — prostate cancer

Example PANCE Answers and Explanations

1. D. This patient has thrombotic thrombocytopenic purpura (TTP), so you would transfuse fresh frozen plasma. Platelet transfusions are good in the treatment of idiopathic thrombocytopenic purpura (ITP) but not TTP. Steroids and splenectomy are treatments for ITP. Some clinicians also use intravenous immunoglobulin in the treatment of ITP.

2. B. Chronic liver disease is associated with a macrocytic anemia. All the other choices are associated with a normocytic, normochromic anemia. Pure red cell aplasia is an autoimmune process in which antibodies are produced against erythropoietin. This causes a hypoproliferative bone marrow concerning the production of red blood cells, but the patient has normal leukocytes and platelets.

3. C. You suspect that the patient has multiple myeloma based on the initial positive monoclonal spike on the serum protein electrophoresis, but the patient may have a monoclonal gammopathy of unknown significance (MGUS). You’d order a skeletal radiographic survey to look for lytic lesions. Choice (A) isn’t right because a CT scan of the thorax, abdomen, and pelvis is used for staging many solid organ cancers as well as lymphomas. A bone scan is good only when you’re looking for bone metastasis concerning solid organ cancers that have osteoblastic activity. You wouldn’t expect to see multiple myeloma, which is predominantly a lytic process. An MRI, Choice (D), or CT scan, Choice (E), with their respective contrasts, wouldn’t be indicated at this time.

4. B. The most common cause of a hypercoagulable state is a Factor V Leiden mutation. Patients can be homozygous or heterozygous for this mutation. The other choices are causes of a hypercoagulable state but are not as common as Factor V Leiden mutation. Antithrombin III deficiency is a common cause of clotting in younger people, as are Protein C and Protein S deficiencies.

5. C. The patient has recurrent problems with mucosal bleeding, which suggests a problem with platelet function. Her platelet count is normal, which should suggest a qualitative platelet problem. Although kidney disease, Choice (D), could cause qualitative platelet function, there are usually other issues present (anemia, uremic symptoms, and so forth). The other answers are not applicable to this problem. Flow cytometry, Choice (E), is sometimes ordered by a hematologist for evaluation of malignancy. A bone marrow biopsy, Choice (B), is not indicated, and Choice (A), an abdominal ultrasound, doesn’t make sense. You would test for von Willebrand disease.

6. C. Alpha-fetoprotein is associated with hepatocellular carcinoma (HCC). The other choices don’t represent the correct tumor markers with their corresponding cancers. CA19-9 is associated with breast cancer, and CA125 is associated with ovarian cancer. CEA is a tumor marker associated with colon cancer. PSA is associated with prostate cancer, not testicular cancer.

About This Article

This article is from the book:

About the book authors:

Rich Snyder, DO, is board certified in both internal medicine and nephrology. He teaches, lectures, and works with PA students, medical students, and medical residents. Barry Schoenborn, coauthor of Medical Dosage Calculations For Dummies, is a long-time technical and science writer.

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