Mixed Deck — All PANCE Topics Flashcards

A 66-year-old woman has a blood pressure of 158/96 mmHg at two separate visits. She has a history of type 2 diabetes and microalbuminuria. Which antihypertensive is most appropriate as first-line therapy?

Answer: Lisinopril

ACE inhibitors (e.g., lisinopril) are first-line in diabetic patients with hypertension and microalbuminuria because they provide renoprotection beyond blood pressure lowering.

A 58-year-old man with peripheral artery disease has an ankle-brachial index (ABI) of 0.55. He has rest pain. Next best step?

Answer: Referral for revascularization

An ABI <0.6 with rest pain indicates critical limb ischemia (CLI), which requires urgent revascularization to prevent limb loss.

A neonate develops seizures at 36 hours of life after a prolonged difficult delivery. Brain MRI shows restricted diffusion in watershed zones. What is the most appropriate intervention?

Answer: Therapeutic hypothermia (whole-body cooling)

Therapeutic hypothermia (33–34°C for 72 hours) is the standard of care for hypoxic-ischemic encephalopathy in neonates ≥ 36 weeks when initiated within 6 hours of birth.

A 28-year-old woman has amenorrhea, galactorrhea, and a serum prolactin of 120 ng/mL. MRI shows a 7 mm pituitary lesion. First-line treatment is:

Answer: Bromocriptine or cabergoline

Dopamine agonists (cabergoline preferred) are first-line for prolactinomas regardless of size.

A 55-year-old woman with COPD and a 60-pack-year history presents with hemoptysis and a 3 cm spiculated pulmonary nodule on CXR. What is the most appropriate next step?

Answer: CT scan of the chest with contrast

A CT scan of the chest is the next step to characterize the nodule's features (size, density, borders) and guide further management including biopsy or PET scan.

What role does collaboration play in gastrointestinal for PANCE professionals?

Answer: It enhances outcomes through diverse perspectives and shared expertise

Collaboration leverages diverse perspectives and combined expertise to achieve better outcomes than any individual could alone.

Which electrolyte abnormality is most characteristic of primary hyperaldosteronism (Conn syndrome)?

Answer: Hypokalemia and hypertension

Excess aldosterone causes sodium retention and potassium wasting, producing hypokalemia with hypertension.

A 55-year-old man undergoes thyroidectomy. Postoperatively he develops perioral numbness and carpopedal spasm. Which sign would you elicit?

Answer: Chvostek sign

Chvostek sign (facial twitch on tapping the facial nerve) indicates hypocalcemia from hypoparathyroidism after thyroidectomy.

Which finding on chest X-ray is most characteristic of a tension pneumothorax?

Answer: Contralateral tracheal deviation with ipsilateral lung collapse

Tension pneumothorax causes mediastinal shift away from the affected side due to positive pressure buildup, displacing the trachea contralaterally.

A 55-year-old male presents with sudden onset of severe 'tearing' chest pain radiating to the back. BP is 180/100 mmHg in the right arm and 160/90 in the left. Which diagnosis is most likely?

Answer: Aortic dissection

Aortic dissection classically presents with tearing chest pain radiating to the back and a blood pressure differential between arms.

A 5-year-old presents with a limp and hip pain. X-ray shows flattening and fragmentation of the femoral head. Labs are normal. What is the most likely diagnosis?

Answer: Legg-Calvé-Perthes disease

Legg-Calvé-Perthes disease is avascular necrosis of the femoral head in children, presenting with limp and X-ray showing femoral head fragmentation.

A 62-year-old man presents with progressive dysphagia to solids more than liquids and a 20-lb weight loss over 3 months. He has a 40-pack-year smoking history. What is the most likely diagnosis?

Answer: Esophageal carcinoma

Progressive dysphagia to solids worse than liquids with significant weight loss in an older smoker is classic for esophageal carcinoma.

A 28-year-old African American male develops hemolytic anemia after starting primaquine for malaria prophylaxis. What is the underlying enzyme deficiency?

Answer: G6PD deficiency

G6PD deficiency causes episodic hemolysis triggered by oxidative stressors like primaquine, dapsone, or fava beans.

A patient with hypertrophic obstructive cardiomyopathy (HOCM) experiences syncope. Which intervention would WORSEN outflow obstruction?

Answer: Amyl nitrite inhalation

Amyl nitrite causes vasodilation and decreases preload and afterload, which worsens HOCM outflow obstruction by allowing greater septal apposition to the anterior mitral leaflet.

Which lab pattern is most consistent with prerenal azotemia?

Answer: BUN:Cr ratio >20:1 with urine sodium <20 mEq/L

Prerenal azotemia shows a BUN:Cr >20:1 and low urine sodium as the kidneys avidly retain sodium to restore perfusion.

A 48-year-old man is found to have a total cholesterol of 280, LDL 190, HDL 38, and triglycerides 250. He has no cardiovascular disease. What is the primary treatment target?

Answer: Lower LDL with high-intensity statin

High-intensity statin therapy targeting LDL reduction is the primary intervention for primary prevention in patients with LDL ≥190 mg/dL per ACC/AHA guidelines.

A 30-year-old woman has recurrent episodes of vertigo lasting 20–30 minutes associated with tinnitus and low-frequency hearing loss. The most likely diagnosis is:

Answer: Ménière disease

Ménière disease presents with episodic vertigo (20 min–12 hr), fluctuating low-frequency sensorineural hearing loss, tinnitus, and aural fullness.

A 55-year-old diabetic patient presents with a painless foot ulcer over the plantar surface of the first metatarsal head. Pulses are intact. What is the primary etiology?

Answer: Peripheral neuropathy

Neuropathic ulcers in diabetics occur at pressure points (plantar metatarsal heads) due to loss of protective sensation from peripheral neuropathy.

A 28-year-old female presents with amenorrhea, galactorrhea, and headaches. Labs show elevated prolactin. MRI reveals a pituitary mass. What is the first-line treatment?

Answer: Bromocriptine or cabergoline

Dopamine agonists (bromocriptine or cabergoline) are first-line therapy for prolactinomas, as they effectively shrink the tumor and normalize prolactin.

A 55-year-old man with small cell lung cancer develops ascending weakness and areflexia two weeks after chemotherapy. Anti-Hu antibodies are detected. This is an example of:

Answer: Paraneoplastic encephalomyelitis/sensory neuronopathy

Anti-Hu antibodies are associated with paraneoplastic sensory neuronopathy/encephalomyelitis, an immune-mediated syndrome triggered by SCLC.