PANCE PANCE 2 — Questions and Answers
Question 1: 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?
- Acute MI
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Esophageal rupture
Correct answer: Aortic dissection
Aortic dissection classically presents with tearing chest pain radiating to the back and a blood pressure differential between arms.
Question 2: A patient on warfarin presents with an INR of 8.0 and active bleeding. What is the most appropriate immediate treatment?
- Hold warfarin and recheck INR in 24 hours
- Administer vitamin K only
- Administer 4-factor PCC and IV vitamin K (Correct answer)
- Transfuse fresh frozen plasma only
Correct answer: Administer 4-factor PCC and IV vitamin K
Life-threatening bleeding with supratherapeutic INR requires 4-factor prothrombin complex concentrate (PCC) plus IV vitamin K for rapid reversal.
Question 3: A 30-year-old woman presents with polyuria, polydipsia, and a serum sodium of 155 mEq/L. Urine osmolality remains low after water deprivation but rises with desmopressin administration. What is the diagnosis?
- Nephrogenic diabetes insipidus
- Central diabetes insipidus (Correct answer)
- Primary polydipsia
- SIADH
Correct answer: Central diabetes insipidus
Response to desmopressin confirms central diabetes insipidus, as ADH deficiency is corrected by exogenous desmopressin.
Question 4: Which murmur is best heard at the left sternal border and increases with inspiration?
- Mitral stenosis
- Aortic regurgitation
- Tricuspid regurgitation (Correct answer)
- Pulmonic stenosis
Correct answer: Tricuspid regurgitation
Tricuspid regurgitation is heard at the left lower sternal border and increases with inspiration (Carvallo's sign) due to increased venous return.
Question 5: A 4-year-old child presents with a barky cough, stridor, and low-grade fever. X-ray shows the 'steeple sign.' What is the most likely diagnosis?
- Epiglottitis
- Croup (laryngotracheobronchitis) (Correct answer)
- Foreign body aspiration
- Bacterial tracheitis
Correct answer: Croup (laryngotracheobronchitis)
Croup (viral laryngotracheobronchitis) causes subglottic narrowing seen as the steeple sign on AP neck X-ray.
Question 6: A 62-year-old male with a history of gout presents with acute swollen red first MTP joint. Synovial fluid analysis reveals negatively birefringent needle-shaped crystals. What is the treatment of choice for the acute attack?
- Allopurinol
- Probenecid
- Indomethacin or colchicine (Correct answer)
- Methotrexate
Correct answer: Indomethacin or colchicine
Acute gout attacks are treated with NSAIDs (e.g., indomethacin) or colchicine; urate-lowering therapy like allopurinol should not be started during an acute attack.
Question 7: 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?
- Surgical resection
- Bromocriptine or cabergoline (Correct answer)
- Radiation therapy
- Leuprolide
Correct answer: Bromocriptine or cabergoline
Dopamine agonists (bromocriptine or cabergoline) are first-line therapy for prolactinomas, as they effectively shrink the tumor and normalize prolactin.
PANCE PANCE 2
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?