PANCE PANCE 2

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?

Accepted Answer

Aortic dissection

Answer

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?

Accepted Answer

Administer 4-factor PCC and IV vitamin K

Answer

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?

Accepted Answer

Central diabetes insipidus

Answer

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?

Accepted Answer

Tricuspid regurgitation

Answer

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?

Accepted Answer

Croup (laryngotracheobronchitis)

Answer

Croup (viral laryngotracheobronchitis) causes subglottic narrowing seen as the steeple sign on AP neck X-ray.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE PANCE 2