PANCE PANCE 3 — Questions and Answers
Question 1: A 45-year-old male is found to have a BP of 155/95 mmHg on three separate occasions. He also has diabetes and proteinuria. What is the most appropriate antihypertensive?
- Hydrochlorothiazide
- Amlodipine
- Lisinopril (Correct answer)
- Metoprolol
Correct answer: Lisinopril
ACE inhibitors like lisinopril are first-line in diabetic patients with hypertension and proteinuria due to their renoprotective effects.
Question 2: A 70-year-old woman presents with sudden painless vision loss in one eye described as 'a curtain coming down.' Fundoscopy shows a pale retina with a cherry-red spot at the macula. What is the diagnosis?
- Retinal vein occlusion
- Retinal detachment
- Central retinal artery occlusion (Correct answer)
- Vitreous hemorrhage
Correct answer: Central retinal artery occlusion
Central retinal artery occlusion presents with sudden painless vision loss, pale ischemic retina, and cherry-red spot at the fovea.
Question 3: A 35-year-old male presents with recurrent episodes of severe unilateral periorbital pain lasting 45-90 minutes, associated with ipsilateral lacrimation and nasal congestion. What is the most likely diagnosis?
- Migraine with aura
- Tension headache
- Cluster headache (Correct answer)
- Trigeminal neuralgia
Correct answer: Cluster headache
Cluster headaches are severe unilateral periorbital headaches with autonomic features (lacrimation, rhinorrhea) lasting 15-180 minutes.
Question 4: A neonate born at 32 weeks develops respiratory distress immediately after birth with grunting, flaring, and retractions. CXR shows diffuse ground-glass opacities. What is the pathophysiology?
- Meconium aspiration
- Transient tachypnea of the newborn
- Surfactant deficiency (Correct answer)
- Congenital pneumonia
Correct answer: Surfactant deficiency
Respiratory distress syndrome (RDS) in premature neonates results from surfactant deficiency, causing diffuse atelectasis and ground-glass appearance on CXR.
Question 5: A 50-year-old male presents with fatigue, weight loss, and splenomegaly. CBC shows WBC 120,000/µL with left shift. Philadelphia chromosome (t[9;22]) is identified. What is the diagnosis?
- Acute lymphoblastic leukemia
- Chronic myelogenous leukemia (Correct answer)
- Polycythemia vera
- Essential thrombocythemia
Correct answer: Chronic myelogenous leukemia
Chronic myelogenous leukemia (CML) is characterized by the Philadelphia chromosome (BCR-ABL fusion) and markedly elevated WBC with left shift.
Question 6: A 22-year-old female presents with joint pain, a butterfly rash, and oral ulcers. Labs show positive ANA, anti-dsDNA, and low complement levels. What is the most likely diagnosis?
- Rheumatoid arthritis
- Systemic lupus erythematosus (Correct answer)
- Sjögren syndrome
- Dermatomyositis
Correct answer: Systemic lupus erythematosus
SLE is confirmed by anti-dsDNA antibodies, low complement, malar rash, arthritis, and oral ulcers meeting ACR criteria.
Question 7: A patient presents with confusion, asterixis, and jaundice. Labs show elevated ammonia, PT, and bilirubin. What is the primary mechanism of the encephalopathy?
- Hypoglycemia from liver failure
- Accumulation of ammonia causing cerebral edema (Correct answer)
- Cerebral hypoperfusion from low albumin
- Thiamine deficiency
Correct answer: Accumulation of ammonia causing cerebral edema
Hepatic encephalopathy results primarily from elevated ammonia, which crosses the blood-brain barrier and causes astrocyte swelling and cerebral dysfunction.
PANCE PANCE 3
A 45-year-old male is found to have a BP of 155/95 mmHg on three separate occasions.
He also has diabetes and proteinuria.
What is the most appropriate antihypertensive?