PANCE PANCE 4 — Questions and Answers
Question 1: A 3-year-old boy is brought in for evaluation of a painless scrotal mass. Transillumination is positive. What is the most likely diagnosis?
- Testicular torsion
- Hydrocele (Correct answer)
- Inguinal hernia
- Epididymitis
Correct answer: Hydrocele
A hydrocele is a fluid-filled sac around the testis that transilluminates and is typically painless in young children.
Question 2: A 68-year-old woman presents with progressive proximal muscle weakness, difficulty rising from a chair, and a heliotrope rash. CK is markedly elevated. What is the diagnosis?
- Polymyalgia rheumatica
- Dermatomyositis (Correct answer)
- Multiple sclerosis
- Myasthenia gravis
Correct answer: Dermatomyositis
Dermatomyositis presents with proximal muscle weakness, elevated CK, and characteristic skin findings including the heliotrope rash.
Question 3: A 25-year-old male presents with painless enlargement of the right testis. Ultrasound shows a solid intratesticular mass. AFP is elevated. What is the most likely tumor type?
- Seminoma
- Yolk sac tumor (Correct answer)
- Leydig cell tumor
- Lymphoma
Correct answer: Yolk sac tumor
Non-seminomatous germ cell tumors (yolk sac tumor) produce AFP; seminomas do not, making AFP elevation characteristic of non-seminomatous tumors.
Question 4: A 40-year-old female presents with fatigue, constipation, and cold intolerance. TSH is 12 µIU/mL, free T4 is low. Anti-TPO antibodies are elevated. What is the most likely diagnosis?
- Graves disease
- Subacute thyroiditis
- Hashimoto thyroiditis (Correct answer)
- Secondary hypothyroidism
Correct answer: Hashimoto thyroiditis
Hashimoto thyroiditis is autoimmune hypothyroidism characterized by elevated TSH, low T4, and positive anti-TPO antibodies.
Question 5: An 8-year-old child develops facial edema and frothy urine. Urinalysis shows 4+ protein. Serum albumin is 1.8 g/dL. No hematuria or hypertension. What is the most likely diagnosis?
- IgA nephropathy
- Nephrotic syndrome — minimal change disease (Correct answer)
- Post-streptococcal glomerulonephritis
- Alport syndrome
Correct answer: Nephrotic syndrome — minimal change disease
Minimal change disease is the most common cause of nephrotic syndrome in children, presenting with massive proteinuria, hypoalbuminemia, and edema without hematuria.
Question 6: A 55-year-old male with alcoholism presents with confusion, ophthalmoplegia, and ataxia. What is the immediate treatment?
- Glucose IV bolus
- Thiamine IV before glucose (Correct answer)
- Haloperidol IM
- Lorazepam IV
Correct answer: Thiamine IV before glucose
Wernicke encephalopathy requires IV thiamine before glucose to prevent precipitation or worsening of the syndrome in thiamine-deficient patients.
Question 7: A 60-year-old male smoker presents with a persistent cough, hemoptysis, and a 4 cm hilar mass on CXR. Biopsy shows small dark cells with nuclear molding and necrosis. What is the cell type?
- Adenocarcinoma
- Squamous cell carcinoma
- Small cell lung cancer (Correct answer)
- Large cell carcinoma
Correct answer: Small cell lung cancer
Small cell lung cancer (SCLC) is a neuroendocrine tumor with characteristic small dark cells, nuclear molding, and central/hilar location strongly associated with smoking.
PANCE PANCE 4
A 3-year-old boy is brought in for evaluation of a painless scrotal mass.
Transillumination is positive.
What is the most likely diagnosis?