PANCE PANCE 5 — Questions and Answers
Question 1: 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?
- Septic arthritis
- Transient synovitis
- Legg-Calvé-Perthes disease (Correct answer)
- Slipped capital femoral epiphysis
Correct 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.
Question 2: A 72-year-old woman with osteoporosis is started on alendronate. What is the most important counseling instruction regarding administration?
- Take with a full glass of water and remain upright for 30 minutes (Correct answer)
- Take with food to improve absorption
- Take at bedtime to reduce GI side effects
- Take with calcium supplements simultaneously
Correct answer: Take with a full glass of water and remain upright for 30 minutes
Bisphosphonates must be taken with a full glass of water and the patient must remain upright for at least 30 minutes to prevent esophageal irritation.
Question 3: A 32-year-old woman at 38 weeks gestation develops severe headache, BP 165/110, and RUQ pain. Labs show thrombocytopenia, elevated LFTs, and low haptoglobin. What is the diagnosis?
- Preeclampsia without severe features
- Gestational hypertension
- HELLP syndrome (Correct answer)
- Acute fatty liver of pregnancy
Correct answer: HELLP syndrome
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of preeclampsia requiring urgent delivery.
Question 4: A 45-year-old male with HIV (CD4 count 80) presents with headache, fever, and meningismus. CSF India ink preparation shows encapsulated yeast. What is the most appropriate treatment?
- Fluconazole alone
- Amphotericin B plus flucytosine (Correct answer)
- Vancomycin plus ceftriaxone
- Trimethoprim-sulfamethoxazole
Correct answer: Amphotericin B plus flucytosine
Cryptococcal meningitis in immunocompromised patients is treated with induction using amphotericin B plus flucytosine, followed by consolidation with fluconazole.
Question 5: A 19-year-old male presents with fever, night sweats, and weight loss. Exam reveals painless cervical lymphadenopathy. Biopsy shows Reed-Sternberg cells. What is the diagnosis?
- Non-Hodgkin lymphoma
- Burkitt lymphoma
- Hodgkin lymphoma (Correct answer)
- Infectious mononucleosis
Correct answer: Hodgkin lymphoma
Reed-Sternberg cells ('owl eye' nuclei) are pathognomonic for Hodgkin lymphoma, which presents with painless lymphadenopathy and B symptoms.
Question 6: A 65-year-old male with BPH and urinary retention is catheterized and drains 1,200 mL of urine. Two hours later he develops gross hematuria and hypotension. What has occurred?
- Urinary tract infection
- Post-obstructive diuresis with hemorrhagic cystitis (Correct answer)
- Bladder rupture
- Vesicoureteral reflux
Correct answer: Post-obstructive diuresis with hemorrhagic cystitis
Rapid decompression of a chronically distended bladder can cause hemorrhagic cystitis from mucosal tears and post-obstructive diuresis leading to hemodynamic instability.
Question 7: A 50-year-old presents with symmetric ascending weakness starting in the legs 2 weeks after a GI illness. Deep tendon reflexes are absent. CSF shows elevated protein with normal cell count (albuminocytologic dissociation). What is the diagnosis?
- Multiple sclerosis
- Myasthenia gravis
- Guillain-Barré syndrome (Correct answer)
- ALS
Correct answer: Guillain-Barré syndrome
Guillain-Barré syndrome is an autoimmune demyelinating polyneuropathy characterized by ascending weakness, areflexia, and albuminocytologic dissociation in CSF.
PANCE PANCE 5
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?