PANCE PANCE Analysis 2

Question 1

A 58-year-old man presents with crushing chest pain radiating to the left arm. ECG shows ST elevations in leads II, III, and aVF. Which coronary artery is most likely occluded?

Accepted Answer

Right coronary artery

Answer

ST elevations in leads II, III, and aVF indicate an inferior MI, which is most commonly caused by occlusion of the right coronary artery.

Question 2

A patient with type 2 diabetes and CKD stage 3 requires glucose-lowering therapy. Which agent is contraindicated due to risk of lactic acidosis?

Accepted Answer

Metformin

Answer

Metformin is contraindicated when eGFR is below 30 mL/min due to risk of lactic acidosis from impaired renal clearance.

Question 3

A 35-year-old woman presents with episodic hypertension, headache, diaphoresis, and palpitations. Plasma free metanephrines are markedly elevated. What is the most appropriate next step?

Accepted Answer

CT scan of the abdomen and pelvis

Answer

Once biochemical confirmation of pheochromocytoma is established, CT of the abdomen and pelvis is performed to localize the tumor before surgical resection.

Question 4

A 22-year-old college student presents with fever, severe headache, photophobia, and a non-blanching petechial rash. What is the most immediate treatment?

Accepted Answer

Administer IV ceftriaxone immediately without delay

Answer

In suspected bacterial meningitis with a petechial rash (suggesting meningococcemia), IV antibiotics must be given immediately without waiting for lumbar puncture to prevent death.

Question 5

A 70-year-old man on warfarin for atrial fibrillation presents with an INR of 8.5 and active GI bleeding. What is the most appropriate reversal strategy?

Accepted Answer

4-factor prothrombin complex concentrate plus vitamin K IV

Answer

For life-threatening bleeding on warfarin, 4-factor PCC provides rapid reversal combined with IV vitamin K for sustained effect.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE PANCE Analysis 2