PANCE PANCE Analysis 3 — Questions and Answers
Question 1: A 40-year-old woman with rheumatoid arthritis presents with fatigue, pallor, and a hemoglobin of 9.5 g/dL. Iron studies show low serum iron, low TIBC, and elevated ferritin. What is the most likely cause of her anemia?
- Iron deficiency anemia
- Anemia of chronic disease (Correct answer)
- Sideroblastic anemia
- Hemolytic anemia
Correct answer: Anemia of chronic disease
Anemia of chronic disease shows low serum iron and TIBC with elevated ferritin, reflecting sequestration of iron by inflammatory cytokines.
Question 2: A 62-year-old man presents with progressive dysphagia to solids more than liquids and a 20-lb weight loss over 3 months. He has a 40-pack-year smoking history. What is the most likely diagnosis?
- Achalasia
- Esophageal carcinoma (Correct answer)
- Diffuse esophageal spasm
- Zenker diverticulum
Correct answer: Esophageal carcinoma
Progressive dysphagia to solids worse than liquids with significant weight loss in an older smoker is classic for esophageal carcinoma.
Question 3: A neonate born at 28 weeks gestation develops respiratory distress within 2 hours of birth. CXR shows bilateral ground-glass opacities and air bronchograms. What is the underlying pathophysiology?
- Meconium aspiration
- Surfactant deficiency (Correct answer)
- Transient tachypnea of the newborn
- Congenital pneumonia
Correct answer: Surfactant deficiency
Respiratory distress syndrome in premature infants results from surfactant deficiency, leading to alveolar collapse and the characteristic ground-glass appearance.
Question 4: A 55-year-old man with a history of alcohol use disorder presents with painless jaundice, clay-colored stools, and dark urine. Ultrasound shows dilation of the common bile duct. What is the most likely cause?
- Choledocholithiasis
- Pancreatic head carcinoma (Correct answer)
- Primary sclerosing cholangitis
- Alcoholic hepatitis
Correct answer: Pancreatic head carcinoma
Painless obstructive jaundice with dilated CBD in an older patient is the classic presentation of pancreatic head carcinoma compressing the bile duct.
Question 5: A 30-year-old woman presents with a butterfly rash, joint pain, oral ulcers, and a positive ANA with anti-dsDNA antibodies. Which complication is most likely to determine her long-term prognosis?
- Dermatitis
- Lupus nephritis (Correct answer)
- Serositis
- Photosensitivity
Correct answer: Lupus nephritis
Lupus nephritis is the most serious complication of SLE and the leading cause of morbidity and mortality, requiring close monitoring of renal function.
Question 6: A 19-year-old male athlete collapses during a basketball game. He is resuscitated from ventricular fibrillation. ECG shows ST elevation in V1-V2 with a right bundle branch block pattern. What is the most likely diagnosis?
- Hypertrophic cardiomyopathy
- Brugada syndrome (Correct answer)
- Long QT syndrome
- Arrhythmogenic right ventricular cardiomyopathy
Correct answer: Brugada syndrome
Brugada syndrome presents with the characteristic coved-type ST elevation in V1-V2 with RBBB pattern and is a cause of sudden cardiac death in young individuals.
Question 7: A 68-year-old woman presents with polyuria, polydipsia, constipation, and confusion. Labs show calcium of 13.8 mg/dL and PTH is elevated. What is the most common cause of this presentation?
- Malignancy-associated hypercalcemia
- Primary hyperparathyroidism (Correct answer)
- Vitamin D toxicity
- Sarcoidosis
Correct answer: Primary hyperparathyroidism
Primary hyperparathyroidism is the most common cause of asymptomatic and symptomatic hypercalcemia with elevated PTH, typically due to a parathyroid adenoma.
PANCE PANCE Analysis 3
A 40-year-old woman with rheumatoid arthritis presents with fatigue, pallor, and a hemoglobin of 9.5 g/dL.
Iron studies show low serum iron, low TIBC, and elevated ferritin.
What is the most likely cause of her anemia?