PANCE PANCE Analysis 4

Question 1

A 50-year-old man with a history of gout presents with acute onset of severe pain and swelling of the first MTP joint. He is on hydrochlorothiazide for hypertension. What is the best initial treatment for the acute attack?

Accepted Answer

Indomethacin

Answer

NSAIDs such as indomethacin are first-line treatment for acute gouty arthritis; urate-lowering agents like allopurinol should not be started during an acute attack.

Question 2

A 4-year-old boy presents with a 3-day history of fever, bilateral conjunctivitis, strawberry tongue, cracked lips, a polymorphous rash, and cervical lymphadenopathy. What is the most important complication to prevent?

Accepted Answer

Coronary artery aneurysms

Answer

Kawasaki disease can cause coronary artery aneurysms, the most serious complication, which is prevented by early treatment with IVIG and aspirin.

Question 3

A 72-year-old woman presents with sudden-onset right-sided weakness and aphasia that resolved completely within 45 minutes. MRI of the brain shows no acute infarct. What is the most appropriate next step?

Accepted Answer

Admit for urgent evaluation and antiplatelet therapy

Answer

A TIA carries a high short-term stroke risk (up to 10% within 2 days), requiring urgent inpatient evaluation including imaging, cardiac monitoring, and antiplatelet therapy.

Question 4

A 28-year-old man presents with painless testicular swelling. Ultrasound shows a hypoechoic intratesticular mass. AFP and beta-hCG are both elevated. What is the most likely diagnosis?

Accepted Answer

Nonseminomatous germ cell tumor

Answer

Elevation of both AFP and beta-hCG indicates a nonseminomatous germ cell tumor (e.g., embryonal carcinoma, yolk sac tumor), as pure seminomas do not elevate AFP.

Question 5

A 34-year-old woman presents with weight gain, cold intolerance, constipation, and dry skin. TSH is 18 mIU/L and free T4 is low. Anti-TPO antibodies are positive. What is the most likely diagnosis?

Accepted Answer

Hashimoto thyroiditis

Answer

Hashimoto thyroiditis (autoimmune) is the most common cause of primary hypothyroidism in the US, characterized by elevated TSH, low T4, and positive anti-TPO antibodies.

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PANCE PANCE Analysis 4