PANCE PANCE Analysis 5 — Questions and Answers
Question 1: A 45-year-old man presents with fatigue, splenomegaly, and a WBC of 120,000/µL with a left shift. Cytogenetics reveal the Philadelphia chromosome t(9;22). What is the first-line treatment?
- Hydroxyurea
- Imatinib (Gleevec) (Correct answer)
- Allogeneic stem cell transplant
- Interferon-alpha
Correct answer: Imatinib (Gleevec)
Imatinib, a BCR-ABL tyrosine kinase inhibitor, is first-line therapy for chronic myeloid leukemia (CML) harboring the Philadelphia chromosome.
Question 2: A 67-year-old man with BPH presents with inability to void, suprapubic distension, and a post-void residual of 800 mL on ultrasound. What is the most immediate intervention?
- Start tamsulosin and reassess in 48 hours
- Urethral catheterization (Correct answer)
- Emergent cystoscopy
- Suprapubic aspiration
Correct answer: Urethral catheterization
Acute urinary retention requires immediate relief via urethral catheterization to decompress the bladder and prevent renal injury.
Question 3: A 3-year-old boy presents with periorbital edema, ascites, and frothy urine. Urinalysis shows 4+ proteinuria. Serum albumin is 1.8 g/dL. What is the most likely diagnosis?
- Nephritic syndrome
- Nephrotic syndrome (Correct answer)
- IgA nephropathy
- Acute tubular necrosis
Correct answer: Nephrotic syndrome
Nephrotic syndrome is characterized by massive proteinuria (>3.5g/day), hypoalbuminemia, edema, and hyperlipidemia; in children, minimal change disease is the most common cause.
Question 4: A 25-year-old woman presents with recurrent episodes of severe unilateral headache with photophobia, phonophobia, and nausea lasting 8-12 hours. She has no neurological deficits. What is the best abortive therapy?
- Acetaminophen 1000 mg
- Sumatriptan 50 mg orally (Correct answer)
- Ergotamine 2 mg
- Prednisone 60 mg
Correct answer: Sumatriptan 50 mg orally
Triptans (5-HT1B/1D agonists) are first-line abortive therapy for moderate-to-severe migraines, providing targeted relief by causing vasoconstriction and blocking pain pathways.
Question 5: A 60-year-old man with newly diagnosed heart failure has an ejection fraction of 30%. He is already on an ACE inhibitor and a beta-blocker. Which additional agent has been shown to reduce mortality in this patient?
- Digoxin
- Spironolactone (Correct answer)
- Amlodipine
- Hydralazine
Correct answer: Spironolactone
Aldosterone antagonists (spironolactone/eplerenone) reduce mortality in HFrEF when added to ACE inhibitor and beta-blocker therapy in appropriately selected patients.
Question 6: A 52-year-old woman presents with progressive proximal muscle weakness making it difficult to rise from a chair, a heliotrope rash on her eyelids, and Gottron papules on her knuckles. What laboratory finding is most helpful in confirming the diagnosis?
- Elevated ESR
- Elevated creatine kinase (Correct answer)
- Positive ANA
- Elevated rheumatoid factor
Correct answer: Elevated creatine kinase
Elevated creatine kinase reflects muscle inflammation and damage in dermatomyositis, making it the most useful confirmatory lab alongside the characteristic skin findings.
Question 7: A 38-year-old man presents with recurrent kidney stones. 24-hour urine shows elevated uric acid. He has a history of gout. What is the most appropriate long-term preventive measure for his kidney stones?
- Increase dietary protein intake
- Urinary alkalinization with potassium citrate and allopurinol (Correct answer)
- Restrict fluid intake
- Start hydrochlorothiazide
Correct answer: Urinary alkalinization with potassium citrate and allopurinol
Uric acid stones form in acidic urine; urinary alkalinization with potassium citrate raises urine pH to dissolve/prevent stones, and allopurinol reduces uric acid production.
PANCE PANCE Analysis 5
A 45-year-old man presents with fatigue, splenomegaly, and a WBC of 120,000/µL with a left shift.
Cytogenetics reveal the Philadelphia chromosome t(9;22).
What is the first-line treatment?