PANCE PANCE Evaluation 4 — Questions and Answers
Question 1: A 3-year-old child presents with a barking cough, inspiratory stridor, and low-grade fever. Neck X-ray shows a 'steeple sign.' What is the most likely diagnosis?
- Epiglottitis
- Foreign body aspiration
- Viral croup (laryngotracheobronchitis) (Correct answer)
- Peritonsillar abscess
Correct answer: Viral croup (laryngotracheobronchitis)
Viral croup causes subglottic narrowing visible as the steeple sign on AP neck X-ray, with characteristic barking cough and inspiratory stridor.
Question 2: A 48-year-old male presents with sudden severe 'thunderclap' headache described as the worst of his life. CT head is negative. What is the next most appropriate step?
- Discharge with sumatriptan for migraine
- Perform MRI brain with gadolinium
- Perform lumbar puncture to detect xanthochromia (Correct answer)
- Order ESR and CRP for temporal arteritis
Correct answer: Perform lumbar puncture to detect xanthochromia
A negative CT does not rule out subarachnoid hemorrhage; lumbar puncture detecting xanthochromia is required to exclude SAH when CT is negative.
Question 3: A 32-year-old woman presents with pleuritic chest pain, malar rash, oral ulcers, and arthralgias. Lab work shows anti-dsDNA antibodies and low complement (C3/C4). What is the most likely diagnosis?
- Rheumatoid arthritis
- Systemic lupus erythematosus (SLE) (Correct answer)
- Sjogren's syndrome
- Mixed connective tissue disease
Correct answer: Systemic lupus erythematosus (SLE)
SLE is characterized by malar rash, oral ulcers, serositis (pleuritis), arthritis, and positive anti-dsDNA with low complement levels.
Question 4: A 70-year-old male smoker presents with a 3-cm solitary pulmonary nodule found incidentally on chest X-ray. What characteristic would MOST suggest a benign lesion?
- Irregular spiculated margins
- Upper lobe location
- Popcorn calcification pattern (Correct answer)
- Doubling time of 90 days
Correct answer: Popcorn calcification pattern
Popcorn calcification is characteristic of pulmonary hamartoma and is a reliable benign pattern, along with central, laminated, or diffuse calcification.
Question 5: A 25-year-old male presents with urethral discharge and dysuria. Gram stain shows gram-negative intracellular diplococci. Which antibiotic regimen is currently recommended by CDC guidelines?
- Azithromycin 1g orally single dose
- Doxycycline 100mg twice daily for 7 days
- Ceftriaxone 500mg IM single dose plus doxycycline 100mg twice daily for 7 days (Correct answer)
- Ciprofloxacin 500mg orally single dose
Correct answer: Ceftriaxone 500mg IM single dose plus doxycycline 100mg twice daily for 7 days
Current CDC guidelines recommend ceftriaxone 500 mg IM (or 1g if weight ≥150 kg) plus doxycycline (if chlamydia not excluded) for uncomplicated gonorrhea.
Question 6: A 60-year-old woman presents with progressive difficulty climbing stairs and rising from a chair over 4 months, with proximal muscle weakness but no muscle pain. CK is mildly elevated. Which antibody is associated with dermatomyositis?
- Anti-Jo-1
- Anti-Mi-2 (Correct answer)
- Anti-SRP
- Anti-MDA5
Correct answer: Anti-Mi-2
Anti-Mi-2 antibodies are highly specific for dermatomyositis (classic DM) and correlate with a good response to treatment.
Question 7: A newborn is found to have bilious vomiting on day 2 of life. X-ray shows a 'double bubble' sign. What is the most likely diagnosis?
- Pyloric stenosis
- Duodenal atresia (Correct answer)
- Hirschsprung disease
- Meconium ileus
Correct answer: Duodenal atresia
Duodenal atresia produces the classic double bubble sign (distended stomach and proximal duodenum) and presents with bilious vomiting in the first 24-48 hours.
PANCE PANCE Evaluation 4
A 3-year-old child presents with a barking cough, inspiratory stridor, and low-grade fever.
Neck X-ray shows a 'steeple sign.' What is the most likely diagnosis?