PANCE PANCE Evaluation 4

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?

Accepted Answer

Viral croup (laryngotracheobronchitis)

Answer

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?

Accepted Answer

Perform lumbar puncture to detect xanthochromia

Answer

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?

Accepted Answer

Systemic lupus erythematosus (SLE)

Answer

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?

Accepted Answer

Popcorn calcification pattern

Answer

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?

Accepted Answer

Ceftriaxone 500mg IM single dose plus doxycycline 100mg twice daily for 7 days

Answer

Current CDC guidelines recommend ceftriaxone 500 mg IM (or 1g if weight ≥150 kg) plus doxycycline (if chlamydia not excluded) for uncomplicated gonorrhea.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE PANCE Evaluation 4