Mixed Deck — All PANRE Topics Flashcards

Which professional attribute is most valued in obstetrics and gynecology within the PANRE field?

Answer: Accountability and commitment to standards

Accountability and commitment to professional standards build trust and ensure consistent, high-quality practice.

A 62-year-old male with a history of chronic liver disease presents with confusion, asterixis, and elevated ammonia. Which medication is first-line to reduce ammonia production in the gut?

Answer: Lactulose

Lactulose is first-line for hepatic encephalopathy; it acidifies the colon, trapping ammonia as ammonium (NH4+) and promoting its excretion.

Which finding on urinalysis is most consistent with nephrotic syndrome?

Answer: Massive proteinuria (>3.5 g/day)

Nephrotic syndrome is defined by massive proteinuria (>3.5 g/day), which drives the associated hypoalbuminemia, edema, and hyperlipidemia.

A child presents with cola-colored urine, periorbital edema, and hypertension 2 weeks after strep throat. What is the most likely diagnosis?

Answer: Post-streptococcal glomerulonephritis

Post-streptococcal glomerulonephritis classically presents 1-3 weeks after Group A Strep pharyngitis with hematuria, edema, and hypertension.

Which professional attribute is most valued in cardiology within the PANRE field?

Answer: Accountability and commitment to standards

Accountability and commitment to professional standards build trust and ensure consistent, high-quality practice.

Which approach best demonstrates mastery of gastroenterology in PANRE practice?

Answer: Applying principles to novel situations with sound judgment

True mastery involves understanding underlying principles well enough to apply them to new and unfamiliar situations with professional judgment.

A 62-year-old man with hypertension develops sudden left-sided weakness and slurred speech that resolves completely in 45 minutes. Workup includes ECG showing atrial fibrillation. Best long-term stroke prevention strategy?

Answer: Anticoagulation with a DOAC

Atrial fibrillation-related TIA requires anticoagulation (preferably a DOAC) to prevent cardioembolic stroke; antiplatelet therapy is insufficient for this indication.

Which of the following symptoms is NOT part of the DSM-5 criteria for major neurocognitive disorder (dementia)?

Answer: Acute onset over hours

Acute onset suggests delirium, not dementia; major NCD requires gradual onset and progressive decline.

A 30-year-old presents with 6 months of grandiosity, decreased need for sleep, pressured speech, and impulsive spending, but continues to work. Which diagnosis best fits?

Answer: Bipolar II disorder, hypomanic episode

Hypomania lasts ≥4 days, does not cause marked impairment, and does not require hospitalization, distinguishing it from mania.

Which urinalysis finding best distinguishes prerenal AKI from intrinsic renal (ATN) AKI?

Answer: Fractional excretion of sodium (FENa) <1%

A FENa <1% indicates intact tubular sodium reabsorption, consistent with prerenal azotemia where tubular function is preserved.

A 70-year-old man with BPH is started on tamsulosin. He develops dizziness after standing. Which mechanism explains this side effect?

Answer: Alpha-1 receptor blockade causing venous pooling

Tamsulosin is an alpha-1 adrenergic blocker; blockade of vascular alpha-1 receptors causes vasodilation and orthostatic hypotension.

A 40-year-old presents with pruritic, excoriated papules on the interdigital web spaces, wrists, and genitalia. His wife has similar symptoms. Mineral oil preparation of a skin scraping reveals what finding?

Answer: Mites, eggs, or feces (scybala)

Scabies is confirmed by identifying Sarcoptes scabiei mites, eggs, or scybala (fecal pellets) on microscopy of skin scrapings from burrows.

Which psychotherapy has the strongest evidence base for borderline personality disorder?

Answer: Dialectical behavior therapy

Dialectical behavior therapy (DBT) is the gold-standard psychotherapy for borderline personality disorder.

A 45-year-old with HIV presents with focal seizures and a ring-enhancing lesion on MRI. The most likely diagnosis is:

Answer: Toxoplasma encephalitis

In HIV-positive patients, a ring-enhancing brain lesion most commonly represents Toxoplasma gondii encephalitis, especially when CD4 count is below 100 cells/µL.

A 30-year-old presents with spontaneous pneumothorax on the right side with 25% lung collapse. He is hemodynamically stable. What is the most appropriate management?

Answer: Small-bore chest tube or aspiration

A primary spontaneous pneumothorax with >20% collapse in a stable patient is typically managed with small-bore chest tube or needle aspiration.

A patient on an ACE inhibitor is found to have bilateral renal artery stenosis. Which lab change is most expected after starting the ACE inhibitor?

Answer: Increased serum creatinine

ACE inhibitors block efferent arteriolar vasoconstriction, causing a significant drop in GFR and a rise in creatinine in bilateral renal artery stenosis.

A 55-year-old male presents with plethora, headache, and pruritus after bathing. Hgb is 19.4 g/dL, Hct 58%, WBC 13,000/μL, platelets 520,000/μL. JAK2 V617F mutation is positive. What is the most likely diagnosis?

Answer: Polycythemia vera

Polycythemia vera is a myeloproliferative neoplasm characterized by elevated red cell mass, JAK2 V617F mutation, and aquagenic pruritus, with associated thrombocytosis and leukocytosis.

A 55-year-old male presents with progressive exertional dyspnea, loud P2, and right heart failure. Echocardiogram shows RVSP of 58 mmHg. Right heart catheterization confirms mean PAP of 32 mmHg with PCWP of 10 mmHg. Which initial treatment is recommended for WHO Group 1 pulmonary arterial hypertension?

Answer: Endothelin receptor antagonist or PDE-5 inhibitor

WHO Group 1 PAH is treated with PAH-specific therapy including endothelin receptor antagonists (ambrisentan, bosentan) or PDE-5 inhibitors (sildenafil, tadalafil).

A 50-year-old man with long-standing GERD undergoes surveillance endoscopy revealing Barrett's esophagus with high-grade dysplasia. What is the recommended management?

Answer: Endoscopic eradication therapy (radiofrequency ablation)

Endoscopic eradication therapy, particularly radiofrequency ablation, is the recommended treatment for Barrett's esophagus with high-grade dysplasia as it effectively eliminates dysplastic epithelium.

A patient with myasthenia gravis undergoes elective surgery. Which medication should be avoided perioperatively due to risk of cholinergic crisis if combined with pyridostigmine?

Answer: Succinylcholine

Succinylcholine is a depolarizing neuromuscular blocker metabolized by acetylcholinesterase; pyridostigmine inhibits this enzyme, leading to prolonged paralysis or crisis.