PANRE Emergency Medicine 2

Question 1

A 55-year-old male presents with crushing chest pain radiating to the left arm. ECG shows ST elevations in leads V1-V4. What is the most appropriate immediate management?

Accepted Answer

Administer IV heparin and arrange emergent PCI

Answer

STEMI with anterior wall involvement requires immediate reperfusion via primary PCI within 90 minutes of first medical contact, with anticoagulation.

Question 2

A 30-year-old woman presents with sudden-onset severe headache described as 'the worst headache of my life.' CT head is negative. What is the next best step?

Accepted Answer

Perform lumbar puncture to evaluate for xanthochromia

Answer

A thunderclap headache with negative CT requires lumbar puncture to detect xanthochromia, which indicates subarachnoid hemorrhage.

Question 3

An 8-year-old child presents with inspiratory stridor, drooling, and prefers to sit in a tripod position. Temperature is 39.5°C. What is the most likely diagnosis?

Accepted Answer

Epiglottitis

Answer

Epiglottitis presents with the classic triad of drooling, dysphagia, and distress along with high fever and a tripod posture to maintain airway patency.

Question 4

A 70-year-old man on warfarin presents after a fall with a GCS of 12 and INR of 3.8. CT shows a subdural hematoma. What reversal agent should be administered?

Accepted Answer

4-factor prothrombin complex concentrate (4F-PCC)

Answer

4F-PCC provides rapid reversal of warfarin anticoagulation and is preferred over FFP for emergent reversal due to faster onset and lower volume.

Question 5

A 45-year-old presents with acute scrotal pain of 2 hours duration. The testicle is tender, elevated, and the cremasteric reflex is absent. What is the priority action?

Accepted Answer

Arrange immediate surgical exploration

Answer

Absent cremasteric reflex with acute scrotal pain is testicular torsion until proven otherwise; surgical detorsion within 6 hours is critical to salvage the testicle.

PANRE Test Practice Test

PANRE Test Practice Test

PANRE Emergency Medicine 2