PANRE PANRE 4 — Questions and Answers
Question 1: A 68-year-old man on aspirin and clopidogrel after a coronary stent presents with melena. Vitals are stable. Which is the most important next step?
- Discontinue all antiplatelet therapy immediately
- Perform urgent upper endoscopy
- Administer IV proton pump inhibitor and consult cardiology before stopping antiplatelets (Correct answer)
- Transfuse 2 units of packed red blood cells
Correct answer: Administer IV proton pump inhibitor and consult cardiology before stopping antiplatelets
In patients with recent stents, abruptly stopping antiplatelets risks stent thrombosis; IV PPI and cardiology consultation are needed before altering antiplatelet therapy.
Question 2: A newborn develops jaundice within the first 24 hours of life. Mother is blood type O negative, baby is A positive. Which condition is most likely?
- Physiologic jaundice
- ABO hemolytic disease of the newborn (Correct answer)
- Biliary atresia
- Crigler-Najjar syndrome
Correct answer: ABO hemolytic disease of the newborn
Jaundice appearing within 24 hours is pathologic; ABO incompatibility with O-negative mother and A-positive infant causes hemolytic disease of the newborn.
Question 3: A 60-year-old woman with a history of breast cancer presents with hypercalcemia, constipation, polyuria, and confusion. Calcium is 13.5 mg/dL. What is the first treatment?
- IV bisphosphonates
- IV normal saline hydration (Correct answer)
- Calcitonin
- Furosemide
Correct answer: IV normal saline hydration
IV normal saline is the first-line treatment for hypercalcemia to restore volume depletion and promote renal calcium excretion.
Question 4: A 35-year-old man presents with bilateral knee pain, oral ulcers, and conjunctivitis after a recent episode of urethritis. Which is the most likely diagnosis?
- Ankylosing spondylitis
- Reactive arthritis (Correct answer)
- Psoriatic arthritis
- Gonococcal arthritis
Correct answer: Reactive arthritis
Reactive arthritis (formerly Reiter syndrome) is characterized by the classic triad of arthritis, urethritis, and conjunctivitis following a genitourinary or GI infection.
Question 5: A 52-year-old smoker presents with hemoptysis, weight loss, and a right hilar mass on chest X-ray. Biopsy shows small, dark cells with scant cytoplasm. Which treatment is most appropriate?
- Surgical lobectomy
- Chemotherapy and radiation (Correct answer)
- Bronchial artery embolization
- Targeted therapy with erlotinib
Correct answer: Chemotherapy and radiation
Small cell lung cancer is exquisitely sensitive to chemotherapy and radiation, making chemoradiation the primary treatment even in limited-stage disease.
Question 6: A 45-year-old woman with systemic lupus erythematosus (SLE) on hydroxychloroquine develops blurry vision. Which complication is most concerning?
- Corneal deposits
- Retinal toxicity (Correct answer)
- Glaucoma
- Cataracts
Correct answer: Retinal toxicity
Hydroxychloroquine can cause irreversible retinal toxicity (bull's eye maculopathy), requiring annual ophthalmologic screening.
Question 7: Which vaccine is contraindicated in a 30-year-old pregnant woman?
- Tetanus, diphtheria, pertussis (Tdap)
- Inactivated influenza
- Pneumococcal polysaccharide
- MMR (measles, mumps, rubella) (Correct answer)
Correct answer: MMR (measles, mumps, rubella)
MMR is a live attenuated vaccine and is absolutely contraindicated in pregnancy due to theoretical risk of fetal infection.
PANRE PANRE 4
A 68-year-old man on aspirin and clopidogrel after a coronary stent presents with melena.
Vitals are stable.
Which is the most important next step?