PANRE PANRE 5 — Questions and Answers
Question 1: A 70-year-old man with BPH is started on tamsulosin. He develops dizziness after standing. Which mechanism explains this side effect?
- Alpha-1 receptor blockade causing venous pooling (Correct answer)
- Beta-1 receptor blockade reducing heart rate
- Inhibition of PDE5 causing vasodilation
- Anticholinergic effects reducing preload
Correct 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.
Question 2: A 40-year-old woman presents with progressive proximal muscle weakness and a heliotrope rash around her eyes. CK is markedly elevated. What is the most likely diagnosis?
- Polymyalgia rheumatica
- Dermatomyositis (Correct answer)
- Systemic lupus erythematosus
- Fibromyalgia
Correct answer: Dermatomyositis
Dermatomyositis presents with proximal muscle weakness, elevated CK, and pathognomonic skin findings including heliotrope rash and Gottron papules.
Question 3: A 55-year-old man with a 30-pack-year smoking history presents with hemoptysis and a coin lesion on chest X-ray. PET scan shows no uptake. What is the next best step?
- Repeat chest X-ray in 6 months
- CT-guided needle biopsy (Correct answer)
- Bronchoscopy with BAL
- Surgical resection without biopsy
Correct answer: CT-guided needle biopsy
A solitary pulmonary nodule in a high-risk smoker with no PET activity requires tissue diagnosis; CT-guided needle biopsy is the most direct approach.
Question 4: A 28-year-old man presents with sudden severe 'thunderclap' headache reaching maximum intensity within seconds. CT head is negative. What is the next step?
- Prescribe sumatriptan and discharge
- Perform lumbar puncture (Correct answer)
- Obtain MRI with gadolinium
- Discharge with neurology follow-up
Correct answer: Perform lumbar puncture
A thunderclap headache with negative CT requires lumbar puncture to rule out subarachnoid hemorrhage, as CT misses 2-5% of SAH.
Question 5: A 50-year-old woman is found to have a fasting glucose of 112 mg/dL on two separate occasions. BMI is 31. Which intervention is most effective at preventing progression to type 2 diabetes?
- Start metformin immediately
- Lifestyle modification with weight loss and exercise (Correct answer)
- Low-dose insulin therapy
- Bariatric surgery referral
Correct answer: Lifestyle modification with weight loss and exercise
The Diabetes Prevention Program showed intensive lifestyle modification reduces diabetes risk by 58%, more effective than metformin (31%) in prediabetes.
Question 6: A 62-year-old woman with osteoporosis on alendronate for 5 years develops sudden mid-shaft femur pain while walking. X-ray shows a transverse fracture with cortical thickening. What is the cause?
- Osteosarcoma
- Atypical femur fracture from bisphosphonate use (Correct answer)
- Stress fracture from overuse
- Pathologic fracture from metastatic disease
Correct answer: Atypical femur fracture from bisphosphonate use
Long-term bisphosphonate use is associated with atypical subtrochanteric and femoral shaft fractures with characteristic transverse pattern and cortical beaking.
Question 7: A patient with schizophrenia on haloperidol develops fever (103°F), muscle rigidity, altered consciousness, and elevated CK. What is the most likely diagnosis?
- Serotonin syndrome
- Neuroleptic malignant syndrome (Correct answer)
- Tardive dyskinesia
- Acute dystonia
Correct answer: Neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to antipsychotics presenting with hyperthermia, lead-pipe rigidity, altered consciousness, and elevated CK.
PANRE PANRE 5
A 70-year-old man with BPH is started on tamsulosin.
He develops dizziness after standing.
Which mechanism explains this side effect?