PANRE Ultimate PANRE 2 — Questions and Answers
Question 1: A 58-year-old male with type 2 diabetes presents with a painless, punched-out ulcer on the plantar surface of his foot. Pedal pulses are intact and monofilament testing shows loss of sensation. What is the primary pathophysiology?
- Peripheral arterial disease
- Peripheral neuropathy (Correct answer)
- Venous insufficiency
- Charcot arthropathy
Correct answer: Peripheral neuropathy
Peripheral neuropathy is the primary driver of neuropathic (diabetic) foot ulcers, causing loss of protective sensation and pressure-induced tissue breakdown.
Question 2: Which antibiotic class is the treatment of choice for community-acquired pneumonia in a healthy outpatient adult with no comorbidities?
- Fluoroquinolones
- Beta-lactams
- Macrolides (Correct answer)
- Tetracyclines
Correct answer: Macrolides
Current IDSA/ATS guidelines recommend macrolides (e.g., azithromycin) as first-line monotherapy for otherwise healthy adults with CAP who have no comorbidities.
Question 3: A 45-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance. TSH is 12 mIU/L and free T4 is low. Which medication is the standard of care?
- Methimazole
- Propylthiouracil
- Levothyroxine (Correct answer)
- Liothyronine
Correct answer: Levothyroxine
Levothyroxine (synthetic T4) is the standard treatment for primary hypothyroidism due to its consistent potency, long half-life, and predictable peripheral conversion to T3.
Question 4: A patient is found to have a serum potassium of 6.8 mEq/L with peaked T waves on ECG. Which intervention should be performed FIRST?
- Sodium polystyrene sulfonate (Kayexalate)
- IV insulin and dextrose
- IV calcium gluconate (Correct answer)
- Sodium bicarbonate
Correct answer: IV calcium gluconate
IV calcium gluconate is given first to stabilize cardiac membranes and prevent potentially fatal arrhythmias, buying time for potassium-lowering therapies.
Question 5: A 32-year-old woman at 10 weeks gestation presents with nausea, vomiting, vaginal bleeding, and a uterus larger than dates. Beta-hCG is markedly elevated and ultrasound shows a 'snowstorm' pattern. What is the diagnosis?
- Threatened abortion
- Ectopic pregnancy
- Complete hydatidiform mole (Correct answer)
- Choriocarcinoma
Correct answer: Complete hydatidiform mole
A snowstorm ultrasound pattern with markedly elevated beta-hCG, uterus larger than dates, and vaginal bleeding is classic for a complete hydatidiform mole.
Question 6: Which finding on urinalysis is most consistent with nephrotic syndrome?
- RBC casts
- WBC casts
- Massive proteinuria (>3.5 g/day) (Correct answer)
- Granular casts
Correct 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.
Question 7: A 70-year-old male smoker presents with progressive dyspnea and a persistent cough. Spirometry reveals FEV1/FVC ratio of 0.62 and an FEV1 of 55% predicted. Which GOLD stage does this represent?
- GOLD 1 (Mild)
- GOLD 2 (Moderate) (Correct answer)
- GOLD 3 (Severe)
- GOLD 4 (Very Severe)
Correct answer: GOLD 2 (Moderate)
GOLD 2 (Moderate COPD) is defined by an FEV1/FVC <0.70 with FEV1 50–80% predicted.
PANRE Ultimate PANRE 2
A 58-year-old male with type 2 diabetes presents with a painless, punched-out ulcer on the plantar surface of his foot.
Pedal pulses are intact and monofilament testing shows loss of sensation.
What is the primary pathophysiology?