PANRE Ultimate PANRE 3 — Questions and Answers
Question 1: A 25-year-old male presents with fever, stiff neck, and photophobia. CSF analysis shows glucose 30 mg/dL, protein 200 mg/dL, and WBC 1,200 cells/µL with 90% neutrophils. What is the most likely organism?
- Listeria monocytogenes
- Streptococcus pneumoniae (Correct answer)
- Neisseria meningitidis
- Cryptococcus neoformans
Correct answer: Streptococcus pneumoniae
S. pneumoniae is the most common cause of bacterial meningitis in adults, presenting with classic neutrophilic pleocytosis and low CSF glucose.
Question 2: A patient on warfarin for atrial fibrillation has an INR of 8.5 with no active bleeding. What is the most appropriate management?
- Hold warfarin and give IV vitamin K
- Hold warfarin only and recheck in 24 hours (Correct answer)
- Give fresh frozen plasma
- Give prothrombin complex concentrate
Correct answer: Hold warfarin only and recheck in 24 hours
For supratherapeutic INR (>8) without bleeding, holding warfarin and rechecking in 24 hours is appropriate; oral vitamin K may be added per guidelines.
Question 3: A 50-year-old woman presents with polyuria and polydipsia. Serum osmolality is 310 mOsm/kg and urine osmolality is 150 mOsm/kg. After water deprivation, urine osmolality remains low. Desmopressin administration increases urine osmolality to 350 mOsm/kg. What is the diagnosis?
- Nephrogenic diabetes insipidus
- Central diabetes insipidus (Correct answer)
- Primary polydipsia
- SIADH
Correct answer: Central diabetes insipidus
Response to desmopressin with an increase in urine osmolality confirms central (neurogenic) diabetes insipidus, where ADH production is deficient.
Question 4: Which ECG finding is most characteristic of Wolff-Parkinson-White (WPW) syndrome during sinus rhythm?
- Prolonged QT interval
- Delta wave with short PR interval (Correct answer)
- ST elevation in V1-V3
- Right bundle branch block
Correct answer: Delta wave with short PR interval
WPW is characterized by a delta wave (slurred QRS upstroke) and short PR interval due to conduction through an accessory pathway bypassing the AV node.
Question 5: A 40-year-old woman presents with a butterfly-shaped facial rash, joint pain, pleuritis, and renal involvement. ANA is positive. Which antibody is most specific for her diagnosis?
- Anti-dsDNA
- Anti-Smith (anti-Sm) (Correct answer)
- Anti-Ro/SSA
- Anti-histone
Correct answer: Anti-Smith (anti-Sm)
Anti-Smith (anti-Sm) antibodies are highly specific for SLE, although anti-dsDNA is more commonly ordered; anti-Sm is the most specific single antibody for SLE.
Question 6: A 65-year-old male with known BPH presents with inability to void, suprapubic pain, and a palpable bladder. What is the immediate management?
- Tamsulosin and re-evaluate in 48 hours
- Urethral catheterization (Correct answer)
- Suprapubic catheterization
- IV furosemide
Correct answer: Urethral catheterization
Acute urinary retention requires immediate bladder decompression; urethral catheterization is the first-line approach when no contraindication exists.
Question 7: A 28-year-old woman presents with episodic headaches, diaphoresis, and hypertension with BP 190/110 during attacks. Urine metanephrines are markedly elevated. What is the most likely diagnosis?
- Primary hyperaldosteronism
- Pheochromocytoma (Correct answer)
- Cushing syndrome
- Renal artery stenosis
Correct answer: Pheochromocytoma
Pheochromocytoma classically presents with paroxysmal hypertension, headache, and diaphoresis ('the 5 H's'), confirmed by elevated urine metanephrines.
PANRE Ultimate PANRE 3
A 25-year-old male presents with fever, stiff neck, and photophobia.
CSF analysis shows glucose 30 mg/dL, protein 200 mg/dL, and WBC 1,200 cells/µL with 90% neutrophils.
What is the most likely organism?