PANRE Ultimate PANRE 3

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?

Accepted Answer

Streptococcus pneumoniae

Answer

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?

Accepted Answer

Hold warfarin only and recheck in 24 hours

Answer

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?

Accepted Answer

Central diabetes insipidus

Answer

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?

Accepted Answer

Delta wave with short PR interval

Answer

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?

Accepted Answer

Anti-Smith (anti-Sm)

Answer

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.

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PANRE Ultimate PANRE 3