PANRE Ultimate PANRE 4 — Questions and Answers
Question 1: A 5-year-old boy presents with fever, drooling, and severe odynophagia. He is sitting in a 'tripod' position and appears toxic. X-ray shows a 'thumbprint sign.' What is the most concerning diagnosis?
- Peritonsillar abscess
- Croup
- Epiglottitis (Correct answer)
- Retropharyngeal abscess
Correct answer: Epiglottitis
The thumbprint sign on lateral neck X-ray with drooling, stridor, and tripod positioning is classic for acute epiglottitis, a life-threatening airway emergency.
Question 2: A 55-year-old woman with rheumatoid arthritis on long-term methotrexate should receive which supplementation to reduce toxicity?
- Vitamin B12
- Folic acid (Correct answer)
- Vitamin D
- Iron
Correct answer: Folic acid
Folic acid supplementation reduces methotrexate-related side effects (mucositis, hepatotoxicity, cytopenias) without significantly reducing its anti-inflammatory efficacy.
Question 3: A 38-year-old male presents with rectal bleeding, weight loss, and change in bowel habits. Colonoscopy reveals a mass in the sigmoid colon. Which tumor marker is most useful for monitoring treatment response?
- PSA
- AFP
- CEA (Correct answer)
- CA 19-9
Correct answer: CEA
Carcinoembryonic antigen (CEA) is the primary tumor marker used to monitor treatment response and surveillance for recurrence in colorectal cancer.
Question 4: A 72-year-old woman on alendronate for osteoporosis presents with mid-thigh pain after minimal trauma. X-ray shows a transverse fracture with cortical beaking of the lateral cortex. What complication occurred?
- Pathologic fracture from metastasis
- Stress fracture
- Atypical femoral fracture from bisphosphonate use (Correct answer)
- Osteomalacic fracture
Correct answer: Atypical femoral fracture from bisphosphonate use
Long-term bisphosphonate use is associated with atypical femoral fractures, characterized by transverse fracture pattern and cortical beaking on the lateral cortex.
Question 5: A 60-year-old male smoker presents with hemoptysis and a central cavitary lung mass on CT. Biopsy shows large cells with abundant cytoplasm and no glandular or squamous features. What is the most likely cell type?
- Adenocarcinoma
- Small cell carcinoma
- Squamous cell carcinoma
- Large cell carcinoma (Correct answer)
Correct answer: Large cell carcinoma
Large cell carcinoma is an undifferentiated NSCLC that lacks features of adenocarcinoma, squamous cell, or small cell carcinoma on histology and is often centrally located.
Question 6: A 30-year-old male presents with bilateral ankle swelling, eye redness, and dysuria following an episode of Chlamydia trachomatis infection. What is the classic triad of his condition?
- Arthritis, uveitis, urethritis
- Arthritis, conjunctivitis, urethritis (Correct answer)
- Arthritis, oral ulcers, uveitis
- Arthritis, skin rash, urethritis
Correct answer: Arthritis, conjunctivitis, urethritis
Reactive arthritis (formerly Reiter syndrome) classically presents with the triad of arthritis, conjunctivitis, and urethritis following a triggering infection.
Question 7: A 45-year-old woman presents with sudden-onset severe headache described as 'the worst headache of my life.' CT head is negative. What is the next best step?
- MRI brain with gadolinium
- Lumbar puncture (Correct answer)
- Start sumatriptan
- EEG
Correct answer: Lumbar puncture
A negative CT head does not rule out subarachnoid hemorrhage; lumbar puncture should be performed to detect xanthochromia or RBCs in CSF.
PANRE Ultimate PANRE 4
A 5-year-old boy presents with fever, drooling, and severe odynophagia.
He is sitting in a 'tripod' position and appears toxic.
X-ray shows a 'thumbprint sign.' What is the most concerning diagnosis?