PANRE Ultimate PANRE 5 — Questions and Answers
Question 1: A 62-year-old male with a history of chronic liver disease presents with confusion, asterixis, and elevated ammonia. Which medication is first-line to reduce ammonia production in the gut?
- Neomycin
- Rifaximin
- Lactulose (Correct answer)
- Metronidazole
Correct answer: Lactulose
Lactulose is first-line for hepatic encephalopathy; it acidifies the colon, trapping ammonia as ammonium (NH4+) and promoting its excretion.
Question 2: A 55-year-old woman is diagnosed with stage IIIa non-small cell lung cancer. She has no druggable mutations. What is the standard of care?
- Surgery alone
- Chemotherapy alone
- Concurrent chemoradiation followed by durvalumab (Correct answer)
- Immunotherapy alone
Correct answer: Concurrent chemoradiation followed by durvalumab
Stage III NSCLC without resectable disease is treated with concurrent chemoradiation followed by consolidation durvalumab (anti-PD-L1) per the PACIFIC trial.
Question 3: A 4-year-old presents with a purpuric rash on the buttocks and lower extremities, colicky abdominal pain, arthritis, and hematuria. Labs show normal platelet count. What is the diagnosis?
- Thrombocytopenic purpura
- Meningococcemia
- IgA vasculitis (Henoch-Schönlein purpura) (Correct answer)
- Leukocytoclastic vasculitis
Correct answer: IgA vasculitis (Henoch-Schönlein purpura)
IgA vasculitis (HSP) is characterized by palpable purpura on buttocks/lower extremities, arthritis, abdominal pain, and renal involvement with normal platelet count.
Question 4: A 48-year-old male with a history of alcoholism presents with confusion, ophthalmoplegia, and ataxia. What is the immediate treatment?
- Glucose
- Thiamine (vitamin B1)
- Naloxone
- Thiamine followed by glucose (Correct answer)
Correct answer: Thiamine followed by glucose
Thiamine must be administered before glucose in alcoholic patients to prevent precipitating or worsening Wernicke encephalopathy; then glucose is given.
Question 5: A 35-year-old woman presents with severe, unilateral periorbital pain occurring nightly for 3 weeks, lasting 45 minutes, with ipsilateral lacrimation and rhinorrhea. What is the diagnosis?
- Migraine with aura
- Trigeminal neuralgia
- Cluster headache (Correct answer)
- Paroxysmal hemicrania
Correct answer: Cluster headache
Cluster headaches are characterized by severe unilateral periorbital pain with ipsilateral autonomic features (lacrimation, rhinorrhea) occurring in clusters, often nocturnally.
Question 6: Which medication used for type 2 diabetes has the most evidence for reducing cardiovascular mortality in patients with established cardiovascular disease?
- Glipizide
- Pioglitazone
- Empagliflozin (Correct answer)
- Sitagliptin
Correct answer: Empagliflozin
SGLT-2 inhibitors like empagliflozin have demonstrated significant reduction in cardiovascular death and hospitalization for heart failure in the EMPA-REG OUTCOME trial.
Question 7: A 68-year-old man with a 40 pack-year history presents with a 2.5 cm solitary pulmonary nodule. PET scan shows no FDG uptake. What is the most appropriate next step?
- CT-guided biopsy immediately
- Surgical resection
- CT surveillance at 3-month intervals (Correct answer)
- Bronchoscopy
Correct answer: CT surveillance at 3-month intervals
A solid pulmonary nodule ≥6 mm in a high-risk patient with no PET activity warrants serial CT surveillance per Fleischner Society guidelines rather than immediate biopsy.
PANRE Ultimate PANRE 5
A 62-year-old male with a history of chronic liver disease presents with confusion, asterixis, and elevated ammonia.
Which medication is first-line to reduce ammonia production in the gut?