PANRE Ultimate PANRE 5

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?

Accepted Answer

Lactulose

Answer

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?

Accepted Answer

Concurrent chemoradiation followed by durvalumab

Answer

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?

Accepted Answer

IgA vasculitis (Henoch-Schönlein purpura)

Answer

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?

Accepted Answer

Thiamine followed by glucose

Answer

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?

Accepted Answer

Cluster headache

Answer

Cluster headaches are characterized by severe unilateral periorbital pain with ipsilateral autonomic features (lacrimation, rhinorrhea) occurring in clusters, often nocturnally.

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PANRE Ultimate PANRE 5