PANRE PANRE 2 — Questions and Answers
Question 1: A 58-year-old man with type 2 diabetes presents with a painless foot ulcer. ABI is 0.6. Which is the most appropriate next step?
- Start oral antibiotics and wound care
- Refer for vascular surgery evaluation (Correct answer)
- Obtain plain X-ray of the foot
- Prescribe compression stockings
Correct answer: Refer for vascular surgery evaluation
An ABI of 0.6 indicates significant peripheral arterial disease, requiring vascular surgery evaluation before wound healing can proceed.
Question 2: A 72-year-old woman on warfarin for atrial fibrillation is started on fluconazole. What is the expected effect?
- Decreased INR due to CYP2C9 induction
- Increased INR due to CYP2C9 inhibition (Correct answer)
- No change in INR
- Decreased INR due to vitamin K competition
Correct answer: Increased INR due to CYP2C9 inhibition
Fluconazole inhibits CYP2C9, which metabolizes warfarin's S-enantiomer, leading to elevated INR and bleeding risk.
Question 3: A 45-year-old woman presents with episodic hypertension, headache, diaphoresis, and palpitations. Which initial test is most appropriate?
- 24-hour urine catecholamines and metanephrines (Correct answer)
- Plasma aldosterone-to-renin ratio
- Thyroid-stimulating hormone
- Urine cortisol
Correct answer: 24-hour urine catecholamines and metanephrines
The classic triad of headache, diaphoresis, and palpitations with episodic hypertension suggests pheochromocytoma, best screened with 24-hour urine metanephrines.
Question 4: A 3-year-old child is brought in with a barking cough, inspiratory stridor, and low-grade fever. Which pathogen is most likely responsible?
- Respiratory syncytial virus
- Parainfluenza virus (Correct answer)
- Bordetella pertussis
- Haemophilus influenzae type b
Correct answer: Parainfluenza virus
Croup (laryngotracheobronchitis) is most commonly caused by parainfluenza virus type 1 and presents with the characteristic barking cough and stridor.
Question 5: Which finding on ECG is most consistent with hyperkalemia?
- Prolonged PR interval with delta waves
- Peaked T waves with widened QRS (Correct answer)
- ST elevation in leads V1-V4
- Shortened QT interval with U waves
Correct answer: Peaked T waves with widened QRS
Hyperkalemia classically produces peaked/tall T waves, followed by QRS widening, PR prolongation, and eventually a sine-wave pattern.
Question 6: A 65-year-old man with COPD is noted to have a hematocrit of 56%. Which mechanism best explains this finding?
- Decreased erythropoietin from renal artery stenosis
- Polycythemia vera with JAK2 mutation
- Secondary polycythemia from chronic hypoxemia (Correct answer)
- Dehydration causing hemoconcentration
Correct answer: Secondary polycythemia from chronic hypoxemia
Chronic hypoxemia in COPD stimulates erythropoietin release, causing secondary polycythemia as a compensatory response.
Question 7: A 28-year-old woman at 10 weeks gestation presents with severe nausea, vomiting, and weight loss of 8 pounds. Urine shows ketonuria. What is the diagnosis?
- Gastroenteritis
- Hyperemesis gravidarum (Correct answer)
- Appendicitis
- Cholecystitis
Correct answer: Hyperemesis gravidarum
Hyperemesis gravidarum is defined by intractable vomiting in pregnancy causing dehydration, ketonuria, and weight loss exceeding 5% of pre-pregnancy weight.
PANRE PANRE 2
A 58-year-old man with type 2 diabetes presents with a painless foot ulcer.
ABI is 0.6.
Which is the most appropriate next step?