PANRE PANRE 3 — Questions and Answers
Question 1: A 50-year-old man with a history of alcohol use disorder presents with confusion, ataxia, and ophthalmoplegia. Which treatment should be given immediately?
- Glucose infusion
- Thiamine 100 mg IV (Correct answer)
- Naloxone IV
- Lorazepam IV
Correct answer: Thiamine 100 mg IV
The classic triad of confusion, ataxia, and ophthalmoplegia is Wernicke encephalopathy; thiamine must be given before glucose to prevent worsening.
Question 2: A 40-year-old woman presents with fatigue, constipation, weight gain, and cold intolerance. TSH is 12 mIU/L and free T4 is low. Which treatment is indicated?
- Propylthiouracil
- Levothyroxine (Correct answer)
- Methimazole
- Radioactive iodine ablation
Correct answer: Levothyroxine
Primary hypothyroidism (elevated TSH, low free T4) is treated with levothyroxine replacement therapy.
Question 3: A 66-year-old woman presents with sudden painless vision loss in one eye described as a 'curtain coming down.' Fundoscopy shows a pale retina with a cherry-red spot at the macula. What is the diagnosis?
- Central retinal vein occlusion
- Central retinal artery occlusion (Correct answer)
- Retinal detachment
- Optic neuritis
Correct answer: Central retinal artery occlusion
Central retinal artery occlusion presents with sudden painless vision loss, pale ischemic retina, and a cherry-red spot at the fovea due to preserved choroidal circulation.
Question 4: A 55-year-old man with rheumatoid arthritis on methotrexate develops a macrocytic anemia. Which supplementation is most appropriate?
- Iron sulfate
- Vitamin B12
- Folate (Correct answer)
- Vitamin B6
Correct answer: Folate
Methotrexate inhibits dihydrofolate reductase, causing folate deficiency; supplemental folic acid is given to mitigate this side effect.
Question 5: A 32-year-old woman presents with recurrent unprovoked DVTs. Labs show a prolonged aPTT that does not correct on mixing study. Which condition is most likely?
- Protein C deficiency
- Factor V Leiden mutation
- Antiphospholipid syndrome (Correct answer)
- Antithrombin III deficiency
Correct answer: Antiphospholipid syndrome
A prolonged aPTT that fails to correct on mixing study suggests an inhibitor (antibody), most consistent with lupus anticoagulant in antiphospholipid syndrome.
Question 6: A 7-year-old boy develops periorbital edema, hypoalbuminemia, massive proteinuria (>3.5 g/day), and hypercholesterolemia. Which diagnosis best fits?
- Henoch-Schönlein purpura
- Nephrotic syndrome (Correct answer)
- Nephritic syndrome
- IgA nephropathy
Correct answer: Nephrotic syndrome
The tetrad of massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia defines nephrotic syndrome; minimal change disease is the most common cause in children.
Question 7: A 24-year-old woman presents with a painful, swollen right knee and right wrist after returning from a camping trip. She also has a scattered papulopustular rash on her arms. Which organism is most likely responsible?
- Staphylococcus aureus
- Neisseria gonorrhoeae (Correct answer)
- Borrelia burgdorferi
- Streptococcus pyogenes
Correct answer: Neisseria gonorrhoeae
Disseminated gonococcal infection classically presents with migratory polyarthritis, tenosynovitis, and dermatitis (papulopustular lesions) in sexually active young adults.
PANRE PANRE 3
A 50-year-old man with a history of alcohol use disorder presents with confusion, ataxia, and ophthalmoplegia.
Which treatment should be given immediately?