Daily PANCE and PANRE

A 51 year-old male with renal artery stenosis and an elevated BUN and creatinine, is newly diagnosed as hypertensive. Which of the following agents should be avoided? A. hydrochlorothiazide-triamterene B. prazosin C. nifedipine D. verapamil E. furosemide Answer: A, hydrochlorothiazide-triamterene This is a potassium sparing diuretic and should be avoided in anyone with renal disease. ACEI […]

A 6 year-old female presents complaining of right ear pain. The tympanic membrane cannot be well visualized. She complains of pain when the tragus is manipulated. Several periauricular lymph nodes are easily palpable. Which of the following is the most likely diagnosis? A. acute otitis media B. acute otitis externa C. eustachian tube dysfunction D. […]

You note polygonal, purple, popular lesions involving the flexor surfaces of a patient’s wrists. The patient has no other lesions. The lesions appear to follow a linear pattern of distribution. What is this phenomenon?  A. Auspitz sign B. Koebner’s phenomenon C. Darier’s sign D. Gorlin’s sign E. Gottron’s papules Answer: B, Koebner’s phenomenon Koebner’s phenomenon is […]

A female presents complaining of a grayish, watery vaginal discharge. The KOH prep does not reveal any hyphae. Clue cells are identified on the wet mount. A paucity of WBCs are noted. What diagnosis is most likely? A. Gonorrhea B. Chlamydia C. Candidiasis D. bacterial vaginosis E. Trichomoniasis Answer: D, bacterial vaginosis Clue cells means BV […]

A 6 year-old male is brought into your office for evaluation of his gait. You note that when ambulatory, the medial aspects of his knees are far apart and his feet are unusually close together. Which of the following best describes this condition? A. cubitus valgus B. cubitus varus C. genu valgus D. genu varum […]

Which of the following agents has a mechanism of action that does not involve beta-receptors? A. epinephrine B. albuterol C. propranolol D. prazosin E. ritodrine Answer: D, prazosin. Of these choices, prazosin is an alpha- blocker. Ritodrine and epinephrine cause beta sympathetic stimulation. Albuterol is a beta agonist. Propranolol is a beta blocker.   Help […]

The results of a barium esophagram reveal esophageal webbing in a woman with long-standing iron deficiency anemia. Her diagnosis is: A. Barretts esophagus. B. achalasia. C. Plummer-Vinson syndrome. D. Dresslers syndrome. E. Ogilvies syndrome.  Answer: C, Plummer-Vinson syndrome. Plummer-Vinson is something to know for those who want a 100% on the exam. There is no need […]

Laboratory report: elevated serum free t4;  low serum TSH level. Which of the following is the MOST likely diagnosis? A. Primary hypothyroidism B. Secondary hypothyroidism C. T3 thyrotoxicosis D. Graves disease E. Chronic Hashimoto’s thyroiditis Answer: D, Graves disease High T4 (hyperthyroid), with a low TSH indicates that the pituitary is working normally, and the […]

Which of the following agents is effective in the treatment of Parkinson’s? A. penicillin B. amantadine C. erythromycin D. acyclovir E. cephalexin Answer: B, amantadine Amantadine (Symmetrel) is effective (somewhat). It is used in treating Influenza A. Another choice is selegiline, and levodopa/carbidopa. The other antibiotics listed here are not useful in Parkinson’s. Help Support […]

The most common cause of curable blindness in the United States is: A. macular degeneration. B. cataracts. C. retinal detachments. D. glaucoma. E. trauma.   Answer: D, glaucoma Again, the wording is difficult in this question. Macular degeneration, retinal detachments and trauma are not preventable. Cataracts are “curable”, but the cataract itself is probably not […]

A 14 month-old female is brought to your office with a 3-day history of a fever of 104 degrees rectally. Suddenly, today, the fever stopped and a rash developed. Examination reveals a diffuse, fine, maculopapular rash. Presently, the child does not appear ill. The most likely diagnosis is: A. Rubella B. Rubeola C. erythema infectiosum […]

Upon review of an EKG you notice periodic, repetitively absent QRS complexes and “grouped beating.” Which of the following is the explanation? A. Third degree heart block B. Mobitz Type II heart block C. Mobitz Type I heart block D. first degree heart block E. sinus tachycardia Answer: C, Mobitz Type I heart block I […]

A patient describes a history of a “curtain being brought down over my right eye it stayed there for a few minutes then was lifted back up.” In which of the following arteries is the etiology of this complaint located? A. anterior cerebral B. middle cerebral C. posterior cerebral D. internal carotid E. external carotid […]

A 32 year-old male presents with dyspnea and a nonproductive cough. His is tachycardic, tachypneic and febrile. Auscultation of his chest reveals scattered rhonchi. His chest x-ray demonstrates a diffuse interstitial infiltrate. His ABG demonstrates moderate hypoxemia and his LDH is elevated. What is the most likely diagnosis? A.  Streptococcal pneumoniae pneumonia B.  Mycoplasma pneumoniae […]

A Caucasian male has a history of a meconium ileus as a newborn, steatorrhea and a positive sweat test. What is the most likely diagnosis? A. Von Gierke’s disease B. Hurler’s syndrome C. Cystic fibrosis D. Hunter’s syndrome E. Cri du chat syndrome Answer: C, Cystic fibrosis This is the classic presentation of Cystic fibrosis […]