PANRE Exam Questions with Verified
Solutions
A 42-year-old female presents after finding a firm, painless bump in her right eyelid. On
examination, you note a 6 mm mass within the tarsus of the right eye. The skin is freely
movable over the mass. The remainder of the ophthalmoscopic examination is
unremarkable. Which of the following is the most likely diagnosis?
A. Pterygium
B. Chalazion
C. Ectropion
D. External hordeolum
E. Internal hordeolum - ANSWER-Chalazion
A chalazion is a painless chronic mass in the eyelid. Hordeolum are acute and red and
painful. Pterygium involves the sclera. Ectropion is when the eyelid sags outwardly and
the lid doesn't close well.
Combinations of antimicrobial agents are commonly employed in the treatment of
meningitis in infants less than three months old. Ampicillin is commonly an agent
included in this regimen. Ampicillin is used empirically for the possible presence of:
A. Escherichia coli
B. Listeria monocytogenes
C. Cytomegalovirus
D. Herpesvirus
E. Hemophilus influenzae - ANSWER-Listeria monocytogenes
While E. Coli can infect an infant delivered vaginally, Ampicillin is given to eliminate
Listeria. CMV & HSV are viruses. E. Coli & H. Flu are also typically resistant to
ampicillin, and more likely a broader spectrum antibiotic would be used
An EKG demonstrates a PR interval of 0.16 seconds, a P to QRS relationship of 1:1, a
variable heart rate and an R to R interval that is noted to accelerate ad decelerate
during the respiratory cycle. What is the diagnosis?
A. Wenckebach
B. third degree heart block
C. atrial fibrillation
D. sinus arrhythmia
,E. atrial flutter - ANSWER-Sinus arrhythmia
This is sinus arrhythmia. Wenckebach & third-degree AVB would have a nonconducted
P wave. A-fib would have no P waves and an irregularly irregular rhythm. A flutter would
have "flutter waves" or a regular rhythm of 150.
While suturing a wound, you opt to use lidocaine with epinephrine. The rationale for
your choice is:
A. an increase in the absorption of the lidocaine.
B. an increase in the diffusion of the lidocaine into the nerve's myelin sheath.
C. an increase in the blood flow to the area of injection.
D. an increase in the duration of anesthesia.
E. a decrease in the risk of infection at the site of injection. - ANSWER-An increase in
the duration of anesthesia
Lidocaine with epinephrine both increases the duration of anesthesia and decreases
blood flow to the area of injection-i.e. penis, nose, fingers, toes
A 48-year-old nurse with a body mass index of 31 presents for an evaluation of back
pain. She relates that historically, she had a positive PPD test a year ago and did not
follow-up as directed. She has recently been experiencing night sweats and coughing.
An x-ray of her lumbar spine reveals osteopenia and cortical breakdown of vertebral
bodies L4 and L5. Which of the following diagnosis is most suspect?
A. compression fractures secondary to obesity
B. degenerative joint disease
C. Potts disease
D. compression fractures secondary to osteoporosis
E. spondylolisthesis - ANSWER-Pott's disease
Pott's disease is TB of the spine. She could have any of the other diseases, but the
question states that she had a positive PPD and did not take meds...that is the clue that
she has active TB in the spine
A 14-year-old is experiencing a severe asthma attack. Although he is using accessory
muscles to breath, auscultation of his chest reveals no audible wheezing. His heart rate
is 160 and his respiratory rate is 52. Which of the following arterial blood gases
represents the worst prognosis?
A. pH = 7.52; pC02 = 28; p02 = 80
B. pH = 7.44; pC02 = 38; p02 = 70
C. pH = 7.60; pC02 = 18; p02 = 60
D. pH= 7.40; pC02 = 40; p02 = 60
E. pH = 7.27; pC02 - 62; p02 = 64 - ANSWER-pH = 7.27; pC02 - 62; p02 = 64
,This patient has a respiratory rate of 52. If she is ventilating, she is blowing off C02 (an
acid) and would be alkalotic and should have a low C02. A pH which is acidic with a
pC02 which is elevated means that she is no longer ventilating at all (she needs
mechanical ventilation or she will die)
A 27-year-old nulliparous female presents because she's been trying to get pregnant for
two years, but has failed. She relates a history of a misdiagnosis of appendicitis that
lead to abscess formation when she was 14 years old. Which of the following diagnostic
studies would be most helpful at this point in her evaluation?
A. TSH level
B. hysterosalpingogram
C. laparoscopy
D. PAP smear
E. pelvic ultrasound - ANSWER-Hysterosalpingogram
While I would disagree that an invasive procedure like HSG should be done first-line,
the thing to remember in this question is that the patient has reason to have tubal
scarring from adhesions (and there is no better answer listed to choose), so, for a board
exam I would choose this answer. The TSH level would not be indicated (she has not
had a pg loss), lap could diagnose the tubal scarring but would be done after an
abnormal HSG. Pap smear is screening for cervical cancer and not indicated in this
case of infertility, and the pelvic US would yield nothing diagnostically about the tubes.
A 34-old female presents complaining of symmetrical redness and swelling of the small
joints of her hands (PIPs and MCPs). She has noted that the symptoms are worst in the
morning. Her erythrocyte sedimentation rate is elevated and her rheumatoid factor is
negative. Which of the following diagnosis is most likely?
A. progressive systemic sclerosis
B. CREST syndrome
C. osteoarthritis
D. rheumatoid arthritis
E. ankylosing spondylitis - ANSWER-Rheumatoid Arthritis
In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA
characteristically includes small joint symmetrical arthritis, with an elevated ESR
(therefore inflammatory, and not OA). 80% of patients with RA will have a positive RF,
but 20% will be negative. PSS involves squamous cell thickening and sclerosis causing
taut skin of the face and hands and difficulty with esophageal motility. CREST syndrome
is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and negative
RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine)
A patient describes a history of recurrent bouts of uveitis. Her chemistry panel reveals
elevated serum calcium and uric acid levels. Her anergy screen is negative. Her chest
x-ray demonstrates bilateral hilar adenopathy. Which diagnosis is most likely?
, A. Silicosis
B. Sarcoidosis
C. Alpha-1 antitrypsin deficiency
D. Histoplasmosis
E. Tuberculosis - ANSWER-Sarcoidosis
Sarcoidosis typically presents with hilar lymphadenopathy and noncaseating
granulomas of the lungs (and other organs). In addition, patients may have eye
involvement (uveitis). Elevations of ACE, Calcium and uric acid are frequently seen.
Which of the following is NOT a characteristic feature of nephrotic syndrome?
A. proteinuria
B. hematuria
C. hypoalbuminemia
D. hyperlipidemia
E. generalized edema - ANSWER-Hematuria
Hematuria is present in NEPHRITIC syndrome. Nephrotic syndrome characteristically
includes proteinuria (>3.5 gm/day), with resulting low serum albumin, hyperlipidemia,
hypertension, hypercoagulability, and generalized edema (from oncotic third-spacing)
Which term is used to describe the characteristic concave or "spoon-shaped" nails of
iron deficiency anemia?
A. leukonychia
B. koilonychias
C. clubbing
D. onycholysis
E. paronychia - ANSWER-Koilonychia
Koilonychia is a spoon-shaping of the nail itself. It is usually a result of iron deficiency
anemia. Leukonychia is often associated with hypoalbuminemia that causes partial or
complete white discoloration of the nails. Leukonychia may also appear as a rare side
effect of systemic chemotherapy in some oncological patients but may also be present
with arsenic poisoning, renal failure pneumonia, or heart disease. Clubbing of the nails
is an actual thickening or elevation of the nail bed - it is a sign of a release of TNF
associated with pulmonary disorders (tissue necrosis factor) typically found in
bronchiectasis, lung cancers and cystic fibrosis (the nails are NOT necessarily
cyanotic.) Onycholysis is a painless separation of the nail from the nail bed. Several or
all nails are usually affected - there are many causes. Paronychia is an infection of the
nail bed and nail margin, usually from trauma or more commonly, nail-biting.
A 52-year-old male presents complaining of urinary frequency, with hesitancy, and
nocturia for the past few months. During his physical examination, you note a
Solutions
A 42-year-old female presents after finding a firm, painless bump in her right eyelid. On
examination, you note a 6 mm mass within the tarsus of the right eye. The skin is freely
movable over the mass. The remainder of the ophthalmoscopic examination is
unremarkable. Which of the following is the most likely diagnosis?
A. Pterygium
B. Chalazion
C. Ectropion
D. External hordeolum
E. Internal hordeolum - ANSWER-Chalazion
A chalazion is a painless chronic mass in the eyelid. Hordeolum are acute and red and
painful. Pterygium involves the sclera. Ectropion is when the eyelid sags outwardly and
the lid doesn't close well.
Combinations of antimicrobial agents are commonly employed in the treatment of
meningitis in infants less than three months old. Ampicillin is commonly an agent
included in this regimen. Ampicillin is used empirically for the possible presence of:
A. Escherichia coli
B. Listeria monocytogenes
C. Cytomegalovirus
D. Herpesvirus
E. Hemophilus influenzae - ANSWER-Listeria monocytogenes
While E. Coli can infect an infant delivered vaginally, Ampicillin is given to eliminate
Listeria. CMV & HSV are viruses. E. Coli & H. Flu are also typically resistant to
ampicillin, and more likely a broader spectrum antibiotic would be used
An EKG demonstrates a PR interval of 0.16 seconds, a P to QRS relationship of 1:1, a
variable heart rate and an R to R interval that is noted to accelerate ad decelerate
during the respiratory cycle. What is the diagnosis?
A. Wenckebach
B. third degree heart block
C. atrial fibrillation
D. sinus arrhythmia
,E. atrial flutter - ANSWER-Sinus arrhythmia
This is sinus arrhythmia. Wenckebach & third-degree AVB would have a nonconducted
P wave. A-fib would have no P waves and an irregularly irregular rhythm. A flutter would
have "flutter waves" or a regular rhythm of 150.
While suturing a wound, you opt to use lidocaine with epinephrine. The rationale for
your choice is:
A. an increase in the absorption of the lidocaine.
B. an increase in the diffusion of the lidocaine into the nerve's myelin sheath.
C. an increase in the blood flow to the area of injection.
D. an increase in the duration of anesthesia.
E. a decrease in the risk of infection at the site of injection. - ANSWER-An increase in
the duration of anesthesia
Lidocaine with epinephrine both increases the duration of anesthesia and decreases
blood flow to the area of injection-i.e. penis, nose, fingers, toes
A 48-year-old nurse with a body mass index of 31 presents for an evaluation of back
pain. She relates that historically, she had a positive PPD test a year ago and did not
follow-up as directed. She has recently been experiencing night sweats and coughing.
An x-ray of her lumbar spine reveals osteopenia and cortical breakdown of vertebral
bodies L4 and L5. Which of the following diagnosis is most suspect?
A. compression fractures secondary to obesity
B. degenerative joint disease
C. Potts disease
D. compression fractures secondary to osteoporosis
E. spondylolisthesis - ANSWER-Pott's disease
Pott's disease is TB of the spine. She could have any of the other diseases, but the
question states that she had a positive PPD and did not take meds...that is the clue that
she has active TB in the spine
A 14-year-old is experiencing a severe asthma attack. Although he is using accessory
muscles to breath, auscultation of his chest reveals no audible wheezing. His heart rate
is 160 and his respiratory rate is 52. Which of the following arterial blood gases
represents the worst prognosis?
A. pH = 7.52; pC02 = 28; p02 = 80
B. pH = 7.44; pC02 = 38; p02 = 70
C. pH = 7.60; pC02 = 18; p02 = 60
D. pH= 7.40; pC02 = 40; p02 = 60
E. pH = 7.27; pC02 - 62; p02 = 64 - ANSWER-pH = 7.27; pC02 - 62; p02 = 64
,This patient has a respiratory rate of 52. If she is ventilating, she is blowing off C02 (an
acid) and would be alkalotic and should have a low C02. A pH which is acidic with a
pC02 which is elevated means that she is no longer ventilating at all (she needs
mechanical ventilation or she will die)
A 27-year-old nulliparous female presents because she's been trying to get pregnant for
two years, but has failed. She relates a history of a misdiagnosis of appendicitis that
lead to abscess formation when she was 14 years old. Which of the following diagnostic
studies would be most helpful at this point in her evaluation?
A. TSH level
B. hysterosalpingogram
C. laparoscopy
D. PAP smear
E. pelvic ultrasound - ANSWER-Hysterosalpingogram
While I would disagree that an invasive procedure like HSG should be done first-line,
the thing to remember in this question is that the patient has reason to have tubal
scarring from adhesions (and there is no better answer listed to choose), so, for a board
exam I would choose this answer. The TSH level would not be indicated (she has not
had a pg loss), lap could diagnose the tubal scarring but would be done after an
abnormal HSG. Pap smear is screening for cervical cancer and not indicated in this
case of infertility, and the pelvic US would yield nothing diagnostically about the tubes.
A 34-old female presents complaining of symmetrical redness and swelling of the small
joints of her hands (PIPs and MCPs). She has noted that the symptoms are worst in the
morning. Her erythrocyte sedimentation rate is elevated and her rheumatoid factor is
negative. Which of the following diagnosis is most likely?
A. progressive systemic sclerosis
B. CREST syndrome
C. osteoarthritis
D. rheumatoid arthritis
E. ankylosing spondylitis - ANSWER-Rheumatoid Arthritis
In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA
characteristically includes small joint symmetrical arthritis, with an elevated ESR
(therefore inflammatory, and not OA). 80% of patients with RA will have a positive RF,
but 20% will be negative. PSS involves squamous cell thickening and sclerosis causing
taut skin of the face and hands and difficulty with esophageal motility. CREST syndrome
is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and negative
RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine)
A patient describes a history of recurrent bouts of uveitis. Her chemistry panel reveals
elevated serum calcium and uric acid levels. Her anergy screen is negative. Her chest
x-ray demonstrates bilateral hilar adenopathy. Which diagnosis is most likely?
, A. Silicosis
B. Sarcoidosis
C. Alpha-1 antitrypsin deficiency
D. Histoplasmosis
E. Tuberculosis - ANSWER-Sarcoidosis
Sarcoidosis typically presents with hilar lymphadenopathy and noncaseating
granulomas of the lungs (and other organs). In addition, patients may have eye
involvement (uveitis). Elevations of ACE, Calcium and uric acid are frequently seen.
Which of the following is NOT a characteristic feature of nephrotic syndrome?
A. proteinuria
B. hematuria
C. hypoalbuminemia
D. hyperlipidemia
E. generalized edema - ANSWER-Hematuria
Hematuria is present in NEPHRITIC syndrome. Nephrotic syndrome characteristically
includes proteinuria (>3.5 gm/day), with resulting low serum albumin, hyperlipidemia,
hypertension, hypercoagulability, and generalized edema (from oncotic third-spacing)
Which term is used to describe the characteristic concave or "spoon-shaped" nails of
iron deficiency anemia?
A. leukonychia
B. koilonychias
C. clubbing
D. onycholysis
E. paronychia - ANSWER-Koilonychia
Koilonychia is a spoon-shaping of the nail itself. It is usually a result of iron deficiency
anemia. Leukonychia is often associated with hypoalbuminemia that causes partial or
complete white discoloration of the nails. Leukonychia may also appear as a rare side
effect of systemic chemotherapy in some oncological patients but may also be present
with arsenic poisoning, renal failure pneumonia, or heart disease. Clubbing of the nails
is an actual thickening or elevation of the nail bed - it is a sign of a release of TNF
associated with pulmonary disorders (tissue necrosis factor) typically found in
bronchiectasis, lung cancers and cystic fibrosis (the nails are NOT necessarily
cyanotic.) Onycholysis is a painless separation of the nail from the nail bed. Several or
all nails are usually affected - there are many causes. Paronychia is an infection of the
nail bed and nail margin, usually from trauma or more commonly, nail-biting.
A 52-year-old male presents complaining of urinary frequency, with hesitancy, and
nocturia for the past few months. During his physical examination, you note a
