PANRE EXAM QUESTIONS AND 100% CORRECT ANSWERS
A 31-year-old African American woman complains of progressive malaise, dyspnea, and
low-grade
fever over the last four weeks. She has recently been treated for iritis. Physical
examination reveals red
nodules over the anterior lower legs and mild hepatomegaly. Chest x-ray study shows
bilateral hilar
adenopathy. Which of the following is the most likely diagnosis?
(A) Lymphoma
(B) Mesothelioma
(C) Sarcoidosis
(D) Tuberculosis
(E) Wegener's granulomatosis - ANSWER C
Answer: sarcoidosis. The patient's age, sex, and race, combined with the insidious
onset of symptoms and x-ray study findings provide a clear indication of this disease.
History of iritis, erythema nodosum in a young African American woman
(A) , Lymphoma, is also an option because lymphoma and sarcoidosis may present
similar symptoms which are usually insidious, such as fever, malaise, dyspnea, visceral
involvement, and a widened
mediastinum. However, are more of an indication of sarcoidosis than lymphoma.
(B) , mesothelioma, is incorrect because the mean age of onset of this disease is
approximately 60
years. Mesothelioma is also commonly found among workers exposed to asbestos.
(D), tuberculosis, is incorrect because this patient does not have the classic
characteristics of this
disease, which include weight loss, night sweats, chronic productive cough, or apical
lesions
shown on chest x-ray study.
, E (Wegener's granulomatosis) is incorrect. This patient is not in her 40s or 50s. She did
not present a prolonged onset of symptoms. There are no upper and lower respiratory
tract symptoms, which include necrotizing granulomatous lesions of the respiratory
tract together with glomerulonephritis and vasculitis. Also, the finding on x-ray study of
hilar adenopathy is not consistent with an x-ray study of a patient with Wegener's
granulomatosis.
The patient is a 47-year-old male who, for the last three weeks, has been experiencing
heaviness in the chest while pushing his lawn mower. He denies any previous treatment
and also denies symptoms at this time. He has smoked one pack of cigarettes daily for
20 years but quit smoking seven years ago.
Physical examination findings are unremarkable. Electrocardiogram shows no
abnormalities. Which of the following is the most appropriate initial diagnostic study?
(A) Coronary arteriography
(B) Echocardiography
(C) Exercise stress test
(D) 24-Hour Holter monitoring
(E) Myocardial perfusion scan - ANSWER C
The most appropriate initial step in the work-up of a patient with recent chest pain
because the test is noninvasive, inexpensive, convenient, and sensitive in this type of
patient.
A: The most diagnostic test that could be performed on a patient with coronary artery
disease would be coronary arteriography; this, however, is not an appropriate initial
test in an asymptomatic patient with no abnormal findings on electrocardiogram.
(B) echocardiography is particularly useful in the assessment of valvular structure,
cardiac size, and ejection fraction, among other anatomic features; thus, this would be
an incorrect choice as echocardiography is not usually used for the investigation of
ischemia due to coronary artery disease.
(D) is incorrect. The indications for 24-hour Holter monitoring include mainly
disturbances of rate and rhythm, although it can detect ST-segment depression. It is
less sensitive than exercise stress testing in confirming the diagnosis of coronary artery
disease during the initial work-up of a patient.
(E) This patient's electrocardiogram shows no abnormalities, and therefore myocardial
A 31-year-old African American woman complains of progressive malaise, dyspnea, and
low-grade
fever over the last four weeks. She has recently been treated for iritis. Physical
examination reveals red
nodules over the anterior lower legs and mild hepatomegaly. Chest x-ray study shows
bilateral hilar
adenopathy. Which of the following is the most likely diagnosis?
(A) Lymphoma
(B) Mesothelioma
(C) Sarcoidosis
(D) Tuberculosis
(E) Wegener's granulomatosis - ANSWER C
Answer: sarcoidosis. The patient's age, sex, and race, combined with the insidious
onset of symptoms and x-ray study findings provide a clear indication of this disease.
History of iritis, erythema nodosum in a young African American woman
(A) , Lymphoma, is also an option because lymphoma and sarcoidosis may present
similar symptoms which are usually insidious, such as fever, malaise, dyspnea, visceral
involvement, and a widened
mediastinum. However, are more of an indication of sarcoidosis than lymphoma.
(B) , mesothelioma, is incorrect because the mean age of onset of this disease is
approximately 60
years. Mesothelioma is also commonly found among workers exposed to asbestos.
(D), tuberculosis, is incorrect because this patient does not have the classic
characteristics of this
disease, which include weight loss, night sweats, chronic productive cough, or apical
lesions
shown on chest x-ray study.
, E (Wegener's granulomatosis) is incorrect. This patient is not in her 40s or 50s. She did
not present a prolonged onset of symptoms. There are no upper and lower respiratory
tract symptoms, which include necrotizing granulomatous lesions of the respiratory
tract together with glomerulonephritis and vasculitis. Also, the finding on x-ray study of
hilar adenopathy is not consistent with an x-ray study of a patient with Wegener's
granulomatosis.
The patient is a 47-year-old male who, for the last three weeks, has been experiencing
heaviness in the chest while pushing his lawn mower. He denies any previous treatment
and also denies symptoms at this time. He has smoked one pack of cigarettes daily for
20 years but quit smoking seven years ago.
Physical examination findings are unremarkable. Electrocardiogram shows no
abnormalities. Which of the following is the most appropriate initial diagnostic study?
(A) Coronary arteriography
(B) Echocardiography
(C) Exercise stress test
(D) 24-Hour Holter monitoring
(E) Myocardial perfusion scan - ANSWER C
The most appropriate initial step in the work-up of a patient with recent chest pain
because the test is noninvasive, inexpensive, convenient, and sensitive in this type of
patient.
A: The most diagnostic test that could be performed on a patient with coronary artery
disease would be coronary arteriography; this, however, is not an appropriate initial
test in an asymptomatic patient with no abnormal findings on electrocardiogram.
(B) echocardiography is particularly useful in the assessment of valvular structure,
cardiac size, and ejection fraction, among other anatomic features; thus, this would be
an incorrect choice as echocardiography is not usually used for the investigation of
ischemia due to coronary artery disease.
(D) is incorrect. The indications for 24-hour Holter monitoring include mainly
disturbances of rate and rhythm, although it can detect ST-segment depression. It is
less sensitive than exercise stress testing in confirming the diagnosis of coronary artery
disease during the initial work-up of a patient.
(E) This patient's electrocardiogram shows no abnormalities, and therefore myocardial
