PANRE Practice Questions (2026) — Free Sample Questions with Answers

Answer: A

Apixaban: Correct. Her CHA2DS2-VASc score is 4 (age 65–74, female sex, hypertension, diabetes), so oral anticoagulation is indicated. Current guidelines prefer a DOAC such as apixaban over warfarin for nonvalvular AF.

Aspirin 81 mg daily: Aspirin alone is not recommended for stroke prevention in AF. It gives little protection and still carries bleeding risk.

No antithrombotic therapy: No therapy would be reasonable only at a CHA2DS2-VASc of 0 in men or 1 in women. Her score of 4 puts her at substantial stroke risk.

Aspirin plus clopidogrel: Dual antiplatelet therapy is inferior to oral anticoagulation for AF stroke prevention, with similar bleeding risk.

Calculate CHA2DS2-VASc. Anticoagulate at ≥2 in men or ≥3 in women, and prefer a DOAC over warfarin in nonvalvular AF. Aspirin alone is not adequate.

Answer: C

Transudate; consistent with heart failure: A transudate would need all three Light's criteria to be negative. Here every criterion is met.

Transudate; protein is under 4 g/dL: Light's criteria use ratios and an LDH cutoff, not an absolute protein value. A pleural protein of 3.9 g/dL does not make the fluid a transudate.

Exudate; meets Light's criteria: Correct. Protein ratio 3.9 ÷ 6.5 = 0.60 (>0.5). LDH ratio 260 ÷ 200 = 1.3 (>0.6). Pleural LDH 260 is above two-thirds of the ULN (148). Meeting any one criterion makes it an exudate.

Cannot classify without pleural pH: Pleural pH helps with parapneumonic effusions (for example, the decision to drain). It is not needed to separate a transudate from an exudate.

Light's criteria (any one = exudate): pleural/serum protein >0.5, pleural/serum LDH >0.6, pleural LDH >2/3 of the serum ULN.

Answer: C

Start the IV regular insulin infusion at 0.1 units/kg/hour now: Insulin moves potassium into cells. Starting it with K+ below 3.3 mEq/L can cause life-threatening hypokalemia and arrhythmia.

Give IV sodium bicarbonate to correct the acidosis first: Bicarbonate is generally kept for pH below about 6.9. It can worsen hypokalemia and is not the priority here.

Give IV potassium, and hold insulin until K+ is at least 3.3: Correct. In DKA, if K+ is below 3.3 mEq/L, hold insulin and replace potassium first. Once K+ is 3.3 or higher, start insulin, with ongoing replacement to keep K+ at 4–5 mEq/L.

Switch to subcutaneous glargine and recheck labs tomorrow: Subcutaneous basal insulin alone is not appropriate initial treatment for moderate to severe DKA, which needs IV insulin and close monitoring.

DKA sequence: fluids first; check K+ before insulin (hold insulin if K+ < 3.3). Add dextrose when glucose falls to about 250. Close the anion gap before switching to subcutaneous insulin.

Answer: D

Order Lyme serology and treat only if the result is positive: Serology is often negative in early localized disease. Erythema migrans in an endemic area is diagnosed clinically and treated without testing.

A single 200-mg dose of doxycycline: A single dose of doxycycline is prophylaxis after a high-risk tick bite. It does not treat established erythema migrans.

IV ceftriaxone for 28 days: IV ceftriaxone is for selected neurologic or cardiac Lyme disease. 28 days is longer than needed even for those.

Oral doxycycline for 10 days: Correct. Erythema migrans is a clinical diagnosis in an endemic area. Treat with oral doxycycline (10 days per IDSA 2020), or amoxicillin or cefuroxime as alternatives.

Erythema migrans (≥5 cm expanding rash after a tick bite in an endemic area) is a clinical diagnosis. Treat with oral doxycycline without serology.

Answer: A

IV labetalol to bring BP below 185/110, then IV thrombolysis: Correct. She is within the window for IV thrombolysis. Blood pressure must be lowered to below 185/110 mm Hg before alteplase (or tenecteplase) and kept below 180/105 for 24 hours afterward.

Give alteplase now, since BP will fall once the stroke is treated: Thrombolysis with BP above 185/110 raises the risk of hemorrhage. BP must be controlled first.

Give aspirin 325 mg and do not give thrombolysis because of the BP: High BP is a reason to treat the pressure, not to withhold thrombolysis from an otherwise eligible patient.

Lower BP to below 120/80 with nitroprusside before any therapy: Aggressive lowering to normal can worsen ischemia in the penumbra. The goal before thrombolysis is below 185/110.

Acute ischemic stroke: BP must be below 185/110 before thrombolysis and below 180/105 for 24 hours afterward. If not thrombolysed, permissive hypertension up to 220/120.

Answer: A

Tamsulosin: Correct. α1-blockers relax prostatic and bladder-neck smooth muscle and improve symptoms within days. They are first-line for bothersome LUTS from BPH. Warn about orthostasis and floppy iris syndrome during cataract surgery.

Finasteride: 5-α-reductase inhibitors shrink larger prostates (above about 30–40 g) over 6–12 months. They do not give rapid relief.

Oxybutynin: Anticholinergics treat overactive bladder. Used alone for obstructive symptoms they can cause urinary retention.

Ciprofloxacin: Antibiotics treat bacterial prostatitis or UTI. A normal urinalysis and no infectious symptoms do not support either.

BPH: α-blocker for fast relief. Add a 5-ARI for large glands (it works over months and lowers PSA by about 50%). Refer if there is retention or other complications.