PANRE Practice Exam Questions and Answers with Explanations

Preparing for the Physician Assistant National Recertifying Exam (PANRE) means more than reviewing notes or memorizing diagnoses. The exam is built around real clinical situations that require careful thinking, sound judgment, and the ability to choose the best next step in patient care. Working through realistic practice questions is an effective way to strengthen your clinical reasoning, refresh important medical concepts, and become more confident before exam day.

Our PANRE Practice Test is designed to help practicing physician assistants build confidence before exam day through comprehensive, exam-style multiple-choice questions that closely reflect the depth, style, and difficulty of the real examination. Whether you are completing the traditional PANRE or preparing using the latest NCCPA recertification blueprint, this practice resource provides an effective way to identify knowledge gaps, reinforce critical concepts, and improve clinical decision-making.

This collection contains 1,000+ carefully developed PANRE practice questions covering medicine, surgery, emergency medicine, pediatrics, women’s health, psychiatry, infectious diseases, cardiology, pulmonology, endocrinology, neurology, gastroenterology, nephrology, hematology, dermatology, rheumatology, orthopedics, critical care, and many additional specialties tested on the examination.

Every question is accompanied by a detailed answer explanation that not only identifies the correct response but also explains why alternative answers are incorrect. This approach reinforces clinical reasoning rather than simple memorization, allowing you to retain information longer and apply it effectively during the actual exam and in clinical practice.

What’s Included

Our comprehensive PANRE practice question bank includes:

• 1,000+ realistic exam-style multiple-choice questions
• Four answer choices for every question
• Detailed clinical explanations for each correct answer
• Evidence-based management principles
• High-yield emergency medicine scenarios
• Interpretation of laboratory values
• ECG recognition and cardiovascular emergencies
• Imaging interpretation concepts
• Pharmacology and medication safety
• Current diagnostic and treatment approaches
• Clinical pearls frequently tested on certification exams
• Questions ranging from moderate to advanced difficulty

Every practice question has been written to simulate the type of patient encounters physician assistants evaluate in primary care, emergency departments, urgent care, hospital medicine, internal medicine, and specialty practice.

Topics Covered

This PANRE study resource includes extensive coverage of nearly every major content area tested by the NCCPA.

Cardiovascular Medicine

Develop confidence managing common and life-threatening cardiovascular disorders, including:

• Acute coronary syndrome
• STEMI and NSTEMI
• Cardiogenic shock
• Heart failure
• Valvular heart disease
• Aortic dissection
• Cardiac tamponade
• Pulmonary embolism
• Arrhythmias
• Hypertensive emergencies
• Endocarditis
• Cardiomyopathies
• Pericardial disease
• Mechanical complications after myocardial infarction

Pulmonary and Critical Care

Practice recognizing respiratory emergencies such as:

• Acute respiratory distress syndrome (ARDS)
• Severe asthma
• COPD exacerbations
• Tension pneumothorax
• Massive hemoptysis
• Pulmonary hypertension
• Diffuse alveolar hemorrhage
• Pneumonia
• Pleural disease
• Mechanical ventilation
• Inhalation injury
• Pulmonary infections
• Respiratory failure

Emergency Medicine

Strengthen rapid decision-making with high-yield emergency scenarios involving:

• Trauma resuscitation
• Shock
• Massive transfusion
• Airway emergencies
• Toxicology
• Poisoning
• Sepsis
• Trauma surgery principles
• Burn management
• Heat stroke
• Hypothermia
• Snake bites
• Electrical injuries
• Disaster medicine

Neurology

Prepare for neurologic disorders including:

• Acute ischemic stroke
• Intracranial hemorrhage
• Seizures
• Status epilepticus
• Brain herniation
• Elevated intracranial pressure
• Meningitis
• Encephalitis
• Guillain-Barré syndrome
• Myasthenic crisis
• Spinal cord emergencies
• Peripheral neuropathies

Gastroenterology

Review commonly tested gastrointestinal diseases, including:

• Upper GI bleeding
• Lower GI bleeding
• Peptic ulcer disease
• Acute pancreatitis
• Cholangitis
• Liver failure
• Cirrhosis
• Portal hypertension
• Esophageal rupture
• Inflammatory bowel disease
• Mesenteric ischemia
• Bowel obstruction
• Perforated viscus

Endocrinology

Master endocrine emergencies and chronic diseases, including:

• Diabetic ketoacidosis
• Hyperosmolar hyperglycemic state
• Thyroid storm
• Myxedema coma
• Adrenal crisis
• Hypercalcemia
• Electrolyte disorders
• Pituitary disorders
• Diabetes management
• Thyroid disease

Infectious Diseases

Review high-yield bacterial, viral, fungal, and parasitic infections, including:

• Sepsis
• Septic shock
• Endocarditis
• Tuberculosis
• HIV-related infections
• Opportunistic infections
• Tick-borne diseases
• Tropical medicine
• Fungal infections
• Meningococcal disease
• Necrotizing soft tissue infections
• Emerging infectious diseases

Nephrology and Electrolytes

Practice diagnosis and management of:

• Acute kidney injury
• Chronic kidney disease
• Glomerulonephritis
• Dialysis emergencies
• Acid-base disorders
• Hyponatremia
• Hypernatremia
• Hyperkalemia
• Hypokalemia
• Calcium disorders
• Magnesium abnormalities

Hematology and Oncology

Prepare for questions involving:

• Thrombotic thrombocytopenic purpura
• Disseminated intravascular coagulation
• Hemolytic anemia
• Leukemia
• Lymphoma
• Tumor lysis syndrome
• Neutropenic fever
• Hyperviscosity syndrome
• Oncologic emergencies
• Transfusion reactions

Women’s Health, Pediatrics, Psychiatry, Dermatology, Rheumatology, and Surgery

Additional sections cover:

• Obstetric emergencies
• Postpartum complications
• Pediatric infectious diseases
• Pediatric emergencies
• Behavioral health
• Autoimmune diseases
• Skin disorders
• Musculoskeletal injuries
• Orthopedic emergencies
• Perioperative medicine
• Surgical complications

Why These Practice Questions Work

Simply reading textbooks is rarely enough to prepare for a modern certification examination. Active recall and repeated exposure to clinically relevant scenarios have consistently been shown to improve long-term retention and diagnostic reasoning.

Each question in this collection challenges you to:

• Identify the most likely diagnosis.
• Interpret clinical presentations.
• Analyze laboratory findings.
• Evaluate imaging results.
• Select appropriate diagnostic testing.
• Choose first-line treatment.
• Recognize medical emergencies.
• Prioritize patient safety.
• Apply current evidence-based medicine.

Rather than focusing on isolated facts, these questions emphasize clinical judgment—the same skill expected during the PANRE.

Who Should Use This Practice Test?

This resource is ideal for:

• Physician Assistants preparing for PANRE
• Physician Assistants completing recertification requirements
• Clinicians returning to practice
• Hospital medicine PAs
• Emergency Medicine PAs
• Family Medicine PAs
• Internal Medicine PAs
• Urgent Care providers
• Surgical Physician Assistants
• Specialty Physician Assistants seeking a comprehensive clinical review

It also serves as an excellent refresher for practicing clinicians who want to strengthen diagnostic reasoning across multiple specialties.

Improve Your Exam Readiness

Consistent practice with high-quality questions remains one of the most effective ways to prepare for the Physician Assistant National Recertifying Exam. Reviewing detailed explanations, understanding why each answer is correct, and learning from incorrect choices help reinforce concepts that are commonly tested on certification examinations.

Whether your goal is passing the PANRE on the first attempt, refreshing your clinical knowledge, or identifying areas that need additional review, this comprehensive collection of 1,000+ Physician Assistant National Recertifying Exam (PANRE) Practice Questions and Answers with Detailed Explanations provides a structured, practical, and realistic study experience that closely mirrors the clinical decision-making expected of today’s certified Physician Assistants.

PANRE Sample Questions and Answers

1. Acute Decompensated Heart Failure

Question

A 72-year-old man with ischemic cardiomyopathy presents with progressive dyspnea, orthopnea, bilateral leg edema, and elevated jugular venous pressure. Oxygen saturation is 92% on room air. Chest radiograph demonstrates pulmonary vascular congestion.

What is the most appropriate initial treatment?

A. IV furosemide

B. Oral hydrochlorothiazide

C. Large-volume IV normal saline

D. Oral prednisone

Correct Answer: A. IV furosemide

Explanation:

Acute decompensated heart failure results from elevated ventricular filling pressures causing pulmonary and systemic congestion. Intravenous loop diuretics, such as furosemide, rapidly reduce preload, improve pulmonary edema, relieve dyspnea, and decrease peripheral edema. Supplemental oxygen should be administered if hypoxemia is present, while blood pressure and renal function require close monitoring. Intravenous fluids worsen congestion, and corticosteroids provide no benefit unless another indication exists. Thiazide diuretics are generally inadequate as initial therapy during significant volume overload. Long-term management includes optimization of guideline-directed medical therapy, sodium restriction, monitoring daily weights, and addressing precipitating factors such as medication nonadherence, arrhythmias, or infection.

2. Community-Acquired Pneumonia Risk Stratification

Question

A 63-year-old woman has fever, productive cough, respiratory rate of 32/min, and confusion. Chest radiograph confirms right lower lobe pneumonia.

Which scoring system helps determine hospitalization need?

A. Wells Score

B. CURB-65

C. CHA₂DS₂-VASc

D. MELD

Correct Answer: B. CURB-65

Explanation:

CURB-65 evaluates severity of community-acquired pneumonia using Confusion, Urea, Respiratory rate ≥30, Blood pressure, and Age ≥65 years. Higher scores predict mortality risk and guide decisions regarding inpatient versus outpatient treatment. This patient demonstrates confusion and tachypnea, placing her at increased risk. Wells score evaluates pulmonary embolism probability, CHA₂DS₂-VASc estimates stroke risk in atrial fibrillation, and MELD predicts liver disease severity. Appropriate management includes timely antibiotic administration, oxygen support when indicated, assessment for sepsis, and evaluation of comorbid illnesses. Early recognition of severe pneumonia improves outcomes and reduces complications including respiratory failure and septic shock.

3. Type 2 Diabetes with Chronic Kidney Disease

Question

A patient with type 2 diabetes has persistent albuminuria and an eGFR of 48 mL/min/1.73 m² despite adequate glycemic control.

Which medication provides additional renal and cardiovascular protection?

A. Pioglitazone

B. SGLT2 inhibitor

C. Sulfonylurea

D. Meglitinide

Correct Answer: B. SGLT2 inhibitor

Explanation:

SGLT2 inhibitors reduce progression of chronic kidney disease and decrease hospitalization for heart failure in eligible patients with type 2 diabetes. Their benefits extend beyond glucose lowering and include renal protection through reduced intraglomerular pressure and improved cardiovascular outcomes. Current evidence supports their use in many patients with chronic kidney disease when kidney function remains above approved thresholds. Sulfonylureas and meglitinides primarily lower glucose but lack comparable renal protection, while pioglitazone may worsen fluid retention in susceptible patients. Monitoring kidney function, blood pressure, albuminuria, and adverse effects remains important after therapy initiation alongside ACE inhibitor or ARB treatment when indicated.

4. Ischemic Stroke Evaluation

Question

A patient develops sudden right arm weakness and expressive aphasia 45 minutes before arriving at the emergency department.

Which diagnostic study should be obtained immediately?

A. MRI spine

B. Noncontrast CT head

C. Carotid ultrasound

D. EEG

Correct Answer: B. Noncontrast CT head

Explanation:

A noncontrast head CT rapidly differentiates ischemic stroke from intracranial hemorrhage before thrombolytic therapy is considered. It is widely available, quick to perform, and identifies bleeding that would contraindicate intravenous thrombolysis. Additional vascular imaging may follow depending on suspected large-vessel occlusion and candidacy for thrombectomy. Delays in imaging reduce opportunities for reperfusion therapy because treatment effectiveness decreases with time. Carotid ultrasound and MRI may be useful later but should not delay emergency evaluation. Prompt recognition, blood glucose assessment, blood pressure management, and activation of the stroke team are essential components of evidence-based acute stroke care.

5. Upper Gastrointestinal Bleeding

Question

A patient presents with hematemesis, melena, tachycardia, and hypotension.

Which intervention should occur first?

A. Colonoscopy

B. Immediate blood pressure stabilization and IV access

C. Oral iron

D. Outpatient H. pylori testing

Correct Answer: B. Immediate blood pressure stabilization and IV access

Explanation:

Initial management of upper gastrointestinal bleeding follows stabilization principles before definitive diagnosis. Establishing large-bore intravenous access, administering isotonic fluids or blood products when indicated, monitoring vital signs, and assessing airway protection are priorities. Laboratory evaluation includes complete blood count, coagulation studies, and blood typing. After stabilization, proton pump inhibitor therapy and urgent upper endoscopy help identify and treat the bleeding source. Colonoscopy evaluates lower gastrointestinal bleeding and is inappropriate initially in hematemesis. Oral iron does not address active hemorrhage. Early resuscitation reduces mortality and improves the safety and effectiveness of subsequent endoscopic intervention.

6. Giant Cell Arteritis

Question

A 70-year-old woman reports unilateral temporal headache, jaw claudication, scalp tenderness, and transient vision loss.

What is the next best step?

A. Begin high-dose corticosteroids immediately

B. Observe for one week

C. Prescribe migraine medication

D. Schedule routine ophthalmology follow-up

Correct Answer: A. Begin high-dose corticosteroids immediately

Explanation:

Giant cell arteritis is a medical emergency because delayed treatment can result in permanent blindness. High-dose corticosteroids should be started immediately when clinical suspicion is high, even before temporal artery biopsy confirmation. Elevated ESR and CRP support the diagnosis but are not required before treatment. Jaw claudication, new headache in older adults, visual symptoms, and scalp tenderness strongly suggest this vasculitis. Temporal artery biopsy or advanced vascular imaging can confirm the diagnosis after therapy begins. Patients require close follow-up for steroid complications and gradual tapering while inflammatory markers and symptoms are monitored throughout treatment.

7. Pulmonary Embolism

Question

A postoperative patient suddenly develops pleuritic chest pain, tachycardia, and hypoxemia.

Which imaging test confirms the diagnosis in a hemodynamically stable patient?

A. CT pulmonary angiography

B. Chest radiograph

C. Echocardiogram only

D. Abdominal CT

Correct Answer: A. CT pulmonary angiography

Explanation:

CT pulmonary angiography is the preferred imaging study for diagnosing pulmonary embolism in hemodynamically stable patients without contraindications to intravenous contrast. Clinical prediction rules, such as the Wells score, help estimate pretest probability before imaging. D-dimer testing may be appropriate in selected low-risk patients but is less useful when clinical suspicion is high. Chest radiographs are frequently normal or nonspecific and cannot exclude pulmonary embolism. Prompt anticoagulation should begin when clinically appropriate, especially if diagnostic delays are expected. Massive pulmonary embolism causing shock requires urgent reperfusion strategies, including thrombolysis or catheter-directed intervention when indicated.

8. Sepsis Recognition

Question

A patient has fever, hypotension, tachycardia, elevated lactate, and suspected urinary tract infection.

Which intervention has the greatest impact on survival?

A. Delay antibiotics until cultures return

B. Early broad-spectrum antibiotics

C. Daily aspirin

D. High-dose corticosteroids for everyone

Correct Answer: B. Early broad-spectrum antibiotics

Explanation:

Early recognition and prompt administration of broad-spectrum antibiotics significantly improve survival in sepsis. Blood cultures should be obtained before antibiotics when feasible, but treatment should not be delayed if cultures cannot be obtained immediately. Fluid resuscitation, lactate measurement, source control, and hemodynamic monitoring are also essential components of sepsis management. Vasopressors are indicated when hypotension persists despite adequate fluid administration. Routine corticosteroid therapy is not recommended for every patient and is generally reserved for refractory septic shock. Timely implementation of evidence-based sepsis bundles reduces mortality, organ dysfunction, and length of hospital stay.

9. Osteoporosis Management

Question

A 68-year-old woman sustains a low-impact vertebral compression fracture.

Which medication is considered first-line therapy?

A. Alendronate

B. Prednisone

C. Calcitonin alone

D. Estrogen for every patient

Correct Answer: A. Alendronate

Explanation:

Bisphosphonates such as alendronate remain first-line pharmacologic therapy for many patients with osteoporosis who are at increased fracture risk. They inhibit osteoclast-mediated bone resorption, improving bone mineral density and reducing vertebral and hip fractures. Adequate calcium and vitamin D intake, weight-bearing exercise, smoking cessation, and fall prevention strategies should accompany medication therapy. Oral bisphosphonates require administration with water while remaining upright to minimize esophageal irritation. Calcitonin has limited long-term effectiveness, systemic corticosteroids worsen bone loss, and estrogen therapy is not routinely recommended solely for osteoporosis because of associated risks and patient-specific considerations.

10. Atrial Fibrillation Stroke Prevention

Question

A 76-year-old man with hypertension and diabetes develops nonvalvular atrial fibrillation.

Why is anticoagulation recommended?

A. To reduce ventricular rate

B. To reduce ischemic stroke risk

C. To convert rhythm immediately

D. To lower cholesterol

Correct Answer: B. To reduce ischemic stroke risk

Explanation:

Patients with atrial fibrillation are at increased risk of thromboembolic stroke due to clot formation within the left atrium, particularly the left atrial appendage. Stroke risk should be assessed using validated tools such as CHA₂DS₂-VASc, with anticoagulation recommended for many patients at elevated risk unless contraindications exist. Direct oral anticoagulants are preferred for most patients with nonvalvular atrial fibrillation because they effectively reduce stroke risk while simplifying management. Anticoagulants do not directly control ventricular rate or restore sinus rhythm. Shared decision-making should include discussion of bleeding risk, medication adherence, and renal function monitoring.

11. COPD Exacerbation

Question

A patient with COPD develops increased dyspnea, sputum production, and wheezing.

Which treatment combination is most appropriate?

A. Short-acting bronchodilator plus systemic corticosteroids

B. Oral antihistamines only

C. Proton pump inhibitor

D. Loop diuretic

Correct Answer: A. Short-acting bronchodilator plus systemic corticosteroids

Explanation:

Acute COPD exacerbations are commonly treated with inhaled short-acting bronchodilators and a short course of systemic corticosteroids, which improve airflow, shorten recovery, and reduce treatment failure. Antibiotics are considered when increased sputum purulence accompanies worsening respiratory symptoms or when ventilatory support is required. Supplemental oxygen should be carefully titrated to avoid excessive hyperoxia while maintaining adequate oxygenation. Smoking cessation, vaccination, pulmonary rehabilitation, and maintenance inhaler optimization reduce future exacerbations. Diuretics and antihistamines do not address the underlying airway inflammation and bronchospasm responsible for an acute COPD exacerbation unless another concurrent condition exists.

12. Acute Bacterial Meningitis

Question

A patient presents with fever, neck stiffness, photophobia, and altered mental status.

What should occur without unnecessary delay?

A. Empiric antibiotics

B. Physical therapy

C. Outpatient observation

D. Antihistamines

Correct Answer: A. Empiric antibiotics

Explanation:

Acute bacterial meningitis is a medical emergency requiring prompt empiric intravenous antibiotics after blood cultures are obtained whenever possible. Treatment should not be delayed for lumbar puncture or neuroimaging if those procedures would significantly postpone therapy. Adjunctive dexamethasone may be appropriate in selected patients when administered before or with the first antibiotic dose. Clinical presentation often includes fever, headache, neck stiffness, and altered mental status, although symptoms vary. Early intervention decreases mortality and neurological complications such as hearing loss, seizures, and cognitive impairment. Hospital admission and close monitoring are essential throughout treatment.

13. Diabetic Ketoacidosis

Question

A patient with type 1 diabetes presents with hyperglycemia, metabolic acidosis, positive ketones, and dehydration.

What is the initial management priority?

A. Aggressive IV fluid resuscitation

B. Oral metformin

C. Sodium restriction

D. Immediate discharge

Correct Answer: A. Aggressive IV fluid resuscitation

Explanation:

Fluid replacement is the first priority in diabetic ketoacidosis because profound dehydration contributes to hypotension, reduced renal perfusion, and electrolyte abnormalities. After initial volume resuscitation, insulin therapy and careful potassium monitoring are initiated because insulin drives potassium into cells and may precipitate hypokalemia. Frequent assessment of blood glucose, electrolytes, acid-base status, and mental status guides treatment adjustments. Identification and correction of precipitating factors, including infection or missed insulin doses, are essential to prevent recurrence. Patients require close monitoring until the anion gap closes and metabolic abnormalities have resolved before transitioning to subcutaneous insulin.

14. Rheumatoid Arthritis

Question

A patient has symmetric swelling of the MCP and PIP joints with prolonged morning stiffness.

Which medication should be started early to slow disease progression?

A. Methotrexate

B. Acetaminophen only

C. Opioids

D. Muscle relaxants

Correct Answer: A. Methotrexate

Explanation:

Methotrexate is the preferred first-line disease-modifying antirheumatic drug for many patients with rheumatoid arthritis because early treatment slows joint destruction, improves function, and increases the likelihood of sustained disease control. Baseline laboratory evaluation includes liver function tests, complete blood count, and renal assessment before therapy. Folic acid supplementation reduces adverse effects associated with methotrexate. Analgesics may relieve symptoms but do not prevent progressive joint damage. Patients require regular monitoring for medication toxicity and assessment of treatment response. Referral to rheumatology facilitates early diagnosis, individualized treatment, and long-term disease management.

15. Thyroid Nodule Evaluation

Question

A 52-year-old woman has a newly discovered 2-cm thyroid nodule.

Which laboratory test should be obtained first?

A. Serum TSH

B. Serum cortisol

C. D-dimer

D. Lipase

Correct Answer: A. Serum TSH

Explanation:

Measurement of serum TSH is the recommended initial laboratory evaluation for most patients with a thyroid nodule. If TSH is suppressed, radionuclide thyroid scanning helps determine whether the nodule is hyperfunctioning, which is rarely malignant. If TSH is normal or elevated, thyroid ultrasonography evaluates suspicious sonographic features and guides the need for fine-needle aspiration based on established size and risk criteria. Most thyroid nodules are benign, but systematic evaluation is essential to identify clinically significant thyroid cancer while avoiding unnecessary invasive procedures. Patient counseling should include appropriate follow-up recommendations and risk assessment.

16. Acute Flaccid Myelitis

Question

A previously healthy 8-year-old boy develops fever followed by sudden asymmetric weakness of his right arm several days after a viral respiratory illness. Sensation remains largely intact.

What is the most likely diagnosis?

A. Acute flaccid myelitis

B. Guillain-Barré syndrome

C. Muscular dystrophy

D. Multiple sclerosis

Correct Answer: A. Acute flaccid myelitis

Explanation:

Acute flaccid myelitis is a rare neurologic syndrome affecting the anterior horn cells of the spinal cord, often following viral infections. Patients develop rapid-onset limb weakness with diminished reflexes while sensation is relatively preserved. MRI of the spinal cord demonstrates gray matter abnormalities. Early neurology consultation, respiratory monitoring, rehabilitation, and supportive care are essential because respiratory muscle weakness may develop unexpectedly.

17. Cesarean Scar Ectopic Pregnancy

Question

A woman with a history of two prior cesarean deliveries presents early in pregnancy with vaginal bleeding. Ultrasound demonstrates implantation within the previous cesarean scar.

What is the major risk if untreated?

A. Uterine rupture with life-threatening hemorrhage

B. Gestational diabetes

C. Placenta previa only

D. Hyperemesis gravidarum

Correct Answer: A. Uterine rupture with life-threatening hemorrhage

Explanation:

Cesarean scar ectopic pregnancy is a rare but dangerous form of ectopic implantation. Continued growth may lead to uterine rupture, catastrophic hemorrhage, placenta accreta spectrum disorders, and maternal death. Early diagnosis using transvaginal ultrasound allows timely management with medical or surgical treatment. Close obstetric follow-up is critical because delayed recognition significantly increases maternal morbidity.

18. Spontaneous Esophageal Rupture vs Myocardial Infarction

Question

A patient presents with severe chest pain after repeated vomiting. ECG and cardiac biomarkers are normal, but CT demonstrates mediastinal air.

Which diagnosis is most likely?

A. Boerhaave syndrome

B. Acute myocardial infarction

C. Stable angina

D. Costochondritis

Correct Answer: A. Boerhaave syndrome

Explanation:

Spontaneous esophageal rupture should be suspected when severe chest pain follows forceful vomiting and imaging demonstrates pneumomediastinum. Early recognition is critical because untreated perforation rapidly progresses to mediastinitis and septic shock. Broad-spectrum antibiotics, surgical consultation, and avoidance of oral intake are immediate priorities. Prompt intervention significantly improves survival.

19. Acute Adrenal Crisis

Question

A 42-year-old woman with primary adrenal insufficiency presents with vomiting, diarrhea, confusion, and profound weakness after several days of influenza. Vital signs are temperature 38.5°C (101.3°F), blood pressure 74/46 mm Hg, heart rate 128/min, and respiratory rate 24/min. Laboratory results reveal sodium 122 mEq/L, potassium 6.4 mEq/L, glucose 48 mg/dL, and creatinine 2.0 mg/dL.

What is the most appropriate immediate management?

A. Intravenous hydrocortisone, aggressive isotonic fluids, and dextrose

B. Begin fludrocortisone only

C. Administer intravenous insulin and discharge once potassium normalizes

D. Obtain serum cortisol level before initiating treatment

Correct Answer: A. Intravenous hydrocortisone, aggressive isotonic fluids, and dextrose

Explanation:

Adrenal crisis is a life-threatening endocrine emergency characterized by hypotension, hypoglycemia, hyponatremia, hyperkalemia, and shock. Treatment should never be delayed while awaiting laboratory confirmation. Immediate intravenous hydrocortisone is preferred because it provides glucocorticoid activity while also offering mineralocorticoid effects at stress doses. Aggressive isotonic saline, correction of hypoglycemia, treatment of hyperkalemia when necessary, and management of the precipitating illness are essential. Delay in corticosteroid administration markedly increases mortality.

20. Aortic Stenosis Causing Syncope

Question

A 74-year-old man reports progressive exertional dyspnea, angina, and two recent syncopal episodes while walking uphill. Examination reveals a harsh crescendo-decrescendo systolic murmur best heard at the right upper sternal border with radiation to the carotids. Echocardiography demonstrates an aortic valve area of 0.7 cm² and a mean gradient of 48 mm Hg.

Which management is most appropriate?

A. Aortic valve replacement

B. Medical therapy with nitrates alone

C. Annual echocardiography only

D. Long-term anticoagulation without intervention

Correct Answer: A. Aortic valve replacement

Explanation:

Symptomatic severe aortic stenosis has a poor prognosis without valve replacement. Once symptoms such as exertional angina, syncope, or heart failure develop, mortality rises sharply if definitive intervention is delayed. Valve replacement may be performed surgically or via transcatheter aortic valve replacement (TAVR) depending on surgical risk, anatomy, and patient characteristics. Medical therapy provides symptom relief but does not alter disease progression.