PANCE key terms

Narrowing of the aortic valve that obstructs left ventricular outflow, producing a harsh crescendo-decrescendo systolic murmur, exertional dyspnea, angina, and syncope; severe symptomatic disease requires valve replacement.

Clinical syndrome of congestion and low forward output with a left ventricular ejection fraction of 40% or less; treated with guideline-directed therapy including renin-angiotensin inhibition, beta-blockade, mineralocorticoid antagonists, and SGLT2 inhibitors.

Supraventricular arrhythmia with chaotic atrial activation, absent P waves, and an irregularly irregular ventricular response; left atrial stasis creates risk of cardioembolic stroke, so anticoagulation is guided by stroke risk scores.

Acute transmural myocardial injury from coronary artery occlusion, diagnosed by ST-segment elevation in contiguous leads and treated with emergency reperfusion by percutaneous coronary intervention or fibrinolysis.

Chronic lung disease of emphysema and small-airway disease, usually tobacco-related, causing progressive dyspnea, chronic cough, air trapping, and a persistently reduced FEV1/FVC ratio with acute exacerbations.

Chronic airway inflammation with variable, reversible bronchoconstriction causing episodic wheeze, cough, chest tightness, and dyspnea; managed with inhaled corticosteroids and as-needed bronchodilators, plus written action plans for exacerbations.

Thrombus, usually from a deep leg vein, obstructing pulmonary arteries and causing acute dyspnea, pleuritic chest pain, tachycardia, and hypoxemia; management depends on hemodynamic stability and right ventricular strain.

Degenerative joint disease with cartilage loss, subchondral sclerosis, and osteophyte formation causing activity-related pain, brief morning stiffness, and bony enlargement, most often at the knees, hips, and hands.

Chronic symmetric inflammatory polyarthritis driven by autoimmunity, with prolonged morning stiffness, small-joint synovitis, and extra-articular disease; early treatment with disease-modifying antirheumatic drugs such as methotrexate prevents joint destruction.

Rising pressure inside a closed fascial compartment that compromises blood flow, causing pain out of proportion, tense swelling, and pain with passive stretch; emergency fasciotomy is needed to prevent muscle and nerve death.

Retrograde flow of gastric contents into the esophagus causing heartburn and regurgitation; alarm features such as dysphagia, weight loss, or bleeding, and refractory symptoms, warrant upper endoscopy.

Advanced hepatic fibrosis with nodular regeneration that causes portal hypertension, impaired synthetic function, ascites, esophageal varices, hepatic encephalopathy, and increased risk of hepatocellular carcinoma.

Sudden inflammation of the pancreas, usually from gallstones or alcohol, diagnosed when two of three criteria are met: characteristic epigastric pain, lipase over three times normal, and consistent imaging.

Abrupt decline in kidney function over hours to days, recognized by a rising serum creatinine or falling urine output and classified as prerenal, intrinsic renal, or postrenal, with hyperkalemia and volume overload as complications.

Kidney damage or reduced glomerular filtration persisting at least three months, staged by GFR, producing anemia, mineral and bone disorder, and progressive risk of end-stage renal disease.

Glomerular injury causing proteinuria above 3.5 grams daily, hypoalbuminemia, edema, and hyperlipidemia, with increased risks of venous thrombosis and serious infection.

Pregnancy-specific hypertensive disorder arising after 20 weeks with proteinuria or maternal organ dysfunction; delivery is definitive treatment, and magnesium sulfate prevents eclamptic seizures in severe disease.

Endometrial-like tissue implanted outside the uterus causing cyclic pelvic pain, dysmenorrhea, dyspareunia, and infertility; the diagnosis is suggested clinically and confirmed by laparoscopy.

Common endocrine disorder defined by oligo-ovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries, causing irregular menses, hirsutism, infertility, and insulin resistance.

Hyperglycemia from insulin resistance and progressive beta-cell failure, diagnosed by hemoglobin A1c, fasting glucose, or glucose tolerance testing, and complicated by microvascular and macrovascular disease.

Acute insulin deficiency with unrestrained ketone production causing hyperglycemia, high-anion-gap metabolic acidosis, dehydration, and total-body potassium depletion; treatment is fluids, insulin infusion, and electrolyte replacement.

Deficient thyroid hormone causing fatigue, cold intolerance, weight gain, constipation, dry skin, and bradycardia, confirmed by an elevated TSH with low free T4 and treated with levothyroxine.

Autoimmune hyperthyroidism caused by TSH-receptor-stimulating antibodies, producing thyrotoxicosis, diffuse goiter, ophthalmopathy, and pretibial myxedema; treated with antithyroid drugs, radioiodine, or surgery.

Sudden focal neurologic deficit from cerebral artery occlusion, treated with intravenous thrombolysis or endovascular thrombectomy within time windows after intracranial hemorrhage is excluded by imaging.

Immune-mediated demyelination of the central nervous system causing relapsing sensory, motor, visual, and cerebellar deficits disseminated in time and space, often accompanied by fatigue and cognitive change.

Purulent infection of the subarachnoid space causing fever, headache, neck stiffness, and altered mental status; cerebrospinal fluid shows neutrophilic pleocytosis with low glucose, and empiric antibiotics must never be delayed.

At least two weeks of depressed mood or loss of interest, with sleep, appetite, energy, concentration, and suicidal symptoms causing functional impairment; treatment includes psychotherapy and antidepressant medication.

Mood disorder defined by at least one manic episode, with elevated or irritable mood, decreased need for sleep, grandiosity, and impulsivity; depression often occurs, and antidepressant monotherapy can trigger mania.

Toxic excess of serotonergic activity from combinations of serotonergic drugs, producing agitation, clonus, hyperreflexia, hyperthermia, and autonomic instability; treatment is stopping the drugs and supportive care.

Microcytic hypochromic anemia from depleted iron stores, with low ferritin, fatigue, pica, and koilonychia; evaluation must identify the source of blood loss, which is often gastrointestinal.

Hemoglobin S polymerization causing vaso-occlusion and hemolysis, with painful crises, acute chest syndrome, and functional asplenia that predisposes to encapsulated bacterial infection.

Immune-mediated platelet activation by heparin-platelet factor 4 antibodies causing thrombocytopenia with paradoxical thrombosis; heparin must be stopped immediately and a non-heparin anticoagulant started.

Malignant tumor of melanocytes assessed by asymmetry, border irregularity, color variation, diameter, and evolution; Breslow depth guides prognosis, and early excision is often curative.

Acute bacterial infection of the deep dermis and subcutaneous fat causing expanding warmth, erythema, swelling, and tenderness, usually from streptococci or Staphylococcus aureus.

Sudden obstruction of aqueous outflow causing severe eye pain, headache, blurred vision with halos, a mid-dilated fixed pupil, and a rock-hard globe; immediate pressure-lowering treatment prevents permanent blindness.

Life-threatening organ dysfunction caused by a dysregulated host response to infection, treated with cultures, early broad-spectrum antibiotics, and fluid resuscitation, often requiring vasopressors.

Infection with Mycobacterium tuberculosis, usually pulmonary, presenting with cough, fever, night sweats, and weight loss; latent infection is treated to prevent reactivation, and active disease requires multidrug therapy.

Colitis caused by toxin-producing Clostridioides difficile, usually after antibiotic exposure, producing watery diarrhea, abdominal cramping, and fever; treated with oral vancomycin or fidaxomicin, avoiding antimotility drugs.