PANCE study plan

Differentiate the four major valvular lesions by auscultatory timing, location, and radiation, and name the confirmatory imaging study for each

Distinguish heart failure with reduced ejection fraction from heart failure with preserved ejection fraction and select guideline-directed first-line pharmacotherapy for each

Interpret ECG tracings for ST-elevation myocardial infarction, atrial fibrillation, and ventricular tachycardia, and state the immediate intervention for each

Compare anticoagulation and rate-versus-rhythm strategies for atrial fibrillation using stroke-risk stratification

Order the initial workup for a patient with syncope and stratify by high-risk features warranting admission

Apply acute coronary syndrome pathways, including timing of reperfusion and choice of antiplatelet and anticoagulant therapy

Select empiric antibiotic therapy for community-acquired pneumonia stratified by outpatient versus inpatient versus ICU setting

Distinguish asthma from chronic obstructive pulmonary disease using spirometry and symptom pattern, and outline step-up controller therapy

Identify life-threatening causes of acute dyspnea and state the first stabilizing maneuver for tension pneumothorax and massive pulmonary embolism

Stage obstructive lung disease severity and match inhaled therapy to stage and exacerbation history

Evaluate suspected pulmonary embolism using pretest probability tools and interpret D-dimer results in low-, moderate-, and high-risk patients

Localize joint pain as intra-articular versus periarticular using passive range-of-motion and provocative maneuvers

Differentiate rheumatoid arthritis from osteoarthritis and gout, and select initial disease-modifying therapy for rheumatoid arthritis

Apply fracture decision rules to ankle and knee injuries and identify which patients require imaging

Screen for red-flag features in acute low back pain and outline emergent management of cauda equina syndrome

Classify skin lesions by morphology and primary configuration, and apply pigment-lesion warning features to decide on biopsy referral

Differentiate psoriasis, atopic dermatitis, tinea, and cellulitis by distribution and surface characteristics, and select first-line treatment for each

Distinguish acute otitis media from otitis externa and identify the examination findings that mandate drainage or referral

Recognize peritonsillar abscess and epiglottitis and state the airway and antibiotic steps for each

Select initial imaging for suspected fracture or ligamentous injury when decision rules are inconclusive

Stage acute kidney injury by severity criteria and distinguish prerenal, intrinsic, and postrenal causes using urinalysis and fractional excretion indices

Differentiate nephrotic from nephritic syndrome by urinalysis, complement levels, and associated systemic findings

Choose empiric and definitive therapy for uncomplicated cystitis, pyelonephritis, and complicated urinary tract infection based on risk factors

Distinguish gastroesophageal reflux disease, peptic ulcer disease, and functional dyspepsia, and apply testing and eradication strategy for Helicobacter pylori

Localize an upper versus lower gastrointestinal bleed and state the initial resuscitation and endoscopic timing for each

Differentiate biliary colic, acute cholecystitis, and acute pancreatitis by history, laboratory pattern, and imaging choice

Apply colorectal cancer screening options and intervals to patients stratified by age and family history

Evaluate abnormal uterine bleeding and first-trimester bleeding by pregnancy status and hemodynamic stability

Diagnose polycystic ovary syndrome and select an appropriate contraceptive and ovulation-induction strategy

Classify thyroid dysfunction by thyroid-stimulating hormone and free thyroxine pattern and select treatment for each pattern

Manage diabetic ketoacidosis with a fluid, insulin, and potassium protocol and calculate the anion gap to track resolution

Localize an acute stroke syndrome by vascular territory and identify the treatment window and contraindications for thrombolysis

Differentiate migraine, cluster headache, and subarachnoid hemorrhage by onset, associated features, and imaging strategy

Screen for major depression and substance use disorder using validated instruments and select first-line pharmacotherapy with monitoring plan

Interpret complete blood count with iron studies and reticulocyte index to classify microcytic and macrocytic anemias

Identify the reversal agent and urgent step for each major anticoagulant in a bleeding patient

Distinguish generalized from focal seizure types and select initial monotherapy

Select empiric antibiotic therapy by infection site and patient risk factors, and adjust for resistance patterns and allergy

Interpret human immunodeficiency virus screening and staging tests and identify indications for opportunistic infection prophylaxis

Recognize sepsis and septic shock and apply the time-based resuscitation bundle

Re-drill your five weakest domains using the error log compiled across weeks 1 through 7

Simulate full-length test conditions to practice pacing, flagging, and time allocation per question