PANCE/PANRE Word Associations

Word Associations
This study sheet is used to help you recognize key words and patterns associated with certain diagnosis. It is N T intended to steer you to re!e!"er answers to test# "ut instead to help you recognize the intent or !ost likely diagnosis. The in$or!ation o$ that speci$ic diagnosis is up to your le%el o$ knowledge. It&s to help narrow that di$$erential so you can $ocus on the speci$ics o$ the !ost likely diagnosis.

CARDIO Description ' E# PN'# ede!a. Echo w/ ()* or R)*# hypokinesis ,*igh output heart $ailure (ow output heart $ailure *eart $ailure a$ter 0RI 1oung athlete with syncope during athletic e%ent or practice. No physical e.a! a"nor!alities Alcoholic with ' E# heart $ailure Alcoholic with palpitations# arrhyth!ia Irregular irregular Atrial $i"rillation or prosthetic %al%e *. angina "ut no acute s.. E32 no acute changes. Crushing CP# dyspnea# palpitations# radiation to neck or le$t ar! C*+ C*+# dilagted cardio!yopathy Pregnancy# thyroto.icosis# ane!ia# "eri"eri# paget&s disease Ische!ic heart disease# *TN# dilated C/# %al%e disease# arrhyth!ia /yocarditis *ypertrophic C/ or $atal arrhyth!ia. 2et E32 or Echo Pri!ary dilated C/ Atrial $i"rillation 4*oliday heart5 Atrial $i"rillation6 4i$ 7 89 or chronic : anticoagulate5 War$arin 4; : - $or A$i"6 ;.< : -.< $or %al%e56 T. War$arin ' is %ita!in 3 'o E.ercise stress test Angina 4i$ lasts !inutes5# A/I i$ lasts 7 -= !inutes. Acute Ische!ia : ,T ele%ation6 In>ury : T wa%e depression6 In$arct : ? wa%e Pericarditis Pericardial e$$usion/ta!ponade# pericarditis# asth!a attack# tension PT@# ,)C o"struction Pericardial e$$usion/ta!ponade Pericardial e$$usion/ta!ponade 4Beck&s triad5
C

Diagnosis Associated

Constant# sharp CP worse lying down# "etter sitting up and leaning $orward pulsus parado.us Electrical alternans# narrow pulse pressure# pulsus parado.us A)'# *ypotension# !u$$led heart sounds

PANCE/PANRE Word Associations

Pericarditis post open heart surgery ,udden onset ripping# tearing chest pain# di!inished pulses +lank pain# hypotension# pulsatile a"do!inal !ass E32 changes# N# )# yellowEgreen %isual distur"ances *. C*+ on diuretic F digo.in 2rossly ele%ated "lood pressure esp. w/ signs o$ E ' *TN T. w/ !eds# cough or angioede!a '/ F *TN *eart $ailure# ()* Post /I T. o$ *TN w/ alphaE"locker *TN not responsi%e to "asic !eds

'ressler&s syndro!e. T. w/ A,A DC. Indo!ethacin or other N,AI' 3. Aortic dissection AAA 'igo.in to.icity 4*ypokale!ia will !ake worse5 ,uspect dig to.icity 4hypokale!ia $ro! diuretic G dig to.icity5 /alignant or 0rgent *TN ACEI is cause ACEI is "est choice ACEI 4i!pro%es sur%i%al# pre%ents de%elop!ent o$ heart $ailure ,.5 BetaE"lockers ,E is postural *ypotension Think secondary *TN !ost likely Renal artery stenosis 4in$rarenal artery5. Bacterial endocarditis 4strep. )iridians5 pre%ention Bacterial endocarditis 4strep. )iridians5 Aortic stenosis 4due to calci$ications : age related 4or "icuspid %al%e E congenital5 Aortic stenosis Aortic Regurgitation/Insu$$iciencyJ ?uincke&s pulse 4su"ungual capillar pulsation5# Corrigan 4rapid rise and $all5# Austin $ilnt 4low pitch !iddiastolic !ur!ur at ape.5 /itral stenosis 4AR/, are BA'5
;

/echanical %al%e or prosthesis F 'ental# 20# 2I# or ortho procedure prophyla.is I)'A w/ new !ur!ur Elderly w/ systolic !ur!ur 'ia!ond shaped# "lowing systolic !ur!ur. /ay ha%e angina# syncope# C*+ (ateral displaced P/I# Canon HaI wa%es# ?uincke&s pulse# Corrigan&s pulse# Austin $lint !ur!ur# de/usset&s sign# water 'iastolic !ur!ur "est heart at ape. without radiation

PANCE/PANRE Word Associations

,ystolic e>ection !ur!ur heard "est at "ase with radiation to le$t cla%icle +e!ale or Post /I# systolic !ur!ur "est K ape. preceded "y click without radiation ,ystolic !ur!ur heard "est at ape. with radiation to le$t a.illa 4apical systolic5 New !ur!ur a$ter /I 4esp. i$ apical systolic5 /ur!ur F *. rheu!atic heart disease Continuous harsh# !achineElike !ur!ur Cyanotic in$ant with systolic thrill K (,B# systolic e>ection !ur!ur L/E click *olosystolic !ur!ur K (,B# !ay ha%e %entricular hypertrophy In$ant w/ dyspnea# di$$iculty $eeding. *olosystolic !ur!ur K (,B# -rd IC,. ()* F R)* Peds w/ leg pain a$ter physical acti%ity# a"nor!al heart sounds# uneMual 0E F (E pulses# ri" notching

Pul!onary stenosis /itral %al%e prolapse /itral regurgitation /itral regurgitation 4caused "y papillary !uscle rupture5 /itral stenosis DC# Tricuspid ,tenosis D; P'A Tetralogy o$ $alot

),' ),'

Coarctation o$ aorta

,hort PR# wide ?R,# 'elta wa%e 1oung $e!ale 4N-=yo5# palpitations# long ar!s F $ingers# pectus e.ca%atu!# ectopic lentis# $le.i"le >oints (E ru"or# no hair# "rittle nails# pallor on ele%ation# cal$ or (E pain esp. with walking short distances relie%ed with rest or at P/ Claudication with rest pain# 4ABI N =.85
-

Wol$EparkinsonEwhite6 a%oid 'igo.in# /ar$an&s ,yndro!e : /)P# Aortic regurgitation# Aortic dissection# Aortic root dilatation# ectopic lentis

Arterial insu$$iciency/PA'# Inter!ittent claudication 4ABI "est choice# ateriogra! gold standard5 T. is arterial "ypass

PANCE/PANRE Word Associations

(E pain a$ter long periods o$ standing. 'ilated# tortuous# %eins Trendelen"erg test o$ e.tre!ities Blue e.tre!ities worse w/ cold e.posure# i!pro%es w/ war!ing PULMONARY Description Rapid# deep la"ored "reathing 'eep "reathing alternating w/ apnea Ca%itations on C@R Apical in$iltrates# +# C# dry cough Pleural thickening on C@R *ilar !ass on C@R Eggshell pattern on C@R 2round glass appearance on C@R Reticular to nodular pattern on C@R Patchy $i"rosis on C@R 2ranulo!as and in$la!!ation o$ al%eoli# s!all "ronchi and s!all "lood %essels 'yspnea a$ter surgery# tra%el 4airplane5# (E +.. /ay ha%e c/o cal$ pain also. (ung scan with per$usion de$ects )enous stasis# %essel wall in>ury# hypercoagula"ility Pediatric with "arking cough# stridor

)aricose %eins. T. w/ co!pression stockings Tests $or %einous insu$$iciency. Acrocyanosis

Diagnosis Associated 3uss!aul "reathing : '3A# /eta"olic acidosis CheyneE,tokes "reathing : heart $ailure# "rain da!age In$ections : lung a"scess# TB 42ohn $ocus5 TB /esothelio!a (ung Ca ,ilicosis 4,and"lasters5 As"estosis 4ship"uilders# "uilding de!olition5 Coal /iner&s lung +ar!ers lung ,arcoidosis

')T/PE PE ')T/PE 4)irchow&s triad5 %iral croup 4laryngotracheo"ronchitis56 T. w/ race!ic epi and glucocorticosteroids i$ stridor at rest. lower respiratory +B# asth!a
8

Pediatric wheezing

PANCE/PANRE Word Associations

'rooling# sni$$ing position# tripod# to.ic Thu!"print sign ,teeple sign Inspiratory stridor Pre!ature in$ant with respiratory distress Pree!ie C@R w/ hypoe.pansion 4AT@5# air "ronchogra!s ,!oker# chronic producti%e cough. N he!optysis# wt. loss. ,!oker# ' E# cough *yperin$lation on C@R# tear drop heart Wheezing# prolonged e.piration Airway ede!a with eosinophils# neutrophils# ly!phocytes +e%er# cough# sputu!. Crackles# decreased "reath sounds# dullness to percussion# Legophony# pectoriloMuy. C@R : in$iltrates or consolidation 7-<yo with PNA. Rusty colored or yellowEgreen sputu!. Acute onset +/C N-< yo# college students. +e%er# cough# L/E sputu!# chills# !uscle aches Bullous !yringitis PNA w/ ,!okers# C P' PNA w/ '/# i!!unoco!pro!ised# Et *. Currant color sputu!. PNA w/ Water# late su!!er# construction site. 'iarrhea. To.ic looking PNA $ro! Nursing ho!es# chronic care $acility. Purulent sputu! PNA F *I)L# AI',# I!!unoco!pro!ised. ,. out o$ proportion to e.a!. 'i$$use
<

Epiglottitis Epiglottitis +B# %iral croup 4laryngotracheo"ronchitis5 +B# %iral croup 4laryngotracheo"ronchitis5 *yaline /" 'isease *yaline /" 'isease Brochitis 4C P'5 C P' E!physe!a Asth!a Asth!a Pneu!onia

,trep. Pneu!onia /ycoplas!a pneu!onia /ycoplas!a pneu!onia *. in$luenza 3le"siella (egionella ,taphylococcus aureus Pneu!ocystis >ero%ecii6 T/PE,/@ G 'rug o$ choice

PANCE/PANRE Word Associations

interstitial F al%eolar in$iltrates PNA F decreased !ental status# poor dental hygiene# dentures# $oul s!elling sputu!# "ronchiectasis. Patchy in$iltrates in dependant lung zones Pediatric with *. recurrent lung in$ections# pancreatitis# reproducti%e pro"le!s# +TT ,weat chloride test Cystic $i"rosis w/ PNA N ; days postEop with $e%er ,ta" wound# hyperresonance to percussion# decreased "reath sounds# ty!pany ,tM" wound# dullness to percussion# decreased "reath sounds. Tall# skinny# !ale# "and student# acute onset oneEsided chest pain# dyspnea ,ta" wound to chest. *ypotension# tracheal shi$t Poor sleeping# o"ese# dayti!e $atigue F drowsy# snoring# *TN# P/ wakening s/p thoracic trau!a. /ultiple ri" $ractures. Chest wall !o%es in with inspiration# out with e.piration.

Aspiration PNA

Cystic $i"rosis 4,taph F Pseudo!onal in$ections usually cause o$ death5 Cystic $i"rosis Pseudo!onas aueroginosa causati%e agent Atelectasis Pneu!othora. *e!othora. ,pontaneous PT@

Tension PT@ "structi%e sleep apnea

+lail chest 4pain control# incenti%e spiro!etry# pul!onary toilet# intu"ation5

GI/NUTRITION Description +at# $orty# $e!ale# $ertile w/ R0? pain +e%er# R0? pain# radiation to "ack Ele%ated Alkaline phosphatase#
O

Diagnosis Associated Cholelithiasis or Cholecystitis Cholecystitis Cholecystitis

PANCE/PANRE Word Associations

urinary "iliru"in +# R0? pain# Aaundice# gallstones F dilated co!!on duct on 0, *. IB'# progressi%e R0? pain# wt loss# +# >aundice F pruritis. Ele%ated "ilru"in F alkaline phosphate. ERCP with "ile duct stenosis# dilatation Ele%ated A,T# A(T# indirect "iliru"in Isolated ele%ated indirect "iliru"in Ele%ated indirect "iliru"in w/ de$ecti%e glucuronyl trans$erase Photosensiti%ity# a"d pain w/ neurologic dys$unction# erythe!a or skin $ragility *.pylori gastritis Chronic cough# "itter taste in !outh or throat# dyspepsia /ultiple or constant 2I ulcer pain despite !edications Ascending cholangitis 4Charcot&s triad5 Pri!ary sclerosing cholangitis 4di$$use intraE and e.trahepatic duct sclerosing and dilatation5 *epatitis 2il"ert&s syndro!e CriglerENa>>ar 'z Porphyria

;anti"iotics F PPI 2ER' PollingerEEllison ,yndro!e

N/)# epigastric a"do!inal pain# worse Acute pancreatitis supine# caused "y alcohol ingestion# or $ollowing $atty !eals PeriEu!"ilical or $lank ecchy!osis A"do!inal distension# "loating# inter!ittent# colicky pain# highE pitched rushes F tinkles Air $luid le%els on upright a"d plain $il! Air under diaphrag!# rigid "oardElike a"do!en 7O=yo +# ((? pain Elderly# *. atherosclerosis. 'ull cra!py periu!"ilical pain postE prandial
Q

Acute pancreatitis 4Cullen F 2rey Turner&s ,ign5 ,B ,B Per$orated %iscus# per$orated ulcer 'i%erticulitis. I) A".# $luids# NP . /esenteric ische!ia

PANCE/PANRE Word Associations

Neonate w/ pro>ectile %o!iting. li%e sized !ass. Choking# cyanosis# respiratory distress# increased secretions in Cst hours o$ li$e Painless rectal "leeding in pediatrics Alcoholic with !assi%e he!optysis +e!ale with recurrent a"do!inal pain# alternating diarrhea# constipation. Pain relie%ed with de$ecation. Bloody 'iarrhea ,upracla%icular (A' 4( 7 R5 *ard periu!"ilical nodule P0'# Pernicious ane!ia 4Type A 2astritis5# *. pylori Apple core lesion Elderly with positi%e he!!ocult. CEA +a!ily history o$ young age colon cancer# !ultiple polyps $ound on colonoscopy A+P CA CRER CAEC;< Che!otherapy induced NF) Tra%eler&s 'iarrhea 2reasy# $oul s!elling# $loating stools. PearEshaped $lagellated protozoan w/ ; HeyesI. Water# tra%el# ca!ping history A$e"rile# watery or loose stool. No
9

Pyloric stenosis Tracheoesophageal $istula /eckel&s di%erticulu! Esophageal %aricies 4T. w/ octreotide5 IB,. TCA&s 4nortriptyline5 good i$ diarrhea predo!inant sy!pto!

0lcerati%e colitis )irchow&s node : !etastatic a"do!inal cancer ,ister !ary Aoseph nodule G indicates !etastatic gastric and pancreatic cancers 2astric Ca Colon Cancer Colon Cancer : get colonoscopy Colon Carcino!a +a!ilial adeno!atous polyposis 42ardner&s syndro!e5 *epatocellular carcino!a# testicular se!ino!a 4ger! cell tu!or5 Pancreatic Ca %arian Carcino!a Treat with ndansetron 4Po$ran5 4<E *T- "lockers5 E. coli is cause. *ydration F Cipro to treat 2iardia

)iral 2astroenteritis

PANCE/PANRE Word Associations

"lood or !ucus A"do!inal pain# diarrhea a$ter picnic/party. Eaten ha!# crea!# custards# !ayonnaise Acute "acterial diarrhea w/ prodro!e o$ *A# +# then cra!py a"d pain F diarrhea Painless rectal "leeding. Bulging perianal !ass w/ straining Pediatric with perianal pruritis esp. at P/. Positi%e cellophane tape test Weight loss# recurrent greasy stools 4steatorrhea5 !i.ed with diarrhea a$ter certain $oods AntiEendo!ysial anti"odies Beri"eri Pellagra ,cur%y Rickets Night "lindness /agenta tongue s/p gastric "ypass surgery or gastric surgery. N# a"d cra!ping# dizziness a$ter eating. No !asses# "leeding ENDOCRINE Description 'ia"etic w/ anore.ia# ane!ia# wt loss# pallor 2astroparesis# i!potence# recurrent in$ections# stockingEglo%e paresthesia *ypoglyce!ia despite glucose ad!inistration. Increased CEpeptide *ypoglyce!ia in alcoholic 'ecreased radioacti%e iodine uptake#
R

,taphylococcus aureus in$ectious diarrhea Ca!pylo"acter >e>uni : !ost co!!on cause o$ acute "acterial diarrhea Internal he!orrhoids Pruritis ani : Pinwor!s 4entero"iasis5. T. is /e"endazole Celiac ,prue Celiac ,prue Thia!ine6 Alcoholics# Neuro ,. Niacin 48'&s der!atitis# diarrhea# de!entia# death5# "right red tongue )it C 4easy "leeding# "ruising# hair F tooth loss# >oint pain F swelling5 )it ' 4 steo!alacia5 )it A de$iciency Ri"o$la%in de$iciency 4B;5 'u!ping syndro!e

Diagnosis Associated CR+ 'ia"etic neuropathy 4Treat w/ TCA 4a!itriptyline5 Insulino!a 2i%e Thia!ine "e$ore glucose to pre%ent Wernicke&s encephalopathy *ashi!oto&s thyroiditis

PANCE/PANRE Word Associations

decreased $ree T8# increased T,* +e!ale# weight loss# palpitations# atrial $i"rillation E.opthal!os# palpitations# wt. loss. Ele%ated radioacti%e idodine uptake Post thyroidecto!y : !ost likely in>ury Post thyroidecto!y : electrolyte watch In$ant w/ round $ace# large protruding tongue# dry skin# u!"ilical hernia# constipation# enlarged a"do!en# poor $eeding# delayed de%elop!ental !ilestones

*yperthyroid 4work it up with T,*# T85 *yperthyroid# 2ra%es '. : T. w/ Radioacti%e iodine Recurrent laryngeal ner%e G hoarseness *ypocalce!ia Congenital *ypothyroidis!

Recurrent *A# *TN not responding to Pheochro!ocyto!a : T. preEop w/ !eds# sweating alpha "locker Attacks o$ se%ere *A# *TN# glucosuria 0rinary catechola!ines# urinary !etanephrines *TN not responsi%e to !eds Renal artery stenosis 4In$rarenal artery5 *TN w/ hypernatre!ia# hypokale!ia Pri!ary Aldosteronis! Wt. gain# ede!a# coarse dry skin# hair# !enorrhagia# cold intolerance# h. transphenoidal surgery F radiation Tetany# hypocalce!ia# cataracts E.ogenous corticosteroid use 'e.a!ethasone suppression test Central o"esity# a"do!inal stria# hyperglyce!ia# !oon $acies# "u$$alo hu!p# easy "ruising Acute steroid withdrawal *ypothyroidis!

*ypoparathyroidis! Cushing syndro!e Cushing syndro!e Cushing syndro!e

Addison&s disease# crisis

C=

PANCE/PANRE Word Associations

*yperpig!entation# hypoglyce!ia# orthostatic hypotension# hypotension not responsi%e to $luids# hypotension $ollowing an illness# trau!a# or surgery Worsening $atigue# wt loss# weakness# recurrent a"do!inal pain# hair loss# hyperpig!entation. *yponatre!ia# hyperkale!ia *yponatre!ia# hyperkale!ia Polyuria# polydipsia. 'ilute urine# *ypernatre!ia Concentrated urine. *yponatre!ia 8<#@ : low hairline# low set ears# we""ed neck# short stature6 shield chest# wide set nipples# in$ertility# lack o$ ,econdary se. characteristics @@1 E short stature# S intelligence6 s!all $ir! testes# gyneco!astia# a"n ar!E"ody length

Addison&s disease# crisis 4(ow aldosterone6 get Rando! or A/ cortisol# ACT* sti!ulation test5

Addison&s disease# crisis 4(ow aldosterone6 get Rando! or A/ cortisol# ACT* sti!ulation test5 Acute adrenal insu$$iciency 4Addison&s crisis5 'ia"etes insipidus ,IA'* Turners 4gonadal dysgenesis

3line$elters 4hypogonadis!5

GU/ELECTROLTES Description *yaline Casts Increased B0N/Cr# low +eNa Irritati%e %oiding sy!pto!s# +e%er# chills# C)A tenderness Crush in>ury# alcoholic on ground# ele%ated CP3# AR+ Painless he!aturia# $lank pain or !ass

Diagnosis Associated Nor!al 4!ay "e present a$ter $e"rile illness# strenuous e.ercise5 Prerenal +ailure 4Azote!ia5 Pyelonephritis Rha"do!yolysis Renal cell Carcino!a

CC

PANCE/PANRE Word Associations

liguria# he!aturia# proteinuria $ollowing streptococcal in$ection *e!aturia# purpuric rash $ollowing streptococcal in$ection *e!aturia# RBC casts# proteinuria RBC casts 3idney F lung "leeding 4he!aturia# he!optysis5 +i"rous "and on lateral penis Can&t retract $oreskin In$la!!ation o$ glans N 8= yo !ale with +e%er# perineal pain# dysuria. 7<= yo o"structi%e %oiding s.# nocturia. +ir! s!ooth enlarged prostate. Nl P,A Incontinence with straining Peaked TEwa%es 0 wa%es ?T prolongation Recurrent kidney stones# ele%ated Calciu!# decreased phosphorus *earing loss or tinnitus w/ !eta"olic acidosis NEURO Description *ead trau!a# disoriented : lucent : co!a (ens shaped he!orrhage Conca%e (P w/ decreased glucose# increased protein (P w/ decreased protein# %ery $ew neutrophils /eningitis and rash

Acute glo!eruloneprhitis 2lo!erulonephritis# *,P 2lo!erulonephritis 2oodpasteures Peyronie&s disease Phi!osis Balanitis Acute prostatitis caused "y Chla!ydia F N. gonorrhea. Treat accordingly 4Bactri! D; choice5. 7 8=yo think e. coli is cause 4T. w/ +?5 BP*. 4Cancer would ha%e $ir!# irregular# nodular nonEtender prostate# ele%ated P,A5 ,tress *yper3ale!ia *ypo3ale!ia *ypocale!ia *yperparathyroidis! Aspirin '

Diagnosis Associated Epidural *e!ato!a Epidural *e!ato!a ,u"dural *e!ato!a Bacterial !eningitis syphilitic !eningitis /eningiococcal
C;

PANCE/PANRE Word Associations

/eningitis F N;!o /eningitis N 8yo /eningitis 7 ;yo# adults )iral /eningitis 0nilateral $acial weakness w/ ina"ility to close eye Adolescent $e!ale w/ *A. L+*.. ,e%ere *A# N/)# photpho"ia. L/E auras /ale# recurrent relapsing *A. Worsened w/ Et *# (acri!ation# sali%ation# rhinorrhea ,udden onset thunderclap *A# Hworse *A o$ !y li$eI 7<= yo $e!ale w/ *A. Te!poral artery tenderness or "lindness

2rp B ,trep# E. coli 4T. N Cyo G )anco L Rocephin5 *. inlu# 2rp B strep# N. !eningititis ,trep# N. !eningititis /u!ps Bell&s palsy 4sel$Eli!iting5

/igraine *A Cluster *A ,u"arachnoid he!orrhage Te!poral arteritis 42iant cell arteritis5. Ele%ated E,R# get te!poral artery "iopsy /, /,

Recurrent episodes o$ %ision change# diplopia# weakness F tingling in e.tre!ities that resol%e !yelin $rag!ents# T Ig2# oligoclonal "ands 4Pathogno onic56 (her!itte&s sign G electrical sensation down "ody w/ neck $le.ion *A worse in A/ w/ $ocal neuro de$icits s/p +all w/ "ilateral (E weakness# urinary and rectal incontinence# decreased rectal tone Ascending paralysis Paralysis a$ter Campylobacter enteritis Weakness and $atigue in upper li!"s# "lurry %ision# diplopia# respiratory

Brain Tu!or 4/C is glio!a5 Cauda eMuine syndro!e G neurosurgical consult 2B, 2B, /yasthenia gra%is
C-

PANCE/PANRE Word Associations

distress 1oung kid with di$$iculty standing $ro! seated position. Cal$ !uscle wasting Pediatric with $e%er or *. 0RI with encephalopathy# e!esis# hyperacti%e re$le.es# hepato!egaly# ele%ated li%er enzy!es Pediatric with episodes o$ "lank stares - !*z spikes on EE2 /uscular dystrophy 4weakness "egins at pel%ic girdle5 Reye&s syndro!e $ro! 0RI/postE$lu or aspirin use

A"sence 4petitE!al5 seizures. A"sence 4petitE!al5 seizures.

HAsh lea$I hypopig!entation o$ trunk Tu"erous sclerosis F E.t# shagreen patch# se"aceous adeno!as# seizures# !ental retardation6 Ass. w/ PC3# renal he!arto!as

!EENT Description N Q= yo "lindness 7 Q= yo "lindness A$$erent papillary de$ect# !arcusE gunn pupils Bilateral pinpoint pupils Bilateral 'I(ATE' pu6ils Diagnosis Associated '/ retinopathy 4/CC5 /acular degeneration ptic ner%e lesion. Tertiary syphilis 4!arcusEgunn5 Pontine he!orrhage Anticholinergics# TCA# antiE parkinsonian drugs# pro$ound hypo.e!ia ptic chias! lesion Ipsilateral optic ner%e lesion Te!poral optic radiation Ipsilateral optic tract lesion r"ital "lowEout $racture6 I!!ediate ophthal!ology re$erral Chalazion
C8

Bilateral he!ianopia (oss o$ central %ision ,uperior contralateral Muadrantopia Te!poral $ield loss Eye trau!a# diplopia. E.ophthal!os# $i.ed upward gaze# hyphe!a Painless# nontender nodule on upper

PANCE/PANRE Word Associations

or lower eyelid Pain$ul swelling o$ upper or lower eyelid Painless# yellow triangular nodule on con>uncti%ia Curtain or %eil o%er !y eyes# new onset $loaters Transient !onocular %ision loss Painless %ision loss. *istory o$ TIA# palpitations# arrhyth!ia# carotid disease# e!"olic source Painless %ision loss. *istory o$ *TN

*ordeolu! Pinguecula 4!ore co!!on on nasal side5 Retinal detach!ent A!aurosis $uga. : TIA# e!"oli CRA 4pale retina# cherry red !acula5

CR) 4"lood F Thunder# retinal he!orrhages5 )ision loss o%er hours to days# pain$ul ptic Neuritis 4assoc. w/ /,5 E / Recurrent episodes o$ %ision change# /, diplopia that resol%e Red eye# watery discharge# preauricular (A' Red eye# copious purulent discharge Red eye# hypere!ia# che!osis# nodular con>uncti%ia Acute Pain$ul red eye# halos 4or colored rings around lights5# hazy# stea!y cornea. Pupil is $i.ed and 4!id5 dilated. nset a$ter "eing in dark roo! 'iplopia# dysarthria# dysphagia 0nilateral $oul s!elling or purulent nasal discharge in a pediatric patient *A# sinus pressure# yellow : green nasal discharge ,neezing# clear rhinorrhea# postE nasal drip# nasal congestion seasonal occurance Pale# ede!atous# "oggy tur"inates Bullous !yringitis titis !edia )iral con>uncti%itis 2onococcal con>uncti%itis Allergic con>uncti%itis Acute angleEclosure glauco!a

)erti"ro"asilar insu$$iciency Nasal +oreign "ody ,inusitis : CT is gold standard Allergic rhinitis. Nedocro!il e$$ecti%e T.. Allergic rhinitis /ycoplas!a pneu!onia ,trep. Pneu!onia# *. in$luenza# strep. Pyogenes# !ora.ella catarhallis
C<

PANCE/PANRE Word Associations

,wi!!er with ear pain# discharge 'ia"etic# ear pain Tinnitus and !eta"olic acidosis ,udden dizzy# %ertigo# hearing loss# tinnitus 'i.Ehallpike !aneu%er ,udden %ertigo with changes in head position ,udden dizzy# N# ). N tinnitus# hearing loss. Recent 0RI 0nilateral ner%e dea$ness in !iddle age Pt ,ensorineural loss 7 <=yo )ertical Nystag!us# insidious onset %ertigo *orizontal Nystag!us# acute onset %ertigo ,!oker# white !outh lesion cannot "e ru""ed o$$ 2ray pharyngeal pseudo!e!"rane# rash# spleno!egaly# supracla%icular (A' College student with sore throat. Enlarged tonsils# anterior cer%ical (A'. ,pleno!egaly. CBC : ele%ated atypical ly!phoctyes

titis e.terna / E# Pseudo!onas# I) a". 4+?5# CT head ,alicylate Ingestion /eniere&s disease6 Treat w/ diuretics F lowEsodiu! diet BPP) BPP) )esti"ular neuronitis# la"rynthitis Acoustic neuro!a 4order /RI5 Pres"yacussis 4*i $reM sounds Cst to go5 Central lesion 4tu!or5 Peripheral lesion (eukoplakia# rule out oral cancer 'iphtheria

EB) E !ononucleosis

!EMATOLOGY/ONCOLOGY Description Philadelphia chro!oso!e Auer rods ReedEstern"erg cells Painless (A' 4us. Neck or a.illa5# (A' in orderly $ashion6 HBI signs L pruritis6 spleno!egaly6 (N pain a$ter drinking alcohol

Diagnosis Associated C/( A/( *odgkin&s ly!pho!a *odgkin&s ly!pho!a

CO

PANCE/PANRE Word Associations

+atigue# P/ sweats# weight loss# painless (A' or neck !ass Painless (A' us. ,cattered. HBI signs *. *TN# nephrotic syndro!e# CR+ or Renal insu$$iciency. 3now CBC. PICA# Pregnant F $atigue# /enstruation. Cheilosis Ane!ia a$ter colecto!y# partial gastrecto!y. 2lossitis# decreased %i"ratory sensation 2OP' L ?uinidine# Nitro$urantoin# ,ul$a +atigue# weakness# low $e%er# purpura# pallor# gingi%al "leeding. No *,/ Ele%ated *g"# *ct# spleno!egaly# post showering pruritis# plethora# engorged retinal %eins ,plenecto!y ,ickle cell ,pontaneous *e!arthrosis /ucosal or gingi%al "leeding# epista.i.# !enorrhagia Continuous "leeding postEop or trau!a. 2i%en !ultiple "lood trans$usions. (ow platelets# increased PT# INR# L $i"rin split products 4increased dEdi!er5

(y!pho!a : do (y!ph node "iopsy. Bone !arrow B. and CT scan used $or staging NonE*odgkin&s ly!pho!a Ane!ia +e 'e$iciency Ane!ia BC; or Pernicious ane!ia *e!olytic ane!ia Aplastic ane!ia

Polycythe!ia %era6 T. G Phle"oto!y

Pneu!ococcal %accine Autoso!al Recessi%e# pain in e.tre!ities a$ter e.ercise# priapris! *e!ophilia A )on Wille"rand disease 'IC

IN"ECTIOUS DISEASE Description /R,A

Diagnosis Associated Hspider "iteI appearing lesion that turns into a"scess. T. w/ )anco L/E ri$a!pin# genta!icin# linezolid
CQ

PANCE/PANRE Word Associations

Clear %ul%ar %esicles# inguinal (A' 2iant /ultinucleated cells Tzank ,!ear Acetowhitening Wood&s light $luoroscopy Bite w/ $e%er# lacri!ation# rhinorrhea# "radycardia# *TN# tachyarrhyth!ias Bite with local ede!a# erythe!a# central necrosis Woods# $orest# hikers. /acular rash at wrist# ankles then !o%es up e.tre!ities then trunk. A$ter < days rash at pal!s F soles Indirect i!!uno$luorescent A"# WeilE +eli. r.n# co!ple!ent Target lesion# arthralgia# Bell&s Palsy Intense pruritis esp. P/. Burrow like lesions at wrists# el"ows# hands# we"s o$ $ingers Raccoons# "ats# skunks 2angrene

*erpes %irus 42enital5 *erpes %irus 42enital5 *erpes %irus 42enital5 Condyloa acu!inata 'er!atophytes in$ections# Erythras!a 4coral red5 Black widow 4neuroto.in5 Brown recluse R/,+ 4Rickettsia rickettsia5

R/,+ 4Rickettsia rickettsia5 (y!e 'z 4Borrelia Burgdor$i5 ,ca"ies

Ra"ies6 gi%e Ig# Ra"ies %accine i$ ani!al is not caught and tested Clostridiu! in$ection : an anaero"ic "acteria. T. w/ hyper"aric o.ygen# Penicillins# surgical e.cision 2onorrhea 2onorrhea

2ra! negati%e intracellular diplococcic ,e.ually acti%e# !ultiple or new partner# urethral discharge# 2ra! negati%e intracellular diplococci Red cer%i. w/ !ucopurulent discharge in se.ually acti%e $e!ale +TAEAB,# /TAETP /alaria prophyla.is

Chla!ydia ,yphilis diagnosis ChloroMuine

C9

PANCE/PANRE Word Associations

MS#/R!EUMATOLOGY Description ,houlder pain a$ter repetiti%e acti%ity# point tenderness at anterior hu!erus or AC >oint. L drop ar! test or apprehension test +oot"all player with "urning pain# nu!"ness# tingling $ro! shoulder to hand which resol%es + ,*# Radial $racture w/ dorsal displace!ent# dinnerE$ork de$or!ity Typing# secretary wrist pain and nu!"/tingling $ro! wrist to hand. New !others# pregnant !ay worsen Pain at "ase o$ thu!"# distal radial styloid. Pain reproduced with ulnar de%iation o$ clenched $ist. *and in>ury a$ter a punch

Diagnosis Associated Rotator cu$$ in>ury 4,IT, !uscles5

Brachial ple.us neurapra.ia# HstingerI. Caused "y stretching o$ "rachial ple.us Colle&s +.6 T. G %olar splint Carpal Tunnel syndro!e de?uer%ain&s tenosyno%itis Bo.er&s $racture. 0lnar gutter w/ intrinsic plus positioning. RI+ i$ angulation 7 8= degress ,coliosis 47 ;< degree Co"" angle G surgery5 ,hin splints# stress $racture. 2et "one scan i$ negati%e .Eray AC( 4look $or description o$ lach!an or drawer test5 (eggECal%eEPerthes 'isease ,C+E sgoodEschlatter disease Patellor$e!oral pain syndro!e : increased ? angle# strengthen Muadriceps /orton&s neuro!a6 T. w/ N,AI's# wide shoes# then steroid in>ections
CR

+e!ale e.a!# asy!!etric posterior chest wall or une%en scapula height with $orward "ending Ti"ial pain a$ter running 4!ilitary recruits5# athletic acti%ity 4running sports5 3nee in>ury during $oot"all ga!e 9 : C=yo !ale with li!p# knee pain C; : C<yo o%erweight !ale knee pain# li!p# hip pain 4knee @R nor!al5 Adolescent !ale with knee pain# tenderness o%er ti"ial tu"erosity Retropatellar knee pain esp. in $e!ales Pain on plantar $oot K ; : -rd !etatarsal. Associated w/ tight

PANCE/PANRE Word Associations

shoes# relie%ed "y re!o%ing shoes. Palpa"le pain$ul !ass Pain a$ter t. o$ $racture w/ cast *(AEB;Q Acute >oint pain. ,wollen# war!# erythe!a. (arge >oint pain. 3nees w/ !edial >oint space narrowing# osteophytes. No erythe!a or war!th. Enlarged PI'# 'IP +e!ale !orning >oint pain F sti$$ness esp. hand/wrists. /CP >oint swelling# ulnar de%iation Acute swollen "ig toe Pro.i!al sy!!etric !uscle pain F sti$$ness esp. shoulder# neck# pel%ic girdle /ale w/ low "ack pain# sti$$ness. Pain worse wakening# i!pro%e during day. 'ecreased R / at spine. Plain $il!s show sacroiliac a"nor!ality. *(AE B;Q positi%e Con>uncti%itis# iritis# arthritis# cer%icitis# urethritis Erythe!a nodosu! +e!ale with Arthralgias# !alar rash# LANA# L antiEdou"le stranded 'NA anti"odies# LantiEphospholipid anti"odies dusky red# well localized single or !ultiple papules or plaMues usually o$ $ace +e!ale# $atigue# general aching# pain at neck# upper shoulders# sleeping pro"le!s# tender points Cold induced pain at e.tre!ities with Co!part!ent syndro!e Ankylosing spondylitis# Reiter&s syndro!e ,eptic arthritis 4syno%ial $luid G leukocytosis# low glucose5 steoarthritis. Aceta!inophen DC choice steoarthritis 4her"erden : PIP6 "ouchard : 'IP5 Rheu!atoid arthritis. /ethotre.ate 4'/AR's5 DC. 2out Poly!yalgia rheu!atica Ankylosing spondylitis6 T. G N,AI's 4Indo!ethacin5

Reiter&s syndro!e ,yste!ic autoi!!une diseases 4RA# IB'5# CP ,(E

'iscoid lupus +i"ro!yalgia 4e.ercise progra! good !anage!ent5

Raynaud&s pheno!enon
;=

PANCE/PANRE Word Associations

color change as they war! up steo!yelitis a$ter stepping on nail wearing sandals or tennis shoes Teenage $e!ale with long "one pain without trau!a or in>ury. @R w/ lytic !ass# !ultiEla!inated periosteal reaction Painless "ony !ass. Plain $il!s G stalky or "roadE"ased pro>ection $ro! "one sur$ace (ytic lesions in the "ack or skull Pseudo!onas aeruginosa 4$oa! padding in shoes5 Ewing sarco!a : periosteal Honion skinI reaction steochondro!a /ultiple !yelo!a

PSYC!E Description 'eterioration o$ cogniti%e $unction# !e!ory Rapid onset o$ cogniti%e sy!pto!s# !ental status $luctuations# an.iety# irrita"ility Paplitations# tre!ors# hyper%entilation or respiratory alkalosis# nu!" or tingling !outh or e.tre!ities +eelings o$ worthlessness# hopelessness# apathy# weight loss# inso!nia# dayti!e sleepiness. Thoughts o$ suicide Raw red hands# cha$ed. Binge eating# la.ati%e use# star%ation Buli!ia with electrolyte disorders Antipsychotic !eds 4phenotiazines5# $acial tics# lip s!acking# tongue disorders# "linking# ata.ia Pt on antipsychotic !eds de%elops altered consciousness# leadEpipe Diagnosis Associated 'e!entia 'eleriu!

An.iety

'epression 4,,RI G drug o$ choice5

"sessi%e co!pulsi%e disorder Buli!ia ner%osa 4T. w/ ,,RI : +luo.etine5 *ypokale!ia# !eta"olic alkalosis Tardi%e dyskinesia Neuroleptic !alignant syndro!e. T. supporti%e care F antipyretics
;C

PANCE/PANRE Word Associations

rigidity# diaphoresis# catatonia. *yperther!ia# tachypnea# "lood pressure changes. E.trapyradi!idal signs# BP changes# altered consciousness# hyperpyre.ia# !uscle rigidity# dysarthria# C) insta"ility# $e%er# pul!onary congestion# diaphoresis. Pt on antipsychotic !eds In$reMuent "linking# tre!or# rigidity# "radykinesia# shu$$ling gait# !asked $acies ,hort li%ed# intense relationships. 'i$$iculty controlling anger esp. when $eeling a"andoned. *. se.ual pro!iscuity and su"stance a"use. Periods o$ e.cessi%e drinking# "uying# spending /ale w/ gyneco!astia# di!inished or delayed secondary se. characteristics# s!all $ir! testicles# long ar!s F legs 4eunechoid "ody ha"itus5 *yponatre!ia w/ "izarre "eha%ior. Antidepressant use w/ anticholinergic side e$$ects# dry !outh# dysrhyth!ias# sedation# orthostatic hypotension REPRO Description +rothy# clear : white or yellowEgreen to gray adherent %aginal discharge# dysuria# %aginal pruritis. )ul%ar and cer%ical erythe!a. +lagellated protozoa +ishy odor# Thin grayish %aginal

Neuroleptic !alignant syndro!e. T. supporti%e care F antipyretics

Parkinson&s

Borderline personality disorder

/anic phase o$ "ipolar disorder

3line$elter ,yndro!e @@1. (ow seru! testosterone F in$ertility.

(ithiu! to.icity TCA o%erdose

Diagnosis Associated Tricho!onas

Bacterial %aginitis6 2ardnerella

;;

PANCE/PANRE Word Associations

discharge# Clue cells Thick white %aginal discharge# hyphae F "uds on 3 * prep Post!enopausal# dyspareunia# thin %aginal discharge# atrophic %ul%ar changes# %aginal petechiae ,econdary a!enorrhea +e!ale with acute a"do!inal pain. No characteristic acute a"do!en pattern ;=yo $e!ale w/ ru""ery# $ir!# wellE circu!scri"ed# nonEtender "reast lesion# doesn&t change w/ cycle -= : <=yo $e!ale# pain$ul# !ultiple# "ilateral "reast !asses that increase in pain and size "e$ore !enses ,pontaneous "loody# serous# or cloudy nipple discharge Breast !ass# nipple retraction# "loody nipple discharge %erweight# irregular !enstrual cycles 4poss. A!enorrhea5# ele%ated "lood sugar# hirsutis! Adolescent $e!ale with !idcycle pain alternating $ro! le$t to right side. Relie%ed w/ N,AI's 'ys!enorrhea# dyspareunia# dyschezia. 0terus is $i.ed# retro$le.ed. Cyclic pel%ic pain. /ay ha%e palpa"le pel%ic !ass +ir! irregular shaped# N NTEN'ER enlarged uterus ,o$tened# tender# di$$usely glo"ular uterine enlarge!ent Oc! unilateral# !o"ile# tender adne.al !ass Pregnant Pregnant L rash# postEauricular or

%aginalis Candida Atrophic %aginitis6 T. G topical estrogen Pregnancy Ectopic pregnancy

+i"roadeno!a +i"rocystic "reast disease

Intraductal papillo!a Breast cancer 4!ass is !ost co!!on presenting clinical !ani$estation5 PC , 4steinEle%enthal syndro!e5 /ittelsch!erz Endo!etriosis. Palpa"le pel%ic !ass : Hchocolate cystI (eio!yo!a Adeno!yosis Tu"oEo%arian a"scess Nagel&s ruleJ (/P L Q : - !o Ru"ella. 2i%e %accine A+TER deli%ery
;-

PANCE/PANRE Word Associations

occipital (A' Pregnant# *A# %isual distur"ance Pregnant# seizures Pregnant N ;= wks gestation w/ %aginal "leeding# a"d F pel%ic pain. Blood $ro! closed cer%ical os. Pregnant N ;= wks gestation w/ %aginal "leeding# a"d F pel%ic pain. Tissue at or said to "e passed $ro! open cer%ical os. Pregnant who drinks during pregnancy and inadeMuate periEnatal care Postpartu! he!orrhage Post!enopausal %aginal "leeding Post!enopausal adne.al !ass

PreEecla!psia Ecla!psia Threatened a"ortion Inco!plete a"ortion 4co!plete a"ortion will ha%e e!pty uterus# co!plete passage o$ $etal tissue# pain resol%es a$ter passage o$ tissue5 +etal alcohol syndro!e : low "irth weight 0terine Atony. T. G uterine !assage Endo!etrial Ca : do endo!etrial "iopsy %arian Ca

DERM Description Procaina!ide# hydralazine F rash Photosensiti%e rash Wood&s light 3 * 2ra! stain Bee$y red# sharp "ordered rash in groin 4in$ants5# under "reast $olds with satellite lesions War!# erythe!atous# tender skin with possi"le induration or $luctuance Red# less distinct "orders. Coral red $luorescence under Wood&s la!p 'istinct# sharp raised de!arcated "order with $e%er# chills. 2roup A ,trep 2rouped %esicles on erythe!atous Diagnosis Associated (upusEtype eruptions TCN# ,ul$a drugs Coral red G Erythras!a +ungus# Candida6 *yphae F "uds# spaghetti F !eat"alls Bacterial in$ections CandidaJ T.J Nystatin/(otri!in crea! ?I' .C8d6 i$ $ails 3etoconazole Cellulitis Erythras!a Erysipelas *erpes %irus
;8

PANCE/PANRE Word Associations

"ase In$ant or pediatric w/ grouped %esicles on thu!" or HtapiocaI %esicles on thu!" Pain preceding %esicular rash in der!ato!al pattern *. 0RI the palpa"le purpuric rash to "uttocks# posterior thighs *oney colored crusts on erythe!atous "ase around nose F !outh ,!all white papules on di$$usely red "ase on "uccal !ucosa Cough# coryza# con>uncti%itis Pastia&s lines# positi%e A, titer ,traw"erry tongue Pruritic raised erythe!atous plaMues 'ewdrops on rose petal# pustules F %esicles at di$$erent stages o$ healing +leshEcolored# pink or yellowE"rown lesion with rough# sandpaper $eel# at sunEe.posed areas NonEpruritic# raised# warty "rownE "lack plaMues# stuck onto skin $eel greasy +lat "rown spots with sharp "orders on dorsu! o$ hand Erythe!atous# do!eEshaped nodule with central plug

*erpetic whitlow *erpes Poster 4i$ in%ol%ed eye G herpes keratitis. N steroids. 2et i!!ediate ophthal!ology re$erral5 *,P 4*. post ,trep A in$ection5 I!petigo. T. G /upirocin 3oplick spots : Ru"eola 4/easles5. ,pots occur "e$ore rash Ru"eola 4/easles5 ,carlet $e%er 42rp A ,trep5 ,carlet $e%er 42rp A ,trep5 0rticaria )aricella 4Chicken Po.5

Actinic 3eratosis ,e"orrheic keratosis (entigines 3eratoacantho!a

Raised pearlyE"orders# telangiectasia# Basal cell Ca central ulcer Pearly papule with u!"ilicated center /olluscu! contagiosu! ,e.ually acti%e person w/ rash on pal!s F soles# general (A' ,ca"ies F Pediatrics ,econdary syphilis 4/oney spots56 )'R( will con$ir! N LINDANE (KWELL). Per!ethrin 4Eli!ite5 is drug o$ choice
;<

PANCE/PANRE Word Associations

Christ!as tree pattern# erythe!atous papules w/ o%al plaues w/ scaly itchy "order. Rash preceded "y lagre o%al plaMue w/ central clearing F scaly "order *ypopig!ented lesions# white# scaly. 2ets worse w/ tanning or sun e.posure Erythe!atic ring with scaly "order F central clearing spaghetti F !eat"alls Thick# yellow# "rittle nails In$ant w/ erythe!atous# scaly crusty lesions at %erte. o$ scalp

Pityriasis rosea6 *erald patch

Pityriasis Al"a Tinea 4$ungal in$ection56 3 * prep G hyphae Tinea 4$ungal in$ection nycho!ycosis. T. G P Ter"ina$ine

Cradle cap : se"orrheic der!atitis 4T. in in$ants w/ "a"y sha!poo# war! oli%e oil co!press# !ild *ydrocortisone crea!6 Adults : seleniu! sul$ide sha!poo5 *andE+ootE/outh disease. Co.ksackie )irus Erythe!a in$ectiosu! H,lapped cheekI# H<th 'zI. Roseola in$antu! 4*erpes%irus56 /otrin# sy!pto!atic treat!ent Roseola in$antu! 4*erpes%irus56 /otrin# sy!pto!atic treat!ent ,carlet +e%er 3awasaki&s 'isease6 look $or cardiac co!plications 4!yocarditis# pericarditis# arteritis# aneurys!s5 Rheu!atic +e%er Psoriasis Psoriatic arthritis
;O

Children N C=yo w/ %esicles on pharyn.# !outh# hands# $eet w/ N ulceration *ealthy looking N <yo with laceElike rash on "oth cheeks : red papules Pediatric with high $e%er then a$ter $e%er !acular rash o%er trunk and neck. 4rash a$ter de$er%esence5 Truncal Rash in pediatric a$ter $e%er +e%er# pharyngitis# HsandpaperI rash o%er $ace# neck# trunk# e.tre!ities *igh $e%er 4up to C=<o+5 . < days then rash. /ay ha%e con>uncti%itis# cracking# lip $issures Erythe!a !arginatu! ,il%ery scaling plaMues on e.tensor sensors. Ausptiz sign# 3oe"ner&s pheno!ena Rat "ite erosions on @R

PANCE/PANRE Word Associations

'ark skinned person with Hwhitening or lighteningI o$ skin. *. pernicious ane!ia or other autoi!!une disease PEDIATRICS Description Introduce solid $oods 4cereal# $ruits5 Cst tooth 4central incisor5 Walks alone - words# $ees sel$ w/ spoon# "uilds tower N ;!o $e%er N <yo $e%er# seizures Pre!ature "irth# $etal !aturity /econiu!Estained a!niotic $luids Positi%e os!otic $ragility test /ousy urine )it ' : Rickets *e!ophilia A# 'uchennes /' Neuro$i"ro!atosis ,ickle cell# C+# P30

)itilligo. ,kin "iopsy to diagnose

Diagnosis Associated 8 : O !o6 a$ter O !o add !eat# eggs# starchy $oods O : 9 !o C< !o ;8 !o ,eptic w/u E "lood C.# (P +e"rile seizure 2i%e corticosteroids +etal distress 2OP' de$iciency 4he!olytic ane!ia w/ o.idati%e drugs : sul$a# nitro$urantoin# Muinidine5 P30 @Elinked do!inant @Elinked Recessi%e Autoso!al do!inant Autoso!al Recessi%e

;Q