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 NOT intended to steer you to remember answers to test, but instead to help
you recognize the intent or most likely diagnosis. The information of that specific diagnosis is
up to your level of knowledge. Its to help narrow that differential so you can focus on the
specifics of the most likely diagnosis.

CARDIO
Description Diagnosis Associated
DOE, PND, edema. Echo w/ LVH or CHF
RVH, hypokinesis
S3 CHF, dilagted cardiomyopathy
High output heart failure Pregnancy, thyrotoxicosis, anemia,
beriberi, pagets disease
Low output heart failure Ischemic heart disease, HTN, dilated
CM, valve disease, arrhythmia
Heart failure after URI Myocarditis

Young athlete with syncope during Hypertrophic CM or fatal arrhythmia.

athletic event or practice. No
physical exam abnormalities
Alcoholic with DOE, heart failure
Alcoholic with palpitations,
arrhythmia
Irregular irregular
Atrial fibrillation or prosthetic valve
Get EKG or Echo
Primary dilated CM
Atrial fibrillation (Holiday heart)
Atrial fibrillation; (if > 48 or chronic
anticoagulate)
Warfarin (2 3 for Afib; 2.5 3.5 for
valve); Tx Warfarin OD is vitamin K

Hx angina but no acute sx. EKG no Do Exercise stress test

acute changes.
Crushing CP, dyspnea, palpitations,
radiation to neck or left arm
Angina (if lasts minutes), AMI if lasts
> 30 minutes. Acute Ischemia ST
elevation; Injury T wave depression;
Infarct Q wave

Constant, sharp CP worse lying down, Pericarditis

better sitting up and leaning forward
1
PANCE/PANRE Word Associations
pulsus paradoxus
Electrical alternans, narrow pulse
pressure, pulsus paradoxus
JVD, Hypotension, muffled heart
sounds
Pericarditis post open heart surgery
Sudden onset ripping, tearing chest
pain, diminished pulses
Flank pain, hypotension, pulsatile
abdominal mass
EKG changes, N, V, yellow-green visual
disturbances
Hx CHF on diuretic & digoxin
Grossly elevated blood pressure esp.
w/ signs of EOD
HTN Tx w/ meds, cough or
angioedema
DM & HTN
Heart failure, LVH
Post MI
Tx of HTN w/ alpha-blocker
HTN not responsive to basic meds
Mechanical valve or prosthesis &
Dental, GU, GI, or ortho procedure
prophylaxis
2
Pericardial effusion/tamponade,
pericarditis, asthma attack, tension
PTX, SVC obstruction
Pericardial effusion/tamponade
Pericardial effusion/tamponade
(Becks triad)
Dresslers syndrome. Tx w/ ASA #1.
Indomethacin or other NSAID OK.
Aortic dissection
AAA
Digoxin toxicity (Hypokalemia will
make worse)
Suspect dig toxicity (hypokalemia from
diuretic = dig toxicity)
Malignant or Urgent HTN
ACEI is cause
ACEI is best choice
ACEI (improves survival, prevents
development of heart failure Sx)
Beta-blockers
SE is postural Hypotension
Think secondary HTN most likely
Renal artery stenosis (infrarenal
artery).
Bacterial endocarditis (strep.
Viridians) prevention
PANCE/PANRE Word Associations
IVDA w/ new murmur
Elderly w/ systolic murmur
Diamond shaped, blowing systolic
murmur. May have angina, syncope,
CHF
Lateral displaced PMI, Canon a
waves, Quinckes pulse, Corrigans
pulse, Austin flint murmur,
deMussets sign, water
Diastolic murmur best heart at apex
without radiation
Systolic ejection murmur heard best at
base with radiation to left clavicle
Female or Post MI, systolic murmur
best @ apex preceded by click
without radiation
Systolic murmur heard best at apex
with radiation to left axilla (apical
systolic)
New murmur after MI (esp. if apical
systolic)
Murmur & Hx rheumatic heart disease
Continuous harsh, machine-like
murmur
Cyanotic infant with systolic thrill @
LSB, systolic ejection murmur +/- click
Holosystolic murmur @ LSB, may have
ventricular hypertrophy
Infant w/ dyspnea, difficulty feeding.
Holosystolic murmur @ LSB, 3rd ICS.
LVH & RVH
3
Bacterial endocarditis (strep.
Viridians)
Aortic stenosis (due to calcifications
age related (or bicuspid valve -
congenital)
Aortic stenosis
Aortic Regurgitation/Insufficiency:
Quinckes pulse (subungual capillar
pulsation), Corrigan (rapid rise and
fall), Austin filnt (low pitch
middiastolic murmur at apex)
Mitral stenosis (ARMS are BAD)
Pulmonary stenosis
Mitral valve prolapse
Mitral regurgitation
Mitral regurgitation (caused by
papillary muscle rupture)
Mitral stenosis #1, Tricuspid Stenosis
#2
PDA
Tetralogy of falot
VSD
VSD
PANCE/PANRE Word Associations
Peds w/ leg pain after physical activity,
abnormal heart sounds, unequal UE &
LE pulses, rib notching
Short PR, wide QRS, Delta wave
Young female (<30yo), palpitations,
long arms & fingers, pectus excavatum,
ectopic lentis, flexible joints
LE rubor, no hair, brittle nails, pallor
on elevation, calf or LE pain esp. with
walking short distances relieved with
rest or at PM
Claudication with rest pain, (ABI <
0.4)
LE pain after long periods of standing.
Dilated, tortuous, veins
Trendelenberg test of extremities
Blue extremities worse w/ cold
exposure, improves w/ warming
PULMONARY
Description
Rapid, deep labored breathing
Deep breathing alternating w/ apnea
Cavitations on CXR
4
Coarctation of aorta
Wolf-parkinson-white; avoid Digoxin,
Marfans Syndrome MVP, Aortic
regurgitation, Aortic dissection,
Aortic root dilatation, ectopic lentis
Arterial insufficiency/PAD,
Intermittent claudication (ABI best
choice, ateriogram gold standard)
Tx is arterial bypass
Varicose veins. Tx w/ compression
stockings
Tests for veinous insufficiency.
Acrocyanosis
Diagnosis Associated
Kussmaul breathing DKA, Metabolic
acidosis
Cheyne-Stokes breathing heart
failure, brain damage
Infections lung abscess, TB (Gohn
focus)
PANCE/PANRE Word Associations

Apical infiltrates, F, C, dry cough TB

Pleural thickening on CXR Mesothelioma
Hilar mass on CXR Lung Ca
Eggshell pattern on CXR Silicosis (Sandblasters)
Ground glass appearance on CXR Asbestosis (shipbuilders, building
demolition)
Reticular to nodular pattern on CXR Coal Miners lung
Patchy fibrosis on CXR Farmers lung
Granulomas and inflammation of Sarcoidosis
alveoli, small bronchi and small blood
vessels

Dyspnea after surgery, travel DVT/PE

(airplane), LE Fx. May have c/o calf
pain also.
Lung scan with perfusion defects PE

Venous stasis, vessel wall injury, DVT/PE (Virchows triad)

hypercoagulability

Pediatric with barking cough, stridor viral croup (laryngotracheobronchitis);

Tx w/ racemic epi and
glucocorticosteroids if stridor at rest.
Pediatric wheezing lower respiratory FB, asthma
Drooling, sniffing position, tripod, Epiglottitis
toxic
Thumbprint sign Epiglottitis
Steeple sign FB, viral croup
(laryngotracheobronchitis)
Inspiratory stridor FB, viral croup
(laryngotracheobronchitis)

Premature infant with respiratory Hyaline Mb Disease

distress
Preemie CXR w/ hypoexpansion (ATX), Hyaline Mb Disease
air bronchograms

5
PANCE/PANRE Word Associations

Smoker, chronic productive cough. Brochitis (COPD)

NO hemoptysis, wt. loss.
Smoker, DOE, cough COPD
Hyperinflation on CXR, tear drop Emphysema
heart
Wheezing, prolonged expiration Asthma
Airway edema with eosinophils, Asthma
neutrophils, lymphocytes

Fever, cough, sputum. Crackles, Pneumonia

decreased breath sounds, dullness to
percussion, +egophony, pectoriloquy.
CXR infiltrates or consolidation
>35yo with PNA. Rusty colored or Strep. Pneumonia
yellow-green sputum. Acute onset F/C
<35 yo, college students. Fever, cough, Mycoplasma pneumonia
+/- sputum, chills, muscle aches
Bullous myringitis Mycoplasma pneumonia
PNA w/ Smokers, COPD H. influenza
PNA w/ DM, immunocompromised, Klebsiella
EtOH. Currant color sputum.
PNA w/ Water, late summer, Legionella
construction site. Diarrhea. Toxic
looking
PNA from Nursing homes, chronic Staphylococcus aureus
care facility. Purulent sputum
PNA & HIV+, AIDS, Pneumocystis jerovecii; TMP-SMX =
Immunocompromised. Sx out of Drug of choice
proportion to exam. Diffuse
interstitial & alveolar infiltrates
PNA & decreased mental status, poor Aspiration PNA
dental hygiene, dentures, foul smelling
sputum, bronchiectasis. Patchy
infiltrates in dependant lung zones

Pediatric with Hx recurrent lung Cystic fibrosis (Staph & Pseudomonal

infections, pancreatitis, reproductive infections usually cause of death)
problems, FTT
6
PANCE/PANRE Word Associations

Sweat chloride test Cystic fibrosis

Cystic fibrosis w/ PNA Pseudomonas aueroginosa causative
agent

< 2 days post-op with fever Atelectasis

Stab wound, hyperresonance to Pneumothorax

percussion, decreased breath sounds,
tympany
Stqb wound, dullness to percussion, Hemothorax
decreased breath sounds.
Tall, skinny, male, band student, acute Spontaneous PTX
onset one-sided chest pain, dyspnea

Stab wound to chest. Hypotension, Tension PTX

tracheal shift

Poor sleeping, obese, daytime fatigue & Obstructive sleep apnea

drowsy, snoring, HTN, PM wakening

s/p thoracic trauma. Multiple rib Flail chest (pain control, incentive
fractures. Chest wall moves in with spirometry, pulmonary toilet,
inspiration, out with expiration. intubation)

GI/NUTRITION
Description Diagnosis Associated
Fat, forty, female, fertile w/ RUQ pain Cholelithiasis or Cholecystitis
Fever, RUQ pain, radiation to back Cholecystitis
Elevated Alkaline phosphatase, urinary Cholecystitis
bilirubin

F, RUQ pain, Jaundice, gallstones & Ascending cholangitis (Charcots

dilated common duct on US triad)
7
PANCE/PANRE Word Associations

Hx IBD, progressive RUQ pain, wt Primary sclerosing cholangitis (diffuse

loss, F, jaundice & pruritis. Elevated intra- and extrahepatic duct
bilrubin & alkaline phosphate. ERCP sclerosing and dilatation)
with bile duct stenosis, dilatation

Elevated AST, ALT, indirect bilirubin Hepatitis

Isolated elevated indirect bilirubin Gilberts syndrome
Elevated indirect bilirubin w/ Crigler-Najjar Dz
defective glucuronyl transferase

Photosensitivity, abd pain w/ Porphyria

neurologic dysfunction, erythema or
skin fragility

H.pylori gastritis 2antibiotics & PPI

Chronic cough, bitter taste in mouth GERD
or throat, dyspepsia
Multiple or constant GI ulcer pain Zollinger-Ellison Syndrome
despite medications

N/V, epigastric abdominal pain, worse Acute pancreatitis

supine, caused by alcohol ingestion, or
following fatty meals

Peri-umbilical or flank ecchymosis Acute pancreatitis (Cullen & Grey

Turners Sign)

Abdominal distension, bloating, SBO

intermittent, colicky pain, high-pitched
rushes & tinkles
Air fluid levels on upright abd plain SBO
film
Air under diaphragm, rigid board-like Perforated viscus, perforated ulcer
abdomen

>60yo F, LLQ pain Diverticulitis. IV Abx, fluids, NPO.

8
PANCE/PANRE Word Associations

Elderly, Hx atherosclerosis. Dull Mesenteric ischemia

crampy periumbilical pain post-prandial

Neonate w/ projectile vomiting. Olive Pyloric stenosis

sized mass.
Choking, cyanosis, respiratory distress,
increased secretions in 1st hours of life
Painless rectal bleeding in pediatrics
Alcoholic with massive hemoptysis
Tracheoesophageal fistula
Meckels diverticulum
Esophageal varicies (Tx w/ octreotide)

Female with recurrent abdominal pain, IBS. TCAs (nortriptyline) good if

alternating diarrhea, constipation. diarrhea predominant symptom
Pain relieved with defecation.

Bloody Diarrhea Ulcerative colitis

Supraclavicular LAD (L > R) Virchows node metastatic abdominal

cancer
Hard periumbilical nodule Sister mary Joseph nodule = indicates
metastatic gastric and pancreatic
cancers
PUD, Pernicious anemia (Type A Gastric Ca
Gastritis), H. pylori
Apple core lesion Colon Cancer
Elderly with positive hemmocult. Colon Cancer get colonoscopy
CEA Colon Carcinoma
Family history of young age colon Familial adenomatous polyposis
cancer, multiple polyps found on (Gardners syndrome)
colonoscopy
AFP Hepatocellular carcinoma, testicular
seminoma (germ cell tumor)
CA 19-9 Pancreatic Ca
CA-125 Ovarian Carcinoma
Chemotherapy induced N&V Treat with Ondansetron (Zofran) (5-
HT3 blockers)

9
PANCE/PANRE Word Associations

Travelers Diarrhea E. coli is cause. Hydration & Cipro to

treat
Greasy, foul smelling, floating stools. Giardia
Pear-shaped flagellated protozoan w/ 2
eyes. Water, travel, camping history
Afebrile, watery or loose stool. No Viral Gastroenteritis
blood or mucus
Abdominal pain, diarrhea after Staphylococcus aureus infectious
picnic/party. Eaten ham, cream, diarrhea
custards, mayonnaise
Acute bacterial diarrhea w/ prodrome Campylobacter jejuni most common
of HA, F, then crampy abd pain & cause of acute bacterial diarrhea
diarrhea

Painless rectal bleeding. Bulging Internal hemorrhoids

perianal mass w/ straining

Pediatric with perianal pruritis esp. at Pruritis ani Pinworms (enterobiasis).

PM. Positive cellophane tape test Tx is Mebendazole

Weight loss, recurrent greasy stools Celiac Sprue

(steatorrhea) mixed with diarrhea
after certain foods
Anti-endomysial antibodies Celiac Sprue

Beriberi Thiamine; Alcoholics, Neuro Sx

Pellagra Niacin (4Ds dermatitis, diarrhea,
dementia, death), bright red tongue
Scurvy Vit C (easy bleeding, bruising, hair &
tooth loss, joint pain & swelling)
Rickets Vit D (Osteomalacia)
Night blindness Vit A deficiency
Magenta tongue Riboflavin deficiency (B2)

s/p gastric bypass surgery or gastric Dumping syndrome

surgery. N, abd cramping, dizziness
after eating. No masses, bleeding

10
PANCE/PANRE Word Associations

ENDOCRINE
Description Diagnosis Associated
Diabetic w/ anorexia, anemia, wt loss, CRF
pallor
Gastroparesis, impotence, recurrent Diabetic neuropathy (Treat w/ TCA
infections, stocking-glove paresthesia (amitriptyline)

Hypoglycemia despite glucose Insulinoma

administration. Increased C-peptide

Hypoglycemia in alcoholic Give Thiamine before glucose to

prevent Wernickes encephalopathy

Decreased radioactive iodine uptake, Hashimotos thyroiditis

decreased free T4, increased TSH
Female, weight loss, palpitations, atrial
fibrillation
Exopthalmos, palpitations, wt. loss.
Elevated radioactive idodine uptake
Hyperthyroid (work it up with TSH,
T4)
Hyperthyroid, Graves Dx Tx w/
Radioactive iodine

Post thyroidectomy most likely injury Recurrent laryngeal nerve = hoarseness

Post thyroidectomy electrolyte Hypocalcemia

watch

Infant w/ round face, large protruding Congenital Hypothyroidism

tongue, dry skin, umbilical hernia,
constipation, enlarged abdomen, poor
feeding, delayed developmental
milestones

Recurrent HA, HTN not responding Pheochromocytoma Tx pre-op w/

to meds, sweating alpha blocker
Attacks of severe HA, HTN,
glucosuria
Urinary catecholamines, urinary
11
PANCE/PANRE Word Associations

metanephrines
HTN not responsive to meds Renal artery stenosis (Infrarenal
artery)
HTN w/ hypernatremia, hypokalemia Primary Aldosteronism

Wt. gain, edema, coarse dry skin, hair, Hypothyroidism

menorrhagia, cold intolerance, hx
transphenoidal surgery & radiation

Tetany, hypocalcemia, cataracts Hypoparathyroidism

Exogenous corticosteroid use Cushing syndrome

Dexamethasone suppression test Cushing syndrome
Central obesity, abdominal stria, Cushing syndrome
hyperglycemia, moon facies, buffalo
hump, easy bruising

Acute steroid withdrawal Addisons disease, crisis

Hyperpigmentation, hypoglycemia, Addisons disease, crisis (Low

orthostatic hypotension, hypotension aldosterone; get Random or AM
not responsive to fluids, hypotension cortisol, ACTH stimulation test)
following an illness, trauma, or surgery

Worsening fatigue, wt loss, weakness, Addisons disease, crisis (Low

recurrent abdominal pain, hair loss,
hyperpigmentation. Hyponatremia,
hyperkalemia
Hyponatremia, hyperkalemia
aldosterone; get Random or AM
cortisol, ACTH stimulation test)
Acute adrenal insufficiency
(Addisons crisis)

Polyuria, polydipsia. Dilute urine, Diabetes insipidus

Hypernatremia
Concentrated urine. Hyponatremia SIADH

12
PANCE/PANRE Word Associations

45,X low hairline, low set ears, Turners (gonadal dysgenesis

webbed neck, short stature; shield
chest, wide set nipples, infertility, lack
of Secondary sex characteristics

XXY - short stature, intelligence; Klinefelters (hypogonadism)

small firm testes, gynecomastia, abn
arm-body length

GU/ELECTROLTES
Description Diagnosis Associated
Hyaline Casts Normal (may be present after febrile
illness, strenuous exercise)
Increased BUN/Cr, low FeNa Prerenal Failure (Azotemia)

Irritative voiding symptoms, Fever, Pyelonephritis

chills, CVA tenderness

Crush injury, alcoholic on ground, Rhabdomyolysis

elevated CPK, ARF

Painless hematuria, flank pain or mass Renal cell Carcinoma

Oliguria, hematuria, proteinuria Acute glomeruloneprhitis

following streptococcal infection
Hematuria, purpuric rash following Glomerulonephritis, HSP
streptococcal infection
Hematuria, RBC casts, proteinuria Glomerulonephritis
RBC casts
Kidney & lung bleeding (hematuria, Goodpasteures
hemoptysis)

Fibrous band on lateral penis Peyronies disease

Cant retract foreskin Phimosis
Inflammation of glans Balanitis
13
PANCE/PANRE Word Associations

< 40 yo male with Fever, perineal pain,
dysuria.
>50 yo obstructive voiding sx,
nocturia. Firm smooth enlarged
prostate. Nl PSA
Acute prostatitis caused by Chlamydia
& N. gonorrhea. Treat accordingly
(Bactrim #2 choice). > 40yo think e.
coli is cause (Tx w/ FQ)
BPH. (Cancer would have firm,
irregular, nodular non-tender prostate,
elevated PSA)

Incontinence with straining Stress

Peaked T-waves HyperKalemia

U waves HypoKalemia
QT prolongation Hypocalemia
Recurrent kidney stones, elevated Hyperparathyroidism
Calcium, decreased phosphorus

Hearing loss or tinnitus w/ metabolic Aspirin OD

acidosis

NEURO
Description Diagnosis Associated
Head trauma, disoriented lucent Epidural Hematoma
coma
Lens shaped hemorrhage Epidural Hematoma
Concave Subdural Hematoma

LP w/ decreased glucose, increased Bacterial meningitis

protein
LP w/ decreased protein, very few syphilitic meningitis
neutrophils
Meningitis and rash Meningiococcal
Meningitis & <2mo Grp B Strep, E. coli (Tx < 1yo = Vanco
+ Rocephin)

Meningitis < 4yo H. inlu, Grp B strep, N. meningititis

14
PANCE/PANRE Word Associations

Meningitis > 2yo, adults Strep, N. meningititis

Viral Meningitis Mumps

Unilateral facial weakness w/ inability Bells palsy (self-limiting)

to close eye

Adolescent female w/ HA. +FHx. Migraine HA

Severe HA, N/V, photphobia. +/-
auras
Male, recurrent relapsing HA. Cluster HA
Worsened w/ EtOH, Lacrimation,
salivation, rhinorrhea
Sudden onset thunderclap HA, worse Subarachnoid hemorrhage
HA of my life
>50 yo female w/ HA. Temporal artery Temporal arteritis (Giant cell arteritis).
tenderness or blindness Elevated ESR, get temporal artery
biopsy

Recurrent episodes of vision change, MS

diplopia, weakness & tingling in
extremities that resolve
myelin fragments, IgG, oligoclonal MS
bands (Pathognomonic); Lhermittes
sign = electrical sensation down body
w/ neck flexion

HA worse in AM w/ focal neuro Brain Tumor (MC is glioma)

deficits

s/p Fall w/ bilateral LE weakness, Cauda equine syndrome =

urinary and rectal incontinence, neurosurgical consult
decreased rectal tone

Ascending paralysis GBS

Paralysis after Campylobacter enteritis GBS
15
PANCE/PANRE Word Associations

Weakness and fatigue in upper limbs, Myasthenia gravis

blurry vision, diplopia, respiratory
distress

Young kid with difficulty standing Muscular dystrophy (weakness begins

from seated position. Calf muscle at pelvic girdle)
wasting

Pediatric with fever or Hx URI with Reyes syndrome from URI/post-flu or

encephalopathy, emesis, hyperactive aspirin use
reflexes, hepatomegaly, elevated liver
enzymes

Pediatric with episodes of blank stares Absence (petit-mal) seizures.

3 mHz spikes on EEG Absence (petit-mal) seizures.

Ash leaf hypopigmentation of trunk Tuberous sclerosis

& Ext, shagreen patch, sebaceous
adenomas, seizures, mental
retardation; Ass. w/ PCK, renal
hemartomas

HEENT
Description Diagnosis Associated
< 70 yo blindness DM retinopathy (MCC)
> 70 yo blindness Macular degeneration
Afferent papillary defect, marcus- Optic nerve lesion. Tertiary syphilis
gunn pupils (marcus-gunn)
Bilateral pinpoint pupils Pontine hemorrhage
Bilateral DILATED pu;ils Anticholinergics, TCA, anti-
parkinsonian drugs, profound
hypoxemia

Bilateral hemianopia Optic chiasm lesion

16
PANCE/PANRE Word Associations

Loss of central vision Ipsilateral optic nerve lesion

Superior contralateral quadrantopia Temporal optic radiation

Temporal field loss Ipsilateral optic tract lesion

Eye trauma, diplopia. Exophthalmos, Orbital blow-out fracture; Immediate
fixed upward gaze, hyphema ophthalmology referral

Painless, nontender nodule on upper Chalazion

or lower eyelid
Painful swelling of upper or lower Hordeolum
eyelid
Painless, yellow triangular nodule on Pinguecula (more common on nasal
conjunctivia side)

Curtain or veil over my eyes, new onset Retinal detachment

floaters
Transient monocular vision loss Amaurosis fugax TIA, emboli
Painless vision loss. History of TIA, CRAO (pale retina, cherry red macula)
palpitations, arrhythmia, carotid
disease, embolic source
Painless vision loss. History of HTN CRVO (blood & Thunder, retinal
hemorrhages)
Vision loss over hours to days, painful Optic Neuritis (assoc. w/ MS)
EOM
Recurrent episodes of vision change, MS
diplopia that resolve

Red eye, watery discharge, Viral conjunctivitis

preauricular LAD
Red eye, copious purulent discharge Gonococcal conjunctivitis
Red eye, hyperemia, chemosis, nodular Allergic conjunctivitis
conjunctivia
Acute Painful red eye, halos (or Acute angle-closure glaucoma
colored rings around lights), hazy,
steamy cornea. Pupil is fixed and (mid)
dilated. Onset after being in dark
room

17
PANCE/PANRE Word Associations
Diplopia, dysarthria, dysphagia
Unilateral foul smelling or purulent
nasal discharge in a pediatric patient
HA, sinus pressure, yellow green
nasal discharge
Sneezing, clear rhinorrhea, post-nasal
drip, nasal congestion seasonal
occurance
Pale, edematous, boggy turbinates
Bullous myringitis
Otitis media
Swimmer with ear pain, discharge
Diabetic, ear pain
Tinnitus and metabolic acidosis
Sudden dizzy, vertigo, hearing loss,
tinnitus
Dix-hallpike maneuver
Sudden vertigo with changes in head
position
Sudden dizzy, N, V. NO tinnitus,
hearing loss. Recent URI
Unilateral nerve deafness in middle
age Pt
Sensorineural loss > 50yo
Vertical Nystagmus, insidious onset
vertigo
Horizontal Nystagmus, acute onset
vertigo
Smoker, white mouth lesion cannot be
rubbed off
Vertibrobasilar insufficiency
Nasal Foreign body
Sinusitis CT is gold standard
Allergic rhinitis. Nedocromil effective
Tx.
Allergic rhinitis
Mycoplasma pneumonia
Strep. Pneumonia, H. influenza, strep.
Pyogenes, moraxella catarhallis
Otitis externa
MOE, Pseudomonas, IV abx (FQ), CT
head
Salicylate Ingestion
Menieres disease; Treat w/ diuretics &
low-sodium diet
BPPV
BPPV
Vestibular neuronitis, labrynthitis
Acoustic neuroma (order MRI)
Presbyacussis (Hi freq sounds 1st to go)
Central lesion (tumor)
Peripheral lesion
Leukoplakia, rule out oral cancer
18
PANCE/PANRE Word Associations

Gray pharyngeal pseudomembrane, Diphtheria

rash, splenomegaly, supraclavicular
LAD

College student with sore throat. EBV - mononucleosis

Enlarged tonsils, anterior cervical
LAD. Splenomegaly. CBC elevated
atypical lymphoctyes

HEMATOLOGY/ONCOLOGY
Description Diagnosis Associated
Philadelphia chromosome CML
Auer rods AML

Reed-sternberg cells Hodgkins lymphoma

Painless LAD (us. Neck or axilla),
LAD in orderly fashion; B signs +
pruritis; splenomegaly; LN pain after
drinking alcohol
Fatigue, PM sweats, weight loss,
painless LAD or neck mass
Painless LAD us. Scattered. B signs
Hodgkins lymphoma
Lymphoma do Lymph node biopsy.
Bone marrow Bx and CT scan used for
staging
Non-Hodgkins lymphoma

Hx HTN, nephrotic syndrome, CRF or Anemia

Renal insufficiency. Know CBC.
PICA, Pregnant & fatigue, Fe Deficiency Anemia
Menstruation. Cheilosis
Anemia after colectomy, partial B12 or Pernicious anemia
gastrectomy. Glossitis, decreased
vibratory sensation
G6PD + Quinidine, Nitrofurantoin, Hemolytic anemia
Sulfa
Fatigue, weakness, low fever, purpura, Aplastic anemia
pallor, gingival bleeding. No HSM

19
PANCE/PANRE Word Associations

Elevated Hgb, Hct, splenomegaly, post Polycythemia vera; Tx = Phlebotomy

showering pruritis, plethora, engorged
retinal veins

Splenectomy Pneumococcal vaccine

Sickle cell Autosomal Recessive, pain in

extremities after exercise, priaprism

Spontaneous Hemarthrosis Hemophilia A

Mucosal or gingival bleeding, epistaxix, Von Willebrand disease
menorrhagia
Continuous bleeding post-op or DIC
trauma. Given multiple blood
transfusions. Low platelets, increased
PT, INR, + fibrin split products
(increased d-dimer)

INFECTIOUS DISEASE
Description Diagnosis Associated
MRSA spider bite appearing lesion that
turns into abscess. Tx w/ Vanco +/-
rifampin, gentamicin, linezolid
Clear vulvar vesicles, inguinal LAD Herpes virus (Genital)
Giant Multinucleated cells Herpes virus (Genital)
Tzank Smear Herpes virus (Genital)
Acetowhitening Condyloa acuminata
Woods light fluoroscopy Dermatophytes infections, Erythrasma
(coral red)

Bite w/ fever, lacrimation, rhinorrhea, Black widow (neurotoxin)

bradycardia, HTN, tachyarrhythmias
Bite with local edema, erythema, Brown recluse
central necrosis
20
PANCE/PANRE Word Associations

Woods, forest, hikers. Macular rash RMSF (Rickettsia rickettsia)

at wrist, ankles then moves up
extremities then trunk. After 5 days
rash at palms & soles

Indirect immunofluorescent Ab, Weil- RMSF (Rickettsia rickettsia)

Felix rxn, complement

Target lesion, arthralgia, Bells Palsy Lyme Dz (Borrelia Burgdorfi)

Intense pruritis esp. PM. Burrow like Scabies

lesions at wrists, elbows, hands, webs
of fingers

Raccoons, bats, skunks Rabies; give Ig, Rabies vaccine if

animal is not caught and tested

Gangrene Clostridium infection an anaerobic

bacteria. Tx w/ hyperbaric oxygen,
Penicillins, surgical excision

Gram negative intracellular Gonorrhea

diplococcic
Sexually active, multiple or new Gonorrhea
partner, urethral discharge, Gram
negative intracellular diplococci

Red cervix w/ mucopurulent discharge Chlamydia

in sexually active female
FTA-ABS, MTA-TP Syphilis diagnosis

Malaria prophylaxis Chloroquine

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PANCE/PANRE Word Associations
MSK/RHEUMATOLOGY
Description
Shoulder pain after repetitive activity,
point tenderness at anterior humerus
or AC joint. + drop arm test or
apprehension test
Football player with burning pain,
numbness, tingling from shoulder to
hand which resolves
FOOSH, Radial fracture w/ dorsal
displacement, dinner-fork deformity
Typing, secretary wrist pain and
numb/tingling from wrist to hand.
New mothers, pregnant may worsen
Pain at base of thumb, distal radial
styloid. Pain reproduced with ulnar
deviation of clenched fist.
Hand injury after a punch
Female exam, asymmetric posterior
chest wall or uneven scapula height
with forward bending
Tibial pain after running (military
recruits), athletic activity (running
sports)
Knee injury during football game
8 10yo male with limp, knee pain
12 15yo overweight male knee pain,
limp, hip pain (knee XR normal)
Adolescent male with knee pain,
tenderness over tibial tuberosity
Retropatellar knee pain esp. in females
Diagnosis Associated
Rotator cuff injury (SITS muscles)
Brachial plexus neurapraxia, stinger.
Caused by stretching of brachial
plexus
Colles Fx; Tx = volar splint
Carpal Tunnel syndrome
deQuervains tenosynovitis
Boxers fracture. Ulnar gutter w/
intrinsic plus positioning. ORIF if
angulation > 40 degress
Scoliosis (> 25 degree Cobb angle =
surgery)
Shin splints, stress fracture. Get bone
scan if negative x-ray
ACL (look for description of lachman
or drawer test)
Legg-Calve-Perthes Disease
SCFE
Osgood-schlatter disease
Patellorfemoral pain syndrome
increased Q angle, strengthen
quadriceps
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PANCE/PANRE Word Associations

Pain on plantar foot @ 2 3rd Mortons neuroma; Tx w/ NSAIDs,

metatarsal. Associated w/ tight wide shoes, then steroid injections
shoes, relieved by removing shoes.
Palpable painful mass

Pain after tx of fracture w/ cast Compartment syndrome

HLA-B27 Ankylosing spondylitis, Reiters

syndrome
Acute joint pain. Swollen, warm, Septic arthritis (synovial fluid =
erythema. leukocytosis, low glucose)
Large joint pain. Knees w/ medial joint Osteoarthritis. Acetaminophen #1
space narrowing, osteophytes. No choice
erythema or warmth.
Enlarged PID, DIP Osteoarthritis (herberden PIP;
bouchard DIP)
Female morning joint pain & stiffness Rheumatoid arthritis. Methotrexate
esp. hand/wrists. MCP joint swelling, (DMARDs) #1.
ulnar deviation
Acute swollen big toe Gout
Proximal symmetric muscle pain & Polymyalgia rheumatica
stiffness esp. shoulder, neck, pelvic
girdle
Male w/ low back pain, stiffness. Pain Ankylosing spondylitis; Tx = NSAIDs
worse wakening, improve during day. (Indomethacin)
Decreased ROM at spine. Plain films
show sacroiliac abnormality. HLA-B27
positive
Conjunctivitis, iritis, arthritis, Reiters syndrome
cervicitis, urethritis

Erythema nodosum Systemic autoimmune diseases (RA,

IBD), OCP
Female with Arthralgias, malar rash, SLE
+ANA, + anti-double stranded DNA
antibodies, +anti-phospholipid
antibodies
23
PANCE/PANRE Word Associations

dusky red, well localized single or Discoid lupus

multiple papules or plaques usually of
face
Female, fatigue, general aching, pain at Fibromyalgia (exercise program good
neck, upper shoulders, sleeping management)
problems, tender points

Cold induced pain at extremities with Raynauds phenomenon

color change as they warm up

Osteomyelitis after stepping on nail Pseudomonas aeruginosa (foam

wearing sandals or tennis shoes padding in shoes)

Teenage female with long bone pain Ewing sarcoma periosteal onion
without trauma or injury. XR w/ lytic skin reaction
mass, multi-laminated periosteal
reaction
Painless bony mass. Plain films = stalky Osteochondroma
or broad-based projection from bone
surface
Lytic lesions in the back or skull Multiple myeloma

PSYCHE
Description Diagnosis Associated
Deterioration of cognitive function, Dementia
memory
Rapid onset of cognitive symptoms, Delerium
mental status fluctuations, anxiety,
irritability

Paplitations, tremors, hyperventilation Anxiety

or respiratory alkalosis, numb or
tingling mouth or extremities
24
PANCE/PANRE Word Associations

Feelings of worthlessness, Depression (SSRI = drug of choice)

hopelessness, apathy, weight loss,
insomnia, daytime sleepiness.
Thoughts of suicide
Raw red hands, chafed. Obsessive compulsive disorder

Binge eating, laxative use, starvation Bulimia nervosa (Tx w/ SSRI

Fluoxetine)
Bulimia with electrolyte disorders Hypokalemia, metabolic alkalosis

Antipsychotic meds (phenotiazines), Tardive dyskinesia

facial tics, lip smacking, tongue
disorders, blinking, ataxia
Pt on antipsychotic meds develops Neuroleptic malignant syndrome. Tx
altered consciousness, lead-pipe supportive care & antipyretics
rigidity, diaphoresis, catatonia.
Hyperthermia, tachypnea, blood
pressure changes.
Extrapyradimidal signs, BP changes, Neuroleptic malignant syndrome. Tx
altered consciousness, hyperpyrexia, supportive care & antipyretics
muscle rigidity, dysarthria, CV
instability, fever, pulmonary
congestion, diaphoresis. Pt on
antipsychotic meds

Infrequent blinking, tremor, rigidity, Parkinsons

bradykinesia, shuffling gait, masked
facies

Short lived, intense relationships. Borderline personality disorder

Difficulty controlling anger esp. when
feeling abandoned. Hx sexual
promiscuity and substance abuse.

Periods of excessive drinking, buying, Manic phase of bipolar disorder

spending

25
PANCE/PANRE Word Associations

Male w/ gynecomastia, diminished or Klinefelter Syndrome XXY. Low

delayed secondary sex characteristics, serum testosterone & infertility.
small firm testicles, long arms & legs
(eunechoid body habitus)

Hyponatremia w/ bizarre behavior. Lithium toxicity

Antidepressant use w/ anticholinergic TCA overdose
side effects, dry mouth, dysrhythmias,
sedation, orthostatic hypotension

REPRO
Description Diagnosis Associated
Frothy, clear white or yellow-green to Trichomonas
gray adherent vaginal discharge,
dysuria, vaginal pruritis. Vulvar and
cervical erythema. Flagellated
protozoa
Fishy odor, Thin grayish vaginal Bacterial vaginitis; Gardnerella
discharge, Clue cells vaginalis
Thick white vaginal discharge, hyphae Candida
& buds on KOH prep
Postmenopausal, dyspareunia, thin Atrophic vaginitis; Tx = topical
vaginal discharge, atrophic vulvar estrogen
changes, vaginal petechiae

Secondary amenorrhea Pregnancy

Female with acute abdominal pain. No Ectopic pregnancy
characteristic acute abdomen pattern

20yo female w/ rubbery, firm, well- Fibroadenoma

circumscribed, non-tender breast
lesion, doesnt change w/ cycle
30 50yo female, painful, multiple, Fibrocystic breast disease
bilateral breast masses that increase in
pain and size before menses

26
PANCE/PANRE Word Associations

Spontaneous bloody, serous, or cloudy Intraductal papilloma

nipple discharge

Breast mass, nipple retraction, bloody Breast cancer (mass is most common
nipple discharge presenting clinical manifestation)

Overweight, irregular menstrual cycles PCOS (stein-leventhal syndrome)

(poss. Amenorrhea), elevated blood
sugar, hirsutism
Adolescent female with midcycle pain Mittelschmerz
alternating from left to right side.
Relieved w/ NSAIDs
Dysmenorrhea, dyspareunia, dyschezia. Endometriosis. Palpable pelvic mass
Uterus is fixed, retroflexed. Cyclic chocolate cyst
pelvic pain. May have palpable pelvic
mass
Firm irregular shaped, NONTENDER Leiomyoma
enlarged uterus
Softened, tender, diffusely globular Adenomyosis
uterine enlargement

6cm unilateral, mobile, tender adnexal Tubo-ovarian abscess

mass

Pregnant Nagels rule: LMP + 7 3 mo

Pregnant + rash, post-auricular or Rubella. Give vaccine AFTER delivery
occipital LAD
Pregnant, HA, visual disturbance Pre-eclampsia
Pregnant, seizures Eclampsia

Pregnant < 20 wks gestation w/ vaginal Threatened abortion

bleeding, abd & pelvic pain. Blood
from closed cervical os.
Pregnant < 20 wks gestation w/ vaginal
bleeding, abd & pelvic pain. Tissue at
or said to be passed from open
cervical os.
Incomplete abortion (complete
abortion will have empty uterus,
complete passage of fetal tissue, pain
resolves after passage of tissue)

27
PANCE/PANRE Word Associations

Pregnant who drinks during pregnancy Fetal alcohol syndrome low birth
and inadequate peri-natal care weight

Postpartum hemorrhage Uterine Atony. Tx = uterine massage

Postmenopausal vaginal bleeding Endometrial Ca do endometrial

biopsy
Postmenopausal adnexal mass Ovarian Ca

DERM
Description Diagnosis Associated
Procainamide, hydralazine & rash Lupus-type eruptions
Photosensitive rash TCN, Sulfa drugs

Woods light Coral red = Erythrasma

KOH Fungus, Candida; Hyphae & buds,
spaghetti & meatballs
Gram stain Bacterial infections

Beefy red, sharp bordered rash in Candida: Tx: Nystatin/Lotrimin

groin (infants), under breast folds with cream QID x14d; if fails Ketoconazole
satellite lesions
Warm, erythematous, tender skin with Cellulitis
possible induration or fluctuance
Red, less distinct borders. Coral red Erythrasma
fluorescence under Woods lamp
Distinct, sharp raised demarcated Erysipelas
border with fever, chills. Group A
Strep
Grouped vesicles on erythematous Herpes virus
base
Infant or pediatric w/ grouped vesicles Herpetic whitlow
on thumb or tapioca vesicles on
thumb

28
PANCE/PANRE Word Associations
Pain preceding vesicular rash in
dermatomal pattern
Hx URI the palpable purpuric rash to
buttocks, posterior thighs
Honey colored crusts on erythematous
base around nose & mouth
Small white papules on diffusely red
base on buccal mucosa
Cough, coryza, conjunctivitis
Pastias lines, positive ASO titer
Strawberry tongue
Pruritic raised erythematous plaques
Dewdrops on rose petal, pustules &
vesicles at different stages of healing
Flesh-colored, pink or yellow-brown
lesion with rough, sandpaper feel, at
sun-exposed areas
Non-pruritic, raised, warty brown-
black plaques, stuck onto skin feel
greasy
Flat brown spots with sharp borders
on dorsum of hand
Erythematous, dome-shaped nodule
with central plug
Raised pearly-borders, telangiectasia,
central ulcer
Pearly papule with umbilicated center
Sexually active person w/ rash on
palms & soles, general LAD
Herpes Zoster (if involved eye =
herpes keratitis. NO steroids. Get
immediate ophthalmology referral)
HSP (Hx post Strep A infection)
Impetigo. Tx = Mupirocin
Koplick spots Rubeola (Measles).
Spots occur before rash
Rubeola (Measles)
Scarlet fever (Grp A Strep)
Scarlet fever (Grp A Strep)
Urticaria
Varicella (Chicken Pox)
Actinic Keratosis
Seborrheic keratosis
Lentigines
Keratoacanthoma
Basal cell Ca
Molluscum contagiosum
Secondary syphilis (Money spots);
VDRL will confirm
29
PANCE/PANRE Word Associations
Scabies & Pediatrics
Christmas tree pattern, erythematous
papules w/ oval plaues w/ scaly itchy
border. Rash preceded by lagre oval
plaque w/ central clearing & scaly
border
Hypopigmented lesions, white, scaly.
Gets worse w/ tanning or sun exposure
Erythematic ring with scaly border &
central clearing
spaghetti & meatballs
Thick, yellow, brittle nails
Infant w/ erythematous, scaly crusty
lesions at vertex of scalp
Children < 10yo w/ vesicles on pharynx,
mouth, hands, feet w/ NO ulceration
Healthy looking < 5yo with lace-like
rash on both cheeks red papules
Pediatric with high fever then after
fever macular rash over trunk and
neck. (rash after defervesence)
Truncal Rash in pediatric after fever
Fever, pharyngitis, sandpaper rash
over face, neck, trunk, extremities
High fever (up to 105oF) x 5 days then
rash. May have conjunctivitis,
cracking, lip fissures
NO LINDANE (KWELL). Permethrin
(Elimite) is drug of choice
Pityriasis rosea; Herald patch
Pityriasis Alba
Tinea (fungal infection); KOH prep =
hyphae
Tinea (fungal infection
Onychomycosis. Tx = PO Terbinafine
Cradle cap seborrheic dermatitis (Tx
in infants w/ baby shampoo, warm olive
oil compress, mild Hydrocortisone
cream; Adults selenium sulfide
shampoo)
Hand-Foot-Mouth disease.
Coxksackie Virus
Erythema infectiosum Slapped
cheek, 5th Dz.
Roseola infantum (Herpesvirus);
Motrin, symptomatic treatment
Roseola infantum (Herpesvirus);
Motrin, symptomatic treatment
Scarlet Fever
Kawasakis Disease; look for cardiac
complications (myocarditis,
pericarditis, arteritis, aneurysms)
30
PANCE/PANRE Word Associations

Erythema marginatum Rheumatic Fever

Silvery scaling plaques on extensor Psoriasis

sensors. Ausptiz sign, Koebners
phenomena
Rat bite erosions on XR Psoriatic arthritis

Dark skinned person with whitening Vitilligo. Skin biopsy to diagnose

or lightening of skin. Hx pernicious
anemia or other autoimmune disease

PEDIATRICS

Description Diagnosis Associated

Introduce solid foods (cereal, fruits) 4 6 mo; after 6 mo add meat, eggs,
starchy foods
1st tooth (central incisor) 6 8 mo
Walks alone 15 mo
3 words, fees self w/ spoon, builds 24 mo
tower

< 2mo fever Septic w/u - blood Cx, LP

< 5yo fever, seizures Febrile seizure

Premature birth, fetal maturity Give corticosteroids

Meconium-stained amniotic fluids Fetal distress

Positive osmotic fragility test G6PD deficiency (hemolytic anemia w/

oxidative drugs sulfa, nitrofurantoin,
quinidine)
Mousy urine PKU

Vit D Rickets X-linked dominant

Hemophilia A, Duchennes MD X-linked Recessive
Neurofibromatosis Autosomal dominant
Sickle cell, CF, PKU Autosomal Recessive

31