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

RVH, hypokinesis
S3
High output heart failure

CHF
CHF, dilagted cardiomyopathy
Pregnancy, thyrotoxicosis, anemia,
beriberi, pagets disease
Ischemic heart disease, HTN, dilated
CM, valve disease, arrhythmia
Myocarditis

Low output heart failure

Heart failure after URI
Young athlete with syncope during
athletic event or practice. No
physical exam abnormalities
Alcoholic with DOE, heart failure
Alcoholic with palpitations,
arrhythmia
Irregular irregular

Hypertrophic CM or fatal arrhythmia.

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

Atrial fibrillation or prosthetic valve

Hx angina but no acute sx. EKG no
acute changes.
Crushing CP, dyspnea, palpitations,
radiation to neck or left arm

Do Exercise stress test

Constant, sharp CP worse lying down,

better sitting up and leaning forward
pulsus paradoxus

Pericarditis

Angina (if lasts minutes), AMI if lasts

> 30 minutes. Acute Ischemia ST
elevation; Injury T wave
depression; Infarct Q wave

Pericardial effusion/tamponade,
pericarditis, asthma attack, tension
PTX, SVC obstruction
Pericardial effusion/tamponade

Electrical alternans, narrow pulse

pressure, pulsus paradoxus
JVD, Hypotension, muffled heart
sounds

Pericardial effusion/tamponade
(Becks triad)
1

PANCE/PANRE Word Associations

Pericarditis post open heart surgery

Dresslers syndrome. Tx w/ ASA #1.

Indomethacin or other NSAID OK.

Sudden onset ripping, tearing chest

pain, diminished pulses
Flank pain, hypotension, pulsatile
abdominal mass

Aortic dissection

EKG changes, N, V, yellow-green

visual disturbances

Digoxin toxicity (Hypokalemia will

make worse)

Hx CHF on diuretic & digoxin

Suspect dig toxicity (hypokalemia

from diuretic = dig toxicity)

Grossly elevated blood pressure esp.

w/ signs of EOD
HTN Tx w/ meds, cough or
angioedema
DM & HTN
Heart failure, LVH

Malignant or Urgent HTN

AAA

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).

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
IVDA w/ new murmur

Bacterial endocarditis (strep.

Viridians) prevention
Bacterial endocarditis (strep.
Viridians)
Aortic stenosis (due to calcifications
age related (or bicuspid valve congenital)
Aortic stenosis

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

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)

Diastolic murmur best heart at apex

without radiation
2

PANCE/PANRE Word Associations

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

Pulmonary stenosis

Holosystolic murmur @ LSB, may

have ventricular hypertrophy
Infant w/ dyspnea, difficulty feeding.
Holosystolic murmur @ LSB, 3rd ICS.
LVH & RVH

VSD

Peds w/ leg pain after physical

activity, abnormal heart sounds,
unequal UE & LE pulses, rib notching

Coarctation of aorta

Short PR, wide QRS, Delta wave

Wolf-parkinson-white; avoid Digoxin,

Young female (<30yo), palpitations,

long arms & fingers, pectus
excavatum, ectopic lentis, flexible
joints

Marfans Syndrome MVP, Aortic

regurgitation, Aortic dissection, Aortic
root dilatation, ectopic lentis

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)

Arterial insufficiency/PAD,
Intermittent claudication (ABI best
choice, ateriogram gold standard)

Mitral valve prolapse

Mitral regurgitation
Mitral regurgitation (caused by
papillary muscle rupture)
Mitral stenosis #1, Tricuspid Stenosis
#2
PDA
Tetralogy of falot

VSD

Tx is arterial bypass

PANCE/PANRE Word Associations

LE pain after long periods of

standing. Dilated, tortuous, veins
Trendelenberg test of extremities

Varicose veins. Tx w/ compression

stockings
Tests for veinous insufficiency.

Blue extremities worse w/ cold

exposure, improves w/ warming

Acrocyanosis

PULMONARY
Description

Diagnosis Associated

Rapid, deep labored breathing

Kussmaul breathing DKA, Metabolic

acidosis

Deep breathing alternating w/ apnea

Cheyne-Stokes breathing heart

failure, brain damage

Cavitations on CXR

Infections lung abscess, TB (Gohn

focus)
TB
Mesothelioma
Lung Ca
Silicosis (Sandblasters)

Apical infiltrates, F, C, dry cough

Pleural thickening on CXR
Hilar mass on CXR
Eggshell pattern on CXR
Ground glass appearance on CXR

Asbestosis (shipbuilders, building

demolition)
Coal Miners lung
Farmers lung
Sarcoidosis

Reticular to nodular pattern on CXR

Patchy fibrosis on CXR
Granulomas and inflammation of
alveoli, small bronchi and small blood
vessels
Dyspnea after surgery, travel
(airplane), LE Fx. May have c/o calf
pain also.
Lung scan with perfusion defects

DVT/PE

Venous stasis, vessel wall injury,

hypercoagulability

DVT/PE (Virchows triad)

Pediatric with barking cough, stridor

viral croup
(laryngotracheobronchitis); Tx w/
racemic epi and glucocorticosteroids
if stridor at rest.
lower respiratory FB, asthma

PE

Pediatric wheezing
4

PANCE/PANRE Word Associations

Drooling, sniffing position, tripod,

toxic
Thumbprint sign
Steeple sign

Epiglottitis
Epiglottitis
FB, viral croup
(laryngotracheobronchitis)
FB, viral croup
(laryngotracheobronchitis)

Inspiratory stridor
Premature infant with respiratory
distress
Preemie CXR w/ hypoexpansion
(ATX), air bronchograms

Hyaline Mb Disease

Smoker, chronic productive cough.

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

Brochitis (COPD)

Fever, cough, sputum. Crackles,

decreased breath sounds, dullness to
percussion, +egophony, pectoriloquy.
CXR infiltrates or consolidation
>35yo with PNA. Rusty colored or
yellow-green sputum. Acute onset
F/C
<35 yo, college students. Fever,
cough, +/- sputum, chills, muscle
aches
Bullous myringitis
PNA w/ Smokers, COPD
PNA w/ DM, immunocompromised,
EtOH. Currant color sputum.
PNA w/ Water, late summer,
construction site. Diarrhea. Toxic
looking
PNA from Nursing homes, chronic
care facility. Purulent sputum
PNA & HIV+, AIDS,
Immunocompromised. Sx out of
proportion to exam. Diffuse
interstitial & alveolar infiltrates

Pneumonia

Hyaline Mb Disease

COPD
Emphysema
Asthma
Asthma

Strep. Pneumonia
Mycoplasma pneumonia
Mycoplasma pneumonia
H. influenza
Klebsiella
Legionella
Staphylococcus aureus
Pneumocystis jerovecii; TMP-SMX =
Drug of choice

PANCE/PANRE Word Associations

PNA & decreased mental status, poor

dental hygiene, dentures, foul
smelling sputum, bronchiectasis.
Patchy infiltrates in dependant lung
zones

Aspiration PNA

Pediatric with Hx recurrent lung

infections, pancreatitis, reproductive
problems, FTT
Sweat chloride test
Cystic fibrosis w/ PNA

Cystic fibrosis (Staph & Pseudomonal

infections usually cause of death)

< 2 days post-op with fever

Atelectasis

Cystic fibrosis
Pseudomonas aueroginosa causative
agent

Stab wound, hyperresonance to

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

Tension PTX

Poor sleeping, obese, daytime fatigue

& drowsy, snoring, HTN, PM wakening

Obstructive sleep apnea

s/p thoracic trauma. Multiple rib

fractures. Chest wall moves in with
inspiration, out with expiration.

Flail chest (pain control, incentive

spirometry, pulmonary toilet,
intubation)

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

Diagnosis Associated
Cholelithiasis or Cholecystitis
Cholecystitis
Cholecystitis
6

PANCE/PANRE Word Associations

F, RUQ pain, Jaundice, gallstones &

dilated common duct on US

Ascending cholangitis (Charcots

triad)

Hx IBD, progressive RUQ pain, wt

loss, F, jaundice & pruritis. Elevated
bilrubin & alkaline phosphate. ERCP
with bile duct stenosis, dilatation

Primary sclerosing cholangitis (diffuse

intra- and extrahepatic duct
sclerosing and dilatation)

Elevated AST, ALT, indirect bilirubin

Isolated elevated indirect bilirubin
Elevated indirect bilirubin w/
defective glucuronyl transferase

Hepatitis
Gilberts syndrome
Crigler-Najjar Dz

Photosensitivity, abd pain w/

neurologic dysfunction, erythema or
skin fragility

Porphyria

H.pylori gastritis
Chronic cough, bitter taste in mouth
or throat, dyspepsia
Multiple or constant GI ulcer pain
despite medications

2antibiotics & PPI

GERD
Zollinger-Ellison Syndrome

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,

intermittent, colicky pain, highpitched rushes & tinkles
Air fluid levels on upright abd plain
film
Air under diaphragm, rigid board-like
abdomen

SBO

>60yo F, LLQ pain

Diverticulitis. IV Abx, fluids, NPO.

Elderly, Hx atherosclerosis. Dull

crampy periumbilical pain postprandial

Mesenteric ischemia

SBO
Perforated viscus, perforated ulcer

PANCE/PANRE Word Associations

Neonate w/ projectile vomiting. Olive

sized mass.
Choking, cyanosis, respiratory
distress, increased secretions in 1st
hours of life
Painless rectal bleeding in pediatrics
Alcoholic with massive hemoptysis

Pyloric stenosis

Female with recurrent abdominal

pain, alternating diarrhea,
constipation. Pain relieved with
defecation.

IBS. TCAs (nortriptyline) good if

diarrhea predominant symptom

Bloody Diarrhea

Ulcerative colitis

Supraclavicular LAD (L > R)

Virchows node metastatic

abdominal cancer
Sister mary Joseph nodule =
indicates metastatic gastric and
pancreatic cancers
Gastric Ca

Tracheoesophageal fistula
Meckels diverticulum
Esophageal varicies (Tx w/
octreotide)

Hard periumbilical nodule

PUD, Pernicious anemia (Type A
Gastritis), H. pylori
Apple core lesion
Elderly with positive hemmocult.

Colon Cancer
Colon Cancer get colonoscopy

CEA

Colon Carcinoma

Family history of young age colon

cancer, multiple polyps found on
colonoscopy
AFP

Familial adenomatous polyposis

(Gardners syndrome)
Hepatocellular carcinoma, testicular
seminoma (germ cell tumor)
Pancreatic Ca
Ovarian Carcinoma
Treat with Ondansetron (Zofran) (5HT3 blockers)

CA 19-9
CA-125
Chemotherapy induced N&V
Travelers Diarrhea

E. coli is cause. Hydration & Cipro to

treat
Giardia

Greasy, foul smelling, floating stools.

Pear-shaped flagellated protozoan w/
2 eyes. Water, travel, camping
history
Afebrile, watery or loose stool. No

Viral Gastroenteritis
8

PANCE/PANRE Word Associations

blood or mucus
Abdominal pain, diarrhea after
picnic/party. Eaten ham, cream,
custards, mayonnaise
Acute bacterial diarrhea w/ prodrome
of HA, F, then crampy abd pain &
diarrhea

Staphylococcus aureus infectious

diarrhea
Campylobacter jejuni most common
cause of acute bacterial diarrhea

Painless rectal bleeding. Bulging

perianal mass w/ straining

Internal hemorrhoids

Pediatric with perianal pruritis esp. at

PM. Positive cellophane tape test

Pruritis ani Pinworms (enterobiasis).

Tx is Mebendazole

Weight loss, recurrent greasy stools

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

Celiac Sprue

Beriberi
Pellagra

Thiamine; Alcoholics, Neuro Sx

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

Celiac Sprue

Scurvy
Rickets
Night blindness
Magenta tongue
s/p gastric bypass surgery or gastric
surgery. N, abd cramping, dizziness
after eating. No masses, bleeding
ENDOCRINE
Description
Diabetic w/ anorexia, anemia, wt loss,
pallor
Gastroparesis, impotence, recurrent
infections, stocking-glove paresthesia

Dumping syndrome

Hypoglycemia despite glucose

administration. Increased C-peptide

Insulinoma

Hypoglycemia in alcoholic

Give Thiamine before glucose to

prevent Wernickes encephalopathy

Decreased radioactive iodine uptake,

Hashimotos thyroiditis

Diagnosis Associated
CRF
Diabetic neuropathy (Treat w/ TCA
(amitriptyline)

PANCE/PANRE Word Associations

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

watch

Hypocalcemia

Infant w/ round face, large protruding

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

Congenital Hypothyroidism

Recurrent HA, HTN not responding to

meds, sweating
Attacks of severe HA, HTN, glucosuria
Urinary catecholamines, urinary
metanephrines
HTN not responsive to meds

Pheochromocytoma Tx pre-op w/
alpha blocker

HTN w/ hypernatremia, hypokalemia

Renal artery stenosis (Infrarenal

artery)
Primary Aldosteronism

Wt. gain, edema, coarse dry skin,

Hypothyroidism
hair, menorrhagia, cold intolerance,
hx transphenoidal surgery & radiation
Tetany, hypocalcemia, cataracts

Hypoparathyroidism

Exogenous corticosteroid use

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

Cushing syndrome
Cushing syndrome
Cushing syndrome

Acute steroid withdrawal

Addisons disease, crisis

10

PANCE/PANRE Word Associations

Hyperpigmentation, hypoglycemia,
orthostatic hypotension, hypotension
not responsive to fluids, hypotension
following an illness, trauma, or
surgery

Addisons disease, crisis (Low

aldosterone; get Random or AM
cortisol, ACTH stimulation test)

Worsening fatigue, wt loss,

weakness, recurrent abdominal pain,
hair loss, hyperpigmentation.
Hyponatremia, hyperkalemia
Hyponatremia, hyperkalemia

Addisons disease, crisis (Low

aldosterone; get Random or AM
cortisol, ACTH stimulation test)

Polyuria, polydipsia. Dilute urine,

Hypernatremia
Concentrated urine. Hyponatremia

Diabetes insipidus

45,X low hairline, low set ears,

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

Turners (gonadal dysgenesis

XXY - short stature, intelligence;

small firm testes, gynecomastia, abn
arm-body length

Klinefelters (hypogonadism)

GU/ELECTROLTES
Description
Hyaline Casts
Increased BUN/Cr, low FeNa

Acute adrenal insufficiency (Addisons

crisis)

SIADH

Diagnosis Associated
Normal (may be present after febrile
illness, strenuous exercise)
Prerenal Failure (Azotemia)

Irritative voiding symptoms, Fever,

chills, CVA tenderness

Pyelonephritis

Crush injury, alcoholic on ground,

elevated CPK, ARF

Rhabdomyolysis

Painless hematuria, flank pain or

mass

Renal cell Carcinoma

Oliguria, hematuria, proteinuria

Acute glomeruloneprhitis
11

PANCE/PANRE Word Associations

following streptococcal infection

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

Glomerulonephritis, HSP
Glomerulonephritis
Goodpasteures

Fibrous band on lateral penis

Cant retract foreskin
Inflammation of glans

Peyronies disease
Phimosis
Balanitis

< 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
U waves
QT prolongation
Recurrent kidney stones, elevated
Calcium, decreased phosphorus

HyperKalemia
HypoKalemia
Hypocalemia
Hyperparathyroidism

Hearing loss or tinnitus w/ metabolic

acidosis

Aspirin OD

NEURO
Description
Head trauma, disoriented lucent
coma
Lens shaped hemorrhage
Concave

Diagnosis Associated
Epidural Hematoma

LP w/ decreased glucose, increased

protein
LP w/ decreased protein, very few
neutrophils
Meningitis and rash
Meningitis & <2mo

Bacterial meningitis

Epidural Hematoma
Subdural Hematoma

syphilitic meningitis
Meningiococcal
Grp B Strep, E. coli (Tx < 1yo =
12

PANCE/PANRE Word Associations

Vanco + Rocephin)
Meningitis < 4yo
Meningitis > 2yo, adults

H. inlu, Grp B strep, N. meningititis

Strep, N. meningititis

Viral Meningitis

Mumps

Unilateral facial weakness w/ inability

to close eye

Bells palsy (self-limiting)

Adolescent female w/ HA. +FHx.

Severe HA, N/V, photphobia. +/auras
Male, recurrent relapsing HA.
Worsened w/ EtOH, Lacrimation,
salivation, rhinorrhea
Sudden onset thunderclap HA,
worse HA of my life
>50 yo female w/ HA. Temporal
artery tenderness or blindness

Migraine HA

Recurrent episodes of vision change,

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

MS

HA worse in AM w/ focal neuro

deficits

Brain Tumor (MC is glioma)

s/p Fall w/ bilateral LE weakness,

urinary and rectal incontinence,
decreased rectal tone

Cauda equine syndrome =

neurosurgical consult

Ascending paralysis
Paralysis after Campylobacter
enteritis
Weakness and fatigue in upper limbs,
blurry vision, diplopia, respiratory
distress

GBS tx: plasma exchange/IVIG

GBS

Cluster HA
Subarachnoid hemorrhage
Temporal arteritis (Giant cell
arteritis). Elevated ESR, get temporal
artery biopsy

MS
Solumedrol- acute attack
Avonox- long term

Myasthenia gravis

13

PANCE/PANRE Word Associations

Young kid with difficulty standing

from seated position. Calf muscle
wasting

Muscular dystrophy (weakness begins

at pelvic girdle)

Pediatric with fever or Hx URI with

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

Reyes syndrome from URI/post-flu or

aspirin use

Pediatric with episodes of blank

stares
3 mHz spikes on EEG

Absence (petit-mal) seizures.

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
< 70 yo blindness
> 70 yo blindness
Afferent papillary defect, marcusgunn pupils
Bilateral pinpoint pupils
Bilateral DILATED pu;ils

Diagnosis Associated
DM retinopathy (MCC)
Macular degeneration
Optic nerve lesion. Tertiary syphilis
(marcus-gunn)
Pontine hemorrhage
Anticholinergics, TCA, antiparkinsonian drugs, profound
hypoxemia

Bilateral hemianopia
Loss of central vision
Superior contralateral quadrantopia

Optic chiasm lesion

Ipsilateral optic nerve lesion
Temporal optic radiation

Temporal field loss

Eye trauma, diplopia. Exophthalmos,
fixed upward gaze, hyphema

Ipsilateral optic tract lesion

Orbital blow-out fracture; Immediate
ophthalmology referral

Painless, nontender nodule on upper

or lower eyelid

Chalazion
14

PANCE/PANRE Word Associations

Painful swelling of upper or lower

eyelid
Painless, yellow triangular nodule on
conjunctivia

Hordeolum

Curtain or veil over my eyes, new

onset floaters
Transient monocular vision loss
Painless vision loss. History of TIA,
palpitations, arrhythmia, carotid
disease, embolic source
Painless vision loss. History of HTN

Retinal detachment

Pinguecula (more common on nasal

side)

Amaurosis fugax TIA, emboli

CRAO (pale retina, cherry red macula)

Vision loss over hours to days, painful

EOM
Recurrent episodes of vision change,
diplopia that resolve

CRVO (blood & Thunder, retinal

hemorrhages)
Optic Neuritis (assoc. w/ MS)
MS

Red eye, watery discharge,

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

Viral conjunctivitis

Diplopia, dysarthria, dysphagia

Vertibrobasilar insufficiency

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

Nasal Foreign body

Bullous myringitis
Otitis media

Mycoplasma pneumonia
Strep. Pneumonia, H. influenza, strep.
Pyogenes, moraxella catarhallis
Otitis externa

Swimmer with ear pain, discharge

Gonococcal conjunctivitis
Allergic conjunctivitis
Acute angle-closure glaucoma

Sinusitis CT is gold standard

Allergic rhinitis. Nedocromil effective
Tx.
Allergic rhinitis

15

PANCE/PANRE Word Associations

Diabetic, ear pain

MOE, Pseudomonas, IV abx (FQ), CT

head

Tinnitus and metabolic acidosis

Sudden dizzy, vertigo, hearing loss,
tinnitus

Salicylate Ingestion
Menieres disease; Treat w/ diuretics
& low-sodium diet

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

BPPV
BPPV

Vertical Nystagmus, insidious onset

vertigo
Horizontal Nystagmus, acute onset
vertigo

Vestibular neuronitis, labrynthitis

Acoustic neuroma (order MRI)
Presbyacussis (Hi freq sounds 1st to
go)
Central lesion (tumor)
Peripheral lesion

Smoker, white mouth lesion cannot

be rubbed off
Gray pharyngeal pseudomembrane,
rash, splenomegaly, supraclavicular
LAD

Leukoplakia, rule out oral cancer

College student with sore throat.

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

EBV - mononucleosis

HEMATOLOGY/ONCOLOGY
Description
Philadelphia chromosome
Auer rods
Reed-sternberg cells
Painless LAD (us. Neck or axilla), LAD
in orderly fashion; B signs +
pruritis; splenomegaly; LN pain after
drinking alcohol
Fatigue, PM sweats, weight loss,

Diphtheria

Diagnosis Associated
CML
AML
Hodgkins lymphoma
Hodgkins lymphoma

Lymphoma do Lymph node biopsy.

16

PANCE/PANRE Word Associations

painless LAD or neck mass

Bone marrow Bx and CT scan used

for staging
Non-Hodgkins lymphoma

Painless LAD us. Scattered. B signs

Hx HTN, nephrotic syndrome, CRF or
Renal insufficiency. Know CBC.
PICA, Pregnant & fatigue,
Menstruation. Cheilosis
Anemia after colectomy, partial
gastrectomy. Glossitis, decreased
vibratory sensation
G6PD + Quinidine, Nitrofurantoin,
Sulfa
Fatigue, weakness, low fever,
purpura, pallor, gingival bleeding. No
HSM

Anemia

Elevated Hgb, Hct, splenomegaly,

post showering pruritis, plethora,
engorged retinal veins

Polycythemia vera; Tx = Phlebotomy

Splenectomy

Pneumococcal vaccine

Sickle cell

Autosomal Recessive, pain in

extremities after exercise, priaprism

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

Hemophilia A
Von Willebrand disease

INFECTIOUS DISEASE
Description
MRSA
Clear vulvar vesicles, inguinal LAD

Fe Deficiency Anemia
B12 or Pernicious anemia
Hemolytic anemia
Aplastic anemia

DIC

Diagnosis Associated
spider bite appearing lesion that
turns into abscess. Tx w/ Vanco +/rifampin, gentamicin, linezolid
Herpes virus (Genital)
17

PANCE/PANRE Word Associations

Giant Multinucleated cells

Tzank Smear
Acetowhitening
Woods light fluoroscopy

Herpes virus (Genital)

Herpes virus (Genital)
Condyloa acuminata
Dermatophytes infections,
Erythrasma (coral red)

Bite w/ fever, lacrimation, rhinorrhea,

bradycardia, HTN, tachyarrhythmias
Bite with local edema, erythema,
central necrosis

Black widow (neurotoxin)

Woods, forest, hikers. Macular rash

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

RMSF (Rickettsia rickettsia)

Indirect immunofluorescent Ab, WeilFelix rxn, complement

RMSF (Rickettsia rickettsia)

Target lesion, arthralgia, Bells Palsy

Lyme Dz (Borrelia Burgdorfi)

Intense pruritis esp. PM. Burrow like

lesions at wrists, elbows, hands,
webs of fingers

Scabies

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

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

Gonorrhea

Red cervix w/ mucopurulent

discharge in sexually active female
FTA-ABS, MTA-TP

Chlamydia

Malaria prophylaxis

Chloroquine

Brown recluse

Gonorrhea

Syphilis diagnosis

18

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

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

Female exam, asymmetric posterior

chest wall or uneven scapula height
with forward bending

Scoliosis (> 25 degree Cobb angle =

surgery)

Tibial pain after running (military

recruits), athletic activity (running
sports)
Knee injury during football game

Shin splints, stress fracture. Get

bone scan if negative x-ray

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
Pain on plantar foot @ 2 3rd
metatarsal. Associated w/ tight
shoes, relieved by removing shoes.
Palpable painful mass

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
Mortons neuroma; Tx w/ NSAIDs,
wide shoes, then steroid injections

19

PANCE/PANRE Word Associations

Pain after tx of fracture w/ cast

Compartment syndrome

HLA-B27

Ankylosing spondylitis, Reiters

syndrome
Septic arthritis (synovial fluid =
leukocytosis, low glucose)
Osteoarthritis. Acetaminophen #1
choice

Acute joint pain. Swollen, warm,

erythema.
Large joint pain. Knees w/ medial
joint space narrowing, osteophytes.
No erythema or warmth.
Enlarged PID, DIP
Female morning joint pain & stiffness
esp. hand/wrists. MCP joint swelling,
ulnar deviation
Acute swollen big toe
Proximal symmetric muscle pain &
stiffness esp. shoulder, neck, pelvic
girdle
Male w/ low back pain, stiffness. Pain
worse wakening, improve during day.
Decreased ROM at spine. Plain films
show sacroiliac abnormality. HLA-B27
positive
Conjunctivitis, iritis, arthritis,
cervicitis, urethritis
Erythema nodosum
Female with Arthralgias, malar rash,
+ANA, + anti-double stranded DNA
antibodies, +anti-phospholipid
antibodies

Osteoarthritis (herberden PIP;

bouchard DIP)
Rheumatoid arthritis. Methotrexate
(DMARDs) #1.
Gout
Polymyalgia rheumatica
Ankylosing spondylitis; Tx = NSAIDs
(Indomethacin)

Reiters syndrome
Systemic autoimmune diseases (RA,
IBD), OCP
SLE

dusky red, well localized single or

multiple papules or plaques usually
of face
Female, fatigue, general aching, pain
at neck, upper shoulders, sleeping
problems, tender points

Discoid lupus

Cold induced pain at extremities with

color change as they warm up

Raynauds phenomenon

Fibromyalgia (exercise program good

management)

20

PANCE/PANRE Word Associations

Osteomyelitis after stepping on nail

wearing sandals or tennis shoes

Pseudomonas aeruginosa (foam

padding in shoes)

Teenage female with long bone pain

without trauma or injury. XR w/ lytic
mass, multi-laminated periosteal
reaction
Painless bony mass. Plain films =
stalky or broad-based projection from
bone surface
Lytic lesions in the back or skull

Ewing sarcoma periosteal onion

skin reaction
Osteochondroma
Multiple myeloma

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

Diagnosis Associated
Dementia

Paplitations, tremors,
hyperventilation or respiratory
alkalosis, numb or tingling mouth or
extremities
Feelings of worthlessness,
hopelessness, apathy, weight loss,
insomnia, daytime sleepiness.
Thoughts of suicide
Raw red hands, chafed.

Anxiety

Binge eating, laxative use, starvation

Bulimia nervosa (Tx w/ SSRI

Fluoxetine)
Hypokalemia, metabolic alkalosis

Bulimia with electrolyte disorders

Antipsychotic meds (phenotiazines),
facial tics, lip smacking, tongue
disorders, blinking, ataxia
Pt on antipsychotic meds develops
altered consciousness, lead-pipe
rigidity, diaphoresis, catatonia.
Hyperthermia, tachypnea, blood

Delerium

Depression (SSRI = drug of choice)

Obsessive compulsive disorder

Tardive dyskinesia
Neuroleptic malignant syndrome. Tx
supportive care & antipyretics

21

PANCE/PANRE Word Associations

pressure changes.
Extrapyradimidal signs, BP changes,
altered consciousness, hyperpyrexia,
muscle rigidity, dysarthria, CV
instability, fever, pulmonary
congestion, diaphoresis. Pt on
antipsychotic meds

Neuroleptic malignant syndrome. Tx

supportive care & antipyretics

Infrequent blinking, tremor, rigidity,

bradykinesia, shuffling gait, masked
facies

Parkinsons

Short lived, intense relationships.

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

Borderline personality disorder

Periods of excessive drinking, buying,

spending

Manic phase of bipolar disorder

Male w/ gynecomastia, diminished or

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

Klinefelter Syndrome XXY. Low serum

testosterone & infertility.

Hyponatremia w/ bizarre behavior.

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

Lithium toxicity
TCA overdose

REPRO
Description
Frothy, clear white or yellow-green
to gray adherent vaginal discharge,
dysuria, vaginal pruritis. Vulvar and
cervical erythema. Flagellated
protozoa
Fishy odor, Thin grayish vaginal
discharge, Clue cells
Thick white vaginal discharge,

Diagnosis Associated
Trichomonas

Bacterial vaginitis; Gardnerella

vaginalis
Candida
22

PANCE/PANRE Word Associations

hyphae & buds on KOH prep

Postmenopausal, dyspareunia, thin
vaginal discharge, atrophic vulvar
changes, vaginal petechiae

Atrophic vaginitis; Tx = topical

estrogen

Secondary amenorrhea
Female with acute abdominal pain.
No characteristic acute abdomen
pattern

Pregnancy
Ectopic pregnancy

20yo female w/ rubbery, firm, wellcircumscribed, non-tender breast

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

Fibroadenoma

Spontaneous bloody, serous, or

cloudy nipple discharge

Intraductal papilloma

Breast mass, nipple retraction,

bloody nipple discharge

Breast cancer (mass is most common

presenting clinical manifestation)

Overweight, irregular menstrual

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

PCOS (stein-leventhal syndrome)

6cm unilateral, mobile, tender

adnexal mass

Tubo-ovarian abscess

Pregnant
Pregnant + rash, post-auricular or
occipital LAD
Pregnant, HA, visual disturbance

Nagels rule: LMP + 7 3 mo

Rubella. Give vaccine AFTER delivery

Fibrocystic breast disease

Mittelschmerz
Endometriosis. Palpable pelvic mass
chocolate cyst
Leiomyoma
Adenomyosis

Pre-eclampsia
23

PANCE/PANRE Word Associations

Pregnant, seizures

Eclampsia

Pregnant < 20 wks gestation w/

vaginal 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.

Threatened abortion

Pregnant who drinks during

pregnancy and inadequate peri-natal
care

Fetal alcohol syndrome low birth

weight

Postpartum hemorrhage

Uterine Atony. Tx = uterine massage

Postmenopausal vaginal bleeding

Endometrial Ca do endometrial
biopsy
Ovarian Ca

Postmenopausal adnexal mass

Incomplete abortion (complete

abortion will have empty uterus,
complete passage of fetal tissue, pain
resolves after passage of tissue)

DERM
Description
Procainamide, hydralazine & rash
Photosensitive rash

Diagnosis Associated
Lupus-type eruptions
TCN, Sulfa drugs

Woods light
KOH

Coral red = Erythrasma

Fungus, Candida; Hyphae & buds,
spaghetti & meatballs
Bacterial infections

Gram stain
Beefy red, sharp bordered rash in
groin (infants), under breast folds
with satellite lesions
Warm, erythematous, tender skin
with possible induration or fluctuance
Red, less distinct borders. Coral red
fluorescence under Woods lamp
Distinct, sharp raised demarcated
border with fever, chills. Group A
Strep
Grouped vesicles on erythematous
base
Infant or pediatric w/ grouped

Candida: Tx: Nystatin/Lotrimin

cream QID x14d; if fails Ketoconazole
Cellulitis
Erythrasma
Erysipelas
Herpes virus
Herpetic whitlow
24

PANCE/PANRE Word Associations

vesicles on thumb or tapioca

vesicles on thumb
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

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)

Pastias lines, positive ASO titer

Strawberry tongue
Pruritic raised erythematous plaques
Dewdrops on rose petal, pustules &
vesicles at different stages of healing

Scarlet fever (Grp A Strep)

Scarlet fever (Grp A Strep)
Urticaria
Varicella (Chicken Pox)

Flesh-colored, pink or yellow-brown

lesion with rough, sandpaper feel, at
sun-exposed areas
Non-pruritic, raised, warty brownblack plaques, stuck onto skin feel
greasy
Flat brown spots with sharp borders
on dorsum of hand
Erythematous, dome-shaped nodule
with central plug

Actinic Keratosis
Seborrheic keratosis
Lentigines
Keratoacanthoma

Raised pearly-borders, telangiectasia, Basal cell Ca

central ulcer
Pearly papule with umbilicated center Molluscum contagiosum
Sexually active person w/ rash on
palms & soles, general LAD

Secondary syphilis (Money spots);

VDRL will confirm

Scabies & Pediatrics

NO LINDANE (KWELL). Permethrin

(Elimite) is drug of choice

25

PANCE/PANRE Word Associations

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

Pityriasis rosea; Herald patch

spaghetti & meatballs

Thick, yellow, brittle nails

Tinea (fungal infection

Onychomycosis. Tx = PO Terbinafine

Infant w/ erythematous, scaly crusty

lesions at vertex of scalp

Cradle cap seborrheic dermatitis (Tx

in infants w/ baby shampoo, warm
olive oil compress, mild
Hydrocortisone cream; Adults
selenium sulfide shampoo)

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

Hand-Foot-Mouth disease.
Coxksackie Virus

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
Erythema marginatum

Pityriasis Alba
Tinea (fungal infection); KOH prep =
hyphae

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)
Rheumatic Fever

Silvery scaling plaques on extensor

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

Psoriasis

Dark skinned person with whitening

or lightening of skin. Hx pernicious

Vitilligo. Skin biopsy to diagnose

Psoriatic arthritis

26

PANCE/PANRE Word Associations

anemia or other autoimmune disease

PEDIATRICS
Description
Introduce solid foods (cereal, fruits)
1st tooth (central incisor)
Walks alone
3 words, fees self w/ spoon, builds
tower

Diagnosis Associated
4 6 mo; after 6 mo add meat, eggs,
starchy foods
6 8 mo
15 mo
24 mo

< 2mo fever

< 5yo fever, seizures

Septic w/u - blood Cx, LP

Febrile seizure

Premature birth, fetal maturity

Meconium-stained amniotic fluids

Give corticosteroids
Fetal distress

Positive osmotic fragility test

Mousy urine

G6PD deficiency (hemolytic anemia

w/ oxidative drugs sulfa,
nitrofurantoin, quinidine)
PKU

Vit D Rickets
Hemophilia A, Duchennes MD
Neurofibromatosis
Sickle cell, CF, PKU

X-linked dominant
X-linked Recessive
Autosomal dominant
Autosomal Recessive

27