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 Get EKG or Echo
physical exam abnormalities
Alcoholic with DOE, heart failure Primary dilated CM
Alcoholic with palpitations, Atrial fibrillation (Holiday heart)
arrhythmia
Irregular irregular Atrial fibrillation; (if > 48 or chronic
anticoagulate)
Atrial fibrillation or prosthetic valve 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, Angina (if lasts minutes), AMI if lasts
radiation to neck or left arm > 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
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PANCE/PANRE Word Associations

pulsus paradoxus Pericardial effusion/tamponade,

pericarditis, asthma attack, tension
PTX, SVC obstruction
Electrical alternans, narrow pulse Pericardial effusion/tamponade
pressure, pulsus paradoxus
JVD, Hypotension, muffled heart Pericardial effusion/tamponade
sounds (Becks triad)
Pericarditis post open heart surgery Dresslers syndrome. Tx w/ ASA #1.
Indomethacin or other NSAID OK.

Sudden onset ripping, tearing chest Aortic dissection

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

EKG changes, N, V, yellow-green visual Digoxin toxicity (Hypokalemia will

disturbances make worse)

Hx CHF on diuretic & digoxin Suspect dig toxicity (hypokalemia from

diuretic = dig toxicity)

Grossly elevated blood pressure esp. Malignant or Urgent HTN

w/ signs of EOD
HTN Tx w/ meds, cough or ACEI is cause
angioedema
DM & HTN ACEI is best choice
Heart failure, LVH ACEI (improves survival, prevents
development of heart failure Sx)
Post MI Beta-blockers
Tx of HTN w/ alpha-blocker SE is postural Hypotension
HTN not responsive to basic meds Think secondary HTN most likely
Renal artery stenosis (infrarenal
artery).

Mechanical valve or prosthesis & Bacterial endocarditis (strep.

Dental, GU, GI, or ortho procedure Viridians) prevention
prophylaxis

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PANCE/PANRE Word Associations

IVDA w/ new murmur Bacterial endocarditis (strep.

Viridians)
Elderly w/ systolic murmur Aortic stenosis (due to calcifications
age related (or bicuspid valve -
congenital)
Diamond shaped, blowing systolic Aortic stenosis
murmur. May have angina, syncope,
CHF
Lateral displaced PMI, Canon a Aortic Regurgitation/Insufficiency:
waves, Quinckes pulse, Corrigans Quinckes pulse (subungual capillar
pulse, Austin flint murmur, pulsation), Corrigan (rapid rise and
deMussets sign, water fall), Austin filnt (low pitch
middiastolic murmur at apex)
Diastolic murmur best heart at apex Mitral stenosis (ARMS are BAD)
without radiation
Systolic ejection murmur heard best at Pulmonary stenosis
base with radiation to left clavicle
Female or Post MI, systolic murmur Mitral valve prolapse
best @ apex preceded by click
without radiation
Systolic murmur heard best at apex Mitral regurgitation
with radiation to left axilla (apical
systolic)
New murmur after MI (esp. if apical Mitral regurgitation (caused by
systolic) papillary muscle rupture)
Murmur & Hx rheumatic heart disease Mitral stenosis #1, Tricuspid Stenosis
#2
Continuous harsh, machine-like PDA
murmur
Cyanotic infant with systolic thrill @ Tetralogy of falot
LSB, systolic ejection murmur +/- click

Holosystolic murmur @ LSB, may have VSD

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

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PANCE/PANRE Word Associations

Peds w/ leg pain after physical activity, Coarctation of aorta

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

Short PR, wide QRS, Delta wave Wolf-parkinson-white; avoid Digoxin,

Young female (<30yo), palpitations, Marfans Syndrome MVP, Aortic

long arms & fingers, pectus excavatum, regurgitation, Aortic dissection,
ectopic lentis, flexible joints Aortic root dilatation, ectopic lentis

LE rubor, no hair, brittle nails, pallor Arterial insufficiency/PAD,

on elevation, calf or LE pain esp. with Intermittent claudication (ABI best
walking short distances relieved with choice, ateriogram gold standard)
rest or at PM
Claudication with rest pain, (ABI < Tx is arterial bypass
0.4)

LE pain after long periods of standing. Varicose veins. Tx w/ compression

Dilated, tortuous, veins stockings
Trendelenberg test of extremities Tests for veinous insufficiency.

Blue extremities worse w/ cold Acrocyanosis

exposure, improves w/ warming

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)
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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

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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
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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)
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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.

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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, Tracheoesophageal fistula
increased secretions in 1st hours of life
Painless rectal bleeding in pediatrics Meckels diverticulum
Alcoholic with massive hemoptysis 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)

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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

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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 Hyperthyroid (work it up with TSH,
fibrillation T4)
Exopthalmos, palpitations, wt. loss. Hyperthyroid, Graves Dx Tx w/
Elevated radioactive idodine uptake 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
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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, aldosterone; get Random or AM
hyperpigmentation. Hyponatremia, cortisol, ACTH stimulation test)
hyperkalemia
Hyponatremia, hyperkalemia Acute adrenal insufficiency
(Addisons crisis)

Polyuria, polydipsia. Dilute urine, Diabetes insipidus

Hypernatremia
Concentrated urine. Hyponatremia SIADH

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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
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PANCE/PANRE Word Associations

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

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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
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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

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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

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PANCE/PANRE Word Associations

Diplopia, dysarthria, dysphagia Vertibrobasilar insufficiency

Unilateral foul smelling or purulent Nasal Foreign body

nasal discharge in a pediatric patient
HA, sinus pressure, yellow green Sinusitis CT is gold standard
nasal discharge
Sneezing, clear rhinorrhea, post-nasal Allergic rhinitis. Nedocromil effective
drip, nasal congestion seasonal Tx.
occurance
Pale, edematous, boggy turbinates Allergic rhinitis

Bullous myringitis Mycoplasma pneumonia

Otitis media Strep. Pneumonia, H. influenza, strep.
Pyogenes, moraxella catarhallis
Swimmer with ear pain, discharge Otitis externa
Diabetic, ear pain MOE, Pseudomonas, IV abx (FQ), CT
head

Tinnitus and metabolic acidosis Salicylate Ingestion

Sudden dizzy, vertigo, hearing loss, Menieres disease; Treat w/ diuretics &
tinnitus low-sodium diet
Dix-hallpike maneuver BPPV
Sudden vertigo with changes in head BPPV
position
Sudden dizzy, N, V. NO tinnitus, Vestibular neuronitis, labrynthitis
hearing loss. Recent URI
Unilateral nerve deafness in middle Acoustic neuroma (order MRI)
age Pt
Sensorineural loss > 50yo Presbyacussis (Hi freq sounds 1st to go)
Vertical Nystagmus, insidious onset Central lesion (tumor)
vertigo
Horizontal Nystagmus, acute onset Peripheral lesion
vertigo

Smoker, white mouth lesion cannot be Leukoplakia, rule out oral cancer
rubbed off

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), Hodgkins lymphoma
LAD in orderly fashion; B signs +
pruritis; splenomegaly; LN pain after
drinking alcohol
Fatigue, PM sweats, weight loss, Lymphoma do Lymph node biopsy.
painless LAD or neck mass Bone marrow Bx and CT scan used for
staging
Painless LAD us. Scattered. B signs 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 Diagnosis Associated
Shoulder pain after repetitive activity, Rotator cuff injury (SITS muscles)
point tenderness at anterior humerus
or AC joint. + drop arm test or
apprehension test
Football player with burning pain, Brachial plexus neurapraxia, stinger.
numbness, tingling from shoulder to Caused by stretching of brachial
hand which resolves plexus
FOOSH, Radial fracture w/ dorsal Colles Fx; Tx = volar splint
displacement, dinner-fork deformity
Typing, secretary wrist pain and Carpal Tunnel syndrome
numb/tingling from wrist to hand.
New mothers, pregnant may worsen
Pain at base of thumb, distal radial deQuervains tenosynovitis
styloid. Pain reproduced with ulnar
deviation of clenched fist.
Hand injury after a punch Boxers fracture. Ulnar gutter w/
intrinsic plus positioning. ORIF if
angulation > 40 degress

Female exam, asymmetric posterior Scoliosis (> 25 degree Cobb angle =

chest wall or uneven scapula height surgery)
with forward bending

Tibial pain after running (military Shin splints, stress fracture. Get bone
recruits), athletic activity (running scan if negative x-ray
sports)
Knee injury during football game ACL (look for description of lachman
or drawer test)
8 10yo male with limp, knee pain Legg-Calve-Perthes Disease
12 15yo overweight male knee pain, SCFE
limp, hip pain (knee XR normal)
Adolescent male with knee pain, Osgood-schlatter disease
tenderness over tibial tuberosity
Retropatellar knee pain esp. in females 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
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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
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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

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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 Incomplete abortion (complete
bleeding, abd & pelvic pain. Tissue at abortion will have empty uterus,
or said to be passed from open complete passage of fetal tissue, pain
cervical os. resolves after passage of tissue)

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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

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PANCE/PANRE Word Associations

Pain preceding vesicular rash in Herpes Zoster (if involved eye =

dermatomal pattern herpes keratitis. NO steroids. Get
immediate ophthalmology referral)
Hx URI the palpable purpuric rash to HSP (Hx post Strep A infection)
buttocks, posterior thighs
Honey colored crusts on erythematous Impetigo. Tx = Mupirocin
base around nose & mouth
Small white papules on diffusely red Koplick spots Rubeola (Measles).
base on buccal mucosa Spots occur before rash
Cough, coryza, conjunctivitis Rubeola (Measles)

Pastias lines, positive ASO titer Scarlet fever (Grp A Strep)

Strawberry tongue Scarlet fever (Grp A Strep)
Pruritic raised erythematous plaques Urticaria
Dewdrops on rose petal, pustules & Varicella (Chicken Pox)
vesicles at different stages of healing

Flesh-colored, pink or yellow-brown Actinic Keratosis

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

Raised pearly-borders, telangiectasia, Basal cell Ca

central ulcer
Pearly papule with umbilicated center Molluscum contagiosum

Sexually active person w/ rash on Secondary syphilis (Money spots);

palms & soles, general LAD VDRL will confirm

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PANCE/PANRE Word Associations

Scabies & Pediatrics NO LINDANE (KWELL). Permethrin

(Elimite) is drug of choice

Christmas tree pattern, erythematous Pityriasis rosea; Herald patch

papules w/ oval plaues w/ scaly itchy
border. Rash preceded by lagre oval
plaque w/ central clearing & scaly
border
Hypopigmented lesions, white, scaly. Pityriasis Alba
Gets worse w/ tanning or sun exposure
Erythematic ring with scaly border & Tinea (fungal infection); KOH prep =
central clearing hyphae

spaghetti & meatballs Tinea (fungal infection

Thick, yellow, brittle nails Onychomycosis. Tx = PO Terbinafine

Infant w/ erythematous, scaly crusty Cradle cap seborrheic dermatitis (Tx

lesions at vertex of scalp in infants w/ baby shampoo, warm olive
oil compress, mild Hydrocortisone
cream; Adults selenium sulfide
shampoo)

Children < 10yo w/ vesicles on pharynx, Hand-Foot-Mouth disease.

mouth, hands, feet w/ NO ulceration Coxksackie Virus
Healthy looking < 5yo with lace-like Erythema infectiosum Slapped
rash on both cheeks red papules cheek, 5th Dz.
Pediatric with high fever then after Roseola infantum (Herpesvirus);
fever macular rash over trunk and Motrin, symptomatic treatment
neck. (rash after defervesence)
Truncal Rash in pediatric after fever Roseola infantum (Herpesvirus);
Motrin, symptomatic treatment
Fever, pharyngitis, sandpaper rash Scarlet Fever
over face, neck, trunk, extremities
High fever (up to 105oF) x 5 days then Kawasakis Disease; look for cardiac
rash. May have conjunctivitis, complications (myocarditis,
cracking, lip fissures pericarditis, arteritis, aneurysms)
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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