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PANCE Flashcards: Blueprint-Aligned Diagnoses, Tests & Next Steps

Study diagnoses, tests, next steps and management with a source-linked PANCE deck organized by the January 2025 NCCPA blueprint.

By author Flashcards Open Source App

About this deck

Reviewed for 2026, this 600-card English deck follows the January 2025 NCCPA PANCE blueprint. Its two public tag axes let you switch between medical-content systems and exam-task retrievals: discriminating history and examination cues, diagnosis, diagnostic-study choice, prevention, next-step intervention, pharmacotherapy, and selected foundations. Every answer links to a current first-party clinical guideline or authoritative public-health or professional body and records the 2026-08-26 review date. Official PANCE eligibility and certification requirements remain with NCCPA. No recalled or leaked exam questions, exam items, mark schemes, curriculum prose, commercial deck wording, logos, figures, or trade dress were copied. Educational review only. This deck isn't medical advice and isn't a substitute for current clinical guidance, supervision, local protocols, or patient-specific judgment. This independently written resource is unofficial and is not affiliated with or endorsed by NCCPA.

Cards in this deck

  2. Card 2

    Question

    When an adult patient with decision-making capacity refuses a recommended treatment, what is the clinician’s next step?

    Answer

    Confirm that the choice is informed and voluntary, explain material risks and alternatives, document the discussion, and respect the refusal.

    Informed Consent · reviewed 2026-08-26

  3. Card 3

    Question

    In a child or adolescent, what core mechanism explains asthma?

    Answer

    Airway inflammation and hyperresponsiveness create variable, usually reversible airflow obstruction.

    2026 GINA Strategy Report · reviewed 2026-08-26

  8. Card 8

    Question

    What core mechanism explains ectopic pregnancy?

    Answer

    Implantation outside the endometrial cavity, usually in the tube, can erode vessels and rupture.

    Ectopic Pregnancy · reviewed 2026-08-26

  10. Card 10

    Question

    What core mechanism explains type 2 diabetes mellitus?

    Answer

    Insulin resistance plus progressive beta-cell dysfunction produces chronic hyperglycemia.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  11. Card 11

    Question

    What core mechanism explains acute angle-closure glaucoma?

    Answer

    Closure of the anterior-chamber angle blocks aqueous outflow and abruptly raises intraocular pressure.

    Management of Angle-Closure Glaucoma · reviewed 2026-08-26

  13. Card 13

    Question

    What core mechanism explains chronic kidney disease?

    Answer

    Progressive nephron loss causes hyperfiltration in remaining nephrons, fibrosis, and multisystem toxin accumulation.

    2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

  16. Card 16

    Question

    In a child or adolescent, what core mechanism explains atopic dermatitis?

    Answer

    Skin-barrier dysfunction and type 2 inflammation increase transepidermal water loss and itch.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  18. Card 18

    Question

    What core mechanism explains uncomplicated cystitis?

    Answer

    Ascending periurethral bacteria inflame the bladder mucosa without renal-parenchymal involvement.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  19. Card 19

    Question

    Which diagnosis causes symmetric synovitis of the MCP, PIP, or wrist joints with prolonged morning stiffness?

    Answer

    Rheumatoid arthritis. Symmetric inflammatory pain and prolonged morning stiffness in MCP, PIP, or wrist joints with synovitis suggest rheumatoid arthritis.

    Rheumatoid Arthritis · reviewed 2026-08-26

  20. Card 20

    Question

    What abilities are assessed when determining decision-making capacity for a specific choice?

    Answer

    The patient must communicate a choice, understand relevant information, appreciate how it applies personally, and reason about the options.

    Informed Consent · reviewed 2026-08-26

  22. Card 22

    Question

    Which diagnosis best fits new clinically significant diarrhea after antibiotics or healthcare exposure, especially with abdominal pain or leukocytosis?

    Answer

    Clostridioides difficile infection. New clinically significant diarrhea after antibiotics or healthcare exposure, with abdominal pain or leukocytosis, suggests C. difficile.

    2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults · reviewed 2026-08-26

  23. Card 23

    Question

    For surgical decision-making, after delivery of the head, retraction against the perineum and failure of the shoulders to deliver indicate which obstetric emergency?

    Answer

    Shoulder dystocia. After delivery of the head, retraction against the perineum and failure of the shoulders to deliver indicates dystocia.

    Shoulder Dystocia · reviewed 2026-08-26

  24. Card 24

    Question

    In a child or adolescent, which diagnosis causes persistent developmentally inappropriate inattention and/or hyperactivity-impulsivity in more than one setting with impairment?

    Answer

    Attention-deficit/hyperactivity disorder. Persistent developmentally inappropriate inattention and/or hyperactivity-impulsivity in more than one setting with impairment suggests ADHD.

    ADHD in Children and Youth: Part 1—Etiology, Diagnosis, and Comorbidity · reviewed 2026-08-26

  25. Card 25

    Question

    Which diagnosis best fits sharp pleuritic chest pain that improves when sitting forward, a friction rub, and diffuse ST elevation?

    Answer

    Acute pericarditis. Sharp pleuritic chest pain that improves when sitting forward, a friction rub, and diffuse ST elevation support pericarditis.

    2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

  27. Card 27

    Question

    For surgical decision-making, identify the condition from this pattern: Proximal weakness, easy bruising, facial plethora, wide violaceous striae, osteoporosis, or difficult diabetes and hypertension are discriminating clues.

    Answer

    Cushing syndrome. Proximal weakness, easy bruising, facial plethora, wide violaceous striae, osteoporosis, or difficult diabetes and hypertension are discriminating clues.

    Diagnosis of Cushing Syndrome: An Endocrine Society Clinical Practice Guideline · reviewed 2026-08-26

  28. Card 28

    Question

    For surgical decision-making, identify the condition from this pattern: Severe unilateral sore throat, muffled voice, drooling, trismus, and uvular deviation suggest a peritonsillar collection.

    Answer

    Peritonsillar abscess. Severe unilateral sore throat, muffled voice, drooling, trismus, and uvular deviation suggest a peritonsillar collection.

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  30. Card 30

    Question

    Which diagnosis may be silent until edema, pruritus, anemia, hypertension, or abnormal urine testing appears?

    Answer

    Chronic kidney disease. CKD may be silent; edema, pruritus, anemia, hypertension, or abnormal urine testing often appears later.

    2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

  34. Card 34

    Question

    Which diagnosis best fits chronic diarrhea, abdominal pain, weight loss, perianal disease, and skip lesions?

    Answer

    Crohn disease. Chronic diarrhea, abdominal pain, weight loss, perianal disease, and skip lesions support Crohn disease.

    Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

  35. Card 35

    Question

    What clinical clue should raise suspicion for pulmonary tuberculosis?

    Answer

    Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern.

    Clinical Overview of Tuberculosis Disease · reviewed 2026-08-26

  36. Card 36

    Question

    Which diagnosis causes well-demarcated erythematous plaques with silvery scale on extensor surfaces and nail pitting?

    Answer

    Plaque psoriasis. Well-demarcated erythematous plaques with silvery scale on extensor surfaces and nail pitting support psoriasis.

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  37. Card 37

    Question

    What clinical clue should raise suspicion for endometriosis?

    Answer

    Cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility suggests endometriosis.

    Endometriosis · reviewed 2026-08-26

  38. Card 38

    Question

    Identify the condition from this pattern: Fever, flank pain, costovertebral-angle tenderness, nausea, and urinary symptoms suggest renal infection.

    Answer

    Acute pyelonephritis. Fever, flank pain, costovertebral-angle tenderness, nausea, and urinary symptoms suggest renal infection.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  39. Card 39

    Question

    What clinical clue should raise suspicion for panic disorder?

    Answer

    Recurrent unexpected panic attacks plus persistent worry or maladaptive avoidance for at least a month suggests panic disorder.

    Panic Disorder: What You Need to Know · reviewed 2026-08-26

  41. Card 41

    Question

    What clinical clue should raise suspicion for tension pneumothorax?

    Answer

    Severe dyspnea, unilateral absent breath sounds, hypotension, distended neck veins, and obstructive shock suggest tension physiology.

    Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

  42. Card 42

    Question

    In a child or adolescent, which next action matters most in diabetic ketoacidosis?

    Answer

    Begin isotonic fluids, replace potassium according to the measured level, and start IV insulin once potassium is safe.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  43. Card 43

    Question

    Who makes decisions when an adult patient lacks capacity and has no applicable advance directive?

    Answer

    Use the legally authorized surrogate and guide decisions by the patient’s known wishes or, if unknown, best interests.

    Decisions for Adult Patients Who Lack Capacity · reviewed 2026-08-26

  44. Card 44

    Question

    For surgical decision-making, which next action matters most in retinal detachment?

    Answer

    Send the patient to an eye doctor or emergency department immediately for retinal evaluation and treatment. Early treatment helps prevent permanent vision loss.

    Retinal Detachment · reviewed 2026-08-26

  45. Card 45

    Question

    What clinical clue should raise suspicion for acute deep-vein thrombosis?

    Answer

    Unilateral leg swelling, pain, warmth, and risk from immobility, surgery, cancer, estrogen, or prior VTE raise suspicion.

    ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26

  46. Card 46

    Question

    Which next action matters most in Crohn disease?

    Answer

    Drain abscesses and involve surgery for obstruction, fistula complications, perforation, or refractory disease.

    Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

  48. Card 48

    Question

    What antimicrobial approach is appropriate for suspected or confirmed pleural infection?

    Answer

    Start empiric antibiotics before culture results, covering likely organisms including anaerobes, then narrow therapy to microbiology and clinical context.

    British Thoracic Society Guideline for Pleural Disease · reviewed 2026-08-26

  51. Card 51

    Question

    Which next action matters most in multiple sclerosis relapse?

    Answer

    Exclude infection or pseudo-relapse, then treat functionally significant relapse and reassess disease-modifying therapy.

    Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

  52. Card 52

    Question

    Which next action matters most in HIV infection?

    Answer

    Link a newly diagnosed patient rapidly to HIV care and begin antiretroviral therapy as soon as feasible.

    Initiation of Antiretroviral Therapy · reviewed 2026-08-26

  53. Card 53

    Question

    For surgical decision-making, which next action matters most in postpartum hemorrhage?

    Answer

    Call the hemorrhage team, massage an atonic uterus, give uterotonics, replace blood products, and control the cause procedurally if needed.

    Postpartum Hemorrhage · reviewed 2026-08-26

  58. Card 58

    Question

    What clinical clue should raise suspicion for acute bacterial rhinosinusitis?

    Answer

    Persistent symptoms beyond 10 days, severe fever with purulent drainage, or worsening after initial improvement are patterns that support bacterial disease.

    Clinical Practice Guideline: Adult Sinusitis Update · reviewed 2026-08-26

  59. Card 59

    Question

    How should a clinician respond when a patient asks not to hear serious diagnostic information?

    Answer

    Explore the request and preferences, confirm it is voluntary, and identify whether the patient wants information shared with a chosen surrogate.

    Withholding Information from Patients · reviewed 2026-08-26

  61. Card 61

    Question

    In a child or adolescent, which next action matters most in atopic dermatitis?

    Answer

    Treat active inflammation and address infection, sleep disruption, and trigger exposure.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  65. Card 65

    Question

    In a child or adolescent, which initial medication regimen is indicated for a convulsive seizure lasting at least five minutes or recurring without recovery?

    Answer

    A benzodiazepine is first-line for convulsive status epilepticus, followed by an appropriate longer-acting antiseizure medicine.

    Treatment of Prolonged Seizures in Children and Adults · reviewed 2026-08-26

  67. Card 67

    Question

    What drug class or regimen fits sepsis?

    Answer

    Use broad therapy matched to source, host, and local resistance, then de-escalate from cultures and response.

    2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26

  71. Card 71

    Question

    What drug class or regimen fits schizophrenia?

    Answer

    Use an antipsychotic through shared decision-making; clozapine is indicated for treatment resistance or persistent suicide risk under monitoring.

    Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26

  73. Card 73

    Question

    What is the key first diagnostic step for primary hypothyroidism?

    Answer

    Measure TSH first in most patients and free T4 to characterize overt disease.

    Guidelines for the Treatment of Hypothyroidism · reviewed 2026-08-26

  74. Card 74

    Question

    In an acutely ill hospitalized medical patient, what VTE prevention strategy is appropriate?

    Answer

    Assess VTE and bleeding risk, then use pharmacologic prophylaxis when indicated or mechanical prophylaxis when anticoagulation is unsuitable.

    ASH VTE Guidelines: Prophylaxis for Medical Patients · reviewed 2026-08-26

  76. Card 76

    Question

    What makes informed consent more than a signed form?

    Answer

    It is a communication process covering the nature, expected benefits, material risks, alternatives, and the option to decline, followed by a voluntary decision.

    Informed Consent · reviewed 2026-08-26

  77. Card 77

    Question

    What condition should be suspected from this finding: Severely elevated pressure with acute neurologic, cardiac, renal, retinal, or aortic injury defines an emergency.

    Answer

    Hypertensive emergency. Severely elevated pressure with acute neurologic, cardiac, renal, retinal, or aortic injury defines an emergency.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

  80. Card 80

    Question

    Which prevention or risk-reduction step is important for early syphilis?

    Answer

    Condom use, partner services, repeat testing for ongoing risk, and prenatal screening reduce transmission and congenital disease.

    Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26

  82. Card 82

    Question

    Which prevention or risk-reduction step is important for abnormal uterine bleeding from anovulation?

    Answer

    Address reversible causes of ovulatory dysfunction, review medicines that worsen bleeding, and monitor for anemia.

    Abnormal Uterine Bleeding · reviewed 2026-08-26

  83. Card 83

    Question

    In a young child, which diagnosis best fits a barking cough, hoarseness, and inspiratory stridor after a viral prodrome?

    Answer

    Croup. Barking cough, hoarseness, and inspiratory stridor after a viral prodrome in a young child suggests croup.

    Acute Management of Croup in the Emergency Department · reviewed 2026-08-26

  88. Card 88

    Question

    What drug class or regimen fits chronic kidney disease?

    Answer

    Use an ACE inhibitor or ARB for appropriate albuminuric CKD and an SGLT2 inhibitor for eligible patients.

    2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

  89. Card 89

    Question

    Which microbiologic test is essential when gonococcal conjunctivitis is suspected?

    Answer

    Obtain a conjunctival specimen for culture; add a locally validated nucleic-acid amplification test when available, and perform susceptibility testing on cultured isolates when indicated.

    Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

  91. Card 91

    Question

    When may treatment proceed without prior consent in an emergency?

    Answer

    When urgent treatment is needed, the patient cannot participate, no surrogate is available, and delay threatens life or serious health; document the circumstances.

    Informed Consent · reviewed 2026-08-26

  93. Card 93

    Question

    What is the key first diagnostic step for subarachnoid hemorrhage?

    Answer

    Use immediate noncontrast CT; if negative but suspicion remains, follow the time-appropriate pathway with lumbar puncture or vascular imaging.

    2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26

  95. Card 95

    Question

    In a child or adolescent, what is the key first diagnostic step for bacterial meningitis?

    Answer

    Obtain blood cultures and lumbar puncture when safe; perform head imaging first only for defined risk features.

    WHO Guidelines on Meningitis Diagnosis, Treatment and Care · reviewed 2026-08-26

  96. Card 96

    Question

    In a postmenopausal woman or man aged 50 or older, which diagnosis is established by a hip or vertebral fragility fracture?

    Answer

    Osteoporosis. A hip or vertebral fracture from low trauma establishes osteoporosis regardless of T-score.

    The clinician’s guide to prevention and treatment of osteoporosis · reviewed 2026-08-26

  97. Card 97

    Question

    What is the key first diagnostic step for preeclampsia with severe features?

    Answer

    Confirm pressure correctly and assess urine protein, CBC, creatinine, liver tests, fetal status, and symptoms.

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  99. Card 99

    Question

    What is the key first diagnostic step for bipolar I mania?

    Answer

    Diagnosis is clinical; assess substances, thyroid disease, medicines, psychosis, and safety.

    Management of Bipolar Disorder in Adults · reviewed 2026-08-26

  100. Card 100

    Question

    How should medication be used in hypertensive emergency?

    Answer

    Choose a titratable IV agent suited to the clinical syndrome; do not rapidly normalize pressure in most presentations.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

  105. Card 105

    Question

    In a patient with prior demyelinating events, which diagnosis fits a new focal neurologic deficit evolving over hours to days and lasting more than 24 hours?

    Answer

    Multiple sclerosis relapse. A focal neurologic deficit evolving over hours to days and lasting over 24 hours, separated in time and space from prior events, suggests relapse.

    Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

  107. Card 107

    Question

    What condition should be suspected from this finding: Acute retroviral illness can cause fever, rash, pharyngitis, lymphadenopathy, or no symptoms; chronic infection may remain silent.

    Answer

    HIV infection. Acute retroviral illness can cause fever, rash, pharyngitis, lymphadenopathy, or no symptoms; chronic infection may remain silent.

    About HIV · reviewed 2026-08-26

  108. Card 108

    Question

    Which prevention or risk-reduction step is important for sudden sensorineural hearing loss?

    Answer

    Counsel patients to seek same-day care for sudden hearing change rather than waiting for spontaneous recovery.

    Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26

  109. Card 109

    Question

    For surgical decision-making, what condition should be suspected from this finding: Heavy postpartum bleeding with uterine atony, retained tissue, trauma, or coagulopathy can rapidly cause shock.

    Answer

    Postpartum hemorrhage. Heavy postpartum bleeding with uterine atony, retained tissue, trauma, or coagulopathy can rapidly cause shock.

    Postpartum Hemorrhage · reviewed 2026-08-26

  110. Card 110

    Question

    What is the clinician’s duty after recognizing a significant medical error that harmed a patient?

    Answer

    Disclose the known facts honestly, explain the clinical impact and next care steps, express appropriate concern, and follow reporting processes.

    Promoting Patient Safety · reviewed 2026-08-26

  111. Card 111

    Question

    Which diagnosis causes an acute, fluctuating disturbance of attention and awareness with disorganized thinking?

    Answer

    Delirium. An acute fluctuating disturbance of attention and awareness with disorganized thinking suggests delirium.

    Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26

  113. Card 113

    Question

    Which next action matters most in uncomplicated cystitis?

    Answer

    Assess for pyelonephritis, pregnancy, obstruction, or sepsis before treating as uncomplicated disease.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  116. Card 116

    Question

    What diagnostic approach is most appropriate when stable chronic hypertension is suspected?

    Answer

    Confirm persistent elevation with standardized office technique and out-of-office monitoring when appropriate.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

  118. Card 118

    Question

    What is the key first diagnostic step for herpes zoster?

    Answer

    Clinical diagnosis is typical; PCR from a lesion is most useful when confirmation matters.

    Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26

  120. Card 120

    Question

    Which bedside pattern best points to migraine with aura?

    Answer

    Recurrent unilateral pulsating headache with nausea or sensory sensitivity, preceded by gradually spreading reversible visual or sensory symptoms, suggests migraine with aura.

    ICHD-3: Migraine with Aura · reviewed 2026-08-26

  121. Card 121

    Question

    What condition should be suspected from this finding: Polyuria, polydipsia, blurred vision, recurrent infections, or an asymptomatic high-risk patient may reveal hyperglycemia.

    Answer

    Type 2 diabetes mellitus. Polyuria, polydipsia, blurred vision, recurrent infections, or an asymptomatic high-risk patient may reveal hyperglycemia.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  123. Card 123

    Question

    For surgical decision-making, what condition should be suspected from this finding: Sudden painful red eye, blurred vision with halos, headache, nausea, a fixed mid-dilated pupil, and a firm globe are classic.

    Answer

    Acute angle-closure glaucoma. Sudden painful red eye, blurred vision with halos, headache, nausea, a fixed mid-dilated pupil, and a firm globe are classic.

    Management of Angle-Closure Glaucoma · reviewed 2026-08-26

  124. Card 124

    Question

    Which bedside pattern best points to abnormal uterine bleeding from anovulation?

    Answer

    Irregular unpredictable bleeding without cyclic ovulation is common at reproductive extremes or with endocrine disruption.

    Abnormal Uterine Bleeding · reviewed 2026-08-26

  125. Card 125

    Question

    How should a clinician manage a boundary-crossing gift from a patient?

    Answer

    Assess its meaning, value, timing, and effect on care; decline gifts that exploit, obligate, or distort the professional relationship.

    Gifts from Patients · reviewed 2026-08-26

  128. Card 128

    Question

    In a child aged 6–11 years or an adolescent, what diagnostic approach is most appropriate when asthma is suspected?

    Answer

    Demonstrate variable expiratory airflow limitation with spirometry and bronchodilator response or an accepted alternative.

    2026 GINA Strategy Report · reviewed 2026-08-26

  129. Card 129

    Question

    Which prevention or risk-reduction step is important for chronic kidney disease?

    Answer

    Control blood pressure, diabetes, tobacco use, and nephrotoxin exposure; vaccinate and reduce cardiovascular risk.

    2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

  132. Card 132

    Question

    Which drug class is preferred before oral therapy for knee osteoarthritis pain when topical treatment is feasible?

    Answer

    Use a topical NSAID first; it provides local pain relief with less systemic exposure than an oral NSAID.

    2019 ACR/Arthritis Foundation Guideline for Osteoarthritis · reviewed 2026-08-26

  133. Card 133

    Question

    A patient has this pattern: Exertional calf discomfort relieved by rest, diminished pulses, and nonhealing foot wounds suggest lower-extremity arterial disease. What is the most likely diagnosis?

    Answer

    Peripheral artery disease. Exertional calf discomfort relieved by rest, diminished pulses, and nonhealing foot wounds suggest lower-extremity arterial disease.

    2024 ACC/AHA Guideline for Lower Extremity Peripheral Artery Disease: Key Points · reviewed 2026-08-26

  135. Card 135

    Question

    Which prevention or risk-reduction step is important for melanoma?

    Answer

    Use sun protection and teach patients to report changing lesions rather than relying on routine self-treatment.

    Melanoma Clinical Guidelines · reviewed 2026-08-26

  137. Card 137

    Question

    Which prevention or risk-reduction step is important for ureteral stone?

    Answer

    High fluid intake and stone-specific dietary changes based on metabolic evaluation reduce recurrence.

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  138. Card 138

    Question

    For surgical decision-making, how should a clinician initially manage ectopic pregnancy?

    Answer

    Hemodynamic instability or suspected rupture requires emergency surgery; stable management depends on imaging, hCG, size, and follow-up reliability.

    Ectopic Pregnancy · reviewed 2026-08-26

  139. Card 139

    Question

    What counseling point helps reduce harm from tension pneumothorax?

    Answer

    After chest trauma or an invasive thoracic procedure, urgently reassess new dyspnea, hypotension, or unilateral breath-sound loss so tension physiology is decompressed without delay.

    Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

  141. Card 141

    Question

    What should happen when a clinician’s personal belief conflicts with a requested legal service?

    Answer

    Disclose the limitation without judgment, protect urgent care, provide timely information or referral, and avoid abandoning the patient.

    Physician Exercise of Conscience · reviewed 2026-08-26

  144. Card 144

    Question

    How should a clinician initially manage primary hypothyroidism?

    Answer

    Start replacement when indicated and recheck TSH after dose changes rather than adjusting from symptoms alone.

    Guidelines for the Treatment of Hypothyroidism · reviewed 2026-08-26

  145. Card 145

    Question

    Which activity counseling can reduce carpal tunnel symptoms or slow progression?

    Answer

    Modify job or recreational activities that aggravate symptoms, especially prolonged wrist flexion or extension.

    Carpal Tunnel Syndrome · reviewed 2026-08-26

  146. Card 146

    Question

    How should a clinician initially manage bacterial conjunctivitis?

    Answer

    Remove contact lenses and urgently assess pain, photophobia, vision loss, corneal opacity, or hyperacute discharge.

    Clinical Overview of Pink Eye (Conjunctivitis) · reviewed 2026-08-26

  147. Card 147

    Question

    Which diagnosis is marked by a rising creatinine or falling urine output after illness, volume loss, nephrotoxin exposure, obstruction, or sepsis?

    Answer

    Acute kidney injury. A rising creatinine or falling urine output after illness, volume loss, nephrotoxin exposure, obstruction, or sepsis indicates AKI.

    KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26

  149. Card 149

    Question

    In a child or adolescent, what condition should be suspected from this finding: Isolated petechiae, bruising, or mucosal bleeding with thrombocytopenia and otherwise preserved cell lines suggests ITP.

    Answer

    Immune thrombocytopenia. Isolated petechiae, bruising, or mucosal bleeding with thrombocytopenia and otherwise preserved cell lines suggests ITP.

    American Society of Hematology 2019 Guidelines for Immune Thrombocytopenia · reviewed 2026-08-26

  151. Card 151

    Question

    A patient has this pattern: Dyspnea with reduced breath sounds, dullness to percussion, and decreased tactile fremitus suggests pleural fluid. What is the most likely diagnosis?

    Answer

    Pleural effusion. Dyspnea with reduced breath sounds, dullness to percussion, and decreased tactile fremitus suggests pleural fluid.

    British Thoracic Society Guideline for Pleural Disease · reviewed 2026-08-26

  152. Card 152

    Question

    How should medication be used in pulmonary tuberculosis?

    Answer

    Treat drug-susceptible disease with a multidrug regimen and adherence support; tailor to susceptibility and patient factors.

    Treatment for Drug-Susceptible Tuberculosis Disease · reviewed 2026-08-26

  153. Card 153

    Question

    How should medication be used in endometriosis?

    Answer

    Combined hormonal contraceptives or progestins are common first-line suppressive therapies when pregnancy is not desired.

    Endometriosis · reviewed 2026-08-26

  154. Card 154

    Question

    How should medication be used in panic disorder?

    Answer

    SSRIs or SNRIs are preferred long-term medicines; benzodiazepines carry dependence and safety risks.

    Panic Disorder: What You Need to Know · reviewed 2026-08-26

  156. Card 156

    Question

    In a patient younger than 16, which diagnosis fits persistent joint swelling, limited motion, or morning stiffness after other causes are excluded?

    Answer

    Juvenile idiopathic arthritis. Persistent joint swelling, limited motion, or morning stiffness beginning before age 16, after excluding other causes, suggests JIA.

    2026 Juvenile Idiopathic Arthritis Guidelines · reviewed 2026-08-26

  157. Card 157

    Question

    Which bedside pattern best points to primary adrenal insufficiency?

    Answer

    Weight loss, fatigue, hypotension, salt craving, hyperpigmentation, hyponatremia, and hyperkalemia suggest primary adrenal failure.

    Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26

  161. Card 161

    Question

    In a child, typically 6 months to 3 years, what immediate plan is appropriate for croup?

    Answer

    Keep the child calm, give dexamethasone, and add nebulized epinephrine for moderate or severe stridor.

    Acute Management of Croup in the Emergency Department · reviewed 2026-08-26

  163. Card 163

    Question

    What is the key first diagnostic step for testicular torsion?

    Answer

    Make a clinical diagnosis and obtain urgent urologic assessment; use Doppler ultrasound only if the diagnosis is uncertain and imaging will not delay exploration.

    Testicular Torsion · reviewed 2026-08-26

  164. Card 164

    Question

    What counseling point helps reduce harm from Parkinson disease?

    Answer

    Exercise, fall-risk reduction, medication review, and driving and swallowing assessment reduce complications.

    Parkinson’s Disease in Adults · reviewed 2026-08-26

  166. Card 166

    Question

    What counseling point helps reduce harm from gonococcal urethritis or cervicitis?

    Answer

    Condom use, routine screening by risk, and partner treatment reduce reinfection and complications.

    Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

  168. Card 168

    Question

    What counseling point helps reduce harm from menopause vasomotor symptoms?

    Answer

    Cooling strategies and avoiding individual triggers can reduce symptom burden; assess bone and cardiovascular risk separately.

    The Menopause Years · reviewed 2026-08-26

  169. Card 169

    Question

    A patient has this pattern: Most chronic infections are asymptomatic; abnormal aminotransferases or risk-based screening may reveal disease. What is the most likely diagnosis?

    Answer

    Chronic hepatitis C. Most chronic infections are asymptomatic; abnormal aminotransferases or risk-based screening may reveal disease.

    Viral Hepatitis Clinical Care · reviewed 2026-08-26

  172. Card 172

    Question

    In a child or adolescent with sickle cell disease, which pain pattern supports an acute vaso-occlusive episode?

    Answer

    Acute severe extremity, back, or bone pain that matches the patient’s typical vaso-occlusive pattern and has no alternative cause supports an acute vaso-occlusive pain episode.

    ASH 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain · reviewed 2026-08-26

  175. Card 175

    Question

    How should medication be used in sudden sensorineural hearing loss?

    Answer

    Offer corticosteroids within the treatment window when appropriate; intratympanic therapy is an option in selected cases.

    Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26

  176. Card 176

    Question

    What is the HIPAA minimum-necessary rule?

    Answer

    For many uses and disclosures, limit protected information to what is reasonably needed for the purpose; the rule does not apply in the same way to disclosures for treatment.

    Minimum Necessary Requirement · reviewed 2026-08-26

  177. Card 177

    Question

    For surgical decision-making, hypotension, elevated jugular venous pressure, tachycardia, muffled heart sounds, and pulsus paradoxus indicate which diagnosis?

    Answer

    Cardiac tamponade. Hypotension, elevated jugular venous pressure, tachycardia, muffled heart sounds, and pulsus paradoxus suggest tamponade physiology.

    2025 Concise Clinical Guidance: Diagnosis and Management of Pericarditis · reviewed 2026-08-26

  178. Card 178

    Question

    In a child or adolescent, what diagnostic approach is most appropriate when acute appendicitis is suspected?

    Answer

    Use ultrasound as the initial imaging study in many children; use CT or MRI when ultrasound is nondiagnostic and suspicion persists, according to local expertise.

    Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26

  179. Card 179

    Question

    For surgical decision-making, sudden focal weakness, facial droop, speech change, gaze deviation, neglect, or ataxia indicate which time-critical diagnosis?

    Answer

    Acute ischemic stroke. Sudden focal weakness, facial droop, speech change, gaze deviation, neglect, or ataxia is stroke until proved otherwise.

    2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke · reviewed 2026-08-26

  180. Card 180

    Question

    A clinician is considering gout flare. Which finding adds the most support?

    Answer

    Abrupt severe monoarthritis with erythema, often at the first metatarsophalangeal joint, suggests gout.

    Gout · reviewed 2026-08-26

  181. Card 181

    Question

    Which diagnosis best fits new cough, fever, dyspnea, pleuritic pain, and focal crackles when an infiltrate is confirmed?

    Answer

    Community-acquired pneumonia. New cough, fever, dyspnea, pleuritic pain, and focal crackles suggest pneumonia, but clinical findings alone are imperfect.

    Diagnosis and Treatment of Adults with Community-acquired Pneumonia · reviewed 2026-08-26

  182. Card 182

    Question

    In a child aged 6–11 years or an adolescent, what medication strategy is appropriate for asthma?

    Answer

    For children 6–11 years and adolescents, use an age-appropriate inhaled corticosteroid-containing strategy rather than short-acting beta agonist-only treatment.

    2026 GINA Strategy Report · reviewed 2026-08-26

  183. Card 183

    Question

    For surgical decision-making, a patient has this pattern: Unilateral pelvic pain or bleeding in early pregnancy, especially with syncope or shoulder pain, raises concern for ectopic implantation. What is the most likely diagnosis?

    Answer

    Ectopic pregnancy. Unilateral pelvic pain or bleeding in early pregnancy, especially with syncope or shoulder pain, raises concern for ectopic implantation.

    Ectopic Pregnancy · reviewed 2026-08-26

  184. Card 184

    Question

    In a child or adolescent, which diagnosis requires at least two weeks of depressed mood or loss of interest with functional change and associated neurovegetative or cognitive symptoms?

    Answer

    Major depressive disorder. At least two weeks of depressed mood or loss of interest with functional change and associated neurovegetative or cognitive symptoms suggests major depression.

    Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders · reviewed 2026-08-26

  186. Card 186

    Question

    For surgical decision-making, what condition should be suspected from this finding: An evolving asymmetric pigmented lesion with border irregularity, color variation, or a concerning outlier pattern requires evaluation.

    Answer

    Melanoma. An evolving asymmetric pigmented lesion with border irregularity, color variation, or a concerning outlier pattern requires evaluation.

    Melanoma Clinical Guidelines · reviewed 2026-08-26

  188. Card 188

    Question

    For surgical decision-making, what condition should be suspected from this finding: Sudden colicky flank pain radiating to the groin with hematuria and restlessness is typical.

    Answer

    Ureteral stone. Sudden colicky flank pain radiating to the groin with hematuria and restlessness is typical.

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  191. Card 191

    Question

    What diagnostic approach is most appropriate when acute bacterial rhinosinusitis is suspected?

    Answer

    Diagnosis is clinical; routine imaging is not needed unless a complication or alternative diagnosis is suspected.

    Clinical Practice Guideline: Adult Sinusitis Update · reviewed 2026-08-26

  192. Card 192

    Question

    What should a clinician do before discussing a patient in a public or semipublic area?

    Answer

    Move to a private setting when practical and use reasonable safeguards so others do not overhear identifiable information.

    Incidental Uses and Disclosures · reviewed 2026-08-26

  193. Card 193

    Question

    A clinician is considering Parkinson disease. Which finding adds the most support?

    Answer

    Bradykinesia plus rest tremor or rigidity, with reduced arm swing and shuffling gait, supports parkinsonism.

    Parkinson’s Disease in Adults · reviewed 2026-08-26

  194. Card 194

    Question

    What immediate plan is appropriate for chronic hepatitis C?

    Answer

    Stage liver disease, review interactions, test for coinfections, and link every patient with active infection to curative treatment.

    Viral Hepatitis Clinical Care · reviewed 2026-08-26

  195. Card 195

    Question

    A clinician is considering gonococcal urethritis or cervicitis. Which finding adds the most support?

    Answer

    Purulent urethral discharge, dysuria, cervicitis, pelvic pain, or exposure may indicate gonorrhea, but infection can be asymptomatic.

    Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

  196. Card 196

    Question

    In a child or adolescent, what immediate plan is appropriate for juvenile idiopathic arthritis?

    Answer

    Refer to pediatric rheumatology early and treat to control inflammation and preserve function.

    2026 Juvenile Idiopathic Arthritis Guidelines · reviewed 2026-08-26

  197. Card 197

    Question

    A clinician is considering menopause vasomotor symptoms. Which finding adds the most support?

    Answer

    Hot flashes, night sweats, sleep disruption, and menstrual transition at the expected age usually identify menopausal vasomotor symptoms.

    The Menopause Years · reviewed 2026-08-26

  198. Card 198

    Question

    Which diagnosis best fits this presentation: Progressive exertional dyspnea, dry cough, bibasilar fine crackles, and clubbing in an older adult suggest fibrotic interstitial disease.

    Answer

    Idiopathic pulmonary fibrosis. Progressive exertional dyspnea, dry cough, bibasilar fine crackles, and clubbing in an older adult suggest fibrotic interstitial disease.

    Idiopathic Pulmonary Fibrosis: An Update and Progressive Pulmonary Fibrosis in Adults · reviewed 2026-08-26

  202. Card 202

    Question

    For surgical decision-making, what is the priority management step for pleural effusion?

    Answer

    Drain a large symptomatic effusion or complicated parapneumonic collection and treat the underlying disease.

    British Thoracic Society Guideline for Pleural Disease · reviewed 2026-08-26

  203. Card 203

    Question

    In acute decompensated heart failure with fluid overload, which drug class is used first to relieve congestion?

    Answer

    Give an intravenous loop diuretic and adjust it to urine output, symptoms, renal function, and electrolytes.

    2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

  204. Card 204

    Question

    For surgical decision-making, what immediate plan is appropriate for subarachnoid hemorrhage?

    Answer

    Stabilize, control pressure carefully, give nimodipine, and obtain urgent neurovascular treatment of the aneurysm.

    2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26

  206. Card 206

    Question

    In a child or adolescent, what immediate plan is appropriate for bacterial meningitis?

    Answer

    Give empiric antibiotics immediately; do not delay for imaging or lumbar puncture when delay is likely.

    WHO Guidelines on Meningitis Diagnosis, Treatment and Care · reviewed 2026-08-26

  207. Card 207

    Question

    In a child or adolescent, which diagnosis fits hyperglycemia with dehydration, abdominal pain, vomiting, Kussmaul respirations, or altered mental status?

    Answer

    Diabetic ketoacidosis. Hyperglycemia with dehydration, abdominal pain, vomiting, Kussmaul respirations, or altered mental status suggests ketoacidosis.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  208. Card 208

    Question

    For surgical decision-making, what immediate plan is appropriate for preeclampsia with severe features?

    Answer

    Stabilize the mother, prevent seizure, control persistent severe pressure, and plan delivery by gestational age and status.

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  209. Card 209

    Question

    For surgical decision-making, new flashes, floaters, and a curtain or shadow across the visual field indicate which diagnosis?

    Answer

    Retinal detachment. New flashes, floaters, and a curtain or shadow across the visual field suggest detachment.

    Retinal Detachment · reviewed 2026-08-26

  210. Card 210

    Question

    What immediate plan is appropriate for bipolar I mania?

    Answer

    Hospitalize when danger, grave disability, or severe psychosis requires containment; stop antidepressant monotherapy.

    Management of Bipolar Disorder in Adults · reviewed 2026-08-26

  211. Card 211

    Question

    May a clinician leave appointment information in a voicemail?

    Answer

    Yes, with reasonable safeguards: keep the message limited and follow any confidential communication request the patient has made.

    Incidental Uses and Disclosures · reviewed 2026-08-26

  213. Card 213

    Question

    How should a clinician initially manage plaque psoriasis?

    Answer

    Assess body-surface area, special-site involvement, symptoms, and joint disease before selecting therapy.

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  216. Card 216

    Question

    Which drug class is first-line for erectile dysfunction when no contraindication such as nitrate use exists?

    Answer

    Use a phosphodiesterase-5 inhibitor after reviewing cardiovascular fitness, interactions, and correct use; never combine it with nitrates.

    Erectile Dysfunction Guideline · reviewed 2026-08-26

  217. Card 217

    Question

    Which pathophysiologic process drives COPD?

    Answer

    Small-airway disease and emphysematous parenchymal destruction cause persistent expiratory flow limitation.

    2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

  218. Card 218

    Question

    Which history or examination finding most strongly supports Crohn disease?

    Answer

    Chronic diarrhea, abdominal pain, weight loss, perianal disease, and skip lesions support Crohn disease.

    Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

  221. Card 221

    Question

    What clinical clue should raise suspicion for hypertensive emergency?

    Answer

    Severely elevated pressure with acute neurologic, cardiac, renal, retinal, or aortic injury defines an emergency.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

  225. Card 225

    Question

    What counseling point helps reduce harm from peritonsillar abscess?

    Answer

    Seek prompt care for worsening unilateral throat pain, drooling, muffled voice, trismus, or breathing difficulty so an abscess and airway risk are not missed.

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  227. Card 227

    Question

    When may protected health information be disclosed to prevent a serious threat?

    Answer

    HIPAA permits a good-faith disclosure consistent with law and ethical standards to someone reasonably able to prevent or lessen a serious and imminent threat.

    HIPAA Disclosure to Prevent or Lessen a Serious and Imminent Threat · reviewed 2026-08-26

  230. Card 230

    Question

    Which bedside pattern best points to herpes zoster?

    Answer

    A painful unilateral grouped-vesicle eruption in a dermatomal distribution is characteristic.

    Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26

  231. Card 231

    Question

    A patient has this pattern: Thrombocytopenia plus microangiopathic hemolytic anemia, often with neurologic, renal, or fever findings, is an emergency. What is the most likely diagnosis?

    Answer

    Thrombotic thrombocytopenic purpura. Thrombocytopenia plus microangiopathic hemolytic anemia, often with neurologic, renal, or fever findings, is an emergency.

    ISTH Guidelines for the Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura · reviewed 2026-08-26

  232. Card 232

    Question

    Which bedside pattern best points to testicular torsion?

    Answer

    Sudden severe unilateral testicular pain with nausea or vomiting, a high-riding transverse testis, and loss of the cremasteric reflex strongly suggests torsion.

    Testicular Torsion · reviewed 2026-08-26

  233. Card 233

    Question

    For surgical decision-making, which diagnosis best fits hematemesis, coffee-ground emesis, or melena with orthostasis?

    Answer

    Upper gastrointestinal bleeding. Hematemesis, coffee-ground emesis, or melena with orthostasis indicates an upper gastrointestinal source until shown otherwise.

    ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26

  234. Card 234

    Question

    In a child or adolescent, what diagnostic approach is most appropriate when generalized tonic-clonic seizure is suspected?

    Answer

    Check glucose and reversible causes; use EEG and brain imaging based on whether this is a first unprovoked event or known epilepsy.

    Epilepsies in Children, Young People and Adults · reviewed 2026-08-26

  235. Card 235

    Question

    Identify the condition from this pattern: Repeated properly measured elevated readings, usually without symptoms, establish the clinical pattern.

    Answer

    Stable chronic hypertension. Repeated properly measured elevated readings, usually without symptoms, establish the clinical pattern.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

  236. Card 236

    Question

    What diagnostic approach is most appropriate when sepsis is suspected?

    Answer

    Measure lactate, obtain cultures before antibiotics when this causes no meaningful delay, and evaluate the source.

    2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26

  237. Card 237

    Question

    For surgical decision-making, in a child with acute severe monoarticular pain, restricted passive motion, fever, or bacteremia risk, which diagnosis must be excluded urgently?

    Answer

    Septic arthritis. Acute severe monoarticular pain, restricted passive motion, fever, or bacteremia risk is septic arthritis until excluded.

    Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26

  238. Card 238

    Question

    What diagnostic approach is most appropriate when pelvic inflammatory disease is suspected?

    Answer

    Test for gonorrhea, chlamydia, HIV, and syphilis; use ultrasound when abscess or another diagnosis is possible.

    Pelvic Inflammatory Disease: STI Treatment Guidelines · reviewed 2026-08-26

  239. Card 239

    Question

    Which pharmacologic approach is preferred for COPD?

    Answer

    Long-acting bronchodilators are maintenance therapy; add inhaled corticosteroid for selected exacerbation-prone patients based on phenotype and eosinophils.

    2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

  240. Card 240

    Question

    What diagnostic approach is most appropriate when schizophrenia is suspected?

    Answer

    Diagnosis is clinical with medical, neurologic, and substance evaluation for first-episode psychosis.

    Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26

  241. Card 241

    Question

    Which next action matters most in hypertensive emergency?

    Answer

    Lower pressure with monitored IV therapy at a controlled rate tailored to the injured organ.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

  242. Card 242

    Question

    How should an interpreter be used for a patient with limited English proficiency?

    Answer

    Use a qualified medical interpreter, speak to the patient directly, pause in short segments, and avoid relying on children or untrained family for consequential decisions.

    Limited English Proficiency Guidance · reviewed 2026-08-26

  246. Card 246

    Question

    Which preventive measure belongs in care for gout flare?

    Answer

    Weight management, limiting excess alcohol, reviewing urate-raising medicines, and long-term urate control reduce flares.

    Gout · reviewed 2026-08-26

  249. Card 249

    Question

    Which test or testing sequence best evaluates suspected COPD?

    Answer

    Post-bronchodilator spirometry confirms persistent airflow obstruction.

    2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

  252. Card 252

    Question

    In a child or adolescent, which pathophysiologic process drives bacterial meningitis?

    Answer

    Bacterial invasion of the subarachnoid space triggers intense inflammation, edema, and raised intracranial pressure.

    WHO Guidelines on Meningitis Diagnosis, Treatment and Care · reviewed 2026-08-26

  253. Card 253

    Question

    Which pathophysiologic process drives preeclampsia with severe features?

    Answer

    Abnormal placentation and systemic endothelial dysfunction produce vasoconstriction and multisystem injury.

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  254. Card 254

    Question

    Which clinical feature defines bipolar I disorder?

    Answer

    At least one manic episode defines bipolar I disorder; a major depressive episode is common but is not required for the diagnosis.

    Management of Bipolar Disorder in Adults · reviewed 2026-08-26

  255. Card 255

    Question

    For surgical decision-making, what is the priority management step for upper gastrointestinal bleeding?

    Answer

    Establish IV access, resuscitate, use a restrictive transfusion strategy for most patients, and arrange endoscopic hemostasis.

    ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26

  256. Card 256

    Question

    Which history or examination finding most strongly supports rheumatoid arthritis?

    Answer

    Symmetric inflammatory pain and prolonged morning stiffness in MCP, PIP, or wrist joints with synovitis suggest rheumatoid arthritis.

    Rheumatoid Arthritis · reviewed 2026-08-26

  257. Card 257

    Question

    What is teach-back?

    Answer

    Ask the patient to explain the plan in their own words so the clinician can find and correct communication gaps without testing or blaming the patient.

    Use the Teach-Back Method · reviewed 2026-08-26

  260. Card 260

    Question

    A clinician is considering sudden sensorineural hearing loss. Which finding adds the most support?

    Answer

    A rapid unilateral hearing decrease, often noticed on waking and sometimes with tinnitus, is an otologic emergency.

    Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26

  261. Card 261

    Question

    Which preventive measure belongs in care for obstructive sleep apnea?

    Answer

    Weight management, alcohol and sedative avoidance near bedtime, and treatment of nasal obstruction reduce severity.

    Sleep Apnea Treatment · reviewed 2026-08-26

  262. Card 262

    Question

    In a child or adolescent, what diagnostic approach is most appropriate when atopic dermatitis is suspected?

    Answer

    Diagnosis is clinical; testing is reserved for an alternative diagnosis or a specific suspected trigger.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  263. Card 263

    Question

    How should a clinician initially manage acute pyelonephritis?

    Answer

    Give fluids and antibiotics, and admit patients with sepsis, inability to take oral therapy, pregnancy concerns, or obstruction.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  264. Card 264

    Question

    For surgical decision-making, which diagnosis best fits this presentation: A sudden maximal-at-onset thunderclap headache, neck stiffness, vomiting, or brief loss of consciousness is concerning.

    Answer

    Subarachnoid hemorrhage. A sudden maximal-at-onset thunderclap headache, neck stiffness, vomiting, or brief loss of consciousness is concerning.

    2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26

  266. Card 266

    Question

    In a child or adolescent, which diagnosis best fits this presentation: Fever, headache, neck stiffness, altered mental status, or a nonblanching rash should trigger urgent evaluation.

    Answer

    Bacterial meningitis. Fever, headache, neck stiffness, altered mental status, or a nonblanching rash should trigger urgent evaluation.

    WHO Guidelines on Meningitis Diagnosis, Treatment and Care · reviewed 2026-08-26

  267. Card 267

    Question

    What drug class or regimen fits stable chronic hypertension?

    Answer

    First-line classes include thiazide-type diuretics, ACE inhibitors or ARBs, and long-acting dihydropyridine calcium-channel blockers.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

  268. Card 268

    Question

    For surgical decision-making, which diagnosis best fits this presentation: New hypertension after 20 weeks with end-organ findings such as severe pressure, thrombocytopenia, liver injury, kidney injury, pulmonary edema, or neurologic symptoms suggests severe disease.

    Answer

    Preeclampsia with severe features. New hypertension after 20 weeks with end-organ findings such as severe pressure, thrombocytopenia, liver injury, kidney injury, pulmonary edema, or neurologic symptoms suggests severe disease.

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  269. Card 269

    Question

    Which pharmacologic approach is preferred for acute pancreatitis?

    Answer

    Routine prophylactic antibiotics do not treat sterile pancreatitis; reserve antimicrobials for proven or strongly suspected infection.

    ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26

  270. Card 270

    Question

    Which diagnosis best fits this presentation: At least one week of elevated or irritable mood with increased energy, decreased sleep, pressured speech, grandiosity, and risky behavior suggests mania.

    Answer

    Bipolar I mania. At least one week of elevated or irritable mood with increased energy, decreased sleep, pressured speech, grandiosity, and risky behavior suggests mania.

    Management of Bipolar Disorder in Adults · reviewed 2026-08-26

  271. Card 271

    Question

    For surgical decision-making, in a child or adolescent, what is the priority management step for septic arthritis?

    Answer

    Drain the joint promptly and start empiric antibiotics after cultures unless the patient is unstable.

    Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26

  273. Card 273

    Question

    In a child or adolescent, which diagnosis causes variable wheeze, cough, chest tightness, or dyspnea that changes over time and with triggers?

    Answer

    Asthma. Variable wheeze, cough, chest tightness, or dyspnea that changes over time and with triggers suggests asthma.

    2026 GINA Strategy Report · reviewed 2026-08-26

  274. Card 274

    Question

    In a child or adolescent, which pathophysiologic process drives diabetic ketoacidosis?

    Answer

    Absolute or marked insulin deficiency drives lipolysis, ketogenesis, osmotic diuresis, and total-body potassium loss.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  275. Card 275

    Question

    How should a clinician respond to a patient requesting an unnecessary antibiotic?

    Answer

    Acknowledge the concern, explain why the antibiotic will not help and may harm, offer a clear alternative plan, and define return precautions.

    Core Elements of Outpatient Antibiotic Stewardship · reviewed 2026-08-26

  276. Card 276

    Question

    Which pathophysiologic process drives retinal detachment?

    Answer

    Fluid passing through a retinal break separates neurosensory retina from the pigment epithelium.

    Retinal Detachment · reviewed 2026-08-26

  281. Card 281

    Question

    After an acute ACL tear, which nonprescription medicines may be used for symptom relief when safe?

    Answer

    Ibuprofen or naproxen can reduce pain and swelling; acetaminophen can reduce pain. Check comorbidities and contraindications before NSAID use.

    Anterior cruciate ligament (ACL) injury - aftercare · reviewed 2026-08-26

  282. Card 282

    Question

    Which preventive measure belongs in care for shoulder dystocia?

    Answer

    Team drills, clear communication, and avoiding fundal pressure reduce preventable harm.

    Shoulder Dystocia · reviewed 2026-08-26

  284. Card 284

    Question

    In a child or adolescent, which preventive measure belongs in care for attention-deficit/hyperactivity disorder?

    Answer

    Use an individualized multimodal plan with psychoeducation, parent and school interventions, and clear functional goals.

    ADHD in Children and Youth: Part 2—Treatment · reviewed 2026-08-26

  287. Card 287

    Question

    During a pulseless arrest, the monitor shows chaotic ventricular activity without organized QRS complexes. Which arrest rhythm is present?

    Answer

    Ventricular fibrillation cardiac arrest. Sudden unresponsiveness with absent normal breathing and no pulse is cardiac arrest; the monitor may show chaotic ventricular activity.

    2025 American Heart Association Guidelines for CPR and ECC: Adult Advanced Life Support · reviewed 2026-08-26

  289. Card 289

    Question

    A patient has this pattern: Progressive weak stream, hesitancy, incomplete emptying, nocturia, and frequency suggest bladder-outlet symptoms. What is the most likely diagnosis?

    Answer

    Benign prostatic hyperplasia. Progressive weak stream, hesitancy, incomplete emptying, nocturia, and frequency suggest bladder-outlet symptoms.

    EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms · reviewed 2026-08-26

  290. Card 290

    Question

    Which test or testing sequence best evaluates suspected primary adrenal insufficiency?

    Answer

    Measure morning cortisol and ACTH, then confirm with cosyntropin testing when the patient is stable.

    Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26

  291. Card 291

    Question

    What medication strategy is appropriate for peritonsillar abscess?

    Answer

    Use antibiotics covering group A streptococci and oral anaerobes after drainage.

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  292. Card 292

    Question

    What belongs in a safe handoff?

    Answer

    State illness severity, active problems, recent changes, pending results, contingency plans, and who owns each next action, then allow questions.

    TeamSTEPPS Communication Module · reviewed 2026-08-26

  294. Card 294

    Question

    For surgical decision-making, identify the condition from this pattern: Pain out of proportion, pain with passive stretch, tense swelling, and progressive neurologic deficits after injury are warning signs.

    Answer

    Acute compartment syndrome. Pain out of proportion, pain with passive stretch, tense swelling, and progressive neurologic deficits after injury are warning signs.

    Management of Acute Compartment Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

  297. Card 297

    Question

    Which history or examination finding most strongly supports shoulder dystocia?

    Answer

    After delivery of the head, retraction against the perineum and failure of the shoulders to deliver indicates dystocia.

    Shoulder Dystocia · reviewed 2026-08-26

  298. Card 298

    Question

    In a child or adolescent, which history or examination finding most strongly supports attention-deficit/hyperactivity disorder?

    Answer

    Persistent developmentally inappropriate inattention and/or hyperactivity-impulsivity in more than one setting with impairment suggests ADHD.

    ADHD in Children and Youth: Part 1—Etiology, Diagnosis, and Comorbidity · reviewed 2026-08-26

  300. Card 300

    Question

    In a child, typically 6 months to 3 years, what clinical clue should raise suspicion for croup?

    Answer

    Barking cough, hoarseness, and inspiratory stridor after a viral prodrome in a young child suggests croup.

    Acute Management of Croup in the Emergency Department · reviewed 2026-08-26

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    600 cards

    PANCE Flashcards: Blueprint-Aligned Diagnoses, Tests & Next Steps

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  303. Card 303

    Question

    For surgical decision-making, in a child or adolescent, identify the condition from this pattern: Periumbilical pain migrating to the right lower quadrant with anorexia, nausea, fever, and focal tenderness is typical.

    Answer

    Acute appendicitis. Periumbilical pain migrating to the right lower quadrant with anorexia, nausea, fever, and focal tenderness is typical.

    Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26

  305. Card 305

    Question

    In a child or adolescent, what is the priority management step for generalized tonic-clonic seizure?

    Answer

    Protect from injury, position for airway safety, time the event, and treat as status epilepticus when it persists.

    Epilepsies in Children, Young People and Adults · reviewed 2026-08-26

  306. Card 306

    Question

    Which diagnosis causes fatigue, cold intolerance, constipation, dry skin, bradycardia, and delayed reflex relaxation?

    Answer

    Primary hypothyroidism. Fatigue, cold intolerance, constipation, dry skin, bradycardia, and delayed reflex relaxation support hypothyroidism.

    Guidelines for the Treatment of Hypothyroidism · reviewed 2026-08-26

  308. Card 308

    Question

    Which diagnosis best fits diffuse conjunctival injection with mucopurulent discharge and eyelids stuck on waking?

    Answer

    Bacterial conjunctivitis. Diffuse conjunctival injection with mucopurulent discharge and eyelids stuck on waking supports bacterial conjunctivitis.

    Clinical Overview of Pink Eye (Conjunctivitis) · reviewed 2026-08-26

  309. Card 309

    Question

    What is the priority management step for pelvic inflammatory disease?

    Answer

    Start empiric treatment promptly; admit for pregnancy, severe illness, abscess, surgical emergency uncertainty, or failed outpatient care.

    Pelvic Inflammatory Disease: STI Treatment Guidelines · reviewed 2026-08-26

  310. Card 310

    Question

    What is closed-loop communication during an emergency?

    Answer

    The receiver repeats the instruction, the sender confirms or corrects it, and completion is announced so the team shares the same state.

    TeamSTEPPS Check-Back Tool · reviewed 2026-08-26

  311. Card 311

    Question

    What is the priority management step for schizophrenia?

    Answer

    Assess danger, catatonia, and ability to care for self, then combine antipsychotic treatment with psychosocial support.

    Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26

  317. Card 317

    Question

    Which diagnosis best fits progressive exertional dyspnea, chronic cough or sputum, and exposure to tobacco, biomass, or occupational irritants?

    Answer

    COPD. Progressive exertional dyspnea, chronic cough or sputum, and exposure to tobacco, biomass, or occupational irritants suggest COPD.

    2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

  318. Card 318

    Question

    Which test or testing sequence best evaluates suspected acute cholecystitis?

    Answer

    Right-upper-quadrant ultrasound is first-line; a gallbladder nuclear-medicine scan (HIDA) is an appropriate next study when ultrasound is negative or equivocal and suspicion remains high.

    ACR Appropriateness Criteria® Right Upper Quadrant Pain · reviewed 2026-08-26

  319. Card 319

    Question

    In a postmenopausal woman or man aged 50 or older, what clinical clue should raise suspicion for osteoporosis?

    Answer

    A fragility fracture, height loss, or kyphosis should prompt assessment for osteoporosis and vertebral fracture.

    The clinician’s guide to prevention and treatment of osteoporosis · reviewed 2026-08-26

  320. Card 320

    Question

    Which pharmacologic approach is preferred for Parkinson disease?

    Answer

    Levodopa provides the strongest motor benefit for many patients; dopamine agonists carry impulse-control and sleep risks.

    Parkinson’s Disease in Adults · reviewed 2026-08-26

  321. Card 321

    Question

    A patient has this pattern: Pressure-like substernal pain with diaphoresis, nausea, or radiation to the arm or jaw is a classic ischemic pattern. What is the most likely diagnosis?

    Answer

    Acute coronary syndrome. Pressure-like substernal pain with diaphoresis, nausea, or radiation to the arm or jaw is a classic ischemic pattern.

    2025 ACC/AHA Guideline for the Management of Patients With Acute Coronary Syndromes · reviewed 2026-08-26

  322. Card 322

    Question

    Which pharmacologic approach is preferred for gonococcal urethritis or cervicitis?

    Answer

    Ceftriaxone is first-line for uncomplicated infection; add chlamydia treatment if it has not been excluded.

    Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

  323. Card 323

    Question

    In a child aged 6 months or older, which examination best evaluates suspected acute otitis media?

    Answer

    Use pneumatic otoscopy to confirm middle-ear effusion and assess for a bulging tympanic membrane; tympanometry is less reliable in young infants.

    Management of Acute Otitis Media in Children Six Months of Age and Older · reviewed 2026-08-26

  324. Card 324

    Question

    Which pharmacologic approach is preferred for menopause vasomotor symptoms?

    Answer

    Systemic menopausal hormone therapy is most effective for eligible patients; nonhormonal options include selected SSRIs, SNRIs, gabapentin, or fezolinetant.

    Hormone Therapy for Menopause · reviewed 2026-08-26

  325. Card 325

    Question

    How should a clinician handle an ambiguous verbal medication order?

    Answer

    Stop and clarify the drug, dose, route, timing, and patient; read it back and do not guess.

    TeamSTEPPS Communication Module · reviewed 2026-08-26

  327. Card 327

    Question

    In a child or adolescent, how should a clinician initially manage asthma?

    Answer

    Assess severity during exacerbation, give repeated bronchodilator, systemic corticosteroid when indicated, oxygen, and escalate for fatigue or silent chest.

    2026 GINA Strategy Report · reviewed 2026-08-26

  331. Card 331

    Question

    For surgical decision-making, in a child or adolescent, which next action matters most in acute appendicitis?

    Answer

    Give fluids, analgesia, antibiotics, and obtain prompt surgical consultation.

    Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26

  334. Card 334

    Question

    In a child or adolescent, which diagnosis fits sudden loss of consciousness with bilateral tonic then clonic movements followed by confusion?

    Answer

    Generalized tonic-clonic seizure. Sudden loss of consciousness with bilateral tonic then clonic movements followed by confusion supports a generalized convulsion.

    Epilepsies in Children, Young People and Adults · reviewed 2026-08-26

  335. Card 335

    Question

    How should medication be used in herpes zoster?

    Answer

    Start an oral antiviral early for eligible patients, especially with severe pain, older age, or high-risk sites.

    Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26

  336. Card 336

    Question

    Which diagnosis is defined by suspected infection with acute organ dysfunction and may include altered mentation, hypotension, tachypnea, or poor perfusion?

    Answer

    Sepsis. Suspected infection with acute organ dysfunction, altered mentation, hypotension, tachypnea, or poor perfusion suggests sepsis.

    2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26

  337. Card 337

    Question

    What medication strategy is appropriate for uncomplicated cystitis?

    Answer

    Nitrofurantoin, trimethoprim-sulfamethoxazole where appropriate, or fosfomycin are common first-line options guided by patient factors and resistance.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  338. Card 338

    Question

    Which diagnosis warrants empiric treatment when lower abdominal pain occurs with cervical-motion, uterine, or adnexal tenderness in a patient at STI risk?

    Answer

    Pelvic inflammatory disease. Lower abdominal pain with cervical motion, uterine, or adnexal tenderness in a patient at STI risk supports empiric PID treatment.

    Pelvic Inflammatory Disease: STI Treatment Guidelines · reviewed 2026-08-26

  339. Card 339

    Question

    How should a clinician confirm or characterize pulmonary embolism?

    Answer

    Use pretest probability with PERC or D-dimer when appropriate and CT pulmonary angiography for indicated stable patients.

    ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26

  340. Card 340

    Question

    Which diagnosis requires at least six months of illness with psychosis and functional decline, including at least one month of active symptoms, after exclusions?

    Answer

    Schizophrenia. At least six months of illness with psychosis and functional decline, including at least one month of active symptoms, supports schizophrenia after exclusions.

    Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26

  342. Card 342

    Question

    What is the priority management step for primary adrenal insufficiency?

    Answer

    Suspected adrenal crisis requires immediate glucocorticoid and isotonic fluid treatment before confirmatory results.

    Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26

  344. Card 344

    Question

    In a child aged 6 months or older, what is the priority management step for acute otitis media?

    Answer

    Provide analgesia; treat severe illness promptly with antibiotics and use 24–48 hours of watchful waiting only for selected mildly ill children with reliable follow-up.

    Management of Acute Otitis Media in Children Six Months of Age and Older · reviewed 2026-08-26

  345. Card 345

    Question

    When antibiotic susceptibility is unknown, which empiric regimen is preferred for most treatment-naive Helicobacter pylori infection?

    Answer

    Use 14-day optimized bismuth quadruple therapy: a proton-pump inhibitor, bismuth, tetracycline, and metronidazole.

    ACG Clinical Guideline: Treatment of Helicobacter pylori Infection · reviewed 2026-08-26

  352. Card 352

    Question

    Which test or testing sequence best evaluates suspected pulmonary tuberculosis?

    Answer

    Obtain chest imaging and multiple respiratory specimens for nucleic-acid testing, smear, and culture with susceptibility testing.

    Clinical and Laboratory Diagnosis for Tuberculosis · reviewed 2026-08-26

  353. Card 353

    Question

    Which test or testing sequence best evaluates suspected endometriosis?

    Answer

    Diagnosis can be clinical with imaging for endometrioma or deep disease; laparoscopy is not mandatory before initial treatment.

    Endometriosis · reviewed 2026-08-26

  354. Card 354

    Question

    Which test or testing sequence best evaluates suspected panic disorder?

    Answer

    Diagnosis is clinical after considering cardiac, pulmonary, endocrine, neurologic, medication, and substance causes.

    Panic Disorder: What You Need to Know · reviewed 2026-08-26

  355. Card 355

    Question

    How can a clinician reduce avoidable harm related to Crohn disease?

    Answer

    Support smoking cessation and use effective maintenance therapy with objective monitoring to reduce relapse and complications.

    Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

  358. Card 358

    Question

    Which history or examination finding most strongly supports peritonsillar abscess?

    Answer

    Severe unilateral sore throat, muffled voice, drooling, trismus, and uvular deviation suggest a peritonsillar collection.

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  359. Card 359

    Question

    When should a safety event or near miss be reported?

    Answer

    Report it through the local safety system promptly, including near misses, so hazards can be corrected without waiting for patient harm.

    Reporting Patient Safety Events · reviewed 2026-08-26

  362. Card 362

    Question

    For surgical decision-making, what immediate plan is appropriate for melanoma?

    Answer

    Prompt complete diagnostic excision and staging guide definitive surgical management.

    Melanoma Clinical Guidelines · reviewed 2026-08-26

  363. Card 363

    Question

    A clinician is considering uncomplicated cystitis. Which finding adds the most support?

    Answer

    Dysuria and frequency without vaginal symptoms strongly support lower urinary infection in an appropriate patient.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  364. Card 364

    Question

    In a child or adolescent, which clinical sequence defines a generalized tonic-clonic seizure?

    Answer

    Loss of consciousness with bilateral tonic stiffening followed by clonic jerking and a postictal period defines the typical sequence.

    Epilepsies in Children, Young People and Adults · reviewed 2026-08-26

  365. Card 365

    Question

    What is the priority management step for chronic kidney disease?

    Answer

    Identify cause, quantify progression risk, treat complications, and refer for high-risk features or advanced disease.

    2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

  366. Card 366

    Question

    Why does sepsis produce its defining clinical pattern?

    Answer

    A dysregulated host response causes endothelial injury, vasodilation, capillary leak, and organ dysfunction.

    2026 Surviving Sepsis Campaign Adult Guidelines · reviewed 2026-08-26

  367. Card 367

    Question

    Which history or examination finding most strongly supports stable chronic hypertension?

    Answer

    Repeated properly measured elevated readings, usually without symptoms, establish the clinical pattern.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

  368. Card 368

    Question

    Why does pelvic inflammatory disease produce its defining clinical pattern?

    Answer

    Ascending polymicrobial infection inflames endometrium and tubes, causing scarring and future ectopic or infertility risk.

    Pelvic Inflammatory Disease: STI Treatment Guidelines · reviewed 2026-08-26

  369. Card 369

    Question

    Which bedside pattern best points to chronic hepatitis C?

    Answer

    Most chronic infections are asymptomatic; abnormal aminotransferases or risk-based screening may reveal disease.

    Viral Hepatitis Clinical Care · reviewed 2026-08-26

  370. Card 370

    Question

    Which symptom domains should a clinician assess in schizophrenia?

    Answer

    Assess positive, negative, cognitive, and mood symptoms together with substance use, functioning, and safety.

    Management of First-Episode Psychosis and Schizophrenia · reviewed 2026-08-26

  371. Card 371

    Question

    For surgical decision-making, an older adult after a fall has groin pain, cannot bear weight, and holds a shortened, externally rotated leg. Which diagnosis is most likely?

    Answer

    Hip fracture. An older adult after a fall with groin pain, inability to bear weight, and a shortened externally rotated leg likely has a hip fracture.

    Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

  372. Card 372

    Question

    In pulmonary embolism with hemodynamic compromise and no prohibitive bleeding risk, which drug class should be considered for reperfusion?

    Answer

    Use systemic thrombolytic therapy followed by anticoagulation; weigh the immediate bleeding risk and activate an advanced-reperfusion pathway.

    ASH 2020 Guidelines for Treatment of Deep Vein Thrombosis and Pulmonary Embolism · reviewed 2026-08-26

  373. Card 373

    Question

    Which diagnosis best fits this presentation: Unilateral leg swelling, pain, warmth, and risk from immobility, surgery, cancer, estrogen, or prior VTE raise suspicion.

    Answer

    Acute deep-vein thrombosis. Unilateral leg swelling, pain, warmth, and risk from immobility, surgery, cancer, estrogen, or prior VTE raise suspicion.

    ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26

  374. Card 374

    Question

    Which preventive measure belongs in care for type 2 diabetes mellitus?

    Answer

    Weight-supportive nutrition, physical activity, tobacco avoidance, and cardiometabolic risk control prevent complications.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  376. Card 376

    Question

    Which preventive measure belongs in care for acute angle-closure glaucoma?

    Answer

    Definitive treatment of the fellow narrow-angle eye helps prevent a second attack.

    Management of Angle-Closure Glaucoma · reviewed 2026-08-26

  377. Card 377

    Question

    Exertional dyspnea, orthopnea, edema, elevated jugular venous pressure, an S3, and an echocardiographic LVEF of 35% indicate which heart-failure phenotype?

    Answer

    Heart failure with reduced ejection fraction (HFrEF). The congestion findings establish heart failure, and an LVEF of 40% or less identifies the reduced-EF phenotype.

    2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

  378. Card 378

    Question

    What clinical clue should raise suspicion for multiple sclerosis relapse?

    Answer

    A focal neurologic deficit evolving over hours to days and lasting over 24 hours, separated in time and space from prior events, suggests relapse.

    Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

  380. Card 380

    Question

    What clinical clue should raise suspicion for HIV infection?

    Answer

    Acute retroviral illness can cause fever, rash, pharyngitis, lymphadenopathy, or no symptoms; chronic infection may remain silent.

    About HIV · reviewed 2026-08-26

  382. Card 382

    Question

    What clinical clue should raise suspicion for postpartum hemorrhage?

    Answer

    Heavy postpartum bleeding with uterine atony, retained tissue, trauma, or coagulopathy can rapidly cause shock.

    Postpartum Hemorrhage · reviewed 2026-08-26

  384. Card 384

    Question

    What clinical clue should raise suspicion for delirium?

    Answer

    An acute fluctuating disturbance of attention and awareness with disorganized thinking suggests delirium.

    Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26

  385. Card 385

    Question

    For surgical decision-making, what immediate plan is appropriate for ureteral stone?

    Answer

    Provide analgesia, check for infection and kidney injury, and decompress urgently when obstruction is infected.

    EAU Guidelines on Urolithiasis · reviewed 2026-08-26

  387. Card 387

    Question

    In a child or adolescent, a clinician is considering atopic dermatitis. Which finding adds the most support?

    Answer

    Chronic pruritic eczematous patches with age-dependent flexural or facial distribution and a relapsing course are typical.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  389. Card 389

    Question

    Which history or examination finding most strongly supports chronic kidney disease?

    Answer

    CKD may be silent; edema, pruritus, anemia, hypertension, or abnormal urine testing often appears later.

    2024 CKD Evaluation and Management Guideline · reviewed 2026-08-26

  390. Card 390

    Question

    Identify the condition from this pattern: Persistent symptoms beyond 10 days, severe fever with purulent drainage, or worsening after initial improvement are patterns that support bacterial disease.

    Answer

    Acute bacterial rhinosinusitis. Persistent symptoms beyond 10 days, severe fever with purulent drainage, or worsening after initial improvement are patterns that support bacterial disease.

    Clinical Practice Guideline: Adult Sinusitis Update · reviewed 2026-08-26

  392. Card 392

    Question

    How should a clinician respond to a patient’s prejudiced request or discriminatory behavior?

    Answer

    Address the behavior directly, explore its reasons, set limits that protect staff and other patients, and do not accommodate invidious discrimination; urgent care still takes priority.

    Discrimination and Disruptive Behavior by Patients · reviewed 2026-08-26

  394. Card 394

    Question

    How should a clinician confirm or characterize acute pancreatitis?

    Answer

    Diagnosis requires two of three: characteristic pain, lipase or amylase at least three times normal, or compatible imaging.

    ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26

  395. Card 395

    Question

    Which next action matters most in pulmonary tuberculosis?

    Answer

    Isolate suspected contagious disease and coordinate promptly with public health.

    Tuberculosis Infection Control · reviewed 2026-08-26

  397. Card 397

    Question

    For surgical decision-making, which next action matters most in endometriosis?

    Answer

    Offer empiric symptom treatment or surgery based on severity, fertility goals, masses, and response.

    Endometriosis · reviewed 2026-08-26

  398. Card 398

    Question

    A patient has this pattern: Sudden dyspnea, pleuritic pain, tachycardia, hypoxemia, hemoptysis, or syncope with VTE risk raises suspicion. What is the most likely diagnosis?

    Answer

    Pulmonary embolism. Sudden dyspnea, pleuritic pain, tachycardia, hypoxemia, hemoptysis, or syncope with VTE risk raises suspicion.

    ASH VTE Guidelines: Diagnosis of Venous Thromboembolism · reviewed 2026-08-26

  399. Card 399

    Question

    Which next action matters most in panic disorder?

    Answer

    During an attack, ensure safety and exclude an emergency; for ongoing disorder, offer cognitive behavioral therapy and/or medication.

    Panic Disorder: What You Need to Know · reviewed 2026-08-26

  401. Card 401

    Question

    What immediate plan is appropriate for COPD?

    Answer

    For an exacerbation, increase short-acting bronchodilation, use systemic steroids, add antibiotics when indicated, and support ventilation.

    2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

  402. Card 402

    Question

    In a child or adolescent, which bedside pattern best points to juvenile idiopathic arthritis?

    Answer

    Persistent joint swelling, limited motion, or morning stiffness beginning before age 16, after excluding other causes, suggests JIA.

    2026 Juvenile Idiopathic Arthritis Guidelines · reviewed 2026-08-26

  403. Card 403

    Question

    What is the priority management step for stable chronic hypertension?

    Answer

    Estimate cardiovascular risk, assess target-organ damage, and set an individualized treatment plan.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

  408. Card 408

    Question

    Which medication prevents seizures in preeclampsia with severe features?

    Answer

    Use magnesium sulfate for seizure prophylaxis while controlling severe hypertension and planning delivery according to maternal and fetal status.

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  409. Card 409

    Question

    What is shared decision-making?

    Answer

    The clinician presents reasonable options and evidence, elicits the patient’s goals and tradeoffs, and reaches a choice together when more than one path is reasonable.

    The SHARE Approach · reviewed 2026-08-26

  410. Card 410

    Question

    In a child aged 6 years or older or an adolescent, what drug class or regimen fits attention-deficit/hyperactivity disorder?

    Answer

    Extended-release stimulants are first-line medication for most children and adolescents when combined with nonpharmacologic care and monitored for benefit and adverse effects.

    ADHD in Children and Youth: Part 2—Treatment · reviewed 2026-08-26

  412. Card 412

    Question

    Which pharmacologic approach is preferred for acute angle-closure glaucoma?

    Answer

    Use pressure-lowering topical agents plus systemic acetazolamide when appropriate; pilocarpine is added after pressure begins to fall.

    Management of Angle-Closure Glaucoma · reviewed 2026-08-26

  413. Card 413

    Question

    Which diagnosis best fits this presentation: A painful unilateral grouped-vesicle eruption in a dermatomal distribution is characteristic.

    Answer

    Herpes zoster. A painful unilateral grouped-vesicle eruption in a dermatomal distribution is characteristic.

    Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26

  415. Card 415

    Question

    What counseling point helps reduce harm from symptomatic aortic stenosis?

    Answer

    Teach patients to report exertional dyspnea, angina, presyncope, or syncope promptly; new symptoms require timely reassessment, and severe symptomatic AS warrants valve-team evaluation rather than surveillance alone.

    2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

  416. Card 416

    Question

    For surgical decision-making, which diagnosis best fits this presentation: Abrupt severe unilateral scrotal pain, a high-riding transverse testis, nausea, and an absent cremasteric reflex are concerning.

    Answer

    Testicular torsion. Sudden severe unilateral pain with nausea or vomiting, a high-riding transverse testis, and loss of the cremasteric reflex is the classic pattern.

    Testicular Torsion · reviewed 2026-08-26

  420. Card 420

    Question

    For surgical decision-making, what condition should be suspected from this finding: Headache, fever, focal deficit, seizure, or signs of raised intracranial pressure after sinus, ear, dental, or bloodstream infection raise suspicion.

    Answer

    Bacterial brain abscess. Headache, fever, focal deficit, seizure, or signs of raised intracranial pressure after sinus, ear, dental, or bloodstream infection raise suspicion.

    ESCMID Guideline on Diagnosis and Treatment of Brain Abscess in Children and Adults · reviewed 2026-08-26

  422. Card 422

    Question

    What condition should be suspected from this finding: Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern.

    Answer

    Pulmonary tuberculosis. Chronic cough, fever, night sweats, weight loss, hemoptysis, or epidemiologic exposure raises concern.

    Clinical Overview of Tuberculosis Disease · reviewed 2026-08-26

  423. Card 423

    Question

    Which pharmacologic approach is preferred for type 2 diabetes mellitus?

    Answer

    Choose glucose-lowering therapy around comorbid ASCVD, heart failure, CKD, weight goals, hypoglycemia risk, and patient priorities; metformin remains appropriate for many.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  424. Card 424

    Question

    For surgical decision-making, which diagnosis best fits cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility?

    Answer

    Endometriosis. Cyclic pelvic pain, dysmenorrhea, deep dyspareunia, painful defecation, or infertility suggests endometriosis.

    Endometriosis · reviewed 2026-08-26

  426. Card 426

    Question

    Which diagnosis requires recurrent unexpected panic attacks plus persistent worry or maladaptive avoidance for at least one month?

    Answer

    Panic disorder. Recurrent unexpected panic attacks plus persistent worry or maladaptive avoidance for at least a month suggests panic disorder.

    Panic Disorder: What You Need to Know · reviewed 2026-08-26

  427. Card 427

    Question

    How should uncertainty be communicated?

    Answer

    Name what is known and unknown, explain the leading possibilities and why, state the plan to reduce uncertainty, and give specific follow-up or return precautions.

    Why Does Clinical Uncertainty Matter? · reviewed 2026-08-26

  428. Card 428

    Question

    Which medication is FDA-approved for moderate-to-severe obstructive sleep apnea in adults with obesity?

    Answer

    Tirzepatide is approved for adults with obesity and moderate-to-severe obstructive sleep apnea, used with a reduced-calorie diet and increased physical activity.

    FDA Approves First Medication for Obstructive Sleep Apnea · reviewed 2026-08-26

  431. Card 431

    Question

    A clinician is considering upper gastrointestinal bleeding. Which finding adds the most support?

    Answer

    Hematemesis, coffee-ground emesis, or melena with orthostasis indicates an upper gastrointestinal source until shown otherwise.

    ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding · reviewed 2026-08-26

  434. Card 434

    Question

    Which treatment should not be offered solely to treat multiple sclerosis?

    Answer

    Do not offer vitamin D solely to treat multiple sclerosis.

    Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

  435. Card 435

    Question

    Which pathophysiologic process drives plaque psoriasis?

    Answer

    IL-23 and Th17 pathway activation drives accelerated keratinocyte turnover.

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  436. Card 436

    Question

    How can a clinician reduce avoidable harm related to HIV infection?

    Answer

    PrEP, condoms, sterile injection equipment, perinatal treatment, and sustained viral suppression prevent transmission.

    Preventing HIV · reviewed 2026-08-26

  437. Card 437

    Question

    Which pathophysiologic process drives acute pyelonephritis?

    Answer

    Ascending infection reaches the renal pelvis and parenchyma, producing systemic illness.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  438. Card 438

    Question

    How can a clinician reduce avoidable harm related to postpartum hemorrhage?

    Answer

    Antenatal anemia treatment, active management of the third stage, and hemorrhage protocols reduce morbidity.

    Postpartum Hemorrhage · reviewed 2026-08-26

  439. Card 439

    Question

    What is the key first diagnostic step for tension pneumothorax?

    Answer

    Diagnosis is clinical in an unstable patient; bedside ultrasound can support it but imaging must not delay decompression.

    Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

  440. Card 440

    Question

    How can a clinician reduce avoidable harm related to delirium?

    Answer

    Orientation, mobility, sleep protection, hearing and vision aids, hydration, and medication review reduce hospital delirium.

    Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26

  445. Card 445

    Question

    A patient has this pattern: Severe persistent epigastric pain radiating to the back with nausea and vomiting is typical. What is the most likely diagnosis?

    Answer

    Acute pancreatitis. Severe persistent epigastric pain radiating to the back with nausea and vomiting is typical.

    ACG Clinical Guideline: Management of Acute Pancreatitis · reviewed 2026-08-26

  448. Card 448

    Question

    Which electrolyte disorder may cause weakness, paresthesias, bradycardia, or ECG changes but can be dangerous even without symptoms?

    Answer

    Hyperkalemia. Weakness, paresthesias, bradycardia, or ECG changes can occur, but dangerous hyperkalemia may be asymptomatic.

    Clinical Practice Guideline: Treatment of Acute Hyperkalaemia in Adults · reviewed 2026-08-26

  450. Card 450

    Question

    Which pharmacologic approach is preferred for heart failure with reduced ejection fraction?

    Answer

    Foundational chronic therapy includes an ARNI or ACE inhibitor/ARB, an evidence-based beta-blocker, an MRA, and an SGLT2 inhibitor when tolerated.

    2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

  451. Card 451

    Question

    For surgical decision-making, severe dyspnea, unilateral absent breath sounds, hypotension, distended neck veins, and obstructive shock indicate which diagnosis?

    Answer

    Tension pneumothorax. Severe dyspnea, unilateral absent breath sounds, hypotension, distended neck veins, and obstructive shock suggest tension physiology.

    Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

  452. Card 452

    Question

    Which bedside pattern best points to ectopic pregnancy?

    Answer

    Unilateral pelvic pain or bleeding in early pregnancy, especially with syncope or shoulder pain, raises concern for ectopic implantation.

    Ectopic Pregnancy · reviewed 2026-08-26

  456. Card 456

    Question

    What clinical clue should raise suspicion for type 2 diabetes mellitus?

    Answer

    Polyuria, polydipsia, blurred vision, recurrent infections, or an asymptomatic high-risk patient may reveal hyperglycemia.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  457. Card 457

    Question

    In a postmenopausal woman or man aged 50 or older, which steps support bone health and reduce fracture risk?

    Answer

    Adequate calcium and vitamin D, weight-bearing and muscle-strengthening exercise, fall-risk reduction, tobacco cessation, and avoiding excess alcohol support bone health.

    The clinician’s guide to prevention and treatment of osteoporosis · reviewed 2026-08-26

  458. Card 458

    Question

    What clinical clue should raise suspicion for acute angle-closure glaucoma?

    Answer

    Sudden painful red eye, blurred vision with halos, headache, nausea, a fixed mid-dilated pupil, and a firm globe are classic.

    Management of Angle-Closure Glaucoma · reviewed 2026-08-26

  461. Card 461

    Question

    Which test or testing sequence best evaluates suspected plaque psoriasis?

    Answer

    Diagnosis is usually clinical; biopsy is reserved for uncertain morphology.

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  463. Card 463

    Question

    What diagnostic approach is most appropriate when uncomplicated cystitis is suspected?

    Answer

    Urinalysis supports the diagnosis; culture is important for complicated, recurrent, resistant, pregnant, or atypical cases.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  466. Card 466

    Question

    How should a clinician initially manage early syphilis?

    Answer

    Treat the patient and ensure partner evaluation; urgent specialist evaluation is needed for ocular, otic, or neurologic disease.

    Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26

  469. Card 469

    Question

    Why does acute cholecystitis produce its defining clinical pattern?

    Answer

    A gallstone can block bile flow, causing gallbladder pain and swelling (inflammation).

    Cholecystectomy · reviewed 2026-08-26

  471. Card 471

    Question

    In a child or adolescent, a clinician is considering septic arthritis. Which finding adds the most support?

    Answer

    Acute severe monoarticular pain, restricted passive motion, fever, or bacteremia risk is septic arthritis until excluded.

    Guideline for Management of Septic Arthritis in Native Joints · reviewed 2026-08-26

  473. Card 473

    Question

    For an eligible infant or selected high-risk child aged 8–19 months, which immunization strategy reduces severe RSV disease?

    Answer

    Use either maternal RSV vaccination or a recommended long-acting RSV antibody to protect infants; give nirsevimab to eligible high-risk children aged 8–19 months entering a second RSV season.

    RSV Immunization Guidance for Infants and Young Children · reviewed 2026-08-26

  474. Card 474

    Question

    Which diagnosis causes weight loss, fatigue, hypotension, salt craving, hyperpigmentation, hyponatremia, and hyperkalemia?

    Answer

    Primary adrenal insufficiency. Weight loss, fatigue, hypotension, salt craving, hyperpigmentation, hyponatremia, and hyperkalemia suggest primary adrenal failure.

    Primary Adrenal Insufficiency Guideline Resources · reviewed 2026-08-26

  475. Card 475

    Question

    What is the ethical approach to a learner performing a procedure?

    Answer

    Tell the patient who will participate, describe supervision, obtain voluntary agreement, and ensure refusal does not compromise care.

    Residents and Fellows: Patient Involvement in Self-Education · reviewed 2026-08-26

  476. Card 476

    Question

    In a child aged 6 months or older, what condition should be suspected from a bulging tympanic membrane with acute ear pain or new otorrhea?

    Answer

    Acute otitis media. A bulging tympanic membrane with acute ear pain or new otorrhea is more specific than redness alone.

    Management of Acute Otitis Media in Children Six Months of Age and Older · reviewed 2026-08-26

  478. Card 478

    Question

    How should medication be used in multiple sclerosis relapse?

    Answer

    High-dose corticosteroids shorten a disabling relapse; they do not alter long-term progression by themselves.

    Multiple Sclerosis in Adults: Management · reviewed 2026-08-26

  480. Card 480

    Question

    How should medication be used in HIV infection?

    Answer

    Use a recommended combination antiretroviral regimen selected for resistance, interactions, comorbidity, pregnancy potential, and patient preference.

    What to Start: Initial Combination Antiretroviral Regimens · reviewed 2026-08-26

  482. Card 482

    Question

    How should medication be used in postpartum hemorrhage?

    Answer

    Oxytocin is first-line for uterine atony; add other uterotonics according to contraindications and give tranexamic acid early when indicated.

    Postpartum Hemorrhage · reviewed 2026-08-26

  483. Card 483

    Question

    In a child or adolescent, which history or examination finding most strongly supports asthma?

    Answer

    Variable wheeze, cough, chest tightness, or dyspnea that changes over time and with triggers suggests asthma.

    2026 GINA Strategy Report · reviewed 2026-08-26

  484. Card 484

    Question

    How should medication be used in delirium?

    Answer

    Reserve short-term antipsychotic use for severe dangerous agitation after reversible causes and contraindications are addressed.

    Delirium: Prevention, Diagnosis and Management · reviewed 2026-08-26

  485. Card 485

    Question

    Which preventive measure belongs in care for herpes zoster?

    Answer

    Age-appropriate recombinant zoster vaccination lowers zoster and postherpetic-neuralgia risk.

    Clinical Overview of Shingles (Herpes Zoster) · reviewed 2026-08-26

  486. Card 486

    Question

    For surgical decision-making, what condition should be suspected from this finding: Abrupt severe chest or back pain, pulse or blood-pressure asymmetry, and a new aortic regurgitation murmur are high-risk clues.

    Answer

    Aortic dissection. Abrupt severe chest or back pain, pulse or blood-pressure asymmetry, and a new aortic regurgitation murmur are high-risk clues.

    2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease · reviewed 2026-08-26

  487. Card 487

    Question

    Which preventive step is required during surgery for viable testicular torsion?

    Answer

    Perform bilateral orchiopexy, fixing the affected and contralateral testes to reduce future torsion risk.

    Testicular Torsion · reviewed 2026-08-26

  489. Card 489

    Question

    Why does primary hypothyroidism produce its defining clinical pattern?

    Answer

    Low thyroid hormone removes feedback inhibition, so TSH rises in primary gland failure.

    Guidelines for the Treatment of Hypothyroidism · reviewed 2026-08-26

  491. Card 491

    Question

    Why does bacterial conjunctivitis produce its defining clinical pattern?

    Answer

    Bacterial infection of the conjunctiva commonly produces red eye with purulent discharge that mats the eyelids.

    Clinical Overview of Pink Eye (Conjunctivitis) · reviewed 2026-08-26

  492. Card 492

    Question

    When is a chaperone appropriate for an intimate examination?

    Answer

    Offer a trained chaperone, respect patient preferences when safety permits, explain the examination, obtain consent, and document who was present.

    Use of Chaperones · reviewed 2026-08-26

  493. Card 493

    Question

    Which diagnosis causes recurrent unilateral pulsating headache with nausea or sensory sensitivity, preceded by gradually spreading reversible visual or sensory symptoms?

    Answer

    Migraine with aura. Recurrent unilateral pulsating headache with nausea or sensory sensitivity, preceded by gradually spreading reversible visual or sensory symptoms, suggests migraine with aura.

    ICHD-3: Migraine with Aura · reviewed 2026-08-26

  494. Card 494

    Question

    What medication strategy is appropriate for Crohn disease?

    Answer

    Corticosteroids can induce remission but are not maintenance therapy; immunomodulator or biologic selection depends on risk and phenotype.

    Updated 2025 ACG Guidelines for Crohn’s Disease · reviewed 2026-08-26

  495. Card 495

    Question

    Which diagnosis best fits a painless chancre or a diffuse rash involving the palms and soles with generalized lymphadenopathy?

    Answer

    Early syphilis. A painless chancre or a diffuse rash involving palms and soles with generalized lymphadenopathy suggests syphilis by stage.

    Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26

  497. Card 497

    Question

    Which diagnosis best fits irregular, unpredictable uterine bleeding at reproductive extremes or with endocrine disruption?

    Answer

    Abnormal uterine bleeding from anovulation. Irregular unpredictable bleeding without cyclic ovulation is common at reproductive extremes or with endocrine disruption.

    Abnormal Uterine Bleeding · reviewed 2026-08-26

  499. Card 499

    Question

    Which diagnosis requires intrusion, avoidance, negative mood or cognition, and hyperarousal lasting more than one month after trauma?

    Answer

    Post-traumatic stress disorder. Intrusion, avoidance, negative mood or cognition, and hyperarousal lasting over a month after trauma suggest PTSD.

    Management of Posttraumatic Stress Disorder and Acute Stress Disorder · reviewed 2026-08-26

  502. Card 502

    Question

    What drug class or regimen fits atrial fibrillation?

    Answer

    Choose anticoagulation from validated thromboembolic-risk assessment; direct oral anticoagulants are preferred for most eligible patients without mechanical valves or moderate-to-severe rheumatic mitral stenosis.

    2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation: Key Perspectives · reviewed 2026-08-26

  503. Card 503

    Question

    In a child or adolescent, which history or examination finding most strongly supports acute appendicitis?

    Answer

    Periumbilical pain migrating to the right lower quadrant with anorexia, nausea, fever, and focal tenderness is typical.

    Guideline for the Diagnosis and Treatment of Appendicitis · reviewed 2026-08-26

  504. Card 504

    Question

    Which diagnosis best fits this presentation: Nocturnal numbness or tingling in the thumb, index, and middle fingers with thenar weakness suggests median-nerve compression.

    Answer

    Carpal tunnel syndrome. Nocturnal numbness or tingling in the thumb, index, and middle fingers with thenar weakness suggests median-nerve compression.

    Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline · reviewed 2026-08-26

  506. Card 506

    Question

    In a child or adolescent, how can a clinician reduce avoidable harm related to diabetic ketoacidosis?

    Answer

    Sick-day planning, continued basal insulin, ketone checks, and early contact for illness reduce recurrence.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  507. Card 507

    Question

    How should a clinician confirm or characterize early syphilis?

    Answer

    Use a nontreponemal test with a treponemal confirmatory test, or the reverse sequence; evaluate neurologic or ocular symptoms separately.

    Primary and Secondary Syphilis: STI Treatment Guidelines · reviewed 2026-08-26

  508. Card 508

    Question

    How can a clinician reduce avoidable harm related to retinal detachment?

    Answer

    Assess sudden new floaters, flashes, or a curtain immediately; early treatment can prevent permanent vision loss. Dilated examination can find a small tear or detachment before vision is affected.

    Retinal Detachment · reviewed 2026-08-26

  510. Card 510

    Question

    How should social media be handled when a clinical story seems de-identified?

    Answer

    Do not post patient material without proper authorization; combinations of details can identify a person even when names are removed.

    Professionalism in the Use of Social Media · reviewed 2026-08-26

  513. Card 513

    Question

    In a child or adolescent, what medication strategy is appropriate for atopic dermatitis?

    Answer

    Topical corticosteroids are first-line for most flares; steroid-sparing topical agents help at sensitive sites or with maintenance.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  516. Card 516

    Question

    Which history or examination finding most strongly supports acute pyelonephritis?

    Answer

    Fever, flank pain, costovertebral-angle tenderness, nausea, and urinary symptoms suggest renal infection.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  517. Card 517

    Question

    For surgical decision-making, which next action matters most in tension pneumothorax?

    Answer

    Perform immediate decompression followed by tube thoracostomy.

    Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

  518. Card 518

    Question

    Which diagnosis best fits this presentation: Chronic diarrhea, bloating, weight loss, iron deficiency, dermatitis herpetiformis, or unexplained osteoporosis can be the clue.

    Answer

    Celiac disease. Chronic diarrhea, bloating, weight loss, iron deficiency, dermatitis herpetiformis, or unexplained osteoporosis can be the clue.

    ACG Clinical Guidelines: Diagnosis and Management of Celiac Disease · reviewed 2026-08-26

  519. Card 519

    Question

    What physiologic disturbance underlies anterior cruciate ligament tear?

    Answer

    An ACL tear removes a primary restraint to anterior tibial translation and rotation, producing anterior and rotational instability.

    The Management of Anterior Cruciate Ligament Injuries · reviewed 2026-08-26

  520. Card 520

    Question

    A clinician is considering heart failure with reduced ejection fraction. Which finding adds the most support?

    Answer

    Exertional dyspnea, orthopnea, edema, elevated jugular venous pressure, and an S3 support volume-overloaded heart failure.

    2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure · reviewed 2026-08-26

  523. Card 523

    Question

    What physiologic disturbance underlies pulmonary tuberculosis?

    Answer

    Mycobacteria survive in macrophages and drive granulomatous inflammation with latent or active disease.

    Clinical Overview of Tuberculosis Disease · reviewed 2026-08-26

  524. Card 524

    Question

    Which antibiotic is required for gonococcal conjunctivitis in an adult?

    Answer

    Give systemic ceftriaxone; consider one-time saline lavage and evaluate for chlamydial coinfection when it has not been excluded.

    Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

  525. Card 525

    Question

    What physiologic disturbance underlies endometriosis?

    Answer

    Estrogen-responsive ectopic endometrial-like tissue drives inflammation, fibrosis, and pain.

    Endometriosis · reviewed 2026-08-26

  526. Card 526

    Question

    What should a clinician do after sending protected information to the wrong recipient?

    Answer

    Act immediately to limit further disclosure, notify the organization’s privacy or security process, document facts, and follow breach assessment requirements.

    Breach Notification Rule · reviewed 2026-08-26

  527. Card 527

    Question

    Which clinical pattern defines a panic attack?

    Answer

    An abrupt surge of intense fear or discomfort with physical and cognitive symptoms that peaks within minutes defines a panic attack.

    Panic Disorder: What You Need to Know · reviewed 2026-08-26

  528. Card 528

    Question

    What clinical clue should raise suspicion for acute kidney injury?

    Answer

    A rising creatinine or falling urine output after illness, volume loss, nephrotoxin exposure, obstruction, or sepsis indicates AKI.

    KDIGO Clinical Practice Guideline for Acute Kidney Injury · reviewed 2026-08-26

  529. Card 529

    Question

    What physiologic disturbance underlies tension pneumothorax?

    Answer

    A one-way pleural air leak raises intrathoracic pressure, collapses the lung, and impairs venous return.

    Thoracic Trauma WSES-AAST Guidelines · reviewed 2026-08-26

  532. Card 532

    Question

    A patient has this pattern: Fever plus a new or changing murmur, embolic findings, injection-drug use, or prosthetic material raises suspicion. What is the most likely diagnosis?

    Answer

    Infective endocarditis. Fever plus a new or changing murmur, embolic findings, injection-drug use, or prosthetic material raises suspicion.

    2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

  536. Card 536

    Question

    Which prevention or risk-reduction step is important for community-acquired pneumonia?

    Answer

    Keep age- and risk-appropriate pneumococcal vaccination current to reduce preventable pneumococcal pneumonia.

    Pneumococcal Vaccine Recommendations · reviewed 2026-08-26

  538. Card 538

    Question

    Which prevention or risk-reduction step is important for ectopic pregnancy?

    Answer

    Early testing after a missed period and prompt evaluation of pain or bleeding reduce rupture morbidity.

    Ectopic Pregnancy · reviewed 2026-08-26

  542. Card 542

    Question

    In a child or adolescent, what drug class or regimen fits diabetic ketoacidosis?

    Answer

    Use continuous IV regular insulin; add dextrose as glucose falls so ketone clearance can continue.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  543. Card 543

    Question

    What is the key first diagnostic step for peritonsillar abscess?

    Answer

    Diagnosis is usually clinical; ultrasound or CT helps when the diagnosis or deep-space extension is uncertain.

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  544. Card 544

    Question

    What does continuity require before ending a clinician-patient relationship?

    Answer

    Give reasonable notice, provide urgent coverage during the transition, offer transfer resources, and make records available as permitted.

    Terminating a Patient-Physician Relationship · reviewed 2026-08-26

  545. Card 545

    Question

    What counseling point helps reduce harm from chronic hepatitis C?

    Answer

    Avoid blood exposure, do not share injection equipment, and screen all adults and each pregnancy as recommended.

    Viral Hepatitis Clinical Care · reviewed 2026-08-26

  547. Card 547

    Question

    In a child or adolescent, what counseling point helps reduce harm from juvenile idiopathic arthritis?

    Answer

    Vaccination, eye screening, activity, and growth monitoring reduce preventable morbidity.

    2026 Juvenile Idiopathic Arthritis Guidelines · reviewed 2026-08-26

  549. Card 549

    Question

    A clinician is considering subarachnoid hemorrhage. Which finding adds the most support?

    Answer

    A sudden maximal-at-onset thunderclap headache, neck stiffness, vomiting, or brief loss of consciousness is concerning.

    2023 Guideline for Aneurysmal Subarachnoid Hemorrhage · reviewed 2026-08-26

  551. Card 551

    Question

    In a child, typically 6 months to 3 years, what counseling point helps reduce harm from croup?

    Answer

    Caregivers should seek urgent assessment for stridor at rest, marked chest retractions, cyanosis, lethargy, or poor air entry.

    Acute Management of Croup in the Emergency Department · reviewed 2026-08-26

  552. Card 552

    Question

    In a child or adolescent, a clinician is considering bacterial meningitis. Which finding adds the most support?

    Answer

    Fever, headache, neck stiffness, altered mental status, or a nonblanching rash should trigger urgent evaluation.

    WHO Guidelines on Meningitis Diagnosis, Treatment and Care · reviewed 2026-08-26

  553. Card 553

    Question

    A clinician is considering preeclampsia with severe features. Which finding adds the most support?

    Answer

    New hypertension after 20 weeks with end-organ findings such as severe pressure, thrombocytopenia, liver injury, kidney injury, pulmonary edema, or neurologic symptoms suggests severe disease.

    Gestational Hypertension and Preeclampsia · reviewed 2026-08-26

  554. Card 554

    Question

    A clinician is considering bipolar I mania. Which finding adds the most support?

    Answer

    At least one week of elevated or irritable mood with increased energy, decreased sleep, pressured speech, grandiosity, and risky behavior suggests mania.

    Management of Bipolar Disorder in Adults · reviewed 2026-08-26

  558. Card 558

    Question

    Which bedside pattern best points to retinal detachment?

    Answer

    New flashes, floaters, and a curtain or shadow across the visual field suggest detachment.

    Retinal Detachment · reviewed 2026-08-26

  559. Card 559

    Question

    How should a clinician respond when requested to falsify a work note or record?

    Answer

    Decline, document objective facts accurately, explain what can truthfully be certified, and preserve the integrity of the record.

    Management of Medical Records · reviewed 2026-08-26

  560. Card 560

    Question

    How can a clinician reduce avoidable harm related to hypertensive emergency?

    Answer

    Accurate home monitoring and sustained treatment adherence reduce progression to crisis.

    2025 High Blood Pressure Guideline · reviewed 2026-08-26

  561. Card 561

    Question

    What clinical clue should raise suspicion for COPD?

    Answer

    Progressive exertional dyspnea, chronic cough or sputum, and exposure to tobacco, biomass, or occupational irritants suggest COPD.

    2026 GOLD Report and Pocket Guide · reviewed 2026-08-26

  562. Card 562

    Question

    Which pharmacologic approach is preferred for acute pyelonephritis?

    Answer

    Select empiric therapy from local resistance and severity, then narrow to the culture.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  563. Card 563

    Question

    Which history or examination finding most strongly supports plaque psoriasis?

    Answer

    Well-demarcated erythematous plaques with silvery scale on extensor surfaces and nail pitting support psoriasis.

    Psoriasis Clinical Guidelines · reviewed 2026-08-26

  564. Card 564

    Question

    What immediate plan is appropriate for Parkinson disease?

    Answer

    Start multidisciplinary care and choose symptomatic treatment by functional impact, age, cognition, and adverse-effect risk.

    Parkinson’s Disease in Adults · reviewed 2026-08-26

  565. Card 565

    Question

    Which diagnosis best fits hypotonic euvolemic hyponatremia with inappropriately concentrated urine after thyroid, adrenal, renal, and diuretic causes are excluded?

    Answer

    Hyponatremia due to SIADH. Nausea, confusion, gait change, seizure, or subtle cognitive symptoms with hypotonic euvolemic hyponatremia may reflect SIADH.

    Clinical Practice Guideline on Diagnosis and Treatment of Hyponatraemia · reviewed 2026-08-26

  566. Card 566

    Question

    What immediate plan is appropriate for gonococcal urethritis or cervicitis?

    Answer

    Treat promptly, test for other STIs, abstain until treatment criteria are met, and arrange partner services.

    Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

  568. Card 568

    Question

    What immediate plan is appropriate for menopause vasomotor symptoms?

    Answer

    Match treatment to symptom burden, uterus status, contraindications, and patient preference.

    Hormone Therapy for Menopause · reviewed 2026-08-26

  574. Card 574

    Question

    In a child or adolescent, which bedside pattern best points to diabetic ketoacidosis?

    Answer

    Hyperglycemia with dehydration, abdominal pain, vomiting, Kussmaul respirations, or altered mental status suggests ketoacidosis.

    Standards of Care in Diabetes—2026 · reviewed 2026-08-26

  575. Card 575

    Question

    For surgical decision-making, how should a clinician initially manage peritonsillar abscess?

    Answer

    Assess the airway, drain the abscess, hydrate, and treat infection.

    Tonsillitis and Peritonsillar Abscess · reviewed 2026-08-26

  576. Card 576

    Question

    Which factors determine a PA’s scope of practice?

    Answer

    A PA’s education and experience, state law, practice-setting policy and credentialing, and the care team’s arrangements together define the services the PA may provide.

    PA Scope of Practice · reviewed 2026-08-26

  581. Card 581

    Question

    Which diagnosis is defined by acute hypoxemic respiratory failure with bilateral opacities not fully explained by cardiac failure after a known insult?

    Answer

    Acute respiratory distress syndrome. Acute hypoxemic respiratory failure with bilateral opacities not fully explained by cardiac failure after a known insult suggests ARDS.

    An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome · reviewed 2026-08-26

  582. Card 582

    Question

    What medication strategy is appropriate for ectopic pregnancy?

    Answer

    Methotrexate is an option for selected stable unruptured ectopic pregnancy without contraindications.

    Ectopic Pregnancy · reviewed 2026-08-26

  584. Card 584

    Question

    In a child or adolescent, identify the condition from this pattern: Chronic pruritic eczematous patches with age-dependent flexural or facial distribution and a relapsing course are typical.

    Answer

    Atopic dermatitis. Chronic pruritic eczematous patches with age-dependent flexural or facial distribution and a relapsing course are typical.

    Atopic Dermatitis Clinical Guidelines · reviewed 2026-08-26

  585. Card 585

    Question

    Which pharmacologic approach is preferred for a postmenopausal woman with osteoporosis at high fracture risk?

    Answer

    Bisphosphonates are first-line for many postmenopausal women at high fracture risk; consider anabolic therapy for very high risk.

    Pharmacological Management of Osteoporosis in Postmenopausal Women · reviewed 2026-08-26

  587. Card 587

    Question

    Which diagnosis best fits dysuria and frequency without vaginal symptoms in an otherwise appropriate patient?

    Answer

    Uncomplicated cystitis. Dysuria and frequency without vaginal symptoms strongly support lower urinary infection in an appropriate patient.

    EAU Guidelines on Urological Infections · reviewed 2026-08-26

  589. Card 589

    Question

    What condition should be suspected from this finding: A single fever in a patient with severe chemotherapy-related neutropenia is an emergency even when examination is unrevealing.

    Answer

    Neutropenic fever. A single fever in a patient with severe chemotherapy-related neutropenia is an emergency even when examination is unrevealing.

    Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy · reviewed 2026-08-26

  590. Card 590

    Question

    What is the purpose of root cause analysis after a serious patient-safety event?

    Answer

    Identify active and latent system contributors, then design and track corrective actions that reduce recurrence rather than stopping at individual blame.

    Root Cause Analysis · reviewed 2026-08-26

  591. Card 591

    Question

    For surgical decision-making, a patient has this pattern: Often asymptomatic hypercalcemia, nephrolithiasis, bone loss, constipation, or neurocognitive symptoms can be the clue. What is the most likely diagnosis?

    Answer

    Primary hyperparathyroidism. Often asymptomatic hypercalcemia, nephrolithiasis, bone loss, constipation, or neurocognitive symptoms can be the clue.

    Evaluation and Management of Primary Hyperparathyroidism: Fifth International Workshop Guidelines · reviewed 2026-08-26

  593. Card 593

    Question

    A patient has this pattern: A rapid unilateral hearing decrease, often noticed on waking and sometimes with tinnitus, is an otologic emergency. What is the most likely diagnosis?

    Answer

    Sudden sensorineural hearing loss. A rapid unilateral hearing decrease, often noticed on waking and sometimes with tinnitus, is an otologic emergency.

    Clinical Practice Guideline: Sudden Hearing Loss (Update) · reviewed 2026-08-26

  594. Card 594

    Question

    Which diagnosis requires bradykinesia plus rest tremor or rigidity and often includes reduced arm swing or a shuffling gait?

    Answer

    Parkinson disease. Bradykinesia plus rest tremor or rigidity, with reduced arm swing and shuffling gait, supports parkinsonism.

    Parkinson’s Disease in Adults · reviewed 2026-08-26

  595. Card 595

    Question

    Which diagnosis best fits purulent urethral discharge, dysuria, cervicitis, pelvic pain, or a relevant sexual exposure, although infection may be asymptomatic?

    Answer

    Gonococcal urethritis or cervicitis. Purulent urethral discharge, dysuria, cervicitis, pelvic pain, or exposure may indicate gonorrhea, but infection can be asymptomatic.

    Gonococcal Infections Among Adolescents and Adults · reviewed 2026-08-26

  596. Card 596

    Question

    Which diagnosis best fits hot flashes, night sweats, sleep disruption, and menstrual transition at the expected age?

    Answer

    Menopause vasomotor symptoms. Hot flashes, night sweats, sleep disruption, and menstrual transition at the expected age usually identify menopausal vasomotor symptoms.

    The Menopause Years · reviewed 2026-08-26

  597. Card 597

    Question

    Which diagnosis causes tremor, autonomic hyperactivity, insomnia, nausea, anxiety, hallucinations, or seizures after reducing heavy alcohol use?

    Answer

    Alcohol withdrawal. Tremor, autonomic hyperactivity, insomnia, nausea, anxiety, hallucinations, or seizures after reducing heavy alcohol use suggests withdrawal.

    The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management · reviewed 2026-08-26

  598. Card 598

    Question

    Which diagnosis causes bloody diarrhea, urgency, tenesmus, and crampy abdominal pain with continuous colonic inflammation?

    Answer

    Ulcerative colitis. Bloody diarrhea, urgency, tenesmus, and crampy abdominal pain with continuous colonic inflammation suggest ulcerative colitis.

    Updated 2025 ACG Guidelines to Manage Adult Ulcerative Colitis Patients · reviewed 2026-08-26

  599. Card 599

    Question

    Which diagnosis best fits abrupt severe monoarthritis with erythema, often at the first metatarsophalangeal joint?

    Answer

    Gout flare. Abrupt severe monoarthritis with erythema, often at the first metatarsophalangeal joint, suggests gout.

    Gout · reviewed 2026-08-26

  600. Card 600

    Question

    For surgical decision-making, which diagnosis best fits this presentation: Exertional dyspnea, angina, or syncope with a harsh crescendo-decrescendo systolic murmur radiating to the carotids is typical.

    Answer

    Symptomatic aortic stenosis. Exertional dyspnea, angina, or syncope with a harsh crescendo-decrescendo systolic murmur radiating to the carotids is typical.

    2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease · reviewed 2026-08-26

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PANCE Flashcards: Blueprint-Aligned Diagnoses, Tests & Next Steps

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