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Left-sided heart failure presents with pulmonary congestion (dyspnea, orthopnea, paroxysmal nocturnal dyspnea). Chronic progression leads to right-sided HF (peripheral edema, ascites). PE causes acute dyspnea with clear lungs. COPD exacerbation causes wheezing and chronic cough. PANCE cardiology stresses CHF symptoms and left vs right failure distinction.

Hemophilia A is an X-linked deficiency of Factor VIII, presenting with hemarthroses, prolonged bleeding, and isolated prolonged aPTT. Hemophilia B (Factor IX deficiency) is similar but less common. Factor VII deficiency prolongs PT. Von Willebrand disease affects platelet adhesion, prolonging bleeding time ± aPTT, but not associated with hemarthroses. Recognizing lab patterns to distinguish coagulopathies is high-yield on the PANCE.

Antisocial personality disorder is diagnosed in adults ≥18 with persistent disregard for rights of others, impulsivity, and criminal behavior, often with conduct disorder before age 15. Conduct disorder is the child/adolescent form. Borderline PD features unstable relationships and self-harm. Narcissistic PD features grandiosity and need for admiration. PANCE psychiatry emphasizes personality disorder distinctions.

Positive pregnancy test + no intrauterine pregnancy on ultrasound + pelvic free fluid strongly suggest ruptured ectopic pregnancy. Appendicitis is common but unrelated to hCG. Ovarian torsion causes unilateral pain with adnexal mass, usually without positive hCG. PID causes pain, discharge, fever, but not positive pregnancy. Recognizing ectopic pregnancy and using diagnostic testing appropriately is high-yield on the PANCE.

In atrial fibrillation with hemodynamic instability (hypotension, altered mental status, chest pain, shock), the immediate step is synchronized cardioversion. IV digoxin and diltiazem are rate-control agents used in stable patients. Anticoagulation is important for long-term stroke prevention but is not the priority in acute instability. Rapid recognition of unstable arrhythmias and appropriate use of cardioversion versus medications is a high-yield cardiovascular emergency topic tested on the PANCE.