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Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Presents with pancytopenia (infections, bleeding, anemia) and blasts in marrow. AML is more common in adults and shows Auer rods. CML shows leukocytosis with Philadelphia chromosome. Aplastic anemia has hypocellular marrow without blasts. PANCE hematology stresses pediatric malignancy presentations.

Barrett’s esophagus is intestinal metaplasia of the esophageal squamous epithelium to columnar epithelium due to chronic GERD. It is a premalignant condition for esophageal adenocarcinoma. Strictures are complications of GERD but without metaplasia. Schatzki rings cause intermittent dysphagia. PANCE highlights recognizing Barrett’s and need for surveillance endoscopy.

This is classic primary hyperparathyroidism, presenting with hypercalcemia, low phosphate, and elevated PTH. Secondary hyperparathyroidism occurs in CKD with high phosphate. Vitamin D toxicity increases calcium but PTH is low. Malignancy-related hypercalcemia typically suppresses PTH. PANCE emphasizes interpreting calcium-PTH relationships.

A young woman with microcytic anemia, normal colonoscopy, and low ferritin raises suspicion for thalassemia trait. Hemoglobin electrophoresis is the confirmatory test. Oral iron is used in iron deficiency, not thalassemia. Bone marrow biopsy is not required. Folate treats macrocytosis. PANCE emphasizes distinguishing iron deficiency anemia from thalassemia.

Octreotide (a somatostatin analog) is first-line pharmacologic therapy for acute variceal bleeding, as it decreases portal venous pressure. Nonselective beta-blockers like propranolol are used for secondary prevention, not acute bleeds. PPIs and sucralfate treat ulcers, not varices. PANCE tests acute GI bleed management and appropriate drug choices.