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Asthma is characterized by reversible airway obstruction demonstrated by ≥12% improvement in FEV₁ after bronchodilator. COPD is irreversible. Bronchiectasis causes chronic purulent sputum and bronchial dilation. Chronic bronchitis is COPD subtype with chronic cough. PANCE requires spirometry interpretation for obstructive diseases.

Classic presentation of pulmonary tuberculosis (TB): fever, night sweats, weight loss, hemoptysis, and cavitary lesions in the upper lobes on imaging. Sarcoidosis presents with bilateral hilar adenopathy and noncaseating granulomas. Lung cancer causes chronic cough, weight loss, hemoptysis but lacks cavitary apical predilection. Histoplasmosis occurs in endemic areas, may mimic TB, but typically includes exposure history (bird/bat droppings). PANCE emphasizes recognition of TB’s clinical/radiographic features and public health implications.

In upper GI bleeds, breakdown of hemoglobin produces urea, increasing BUN disproportionate to creatinine. This finding helps distinguish upper vs lower GI bleed. Hemolysis does not raise BUN. Prerenal azotemia elevates BUN but would not be linked to melena. Renal failure elevates both BUN and creatinine. PANCE highlights subtle lab interpretations in GI bleeding.

Panic disorder requires recurrent unexpected panic attacks plus ≥1 month of persistent concern or behavior change. Attacks peak within 10 minutes and include palpitations, sweating, fear of dying. GAD involves chronic, nonspecific worry. Social anxiety involves fear of scrutiny. PTSD follows trauma with flashbacks and hyperarousal. PANCE psychiatry highlights panic disorder diagnostic criteria.

For minors, the physician/PA must prioritize best interest of the child. If parents refuse life-saving care, providers should obtain a court order and provide transfusion. Parental refusal does not override child welfare. PANCE professional practice emphasizes child protection and limits of parental authority.