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A pituitary prolactinoma (microadenoma <10 mm) causing hyperprolactinemia results in amenorrhea, galactorrhea, and infertility due to suppression of GnRH and gonadotropins. First-line therapy is a dopamine agonist (cabergoline preferred, bromocriptine alternative) which normalizes prolactin, reduces tumor size, and restores menses/fertility. Surgery is reserved for macroadenomas with visual field compromise or refractory cases. OCPs can provide cycle control but do not address the underlying tumor. Radiation is rarely used. This aligns with endocrine/reproductive diagnostics and pharmacologic therapeutics in PANCE content.

For suspected acute cholangitis or biliary obstruction, the best initial test is RUQ ultrasound to evaluate gallstones and biliary dilation. CT may be used if US is inconclusive. X-ray has low sensitivity. Endoscopy (ERCP) is therapeutic after diagnosis. PANCE testing focuses on diagnostic pathways for biliary disease.

Generalized anxiety disorder (GAD) is defined as excessive, uncontrollable worry occurring most days for ≥6 months with ≥3 associated symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance). Panic disorder involves recurrent panic attacks with fear of recurrence. Major depression involves pervasive low mood and anhedonia. Acute stress disorder occurs within 1 month of trauma. Treatment includes CBT and SSRIs/SNRIs. Understanding DSM-5 diagnostic criteria and management is critical for PANCE psychiatry.

Prescribing for friends or family without a proper exam violates medical ethics and legal standards. The PA should decline and refer for appropriate evaluation. Prescribing casually risks harm, dependency, and liability. Providing OTC advice is permissible but does not replace medical care. PANCE professional practice emphasizes safe prescribing and professional boundaries.

Orbital blowout fracture of the maxillary bone traps the inferior rectus muscle, causing diplopia with upward gaze and enophthalmos. Retinal detachment causes flashes/floaters. Hyphema is blood in anterior chamber. Corneal abrasion causes severe pain and fluorescein uptake. PANCE ENT emphasizes trauma-related orbital emergencies.