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Major depressive disorder is diagnosed after ≥2 weeks of depressed mood or anhedonia plus associated symptoms (sleep, appetite, concentration, energy, guilt, suicidality). For moderate to severe depression in adults, first-line treatment includes SSRIs (e.g., sertraline, fluoxetine) or other antidepressants (SNRIs, bupropion, mirtazapine), sometimes combined with psychotherapy. CBT alone is effective for mild depression. ECT is reserved for severe depression with suicidality, psychotic features, or treatment resistance. Light therapy is indicated for seasonal affective disorder. PANCE emphasizes diagnostic reasoning and therapeutic planning in psychiatry, requiring recognition of treatment hierarchy and safe, evidence-based first-line choices.

Primary hyperaldosteronism (Conn’s syndrome) presents with hypertension, hypokalemia, metabolic alkalosis, high aldosterone, and low renin. Cushing’s causes cortisol excess. Pheochromocytoma presents with episodic HTN, headaches, and sweating. Renal artery stenosis increases renin levels. PANCE endocrine highlights interpretation of renin–aldosterone ratios.

The principle of nonmaleficence means “do no harm.” Prescribing antibiotics unnecessarily exposes patients to side effects, resistance, and C. difficile infection. Autonomy is about respecting patient choice but does not obligate harmful practice. Justice concerns fairness in distribution of resources. Fidelity relates to trust, but the harm principle predominates here. PANCE professional practice questions frequently test ethical reasoning in clinical scenarios.

Torsades de pointes is a form of polymorphic VT associated with prolonged QT interval (from drugs, electrolyte imbalance, or congenital syndromes). It may degenerate into VFib. VFib is chaotic with no P-QRS-T pattern. SVT is narrow-complex tachycardia. Atrial flutter shows sawtooth P waves. PANCE cardiology stresses arrhythmia recognition and drug causes of QT prolongation.

Immune thrombocytopenia (ITP) presents with isolated thrombocytopenia, normal Hb/WBC, and normal coagulation studies. Hemophilia A prolongs aPTT. vWD causes mucocutaneous bleeding with abnormal vWF and prolonged bleeding time. DIC presents with low platelets plus prolonged PT/aPTT and elevated D-dimer. Recognizing isolated thrombocytopenia as ITP is a key PANCE hematology skill.