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Hypertrophic cardiomyopathy (HCM) is an autosomal dominant condition with asymmetric septal hypertrophy, dynamic LV outflow obstruction, and sudden death risk. Murmur increases with Valsalva or standing (↓ preload). Aortic stenosis murmur does not change with preload. MVP causes mid-systolic click. Dilated cardiomyopathy causes S3 gallop but not dynamic murmurs. PANCE emphasizes identifying dangerous murmurs and family history red flags.

Cushing’s disease is due to a pituitary adenoma secreting ACTH, leading to excess cortisol. In Cushing’s disease, ACTH is elevated, and cortisol is not suppressed by low-dose dexamethasone but may be suppressed by high-dose. Adrenal adenomas cause low ACTH. Exogenous steroid use suppresses ACTH. Ectopic ACTH (e.g., small cell lung cancer) also elevates ACTH but does not suppress with high-dose dexamethasone. Understanding endocrine testing algorithms is high yield on PANCE.

Multiple sclerosis (MS) is a demyelinating disease of the CNS characterized by optic neuritis, weakness, sensory deficits, and MRI showing demyelinating plaques. GBS affects PNS with ascending weakness. Myasthenia gravis involves neuromuscular junction. ALS affects upper and lower motor neurons but spares sensation and optic nerves. Recognition of MS presentations and MRI findings is crucial on PANCE.

The classic “stones, bones, abdominal groans, psychic overtones” with high calcium, high PTH, low phosphate indicates primary hyperparathyroidism, usually from a parathyroid adenoma. Secondary hyperparathyroidism occurs in chronic kidney disease with low calcium and high phosphate. Malignancy-related hypercalcemia usually has suppressed PTH. Hypoparathyroidism causes hypocalcemia. Correct endocrine interpretation of calcium/PTH disorders is high yield on PANCE.

Pulmonary tuberculosis often presents with upper lobe cavitary lesions and acid-fast bacilli on sputum culture. Squamous carcinoma may cavitate but is not acid-fast. Aspergillomas colonize pre-existing cavities. Sarcoidosis causes bilateral hilar lymphadenopathy, not cavitary lesions. PANCE pulmonary objectives highlight TB recognition with imaging and labs.