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Cholestasis from biliary obstruction (e.g., gallstones, pancreatic cancer) causes elevated conjugated bilirubin + alkaline phosphatase. Viral hepatitis elevates AST/ALT more. Hemolysis causes unconjugated hyperbilirubinemia. Gilbert’s causes mild unconjugated bilirubin, often after stress. PANCE requires lab interpretation of liver injury vs obstruction.

Plummer-Vinson syndrome is characterized by the triad: dysphagia, iron deficiency anemia, and esophageal webs. It carries an increased risk of squamous cell carcinoma of the esophagus. Zollinger-Ellison involves gastrinoma. Mallory-Weiss is mucosal tear after vomiting. Boerhaave is full-thickness rupture. PANCE requires identifying rare but high-yield syndromes.

Idiopathic pulmonary fibrosis (IPF) presents with progressive dyspnea, dry cough, and basilar crackles. Imaging shows honeycombing and reticular opacities. COPD causes obstructive changes. Sarcoidosis causes hilar lymphadenopathy and noncaseating granulomas. Asthma shows reversible obstruction. Recognition of interstitial lung disease imaging patterns is emphasized on PANCE.

Bronchiectasis is permanent dilation of bronchi due to recurrent infection/inflammation, often associated with cystic fibrosis. Patients present with chronic productive cough, purulent/foul sputum, and recurrent infections. Chronic bronchitis causes productive cough ≥3 months for 2 years but without bronchial dilation. Emphysema causes dyspnea and hyperinflation. Asthma involves reversible airway obstruction without chronic bronchial changes. Imaging findings make bronchiectasis diagnosis distinctive, a key PANCE pulmonary concept.

Corynebacterium diphtheriae can produce a toxin causing pharyngitis with tight adherent pseudomembranes, cervical adenopathy (“bull neck”), and systemic complications (myocarditis, neuropathy). Management requires prompt administration of diphtheria antitoxin (obtained through public health channels) to neutralize circulating toxin, plus antibiotics (erythromycin or penicillin) to eradicate bacteria and prevent transmission. Delay in antitoxin increases morbidity because it does not neutralize toxin already bound to tissues. Isolation and contact tracing are necessary, and patients should be up-to-date on Tdap boosters once recovered. Amoxicillin alone is inadequate; waiting for cultures risks progression. Supportive care is necessary but not sufficient. This aligns with ID recognition of vaccine-preventable diseases, urgent therapeutics, and public health measures emphasized in PANCE objectives.