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Central retinal vein occlusion (CRVO) presents with sudden painless vision loss and “blood and thunder” retinal hemorrhages. CRAO shows cherry-red spot. Retinal detachment shows flashes/floaters and curtain-like vision loss. Macular degeneration is chronic central vision loss. PANCE ophthalmology stresses fundoscopy findings for vascular occlusions.

Addison’s disease (primary adrenal insufficiency) causes cortisol deficiency and high ACTH, leading to hyperpigmentation. Hyponatremia and hyperkalemia are common due to aldosterone deficiency. Secondary adrenal insufficiency shows low ACTH and no hyperpigmentation. Cushing’s is cortisol excess. Hyperaldosteronism causes hypertension and hypokalemia, not low cortisol. Recognizing adrenal disorders is crucial on PANCE.

The most likely rhythm is paroxysmal supraventricular tachycardia (PSVT). After vagal maneuvers, the drug of choice is adenosine, which transiently blocks AV nodal conduction. Beta-blockers and calcium channel blockers may be used if adenosine is contraindicated. Electrical cardioversion is reserved for unstable patients. PANCE emphasizes acute arrhythmia recognition and stepwise treatment.

ST elevation in inferior leads (II, III, aVF) indicates RCA occlusion. LAD supplies anterior wall (V1–V4). Circumflex supplies lateral wall (I, aVL, V5–V6). Left main causes widespread changes. PANCE cardiology emphasizes ECG localization of MI.

This is iron deficiency anemia: microcytic anemia with low ferritin, high TIBC. The next step is oral iron supplementation (ferrous sulfate) with investigation for bleeding, especially GI sources in adults. IV iron is for intolerance or malabsorption. Bone marrow biopsy is rarely required. Transfusion is reserved for severe, symptomatic anemia or hemodynamic instability. PANCE focuses on correct interpretation of CBC/iron studies and stepwise management.