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Left-sided heart failure produces pulmonary congestion and elevated left ventricular filling pressures. Classic signs include an S3 gallop (ventricular filling sound), pulmonary rales, and displaced PMI from cardiomegaly. Right-sided heart failure signs (JVD, hepatomegaly, edema, ascites) occur with progression or cor pulmonale. The exam skill lies in correlating auscultatory findings (S3 gallop strongly predictive of systolic dysfunction) with patient presentation. The PANCE emphasizes accurate physical exam interpretation and distinguishing left vs right heart failure manifestations.

Cushing’s syndrome is due to excess cortisol, presenting with obesity, moon facies, buffalo hump, striae, and weakness. Failure to suppress cortisol with dexamethasone confirms hypercortisolism. Addison’s is adrenal insufficiency (low cortisol). Acromegaly is GH excess. Hyperaldosteronism causes hypertension with hypokalemia. PANCE endocrine emphasizes dexamethasone suppression test interpretation.

Chronic myeloid leukemia (CML) is associated with the Philadelphia chromosome (BCR-ABL fusion, t(9;22)). It presents with leukocytosis, splenomegaly, and systemic symptoms. AML shows blasts and Auer rods. CLL presents in elderly with lymphocytosis. ALL is common in children. PANCE hematology stresses cytogenetic associations.

Sickle cell disease presents with vaso-occlusive pain crises, normocytic hemolytic anemia, target cells, and Howell-Jolly bodies (autosplenectomy). Thalassemia shows microcytic anemia with target cells. Iron deficiency shows microcytosis with low ferritin. Autoimmune hemolysis shows positive Coombs test. Identifying sickle cell complications and peripheral smear findings is high yield on PANCE.

Primary hypothyroidism shows high TSH and low free T4, most commonly due to Hashimoto’s thyroiditis. Secondary hypothyroidism (pituitary) shows low TSH and low T4. Hyperthyroidism shows low TSH, high T4. Subclinical hypothyroidism has high TSH but normal T4. PANCE endocrine emphasizes interpreting thyroid function tests.