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PANCE — Cardiology and Pulmonology flashcards

10 of 74 cards free to study here · 2 topics · the whole deck is built into Willys

Board-style vignettes on ACS and ECG localization, heart failure, murmurs, arrhythmias, pericardial disease, endocarditis, hypertension and lipids, plus asthma, COPD, pneumonia, PE, TB, sarcoidosis, lung cancer and pleural disease.

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Learn deck · part of PANCE (Physician Assistant boards) · written against: NCCPA PANCE content blueprint, effective January 2025 (organ systems); no dosing. Updated 2026-10-10.

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  1. A 62-year-old with crushing chest pain has ST elevation in leads II, III and aVF. Which coronary artery is most likely occluded?
    The right coronary artery in most people, because most hearts are right-dominant and leads II, III and aVF face the inferior wall.

    Watch out: in a left-dominant circulation the left circumflex supplies the inferior wall instead.
    Cardiovascular › Coronary Disease and ECG
  2. A patient with an inferior STEMI becomes hypotensive after sublingual nitroglycerin. Lungs are clear and the neck veins are distended. What complication explains this, and how do you confirm it?
    Right ventricular infarction: the RV depends on preload, so a venodilator drops cardiac output. Confirm with right-sided leads (ST elevation in V4R), support pressure with IV fluids, and avoid nitrates and diuretics.
    Cardiovascular › Coronary Disease and ECG
  3. ST elevation confined to V1 through V4 points to occlusion of which artery?
    The left anterior descending (LAD) artery, which supplies the septum (V1–V2) and anterior wall (V3–V4).
    Cardiovascular › Coronary Disease and ECG
  4. A patient with chest pain has horizontal ST depression in V1–V3 with tall, broad R waves in those leads. What should you suspect, and how do you confirm it?
    A posterior wall MI: the anterior leads show the mirror image of posterior ST elevation. Confirm with posterior leads V7–V9, and manage it as a STEMI equivalent.
    Cardiovascular › Coronary Disease and ECG
  5. A patient had an MI 4 days ago and now has new chest pain, but troponin is still elevated from the first event. How is reinfarction detected?
    A further troponin rise of more than 20% on serial samples, together with new ischemic symptoms or ECG changes.

    Watch out: older teaching used CK-MB because it normalizes within 2–3 days, but the fourth universal definition of MI (2018) relies on troponin for reinfarction too.
    Cardiovascular › Coronary Disease and ECG
  6. How do pulmonary function tests separate asthma from COPD?
    Both reduce the FEV1/FVC ratio. In asthma the obstruction is largely reversible after a bronchodilator; in COPD a post-bronchodilator FEV1/FVC below 0.70 persists.
    Pulmonary › Obstructive Disease
  7. Which pulmonary function finding separates emphysema from chronic bronchitis or asthma?
    A reduced DLCO (diffusing capacity), because emphysema destroys the alveolar–capillary surface. DLCO is normal in chronic bronchitis and normal or high in asthma.
    Pulmonary › Obstructive Disease
  8. Besides smoking cessation, which treatment is classically shown to prolong survival in COPD with chronic resting hypoxemia?
    Long-term supplemental oxygen, used for most hours of the day, in patients with severe chronic resting hypoxemia. It is the classic survival benefit alongside quitting smoking; bronchodilators are given mainly for symptoms and exacerbations.
    Pulmonary › Obstructive Disease
  9. A 38-year-old nonsmoker has emphysema concentrated in the lower lobes and abnormal liver enzymes. What is the likely diagnosis?
    Alpha-1 antitrypsin deficiency, which causes panacinar, basilar emphysema plus liver disease from misfolded protein trapped in hepatocytes. Smoking-related emphysema is centriacinar and upper-lobe.
    Pulmonary › Obstructive Disease
  10. Which therapies are standard for an acute COPD exacerbation?
    Short-acting bronchodilators, a short course of systemic corticosteroids, and antibiotics when sputum becomes purulent. Noninvasive positive-pressure ventilation is used for hypercapnic respiratory acidosis.
    Pulmonary › Obstructive Disease

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About these cards

Review status: Second-reader reviewed, with corrections applied.

Checked against:

  • NCCPA PANCE content blueprint, effective January 2025 (topic outline only; no text copied)
  • Checked against standard internal-medicine references (reference only; no text copied)
  • Checked against the 2025 AHA/ACC high blood pressure guideline, the 2026 ACC/AHA dyslipidemia guideline, the 2023 ACC/AHA/ACCP/HRS atrial fibrillation guideline, the 2022 AHA/ACC/HFSA heart failure guideline, the 2024 AHA/ACC hypertrophic cardiomyopathy guideline, the 2025 ESC myocarditis and pericarditis guideline, the Fourth Universal Definition of Myocardial Infarction (2018), GINA 2026 and USPSTF recommendations (abdominal aortic aneurysm 2019, lung cancer 2021) (reference only; no text copied)
  • Checked against the 2023 BTS guideline for pleural disease, the NCI PDQ small cell lung cancer treatment summary (health professional version, 2025) and FDA prescribing information for durvalumab and atezolizumab on DailyMed (US National Library of Medicine; public domain) (reference only; no text copied)

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