PANCE — GI, Renal and Endocrine flashcards
10 of 73 cards free to study here · 3 topics · the whole deck is built into Willys
Board-style vignettes on diabetes, thyroid, parathyroid, adrenal and pituitary disease; esophagus, stomach, liver, biliary tree, pancreas and bowel; and AKI, CKD, glomerular disease, electrolytes, acid-base and stones.
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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An asymptomatic adult has an A1c of 6.8% on routine labs. Is diabetes diagnosed?Not yet: without unequivocal hyperglycemia or classic symptoms, the result must be confirmed by a second abnormal test (repeat A1c or a fasting or 2-hour glucose). Diagnostic thresholds are A1c 6.5% or more, fasting glucose 126 mg/dL or more, or 2-hour OGTT glucose 200 mg/dL or more.Endocrine › Diabetes
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A patient with type 2 diabetes has heart failure with reduced ejection fraction. Which drug class is recommended for cardiorenal protection regardless of A1c?An SGLT2 inhibitor (such as empagliflozin or dapagliflozin), which lowers heart-failure hospitalization and slows CKD progression. GLP-1 receptor agonists with proven benefit are the counterpart choice for established atherosclerotic disease.Endocrine › Diabetes
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How does metformin lower glucose, and what is its most serious adverse effect?It decreases hepatic gluconeogenesis and improves insulin sensitivity, without causing hypoglycemia on its own. Its rare but serious adverse effect is lactic acidosis, which is why it is avoided in severe renal impairment (eGFR below 30).Endocrine › Diabetes
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Which diabetes drug class carries a boxed warning about thyroid C-cell tumors, and who should not receive it?GLP-1 receptor agonists (such as semaglutide and liraglutide). Those that carry the warning are contraindicated with a personal or family history of medullary thyroid carcinoma or MEN 2.Endocrine › Diabetes
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A patient has dysphagia to both solids and liquids from the start, regurgitation of undigested food, and a bird's-beak barium swallow. What is the most accurate test?Esophageal manometry, which shows incomplete lower esophageal sphincter relaxation and absent peristalsis in achalasia. Endoscopy is still done to exclude a tumor mimicking it (pseudoachalasia).Gastrointestinal › Esophagus and Stomach
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An older patient's dysphagia has progressed from solids to liquids over months with weight loss. What is the likely diagnosis and best test?Esophageal cancer, diagnosed by upper endoscopy with biopsy. Squamous cell carcinoma links to smoking and alcohol in the mid esophagus; adenocarcinoma links to GERD and Barrett esophagus in the distal esophagus.Gastrointestinal › Esophagus and Stomach
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Biopsy in a patient with long-standing GERD shows intestinal metaplasia with goblet cells in the distal esophagus. What is the diagnosis, and why does it matter?Barrett esophagus, the precursor of esophageal adenocarcinoma. Patients need PPI therapy and surveillance endoscopy; dysplasia is treated with endoscopic eradication.Gastrointestinal › Esophagus and Stomach
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A dehydrated patient has a creatinine rise, a BUN-to-creatinine ratio above 20 and a fractional excretion of sodium of 0.4%. What type of AKI is this?Prerenal AKI: the tubules are intact and avidly reabsorb sodium, so the FENa is below 1%.Renal › Kidney Injury and CKD
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A hypotensive ICU patient develops AKI with muddy brown granular casts and a FENa above 2%. What is the diagnosis?Acute tubular necrosis, from ischemia or toxins such as aminoglycosides, IV contrast or myoglobin. Damaged tubules can no longer reabsorb sodium.Renal › Kidney Injury and CKD
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A week after starting a new antibiotic, a patient has fever, rash, rising creatinine and white blood cell casts. What is the diagnosis and first step?Acute interstitial nephritis, a hypersensitivity reaction often to penicillins, cephalosporins, PPIs or NSAIDs; eosinophilia may be present. Stop the offending drug.Renal › Kidney Injury and CKD
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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 in Oct 2026 against the ADA Standards of Care in Diabetes 2026, the 2025 Endocrine Society primary aldosteronism guideline, American Thyroid Association thyroiditis guidance, the 2023 Pituitary Society prolactinoma consensus statement, the 2021 USPSTF colorectal cancer screening recommendation, the 2017 EASL primary biliary cholangitis and 2018 EASL decompensated cirrhosis guidelines, the 2021 ASCRS colonic volvulus guideline, the KDIGO 2021 glomerular diseases guideline, the 2014 European hyponatremia guideline, and FDA metformin, SGLT2 inhibitor and ursodiol labeling (reference only; no text copied)
- First-trimester antithyroid choice checked against the 2026 American Thyroid Association guidelines for thyroid disease in preconception, pregnancy and postpartum, the 2016 American Thyroid Association hyperthyroidism guidelines (recommendations 80 and 88) and the propylthiouracil and methimazole labels on DailyMed (reference only; no text copied).
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