Physician Assistant National Certifying Examination (PANCE) Dermatology, EENT, and Hematology-Oncology Syllabus

Dermatology, EENT, and Hematology-Oncology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Dermatology, EENT, and Hematology-Oncology in Physician Assistant National Certifying Examination (PANCE), not a summary of it.

1. 1

   Dermatologic Disorders

   5 topics

   • Eczematous and papulosquamous disorders
     • Atopic dermatitis, psoriasis, lichen planus
   • Bacterial, viral, and fungal skin infections
   • Acne, rosacea, and folliculitis
   • Skin cancer
     • Melanoma, basal cell, squamous cell carcinoma
   • Bullous and hypersensitivity dermatoses
2. 2

   Eye Disorders

   5 topics

   • Conjunctivitis and red eye differential
   • Glaucoma
     • Acute angle-closure versus open-angle
   • Cataract and macular degeneration
   • Retinal detachment and ocular trauma
   • Orbital and periorbital cellulitis
3. 3

   Ear, Nose, and Throat Disorders

   5 topics

   • Otitis media and otitis externa
   • Hearing loss and vertigo
   • Rhinitis and sinusitis
   • Pharyngitis and peritonsillar abscess
   • Epistaxis and oral lesions
4. 4

   Hematologic Disorders

   4 topics

   • Anemias
     • Iron deficiency, B12/folate, hemolytic, aplastic
   • Hemoglobinopathies
     • Sickle cell disease and thalassemia
   • Coagulation and bleeding disorders
     • Hemophilia, von Willebrand, DIC, thrombocytopenia
   • Hypercoagulable states
5. 5

   Oncology and Immunologic Disorders

   5 topics

   • Leukemias
     • Acute versus chronic, lymphoid versus myeloid
   • Lymphomas
     • Hodgkin versus non-Hodgkin
   • Plasma cell disorders and multiple myeloma
   • Oncologic emergencies
   • Immunodeficiency and hypersensitivity reactions

Dermatology, EENT, and Hematology-Oncology flashcards for Physician Assistant National Certifying Examination (PANCE)

20 of 51 cards from the Dermatology, EENT, and Hematology-Oncology deck — real questions with worked answers.

1. What is the classic presentation and most common location of atopic dermatitis (eczema) in adults versus infants?

   Atopic dermatitis presents as pruritic, erythematous, scaly patches. In infants it favors the face, scalp, and extensor surfaces; in adults/children it favors flexural areas (antecubital and popliteal fossae). It is part of the atopic triad with asthma and allergic rhinitis.

2. What distinguishes the plaques of psoriasis, and what are the Auspitz sign and Koebner phenomenon?

   Psoriasis shows well-demarcated erythematous plaques with silvery scale on extensor surfaces, scalp, and nails (pitting). Auspitz sign = pinpoint bleeding when scale is removed. Koebner phenomenon = new lesions forming at sites of trauma.

3. What is the characteristic morphology and course of pityriasis rosea?

   Begins with a single 'herald patch' (salmon-colored, scaly), followed days later by a 'Christmas tree' distribution of oval scaly lesions along skin cleavage lines on the trunk. Self-limited, resolves in 6-8 weeks. Consider checking RPR to rule out secondary syphilis.

4. What organism causes impetigo, and how do non-bullous and bullous forms differ?

   Caused by Staphylococcus aureus (and Streptococcus pyogenes). Non-bullous (most common) shows honey-colored crusts. Bullous impetigo (S. aureus exfoliative toxin) shows flaccid bullae. Treat with topical mupirocin or oral antibiotics if extensive.

5. What is erysipelas and how does it differ clinically from cellulitis?

   Erysipelas is a superficial dermal/lymphatic infection, usually from group A Streptococcus, presenting as a raised, sharply demarcated, bright-red plaque (often on the face/legs). Cellulitis is deeper (dermis/subcutaneous fat) with poorly defined borders.

6. How does herpes zoster (shingles) present, and what is the antiviral treatment window?

   Reactivation of varicella-zoster virus causing a painful vesicular rash in a unilateral dermatomal distribution that does not cross midline. Start antivirals (acyclovir, valacyclovir, famciclovir) within 72 hours of rash onset to reduce postherpetic neuralgia.

7. What is the significance of Hutchinson sign in herpes zoster?

   Vesicles on the tip/side of the nose (nasociliary branch of CN V1) signal herpes zoster ophthalmicus and risk of ocular involvement. Requires urgent ophthalmology referral and systemic antivirals.

8. How are tinea infections diagnosed and what is the first-line treatment for tinea corporis?

   Dermatophyte infections diagnosed by KOH prep showing branching septate hyphae. Tinea corporis presents as an annular, scaly plaque with central clearing. First-line is a topical antifungal (e.g., terbinafine, clotrimazole). Tinea capitis requires oral antifungals (griseofulvin/terbinafine).

9. What KOH finding characterizes tinea versicolor, and what organism causes it?

   Caused by Malassezia (Pityrosporum). KOH shows a 'spaghetti and meatballs' appearance (hyphae and spores). Presents as hypo- or hyperpigmented macules on the trunk. Treat with topical selenium sulfide or topical/oral azoles.

10. Describe the grading/types of acne vulgaris and the stepwise treatment approach.

    Comedonal (open/closed comedones), inflammatory (papules/pustules), and nodulocystic. Treatment: topical retinoids ± benzoyl peroxide for mild; add topical/oral antibiotics for moderate; oral isotretinoin for severe nodulocystic or refractory disease.

11. What monitoring is required for patients on oral isotretinoin?

    Teratogenic—requires iPLEDGE enrollment with two forms of contraception and monthly pregnancy tests. Monitor lipids and LFTs. Side effects: dry skin/mucosa, mood changes, and possible elevation of triglycerides.

12. How does rosacea present, and what triggers and treatments are associated?

    Central facial erythema, telangiectasias, papules/pustules, and flushing; phymatous (rhinophyma) in advanced disease. NO comedones (distinguishes from acne). Triggers: heat, alcohol, spicy food, sun. Treat with topical metronidazole/azelaic acid, oral doxycycline, and trigger avoidance.

13. What is the difference between bacterial folliculitis and 'hot tub' folliculitis?

    Bacterial folliculitis is usually S. aureus, presenting as follicular pustules. 'Hot tub' folliculitis is caused by Pseudomonas aeruginosa after exposure to contaminated water; it is typically self-limited.

14. What is the most common skin cancer overall, and how does basal cell carcinoma classically appear?

    Basal cell carcinoma (BCC) is the most common skin cancer. Classic nodular BCC is a pearly, pink papule with rolled borders, central ulceration ('rodent ulcer'), and telangiectasias. Rarely metastasizes but is locally invasive.

15. How does squamous cell carcinoma present and what is its precursor lesion?

    SCC presents as a firm, scaly, ulcerated or crusted nodule/plaque on sun-exposed skin; can arise from actinic keratosis (precursor). It has higher metastatic potential than BCC, especially on the lip/ear.

16. What are the ABCDE criteria for melanoma?

    Asymmetry, Border irregularity, Color variegation, Diameter $> 6\,\text{mm}$, and Evolution (change over time). Any of these warrants biopsy. The most important prognostic factor is Breslow depth (tumor thickness).

17. What prognostic measurement determines melanoma staging and survival?

    Breslow depth (thickness in mm) is the single most important prognostic factor. Greater depth correlates with higher metastatic risk and worse survival. Sentinel lymph node biopsy is considered for lesions $\geq 0.8\,\text{mm}$.

18. What is pemphigus vulgaris, and which clinical sign is positive?

    An autoimmune blistering disease with IgG antibodies against desmoglein (desmosomes), causing flaccid intraepidermal bullae and painful oral erosions. Nikolsky sign is POSITIVE (skin sloughs with lateral pressure). Can be fatal without immunosuppression.

19. How does bullous pemphigoid differ from pemphigus vulgaris?

    Bullous pemphigoid is subepidermal with IgG antibodies against the hemidesmosome basement membrane (BP180/BP230), producing TENSE bullae in elderly patients, usually sparing mucosa. Nikolsky sign is NEGATIVE. Generally less severe than pemphigus.

20. What distinguishes Stevens-Johnson syndrome (SJS) from toxic epidermal necrolysis (TEN)?

    Both are hypersensitivity reactions (often drug-induced) with epidermal detachment and positive Nikolsky sign. SJS involves $< 10\%$ of body surface area; TEN involves $> 30\%$; SJS/TEN overlap is $10\text{-}30\%$. Stop offending drug; supportive ICU/burn care.

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