Physician Assistant National Certifying Examination (PANCE) Infectious Disease, Professional Practice, and Clinical Skills Syllabus

Infectious Disease, Professional Practice, and Clinical Skills syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Infectious Disease, Professional Practice, and Clinical Skills in Physician Assistant National Certifying Examination (PANCE), not a summary of it.

1. 1

   Systemic and Multisystem Infections

   4 topics

   • Sepsis and septic shock
     • Sepsis recognition and early resuscitation bundles
   • HIV/AIDS
     • Diagnosis, antiretroviral therapy, opportunistic infections
   • Tick-borne and vector-borne illnesses
   • Fungal and parasitic infections
2. 2

   Antimicrobial Therapy and Stewardship

   4 topics

   • Antibiotic classes and spectra
   • Antiviral, antifungal, and antiparasitic agents
   • Antimicrobial resistance and stewardship
   • Vaccination and immunization schedules
3. 3

   Pharmacology and Therapeutics

   4 topics

   • Pharmacokinetics and pharmacodynamics
   • Drug interactions and adverse reactions
   • Toxicology and common overdoses
     • Acetaminophen, opioids, anticholinergics, antidotes
   • Pain management and controlled substance prescribing
4. 4

   Professional Practice and Patient Safety

   4 topics

   • Medical ethics and informed consent
   • Health maintenance and preventive screening
   • Evidence-based medicine and biostatistics
     • Sensitivity, specificity, predictive values
     • Study design and interpretation
   • Patient safety, quality improvement, and risk management
5. 5

   Emergency and Acute Care Skills

   5 topics

   • Basic and advanced cardiac life support
   • Shock recognition and management
   • Trauma assessment and primary survey
   • Environmental emergencies
     • Burns, hypothermia, heat illness, bites
   • Procedural skills and clinical interventions

Infectious Disease, Professional Practice, and Clinical Skills flashcards for Physician Assistant National Certifying Examination (PANCE)

20 of 51 cards from the Infectious Disease, Professional Practice, and Clinical Skills deck — real questions with worked answers.

1. What are the SOFA-based criteria (Sepsis-3 definition) for sepsis and septic shock?

   Sepsis = life-threatening organ dysfunction caused by a dysregulated host response to infection, identified clinically by an increase in SOFA score of $\geq 2$ points. Septic shock = sepsis with persistent hypotension requiring vasopressors to maintain MAP $\geq 65$ mmHg AND serum lactate $> 2$ mmol/L despite adequate fluid resuscitation.

2. What are the qSOFA criteria used to rapidly screen for poor outcomes in suspected sepsis?

   qSOFA ($\geq 2$ of 3 predicts higher mortality): respiratory rate $\geq 22$/min, altered mentation (GCS $< 15$), and systolic blood pressure $\leq 100$ mmHg.

3. In the Surviving Sepsis 1-hour bundle, what are the core early interventions?

   Measure lactate (remeasure if $> 2$), obtain blood cultures before antibiotics, give broad-spectrum antibiotics, begin rapid crystalloid $30\ \text{mL/kg}$ for hypotension or lactate $\geq 4$ mmol/L, and start vasopressors if hypotensive during/after fluids to keep MAP $\geq 65$ mmHg.

4. What is the first-line vasopressor in septic shock?

   Norepinephrine is first-line. Vasopressin or epinephrine may be added; dobutamine is added for persistent hypoperfusion with adequate filling (cardiac dysfunction).

5. What CD4 count defines AIDS, and what are the AIDS-defining opportunistic infections at key thresholds?

   AIDS = CD4 $< 200\ \text{cells}/\mu\text{L}$ (or an AIDS-defining illness). Prophylaxis thresholds: CD4 $< 200$ → Pneumocystis (PCP) prophylaxis with TMP-SMX; CD4 $< 100$ → add Toxoplasma prophylaxis (TMP-SMX); CD4 $< 50$ → Mycobacterium avium complex prophylaxis (azithromycin).

6. What is the recommended first-line ART regimen class backbone for treatment-naive HIV patients, and what is the treatment goal?

   An integrase strand transfer inhibitor (INSTI, e.g., bictegravir or dolutegravir) plus two NRTIs (e.g., tenofovir + emtricitabine). Goal is sustained virologic suppression: undetectable plasma HIV RNA (viral load $< 50$ copies/mL); U=U (undetectable = untransmittable).

7. What is the classic clinical presentation and treatment of Lyme disease?

   Caused by Borrelia burgdorferi via Ixodes (deer) tick. Early localized: erythema migrans ("bull's-eye" rash). Disseminated: facial nerve palsy, AV block/carditis, migratory arthritis. Treatment: doxycycline (first-line); amoxicillin or cefuroxime as alternatives; IV ceftriaxone for carditis/CNS disease.

8. Contrast the vectors and key features of Rocky Mountain spotted fever vs. ehrlichiosis vs. babesiosis.

   RMSF: Rickettsia rickettsii, Dermacentor tick, petechial rash spreading from wrists/ankles to trunk → treat doxycycline. Ehrlichiosis: Ehrlichia chaffeensis, Lone Star tick, morulae in monocytes → doxycycline. Babesiosis: Babesia microti, Ixodes tick, hemolytic anemia with intraerythrocytic "Maltese cross" → atovaquone + azithromycin.

9. What is the treatment of choice for malaria caused by chloroquine-resistant Plasmodium falciparum?

   Artemisinin-based combination therapy (ACT) for uncomplicated disease; IV artesunate for severe malaria. For P. vivax/ovale add primaquine (after checking G6PD) to eradicate hypnozoites and prevent relapse.

10. Name the first-line treatment for cryptococcal meningitis and how it differs from candidemia treatment.

    Cryptococcal meningitis: induction with liposomal amphotericin B + flucytosine, then fluconazole consolidation/maintenance. Candidemia: an echinocandin (e.g., caspofungin, micafungin) is first-line; step down to fluconazole if susceptible.

11. Match these antibiotic classes to their mechanism: beta-lactams, aminoglycosides, fluoroquinolones, macrolides, glycopeptides.

    Beta-lactams (penicillins, cephalosporins, carbapenems): inhibit cell wall synthesis (bind PBPs). Aminoglycosides: bind 30S, inhibit protein synthesis (bactericidal). Fluoroquinolones: inhibit DNA gyrase/topoisomerase IV. Macrolides: bind 50S, inhibit protein synthesis (bacteriostatic). Glycopeptides (vancomycin): inhibit cell wall by binding D-Ala-D-Ala.

12. Which antibiotics provide reliable anti-pseudomonal coverage?

    Piperacillin-tazobactam, cefepime, ceftazidime, carbapenems (except ertapenem), aztreonam, fluoroquinolones (ciprofloxacin, levofloxacin), aminoglycosides, and ceftolozane-tazobactam.

13. What are the first-line antibiotic options for MRSA?

    Vancomycin (IV) or linezolid for serious/invasive MRSA; daptomycin (not for pneumonia—inactivated by surfactant); ceftaroline. For mild skin/soft tissue MRSA: TMP-SMX, doxycycline, or clindamycin.

14. Which antibiotic classes are most associated with these toxicities: QT prolongation, nephrotoxicity/ototoxicity, tendon rupture, and red man syndrome?

    QT prolongation: macrolides and fluoroquinolones. Nephrotoxicity/ototoxicity: aminoglycosides (and vancomycin nephrotoxicity). Tendon rupture/tendinopathy: fluoroquinolones. Red man syndrome: rapid vancomycin infusion (histamine release).

15. What is the mechanism and clinical use of oseltamivir, acyclovir, and ganciclovir?

    Oseltamivir: neuraminidase inhibitor for influenza A/B (best within 48 h). Acyclovir: guanosine analog activated by viral thymidine kinase, treats HSV/VZV. Ganciclovir: treats CMV (more myelosuppressive); valganciclovir is the oral prodrug.

16. Compare the mechanisms of azole antifungals vs. echinocandins vs. amphotericin B.

    Azoles (fluconazole, voriconazole): inhibit ergosterol synthesis via lanosterol $14\alpha$-demethylase (CYP-dependent). Echinocandins (caspofungin): inhibit $\beta$-(1,3)-D-glucan synthase (cell wall). Amphotericin B: binds ergosterol, forms membrane pores (nephrotoxic, infusion reactions).

17. What is the drug of choice for the common helminth and protozoal infections: pinworm, giardiasis, and toxoplasmosis?

    Pinworm (Enterobius): albendazole or pyrantel pamoate. Giardiasis: metronidazole (or tinidazole/nitazoxanide). Toxoplasmosis: pyrimethamine + sulfadiazine + leucovorin.

18. Define the major mechanisms of antimicrobial resistance.

    1) Enzymatic inactivation (e.g., $\beta$-lactamases, ESBLs, carbapenemases). 2) Target site modification (e.g., altered PBP2a in MRSA, ribosomal methylation). 3) Decreased uptake / porin loss. 4) Efflux pumps. 5) Metabolic bypass (e.g., altered folate pathway).

19. What are the core principles of antimicrobial stewardship?

    Right drug, dose, route, and duration; obtain cultures before antibiotics; use narrowest effective spectrum; de-escalate based on culture data; switch IV to oral when appropriate; set a defined duration/stop date; avoid antibiotics for viral or non-infectious illness.

20. What are the routinely recommended childhood vaccines given at birth and the typical 2/4/6-month series?

    Birth: HepB. At 2, 4, 6 months: DTaP, Hib, IPV, PCV (pneumococcal conjugate), rotavirus, and HepB. Rotavirus is oral and live-attenuated; the series provides primary immunity against these pathogens.

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