Physician Assistant National Certifying Examination (PANCE) Pulmonary System Syllabus

Pulmonary System syllabus — full chapter and topic list

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

1. 1

   Obstructive Airway Disease

   4 topics

   • Asthma
     • Severity classification and stepwise therapy
     • Acute exacerbation management
   • Chronic obstructive pulmonary disease
     • GOLD staging and inhaler selection
     • Exacerbation and oxygen therapy
   • Bronchiectasis
   • Cystic fibrosis
2. 2

   Infectious and Inflammatory Lung Disease

   4 topics

   • Community-acquired pneumonia
     • CURB-65 and empiric antibiotics
   • Hospital-acquired and aspiration pneumonia
   • Pulmonary tuberculosis
     • Latent versus active TB testing and treatment
   • Acute bronchitis and influenza
3. 3

   Pulmonary Vascular and Critical Care

   4 topics

   • Pulmonary embolism
     • Wells criteria and D-dimer
     • CT angiography and anticoagulation
   • Pulmonary hypertension
   • Acute respiratory distress syndrome
   • Respiratory failure and mechanical ventilation basics
4. 4

   Neoplastic and Restrictive Disease

   4 topics

   • Lung cancer
     • Small cell versus non-small cell
     • Solitary pulmonary nodule workup
   • Interstitial lung disease and pulmonary fibrosis
   • Sarcoidosis
   • Pneumoconioses and occupational lung disease
5. 5

   Pleural and Upper Airway Disorders

   4 topics

   • Pleural effusion and Light's criteria
   • Pneumothorax
     • Spontaneous versus tension
   • Obstructive sleep apnea
   • Acute epiglottitis and croup

Pulmonary System flashcards for Physician Assistant National Certifying Examination (PANCE)

22 of 53 cards from the Pulmonary System deck — real questions with worked answers.

1. What are the three classic spirometry findings that define asthma's reversible obstruction?

   Obstructive pattern with reduced $\frac{FEV_{1}}{FVC}$ ratio, plus reversibility shown by an increase in $FEV_{1}$ of $\geq 12\%$ and $\geq 200\,\text{mL}$ after a bronchodilator.

2. Asthma: what is the stepwise pharmacologic management ladder from intermittent to severe persistent disease?

   Step 1: SABA PRN (or low-dose ICS-formoterol PRN). Step 2: low-dose ICS. Step 3: low-dose ICS + LABA. Step 4: medium-dose ICS-LABA. Step 5: high-dose ICS-LABA $\pm$ add-on (LAMA, biologic). Step 6: add oral corticosteroids.

3. What is the first-line treatment for an acute asthma exacerbation in the emergency setting?

   Inhaled short-acting beta-2 agonists (albuterol), supplemental oxygen, systemic corticosteroids, and ipratropium for severe cases; consider magnesium sulfate IV in refractory cases.

4. In an asthma exacerbation, why is a 'normalizing' or rising $PaCO_{2}$ an ominous sign?

   Early in an exacerbation the patient hyperventilates causing respiratory alkalosis (low $PaCO_{2}$). A normal or rising $PaCO_{2}$ signals respiratory muscle fatigue and impending respiratory failure, warranting consideration of intubation.

5. What spirometric criterion defines COPD (post-bronchodilator)?

   A post-bronchodilator $\frac{FEV_{1}}{FVC} < 0.70$, indicating fixed/incompletely reversible airflow obstruction.

6. How are the GOLD spirometric severity stages of COPD graded by $FEV_{1}$ (% predicted)?

   GOLD 1 (mild): $FEV_{1} \geq 80\%$. GOLD 2 (moderate): $50\% \leq FEV_{1} < 80\%$. GOLD 3 (severe): $30\% \leq FEV_{1} < 50\%$. GOLD 4 (very severe): $FEV_{1} < 30\%$. All require ratio $< 0.70$.

7. COPD: which two interventions have been proven to reduce mortality?

   Smoking cessation and long-term supplemental oxygen therapy (in chronic hypoxemic patients with $PaO_{2} \leq 55\,\text{mmHg}$ or $SaO_{2} \leq 88\%$).

8. Compare 'pink puffer' versus 'blue bloater' phenotypes in COPD.

   Pink puffer (emphysema-predominant): thin, barrel-chested, pursed-lip breathing, relatively normal oxygenation. Blue bloater (chronic bronchitis-predominant): cyanotic, overweight, productive cough, hypoxemia, hypercapnia, cor pulmonale, peripheral edema.

9. What is the definition of chronic bronchitis?

   A productive cough for at least 3 months in each of 2 consecutive years, not attributable to another cause.

10. Which inherited deficiency should be suspected in COPD/emphysema in a young, non-smoking patient, especially with basilar (lower lobe) disease?

    Alpha-1 antitrypsin deficiency, which causes panacinar emphysema and may also cause liver cirrhosis.

11. What is the classic imaging (CT) finding of bronchiectasis?

    Permanently dilated bronchi with the 'signet ring sign' (airway larger than its accompanying pulmonary artery) and 'tram-track' parallel bronchial walls; airways fail to taper.

12. What is the most common genetic mutation causing cystic fibrosis and which protein/channel does it affect?

    The $\Delta F508$ (Phe508del) mutation in the CFTR gene, encoding a defective cAMP-regulated chloride channel; inheritance is autosomal recessive.

13. What is the diagnostic test of choice for cystic fibrosis and its threshold?

    The sweat chloride test; a chloride concentration $\geq 60\,\text{mmol/L}$ is diagnostic (intermediate is $30$–$59\,\text{mmol/L}$).

14. Which two respiratory pathogens are most characteristically associated with chronic airway infection in cystic fibrosis?

    Staphylococcus aureus (especially in younger patients) and Pseudomonas aeruginosa (especially mucoid strains in older patients); Burkholderia cepacia portends a worse prognosis.

15. What is the most common bacterial cause of community-acquired pneumonia (CAP)?

    Streptococcus pneumoniae (pneumococcus).

16. What does each component of the CURB-65 score for pneumonia severity represent?

    Confusion; Urea $> 7\,\text{mmol/L}$ (BUN $> 19\,\text{mg/dL}$); Respiratory rate $\geq 30$; Blood pressure (SBP $< 90$ or DBP $\leq 60\,\text{mmHg}$); Age $\geq 65$. Each scores 1 point; score $\geq 2$ suggests need for admission.

17. What is the recommended outpatient empiric antibiotic therapy for CAP in an otherwise healthy patient with no comorbidities?

    Amoxicillin (high dose), doxycycline, or a macrolide (azithromycin) in areas of low pneumococcal macrolide resistance.

18. Which organism causes CAP associated with hyponatremia, GI symptoms, and exposure to contaminated water (air conditioning, cooling towers)?

    Legionella pneumophila; diagnosed with a urine antigen test and treated with a macrolide or fluoroquinolone.

19. How is hospital-acquired pneumonia (HAP) defined, and how does it differ from ventilator-associated pneumonia (VAP)?

    HAP is pneumonia occurring $\geq 48$ hours after hospital admission, not incubating at admission. VAP is pneumonia occurring $> 48$ hours after endotracheal intubation.

20. Which pathogens must empiric therapy for HAP/VAP cover that are not typical in CAP?

    Multidrug-resistant organisms: Pseudomonas aeruginosa, MRSA, and other gram-negative rods (e.g., Acinetobacter, Enterobacter). Empiric coverage often includes an antipseudomonal beta-lactam plus MRSA coverage (vancomycin or linezolid).

21. Aspiration pneumonia: which lung segments are most commonly involved and why?

    The right lower lobe (and posterior segment of the right upper lobe / superior segment of the right lower lobe when supine), because the right mainstem bronchus is wider, shorter, and more vertical, favoring gravitational flow of aspirate.

22. What organism causes tuberculosis, and what stain/feature characterizes it?

    Mycobacterium tuberculosis, an acid-fast bacillus (AFB) with a mycolic-acid-rich cell wall; it is an obligate aerobe, hence its predilection for the high-oxygen apical lung segments.

See more Pulmonary System flashcards →

Planning Pulmonary System for Physician Assistant National Certifying Examination (PANCE)

Pulmonary System (Physician Assistant National Certifying Examination (PANCE)) FAQ