The NCCPA™ PANCE Content Blueprint devotes 6% of the exam to Eyes, Ears, Nose, and Throat, and the PANRE blueprint devotes 8%. This high-yield review summarizes every topic on both blueprints, including a combined flashcard set.
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| Eye Disorders (PEARLS) | |
| Conjunctivitis (ReelDx) |
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| Subconjunctival hemorrhage | Painless, sharply demarcated bright red patch with normal vision after Valsalva, trauma, or anticoagulation. Reassurance — resolves in about 2 weeks; check BP and coagulation if recurrent |
| Cataract | Painless blurred vision over months to years, glare, halos around lights; opacification of the lens with a diminished or absent red reflex. Surgical lens replacement when vision limits function |
| Corneal ulcer | Contact lens wearers (Pseudomonas); pain, photophobia, round ulcer with white stromal infiltrate on fluorescein, hypopyon if severe. Same-day ophthalmology, topical fluoroquinolone, no patching, no steroids |
| Keratitis / infectious corneal disease |
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| Pterygium (ReelDx) | Elevated, fleshy, triangular fibrovascular growth from the nasal conjunctiva onto the cornea; UV/wind exposure. Excise if it threatens the visual axis (versus pinguecula, which does not cross onto the cornea) |
| Iritis (anterior uveitis) | Painful red eye, photophobia (including consensual), ciliary flush, miotic irregular pupil, cells and flare in the anterior chamber. Associated with HLA-B27 disease (ankylosing spondylitis, IBD, reactive arthritis), sarcoidosis. Topical steroids + cycloplegic, ophthalmology |
| Scleritis | Severe, deep, boring eye pain that wakes the patient, violaceous injection that does not blanch with phenylephrine; half have systemic disease (RA, granulomatosis with polyangiitis). Systemic NSAIDs/steroids, ophthalmology. Versus episcleritis: mild, sectoral, blanches, self-limited |
| Uveitis | Anterior = iritis (above). Posterior/panuveitis: floaters and painless vision loss — CMV retinitis in HIV (CD4 < 50), toxoplasmosis, sarcoidosis, Behçet. Dilated exam and ophthalmology; treat the cause |
| Dacryoadenitis | Inflammation of the lacrimal gland — superotemporal lid swelling and tenderness, S-shaped lid; viral (mumps, EBV) or bacterial. Warm compresses; antibiotics if bacterial |
| Dacryocystitis | Infection of the lacrimal sac from nasolacrimal duct obstruction — inferomedial swelling, tearing, pus expressed from the punctum; S. aureus, strep. Warm compresses + oral antibiotics (Augmentin/clindamycin); dacryocystorhinostomy if recurrent |
| Dacryostenosis (nasolacrimal duct obstruction) | Infant with chronic tearing and mattering but a white, quiet eye; most common congenital lacrimal problem. Lacrimal sac massage; resolves spontaneously by 12 months in 90%; probing if persistent |
| Keratoconjunctivitis sicca (dry eye) | Gritty, burning, foreign body sensation, worse late in the day; Schirmer test < 10 mm; think Sjögren syndrome with dry mouth. Artificial tears, cyclosporine drops, punctal plugs |
| Blepharitis | Eyelid margin inflammation: crusting, scaling, red-rimmed lids, lash flaking, dry eyes; associated with seborrhea and rosacea. Warm compresses + lid hygiene |
| Chalazion | Painless (non-infectious) granuloma of a meibomian gland — a "cold" lid nodule, versus hordeolum (painful, infectious, "hot"). Warm compresses; I&D or steroid injection if persistent |
| Ectropion | Eyelid turns outward, exposing the palpebral conjunctiva → red, irritated eye, tearing. Lubricants; surgical correction is definitive |
| Entropion | Eyelid turns inward — lashes abrade the cornea (foreign body sensation, tearing); age-related tissue laxity. Surgical correction is definitive |
| Hordeolum (ReelDx) | Painful, warm (hot), swollen red lump on the lid margin (S. aureus), unlike a painless chalazion. Think "H" for Hot = Hordeolum. Warm compresses |
| Nystagmus (ReelDx) |
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| Optic neuritis (ReelDx) | Acute inflammation/demyelination of the optic nerve → monocular vision loss, pain with eye movement, afferent pupillary defect, red desaturation. Multiple sclerosis is the classic association; IV methylprednisolone; MRI brain |
| Papilledema (ReelDx) | Bilateral optic disc swelling from increased intracranial pressure; headache, transient visual obscurations, enlarged blind spot. Neuroimaging before LP; think idiopathic intracranial hypertension in an obese young woman |
| Orbital cellulitis (ReelDx) | Pain with eye movement, decreased extraocular motility, proptosis, fever — usually from ethmoid sinusitis. CT orbits; admit for IV antibiotics (vancomycin + ceftriaxone); cavernous sinus thrombosis is the feared complication |
| Periorbital (preseptal) cellulitis | Lid erythema and swelling with normal extraocular movements, no pain with eye movement, no proptosis, normal vision — infection anterior to the orbital septum. Oral antibiotics (Augmentin or clindamycin); CT if any doubt about orbital involvement |
| Macular degeneration | Gradual central vision loss and metamorphopsia (Amsler grid) in older adults
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| Retinal detachment | Painless flashes and floaters, then a curtain or shadow across the visual field; myopia, trauma, prior cataract surgery. Emergent ophthalmology — keep the patient still with the head positioned so the detachment settles back |
| Retinopathy (diabetic, hypertensive) |
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| Retinal vascular occlusion | Sudden, painless, unilateral vision loss
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| Amaurosis fugax | Transient monocular vision loss — a "curtain" descending for seconds to minutes, then full recovery; retinal TIA from ipsilateral carotid emboli. Carotid duplex, stroke workup, antiplatelet; ESR/CRP if > 50 to exclude giant cell arteritis |
| Amblyopia | Reduced vision in a structurally normal eye from abnormal visual development before age 7–8 — strabismus, unequal refractive error, or deprivation (congenital cataract). Patch or penalize the good eye; correct the cause early — irreversible after the critical period |
| Glaucoma |
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| Presbyopia | Age-related loss of lens accommodation after 40 — trouble reading up close, holding print at arm's length. Reading glasses; not a disease |
| Strabismus (ReelDx) | Any ocular misalignment; diagnose with the cover/uncover test and corneal light reflex. Exotropia: out-turning, Esotropia: in-turning. Treat early (patching/correction/surgery) to prevent amblyopia; new-onset in an adult → neuroimaging |
| Ear Disorders (PEARLS) | |
| Cerumen impaction | Conductive hearing loss, fullness, tinnitus, itching; cotton swabs push wax deeper. Cerumenolytics, irrigation (not if TM perforation or tubes), or curette under direct vision |
| Otitis externa (acute, malignant) |
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| Acoustic neuroma | Benign Schwann cell tumor (vestibular schwannoma) of CN VIII. Slowly progressive unilateral sensorineural hearing loss + tinnitus ± imbalance; bilateral = NF2. MRI with gadolinium; observation, stereotactic radiation, or surgery |
| Dysfunction of the eustachian tube (ReelDx) | Ear fullness, popping, "underwater" hearing, fluctuating conductive hearing loss; retracted TM. Common in young children (short, horizontal tube); resolves with growth. Intranasal steroids, autoinsufflation, treat allergies |
| Labyrinthitis | Acute continuous vertigo + hearing loss (± tinnitus) lasting days after a viral URI, no focal neuro deficits. Versus vestibular neuritis = same vertigo without hearing loss; versus Meniere = episodic, recurrent. Meclizine/antiemetics short-term, then vestibular rehab |
| Vertigo (ReelDx) |
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| Cholesteatoma | Painless, foul-smelling otorrhea with conductive hearing loss; chronic eustachian tube dysfunction → retraction pocket of the TM (pars flaccida) that traps keratin and erodes the ossicles. Pearly white mass on otoscopy; CT temporal bone; surgical excision |
| Acute/chronic otitis media (ReelDx) |
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| Otosclerosis | Progressive conductive hearing loss in a young adult (20s–40s) with a normal TM, often family history, worsens in pregnancy; abnormal bony remodeling fixes the stapes footplate. Audiogram: Carhart notch. Hearing aid or stapedectomy |
| Tympanic membrane perforation (ReelDx) | Pain, otorrhea, conductive hearing loss after AOM or trauma; most heal spontaneously — keep the ear dry. AOM with perforation → oral amoxicillin 10 days; clean traumatic perforation needs no antibiotics. If drops are used, choose a fluoroquinolone — never aminoglycoside (Cortisporin) drops through a perforation. ENT if not healed at 4 weeks; vertigo or facial weakness = urgent |
| Hearing impairment — conductive and sensorineural |
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| Mastoiditis (ReelDx) | Complication of AOM: fever, otalgia, postauricular pain, erythema, and swelling with forward displacement of the auricle. CT temporal bone; admit for IV antibiotics + myringotomy/drainage; mastoidectomy if abscess |
| Meniere disease | Triad of episodic vertigo (20 min–hours), low-frequency sensorineural hearing loss, and tinnitus with aural fullness from endolymphatic hydrops. Low-salt diet + diuretics (HCTZ/triamterene); avoid caffeine/alcohol; intratympanic steroids or gentamicin if refractory |
| Tinnitus | Perceived sound without an external stimulus — ringing, hissing, buzzing, or whooshing. Most is associated with sensorineural hearing loss: noise, presbycusis, ototoxic drugs (aspirin/salicylates, aminoglycosides, loop diuretics, cisplatin, quinine), Meniere, acoustic neuroma. Pulsatile or unilateral tinnitus → imaging |
| Foreign Bodies of the Eyes, Ears, Nose, and Throat | |
| Foreign body in ear (ReelDx) | Insects: immobilize first with mineral oil or viscous lidocaine, then remove. Do not irrigate organic material (beans swell) or button batteries (remove emergently). Irrigation or instrumentation for inert objects; ENT if not easily removed |
| Foreign body in eye | Evert the lid; remove superficial FB with irrigation or a needle/burr after topical anesthetic; metallic FB leaves a rust ring (burr). Suspected intraocular FB (high-velocity mechanism, Seidel sign) → shield the eye, CT, emergent ophthalmology |
| Foreign body in nose (ReelDx) | Unilateral purulent, foul-smelling nasal discharge in a child. Positive-pressure ("parent's kiss") or instrument removal; button batteries and paired magnets are emergencies (septal necrosis) |
| Trauma of the Eyes, Ears, Nose, and Throat | |
| Barotrauma of the ear | Divers and air travel (descent) — sudden ear pain/fullness that may resolve with a "pop"; TM retraction, hemotympanum, or perforation. Decongestants and autoinsufflation; avoid flying/diving with a URI |
| Blowout fracture (ReelDx) | Blunt orbital trauma → diplopia on upward gaze (inferior rectus entrapment), enophthalmos (sunken eye), cheek/upper lip/gum numbness from infraorbital nerve injury. CT orbits; no nose blowing; surgery for entrapment or large defects |
| Corneal abrasion (ReelDx) | Sudden eye pain, photophobia, tearing, foreign body sensation after minor trauma; fluorescein uptake in the defect. Topical antibiotic (antipseudomonal for contact lens wearers), no patching, never discharge with topical anesthetic |
| Globe rupture | Penetrating or severe blunt trauma with teardrop (peaked) pupil, positive Seidel sign, 360° subconjunctival hemorrhage, shallow anterior chamber, marked vision loss. Rigid shield — no patch, no pressure, no tonometry; NPO, tetanus, IV antibiotics, CT, emergent ophthalmology |
| Hyphema (ReelDx) | Blood layering in the anterior chamber after blunt trauma; may block vision. Head of bed elevated, eye shield, avoid NSAIDs/aspirin, check IOP, ophthalmology; screen for sickle cell (rebleeding, IOP spikes) |
| Nose and Sinus Disorders (PEARLS) | |
| Epistaxis (ReelDx) |
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| Nasal polyps | Pale, teardrop-shaped gray growths from the middle meatus; Samter triad: asthma, aspirin sensitivity, nasal polyps. Intranasal steroids first-line; polyps in a child → test for cystic fibrosis |
| Rhinitis (ReelDx) |
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| Sinusitis (ReelDx) | Facial pain/pressure worse with bending forward, purulent drainage, nasal obstruction. Clinical diagnosis — no imaging for uncomplicated acute sinusitis; CT is the study of choice for chronic disease (> 12 weeks) or complications. Antibiotics only if symptoms > 10 days without improvement, severe onset (fever ≥ 39°C + purulent discharge ≥ 3–4 days), or "double worsening": Augmentin 875/125 BID × 5–7 days (children 10 days); doxycycline if penicillin-allergic |
| Oropharyngeal Disorders (PEARLS) | |
| Angioedema | Nonpitting swelling of lips, tongue, face, or airway — airway first
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| Aphthous ulcers (ReelDx) | Painful, shallow ulcers with a yellow-gray fibrinoid center and red halo on non-keratinized mucosa (versus oral HSV: grouped vesicles on keratinized mucosa/vermilion border after a tingling prodrome — acyclovir). Topical steroids or viscous lidocaine; biopsy if > 3 weeks; recurrent + genital ulcers → Behçet |
| Oral candidiasis (ReelDx) | White plaques that scrape off, leaving an erythematous base that may bleed; KOH prep shows budding yeast/pseudohyphae. Nystatin swish or fluconazole; in an adult without inhaled steroids/antibiotics, think HIV or diabetes |
| Deep neck infection |
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| Dental abscess | Severe localized tooth pain, swelling and fluctuance at the gum line, pain to percussion, possible facial cellulitis. Penicillin or amoxicillin (clindamycin if allergic), I&D if fluctuant, urgent dental referral; spread to submandibular space → Ludwig angina |
| Dental caries | Streptococcus mutans + dietary sugar demineralize enamel; pain with sweets, cold, or heat; brown/black pits. Prevention: fluoride (water, toothpaste, varnish from first tooth eruption), no bottle in bed; dental restoration |
| Epiglottitis | Drooling, dysphagia, distress (tripod position, muffled voice, stridor); Hib in unvaccinated children, now more often adults. Do not examine the throat or agitate the child — secure the airway first (OR/anesthesia), then lateral neck X-ray: thumbprint sign; IV ceftriaxone |
| Gingivitis |
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| Laryngitis | Hoarseness, almost always viral — voice rest, humidification. Hoarseness > 2–3 weeks, especially with tobacco/alcohol use → laryngoscopy to exclude squamous cell carcinoma |
| Peritonsillar abscess (ReelDx) | "Hot potato" (muffled) voice, trismus, unilateral tonsillar bulge with uvular deviation to the opposite side. Needle aspiration or I&D + antibiotics (Augmentin or clindamycin) |
| Pharyngitis (ReelDx) |
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| Parotitis (ReelDx) |
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| Sialadenitis | Bacterial infection of a salivary gland (S. aureus), usually behind sialolithiasis — an obstructing stone (most often submandibular/Wharton's duct) causing pain and swelling with meals. Clinical diagnosis; ultrasound or CT to find the stone/abscess. Warm compresses, massage, sialagogues (sour candy), hydration, dicloxacillin or Augmentin; pus from the duct → culture |
| Leukoplakia | White plaque that cannot be rubbed off (versus candidiasis); tobacco/alcohol — premalignant, biopsy; erythroplakia (red) carries a much higher malignancy rate. Versus oral hairy leukoplakia: corrugated white lesion on the lateral tongue, EBV, HIV |
| Temporomandibular disorders | Jaw pain worse with chewing, clicking/popping, limited opening, tenderness of the masticatory muscles or TMJ, often with bruxism or stress; ear pain referred with a normal ear exam. Soft diet, NSAIDs, heat, night guard, jaw exercises; surgery rarely |
EENT Benign and Malignant Neoplasms
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