3/3/26, 2:21 PM PANCE 2026
PANCE ACTUAL EXAM 2026\NEWEST EXAM WITH COMPLETE
QUESTIONS AND ACCURATE DETAILED ANSWERS\(Verified
Answers) Already Graded A+ | Guaranteed Success!! Newest Exam
| Just Released!! LATEST UPDATE!!! 2026 ASSURED PASS
MC form of cardiomyopathy and its type of dysfunction
Dilated cardiomyopathy, systolic dysfunction (HFrEF)
Insomnia mainstay Tx
CBT + sleep hygiene
What is the purpose of administering gluteal injections with the specific parameters?
Ventrogluteal site = BEST
Safer than dorsogluteal (avoids sciatic nerve & major vessels)
Consistent anatomy, even in obese patients
Landmarks (classic):
Heel of hand on greater trochanter
Index finger → ASIS
Middle finger spreads along iliac crest
Inject in the V-shaped triangle
Why use the gluteal muscles?
Large muscle mass → allows larger volumes of medication
Good blood supply → reliable absorption
Less pain/irritation for viscous or oil-based meds
Used for deep intramuscular delivery when oral/IV not appropriate
1/454
,3/3/26, 2:21 PM PANCE 2026
When can you start accumulating CME credits?
As soon as you get your certification / license
Tx of SIADH
SIADH — Syndrome of Inappropriate Antidiuretic Hormone Lab hallmark:
- Hyponatremia (Na <135)
- Low serum osmolality
- Urine osmolality > serum osmolality
- Euvolemic clinically
Treatment — Depends on Severity
1. Mild/Asymptomatic (Na >120 mEq/L)
First-line: Fluid restriction (~800–1000 mL/day) Salt tablets or high-protein
diet (if needed) Monitor sodium carefully
2. Moderate/Severe Symptoms (Na <120 mEq/L or neurologic symptoms
(confusion, seizures)
Hypertonic saline (3%) — give slowly
Avoid correcting >8–10 mEq/L in 24h (risk central pontine myelinolysis)
Loop diuretics (e.g., furosemide) sometimes added to increase free water
excretion
3. Chronic/Refractory SIADH
Demeclocycline — inhibits ADH in the kidney
Vaptans (tolvaptan, conivaptan) — ADH receptor antagonists (used in
hospitalized patients)
2/454
,3/3/26, 2:21 PM PANCE 2026
Treatment of central DI
Problem: Lack of ADH (vasopressin) from posterior pituitary
Result: Large volumes of dilute urine, polydipsia, hypernatremia
Treatment
1. First-Line Therapy = Desmopressin (DDAVP)
Synthetic ADH analog - Reduce urine output, control thirst, normalize Na
2. Supportive Measures
Free water replacement if hypernatremic or dehydrated
Monitor serum sodium and osmolality
3. Other Options (if mild or partial DI)
Thiazide diuretics (e.g.,
hydrochlorothiazide)
Reduce urine output via mild volume depletion → increased proximal water
reabsorption
Low-solute diet (reduces osmotic diuresis)
3/454
, 3/3/26, 2:21 PM PANCE 2026
Treatment of nephrogenic DI
Problem: Kidneys do not respond to ADH (vasopressin)
Causes: X-linked mutations in V2 receptor or aquaporin-2
Acquired: Lithium, hypercalcemia, hypokalemia, certain medications (demeclocycline
rarely)
Result: Polyuria, polydipsia, hypernatremia despite normal/high ADH
Treatment
1. Remove or treat underlying cause
Stop lithium if possible
Correct hypercalcemia or hypokalemia
2. Medications to reduce urine output
Thiazide diuretics (e.g., hydrochlorothiazide)
Cause mild volume depletion → kidneys reabsorb more water proximally
Amiloride in lithium-induced nephrogenic DI
NSAIDs (e.g., indomethacin)
Reduce renal prostaglandins → enhance concentrating ability
3. Supportive Measures
Free water replacement (PO or IV) to prevent dehydration
Low-solute diet (limits osmotic diuresis)
4/454
PANCE ACTUAL EXAM 2026\NEWEST EXAM WITH COMPLETE
QUESTIONS AND ACCURATE DETAILED ANSWERS\(Verified
Answers) Already Graded A+ | Guaranteed Success!! Newest Exam
| Just Released!! LATEST UPDATE!!! 2026 ASSURED PASS
MC form of cardiomyopathy and its type of dysfunction
Dilated cardiomyopathy, systolic dysfunction (HFrEF)
Insomnia mainstay Tx
CBT + sleep hygiene
What is the purpose of administering gluteal injections with the specific parameters?
Ventrogluteal site = BEST
Safer than dorsogluteal (avoids sciatic nerve & major vessels)
Consistent anatomy, even in obese patients
Landmarks (classic):
Heel of hand on greater trochanter
Index finger → ASIS
Middle finger spreads along iliac crest
Inject in the V-shaped triangle
Why use the gluteal muscles?
Large muscle mass → allows larger volumes of medication
Good blood supply → reliable absorption
Less pain/irritation for viscous or oil-based meds
Used for deep intramuscular delivery when oral/IV not appropriate
1/454
,3/3/26, 2:21 PM PANCE 2026
When can you start accumulating CME credits?
As soon as you get your certification / license
Tx of SIADH
SIADH — Syndrome of Inappropriate Antidiuretic Hormone Lab hallmark:
- Hyponatremia (Na <135)
- Low serum osmolality
- Urine osmolality > serum osmolality
- Euvolemic clinically
Treatment — Depends on Severity
1. Mild/Asymptomatic (Na >120 mEq/L)
First-line: Fluid restriction (~800–1000 mL/day) Salt tablets or high-protein
diet (if needed) Monitor sodium carefully
2. Moderate/Severe Symptoms (Na <120 mEq/L or neurologic symptoms
(confusion, seizures)
Hypertonic saline (3%) — give slowly
Avoid correcting >8–10 mEq/L in 24h (risk central pontine myelinolysis)
Loop diuretics (e.g., furosemide) sometimes added to increase free water
excretion
3. Chronic/Refractory SIADH
Demeclocycline — inhibits ADH in the kidney
Vaptans (tolvaptan, conivaptan) — ADH receptor antagonists (used in
hospitalized patients)
2/454
,3/3/26, 2:21 PM PANCE 2026
Treatment of central DI
Problem: Lack of ADH (vasopressin) from posterior pituitary
Result: Large volumes of dilute urine, polydipsia, hypernatremia
Treatment
1. First-Line Therapy = Desmopressin (DDAVP)
Synthetic ADH analog - Reduce urine output, control thirst, normalize Na
2. Supportive Measures
Free water replacement if hypernatremic or dehydrated
Monitor serum sodium and osmolality
3. Other Options (if mild or partial DI)
Thiazide diuretics (e.g.,
hydrochlorothiazide)
Reduce urine output via mild volume depletion → increased proximal water
reabsorption
Low-solute diet (reduces osmotic diuresis)
3/454
, 3/3/26, 2:21 PM PANCE 2026
Treatment of nephrogenic DI
Problem: Kidneys do not respond to ADH (vasopressin)
Causes: X-linked mutations in V2 receptor or aquaporin-2
Acquired: Lithium, hypercalcemia, hypokalemia, certain medications (demeclocycline
rarely)
Result: Polyuria, polydipsia, hypernatremia despite normal/high ADH
Treatment
1. Remove or treat underlying cause
Stop lithium if possible
Correct hypercalcemia or hypokalemia
2. Medications to reduce urine output
Thiazide diuretics (e.g., hydrochlorothiazide)
Cause mild volume depletion → kidneys reabsorb more water proximally
Amiloride in lithium-induced nephrogenic DI
NSAIDs (e.g., indomethacin)
Reduce renal prostaglandins → enhance concentrating ability
3. Supportive Measures
Free water replacement (PO or IV) to prevent dehydration
Low-solute diet (limits osmotic diuresis)
4/454
