{"id":10372,"date":"2026-07-13T00:20:00","date_gmt":"2026-07-13T08:20:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=10372"},"modified":"2026-06-30T12:28:47","modified_gmt":"2026-06-30T20:28:47","slug":"pance-question-of-the-day-bloody-nose","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose","title":{"rendered":"PANCE\u00ae Question of the Day: Bloody nose"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\/#The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\" >The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Prepare for the PANCE\u00ae with this emergency department scenario involving a patient with high fever, headache, nausea, vomiting, and a bloody nose. What&#8217;s the diagnosis? Let\u2019s find out!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 32-year-old man presents to the emergency department with <strong>high fever, headache, nausea, <\/strong>and <strong>vomiting<\/strong>. He was in the emergency department a few days ago for a bloody nose. <strong>Temperature is 38.3\u00b0C (101\u00b0F), blood pressure is 74\/40 mmHg, heart rate is 130\/min, respiratory rate is 20\/min, <\/strong>and <strong>oxygen saturation is 95% on room air.<\/strong> On physical examination, he appears acutely ill with bilateral nasal packing still in place. His skin examination reveals a diffuse, erythematous macular rash. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following laboratory findings would be consistent with the underlying condition?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Elevated serum creatinine level<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Elevated eosinophils<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Normal lactic acid<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Elevated serum calcium<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Elevated serum bicarbonate<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down to find the answer!&nbsp;<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Elevated serum creatinine level<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct: <\/strong>See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Elevated eosinophils<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This patient is presenting with signs and symptoms of toxic shock syndrome. Laboratory studies will generally demonstrate elevated neutrophils and bands, not eosinophils.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Normal lactic acid<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This patient is presenting with signs and symptoms of toxic shock syndrome. This typically is associated with an elevated lactic acid due to decreased perfusion from shock.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Elevated serum calcium<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This patient is presenting with signs and symptoms of toxic shock syndrome. Hypocalcemia may be seen in this condition.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Elevated serum bicarbonate<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This patient is presenting with signs and symptoms of toxic shock syndrome. Metabolic acidosis, and thus a low serum bicarbonate level, would be expected in this condition.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"936\" height=\"493\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_45c915.png\" alt=\"Osmosis.org educational diagram illustrating toxic shock syndrome. A human figure is shown with fever, hypotension, and multiple organ failure, alongside a magnified view of bacteria. The graphic depicts activation of T lymphocytes and widespread cytokine release into the bloodstream, illustrating the excessive immune response that leads to systemic inflammation and shock.\" class=\"wp-image-10375\" style=\"aspect-ratio:1.898594949867543;width:509px;height:auto\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_45c915.png 936w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_45c915.png?resize=300,158 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/image_45c915.png?resize=768,405 768w\" sizes=\"auto, (max-width: 936px) 100vw, 936px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient\u2019s presentation is consistent with <strong>toxic shock syndrome (TSS)<\/strong>, most likely <strong>staphylococcal TSS related to nasal packing placed for epistaxis<\/strong>. TSS is characterized by <strong>fever, hypotension, diffuse erythematous rash, <\/strong>and <strong>signs of multiorgan dysfunction,<\/strong> such as an <strong>elevated serum creatinine level<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Toxic shock syndrome is a severe toxin-mediated illness caused by certain strains of <strong>Staphylococcus aureus or Streptococcus pyogenes<\/strong>. These toxins trigger widespread <strong>T-cell activation and massive cytokine release<\/strong>, which can lead to <strong>shock and multiorgan dysfunction<\/strong>. Most cases are caused by toxin-producing strains of S. aureus, although streptococcal TSS can occur. Streptococcal TSS is frequently associated with positive blood or tissue cultures, whereas staphylococcal TSS is often diagnosed clinically because blood cultures are commonly negative.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Laboratory studies in TSS can show a multitude of findings.<\/strong> Leukocytosis with a left shift, anemia, and thrombocytopenia may be seen on a complete blood cell count. Metabolic studies may demonstrate elevated BUN and creatinine levels, elevated liver enzymes, hypoalbuminemia, and elevated creatine kinase, particularly when myositis or necrotizing soft tissue infection is present. Lactic acidosis, electrolyte abnormalities, and disseminated intravascular coagulation (DIC) may also occur. <strong>The specific laboratory abnormalities vary depending on the severity of shock and the degree of organ involvement.<\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Toxic shock syndrome commonly causes laboratory evidence of multiorgan dysfunction, including elevated creatinine and liver enzymes, lactic acidosis, and hematologic abnormalities.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Review this Osmosis content: <a href=\"https:\/\/www.osmosis.org\/learn\/Toxic_shock_syndrome:_Clinical_sciences\">Toxic shock syndrome: Clinical sciences<\/a><\/strong><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Centers for Disease Control and Prevention (2022). <strong>Streptococcal toxic shock syndrome.<\/strong> Retrieved September 24, 2023, from https:\/\/www.cdc.gov\/groupastrep\/diseases-hcp\/Streptococcal-Toxic-Shock-Syndrome.html<\/li>\n\n\n\n<li>Jameson, J., Fauci, A.S., et al. (2018). Chapter 135: <strong>Staphylococcal infections. <\/strong>Harrison\u2019s Principles of Internal Medicine, 20e. McGraw Hill.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><a href=\"http:\/\/osmosis.org\/plans\/pa\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><strong><em>Get your&nbsp;<a href=\"http:\/\/osmosis.org\/plans\/pa\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;today to discover why millions of clinicians and caregivers love learning by Osmosis.<\/em><\/strong><a href=\"https:\/\/www.osmosis.org\/plans\/rn\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"https:\/\/www.osmosis.org\/plans\/rn\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A patient presents with fever, hypotension, rash, and signs of systemic illness after a recent nasal procedure. Can you identify the diagnosis and the laboratory abnormality most consistent with this life-threatening condition?<\/p>\n","protected":false},"author":208,"featured_media":10376,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[20,38,1371,37,1366],"tags":[2967,489,3108,1344,440,614,3211,462,1599,279,967,3210,3208,809,3209],"class_list":["post-10372","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exam-prep","category-pance","category-pance-questions","category-pa","category-questions","tag-board-exam-prep","tag-clinical-reasoning","tag-clinical-vignette","tag-critical-care","tag-emergency-medicine","tag-infectious-diseases","tag-multiorgan-dysfunction","tag-osmosis","tag-pance-prep","tag-patient-assessment","tag-physician-assistant-education","tag-sepsis","tag-shock","tag-staphylococcus-aureus","tag-toxic-shock-syndrome"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>PANCE\u00ae Question of the Day: Bloody nose - Osmosis Blog<\/title>\n<meta name=\"description\" content=\"Test your PANCE knowledge with a toxic shock syndrome case focused on diagnosis, shock, and laboratory findings.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"PANCE\u00ae Question of the Day: Bloody nose - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Test your PANCE knowledge with a toxic shock syndrome case focused on diagnosis, shock, and laboratory findings.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2026-07-13T08:20:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-06-30T20:28:47+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Rowan Bell, MD\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\"},\"author\":{\"name\":\"Rowan Bell, MD\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/87786c55677ccd769cb76475a1c7af25\"},\"headline\":\"PANCE\u00ae Question of the Day: Bloody nose\",\"datePublished\":\"2026-07-13T08:20:00+00:00\",\"dateModified\":\"2026-06-30T20:28:47+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\"},\"wordCount\":600,\"commentCount\":1,\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg\",\"keywords\":[\"board exam prep\",\"clinical reasoning\",\"clinical vignette\",\"critical care\",\"emergency medicine\",\"infectious diseases\",\"multiorgan dysfunction\",\"Osmosis\",\"PANCE prep\",\"patient assessment\",\"physician assistant education\",\"sepsis\",\"shock\",\"Staphylococcus aureus\",\"toxic shock syndrome\"],\"articleSection\":[\"Exam Prep\",\"PANCE\",\"PANCE\",\"Physician Assistants\/Associates (PA)\",\"Questions of the Day\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\",\"url\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\",\"name\":\"PANCE\u00ae Question of the Day: Bloody nose - Osmosis Blog\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg\",\"datePublished\":\"2026-07-13T08:20:00+00:00\",\"dateModified\":\"2026-06-30T20:28:47+00:00\",\"description\":\"Test your PANCE knowledge with a toxic shock syndrome case focused on diagnosis, shock, and laboratory findings.\",\"breadcrumb\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#primaryimage\",\"url\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg\",\"contentUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg\",\"width\":1080,\"height\":1080,\"caption\":\"PANCE\u00ae Question of the Day: Bloody nose\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.osmosis.org\/blog\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"PANCE\u00ae Question of the Day: Bloody nose\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#website\",\"url\":\"https:\/\/www.osmosis.org\/blog\/\",\"name\":\"Osmosis Blog\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.osmosis.org\/blog\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#organization\",\"name\":\"Osmosis Blog\",\"url\":\"https:\/\/www.osmosis.org\/blog\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png\",\"contentUrl\":\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png\",\"width\":1276,\"height\":596,\"caption\":\"Osmosis Blog\"},\"image\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/87786c55677ccd769cb76475a1c7af25\",\"name\":\"Rowan Bell, MD\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/c135a328367d047240dce1c11e1fcdcbb9b08a22b434c9256001bbfe9e0555dd?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/c135a328367d047240dce1c11e1fcdcbb9b08a22b434c9256001bbfe9e0555dd?s=96&d=mm&r=g\",\"caption\":\"Rowan Bell, MD\"},\"description\":\"Author: Rowan Bell, MD, Clinical Content Writer, Osmosis from Elsevier. Rowan graduated from McGovern Medical School at UTHealth Houston TX in 2021 and completed their internship in Pediatrics at Maynard Children's Hospital through ECU Health in Greenville NC. They joined the Osmosis team in 2023 to contribute to medical education by writing clinical science scripts on pediatric topics. Rowan is passionate about medicine, education, and the humanities, and they're proud to be part of advancing the Osmosis vision of \\\"everyone who cares for someone with learn by Osmosis.\\\"\",\"url\":\"https:\/\/www.osmosis.org\/blog\/author\/rowanbell\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"PANCE\u00ae Question of the Day: Bloody nose - Osmosis Blog","description":"Test your PANCE knowledge with a toxic shock syndrome case focused on diagnosis, shock, and laboratory findings.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose","og_locale":"en_US","og_type":"article","og_title":"PANCE\u00ae Question of the Day: Bloody nose - Osmosis Blog","og_description":"Test your PANCE knowledge with a toxic shock syndrome case focused on diagnosis, shock, and laboratory findings.","og_url":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose","og_site_name":"Osmosis Blog","article_published_time":"2026-07-13T08:20:00+00:00","article_modified_time":"2026-06-30T20:28:47+00:00","og_image":[{"width":1080,"height":1080,"url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg","type":"image\/jpeg"}],"author":"Rowan Bell, MD","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":["Article","BlogPosting"],"@id":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#article","isPartOf":{"@id":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose"},"author":{"name":"Rowan Bell, MD","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/87786c55677ccd769cb76475a1c7af25"},"headline":"PANCE\u00ae Question of the Day: Bloody nose","datePublished":"2026-07-13T08:20:00+00:00","dateModified":"2026-06-30T20:28:47+00:00","mainEntityOfPage":{"@id":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose"},"wordCount":600,"commentCount":1,"publisher":{"@id":"https:\/\/www.osmosis.org\/blog\/#organization"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#primaryimage"},"thumbnailUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg","keywords":["board exam prep","clinical reasoning","clinical vignette","critical care","emergency medicine","infectious diseases","multiorgan dysfunction","Osmosis","PANCE prep","patient assessment","physician assistant education","sepsis","shock","Staphylococcus aureus","toxic shock syndrome"],"articleSection":["Exam Prep","PANCE","PANCE","Physician Assistants\/Associates (PA)","Questions of the Day"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#respond"]}]},{"@type":"WebPage","@id":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose","url":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose","name":"PANCE\u00ae Question of the Day: Bloody nose - Osmosis Blog","isPartOf":{"@id":"https:\/\/www.osmosis.org\/blog\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#primaryimage"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#primaryimage"},"thumbnailUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg","datePublished":"2026-07-13T08:20:00+00:00","dateModified":"2026-06-30T20:28:47+00:00","description":"Test your PANCE knowledge with a toxic shock syndrome case focused on diagnosis, shock, and laboratory findings.","breadcrumb":{"@id":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#primaryimage","url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg","contentUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg","width":1080,"height":1080,"caption":"PANCE\u00ae Question of the Day: Bloody nose"},{"@type":"BreadcrumbList","@id":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-nose#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.osmosis.org\/blog"},{"@type":"ListItem","position":2,"name":"PANCE\u00ae Question of the Day: Bloody nose"}]},{"@type":"WebSite","@id":"https:\/\/www.osmosis.org\/blog\/#website","url":"https:\/\/www.osmosis.org\/blog\/","name":"Osmosis Blog","description":"","publisher":{"@id":"https:\/\/www.osmosis.org\/blog\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.osmosis.org\/blog\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/www.osmosis.org\/blog\/#organization","name":"Osmosis Blog","url":"https:\/\/www.osmosis.org\/blog\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/","url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png","contentUrl":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/07\/OsmosisElsevierStacked.png","width":1276,"height":596,"caption":"Osmosis Blog"},"image":{"@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/87786c55677ccd769cb76475a1c7af25","name":"Rowan Bell, MD","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.osmosis.org\/blog\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/c135a328367d047240dce1c11e1fcdcbb9b08a22b434c9256001bbfe9e0555dd?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/c135a328367d047240dce1c11e1fcdcbb9b08a22b434c9256001bbfe9e0555dd?s=96&d=mm&r=g","caption":"Rowan Bell, MD"},"description":"Author: Rowan Bell, MD, Clinical Content Writer, Osmosis from Elsevier. Rowan graduated from McGovern Medical School at UTHealth Houston TX in 2021 and completed their internship in Pediatrics at Maynard Children's Hospital through ECU Health in Greenville NC. They joined the Osmosis team in 2023 to contribute to medical education by writing clinical science scripts on pediatric topics. Rowan is passionate about medicine, education, and the humanities, and they're proud to be part of advancing the Osmosis vision of \"everyone who cares for someone with learn by Osmosis.\"","url":"https:\/\/www.osmosis.org\/blog\/author\/rowanbell"}]}},"jetpack_featured_media_url":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/07\/PANCE-Question-of-the-Day-Bloody-Nose.jpg","jetpack-related-posts":[{"id":10215,"url":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-diabetic-ketoacidosis","url_meta":{"origin":10372,"position":0},"title":"PANCE\u00ae Question of the Day: Diabetic ketoacidosis","author":"Rowan Bell, MD","date":"June 22, 2026","format":false,"excerpt":"A patient with diabetic ketoacidosis improves clinically but remains acidotic and hypotensive. Can you identify the next best management step in this high-yield PANCE-style scenario?","rel":"","context":"In &quot;Exam Prep&quot;","block_context":{"text":"Exam Prep","link":"https:\/\/www.osmosis.org\/blog\/category\/exam-prep"},"img":{"alt_text":"PANCE\u00ae Question of the Day: Diabetic ketoacidosis","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/06\/PANCE-Question-of-the-Day-Diabetic-Ketoacidosis.jpg","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/06\/PANCE-Question-of-the-Day-Diabetic-Ketoacidosis.jpg 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/06\/PANCE-Question-of-the-Day-Diabetic-Ketoacidosis.jpg 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/06\/PANCE-Question-of-the-Day-Diabetic-Ketoacidosis.jpg 2x"},"classes":[]},{"id":9243,"url":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-bloody-stool","url_meta":{"origin":10372,"position":1},"title":"PANCE\u00ae Question of the Day: Bloody stool","author":"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD","date":"February 18, 2026","format":false,"excerpt":"A child presents with bright red blood stool and pain during bowel movements. Understanding key history elements helps guide diagnosis and care.","rel":"","context":"In &quot;Exam Prep&quot;","block_context":{"text":"Exam Prep","link":"https:\/\/www.osmosis.org\/blog\/category\/exam-prep"},"img":{"alt_text":"PANCE\u00ae Question of the Day: Bloody stool","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/02\/PANCE-Question-of-the-Day-Bloody-Stool.jpg","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/02\/PANCE-Question-of-the-Day-Bloody-Stool.jpg 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/02\/PANCE-Question-of-the-Day-Bloody-Stool.jpg 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/02\/PANCE-Question-of-the-Day-Bloody-Stool.jpg 2x"},"classes":[]},{"id":9086,"url":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-hemoptysis","url_meta":{"origin":10372,"position":2},"title":"PANCE\u00ae Question of the Day: Hemoptysis","author":"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD","date":"January 19, 2026","format":false,"excerpt":"A 45-year-old with productive cough, hemoptysis, and systemic symptoms presents with cavitary lung lesions. Recognize key clinical and imaging features to guide diagnosis.","rel":"","context":"In &quot;Exam Prep&quot;","block_context":{"text":"Exam Prep","link":"https:\/\/www.osmosis.org\/blog\/category\/exam-prep"},"img":{"alt_text":"PANCE Question of the Day: Hemoptysis","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/PANCE-Question-of-the-Day-Hemoptysis.jpg","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/PANCE-Question-of-the-Day-Hemoptysis.jpg 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/PANCE-Question-of-the-Day-Hemoptysis.jpg 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2026\/01\/PANCE-Question-of-the-Day-Hemoptysis.jpg 2x"},"classes":[]},{"id":7916,"url":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-confusion","url_meta":{"origin":10372,"position":3},"title":"PANCE\u00ae Question of the Day: Confusion","author":"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD","date":"October 6, 2025","format":false,"excerpt":"Review a clinical scenario highlighting features of delirium, assessment strategies, and distinctions from dementia and other cognitive disorders.","rel":"","context":"In &quot;Exam Prep&quot;","block_context":{"text":"Exam Prep","link":"https:\/\/www.osmosis.org\/blog\/category\/exam-prep"},"img":{"alt_text":"PANCE Question of the day confusion","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/PANCE-Question-of-the-day-confusion.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/PANCE-Question-of-the-day-confusion.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/PANCE-Question-of-the-day-confusion.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/PANCE-Question-of-the-day-confusion.png 2x"},"classes":[]},{"id":6131,"url":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-right-leg-pain","url_meta":{"origin":10372,"position":4},"title":"PANCE\u00ae Question of the Day: Right leg pain","author":"Rowan Bell, MD &amp; Marina Horiates Kerekes, MD","date":"June 4, 2025","format":false,"excerpt":"Explore today\u2019s PANCE\u00ae question on a pediatric case of right leg pain and learn the critical next step in managing this fascinating case!","rel":"","context":"In &quot;Exam Prep&quot;","block_context":{"text":"Exam Prep","link":"https:\/\/www.osmosis.org\/blog\/category\/exam-prep"},"img":{"alt_text":"PANCE\u00ae Question of the Day Right leg pain","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/06\/PANCE_2025_Q2__Right_leg_pain_1_.png","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/06\/PANCE_2025_Q2__Right_leg_pain_1_.png 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/06\/PANCE_2025_Q2__Right_leg_pain_1_.png 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/06\/PANCE_2025_Q2__Right_leg_pain_1_.png 2x"},"classes":[]},{"id":1489,"url":"https:\/\/www.osmosis.org\/blog\/pance-review-essentials-the-osmosis-ultimate-guide","url_meta":{"origin":10372,"position":5},"title":"PANCE\u00ae Review Essentials: The Osmosis Ultimate Guide","author":"Fergus Baird, MA","date":"July 29, 2020","format":false,"excerpt":"The PANCE\u00ae exam is what stands between a physician assistant student and certification. This five-hour, 300-question exam covers the breadth of content a PA student learns in school.\u00a0 Though it can be challenging to study for the PANCE given the volume of content you\u2019re expected to know, Osmosis has a\u2026","rel":"","context":"In &quot;Exam Prep&quot;","block_context":{"text":"Exam Prep","link":"https:\/\/www.osmosis.org\/blog\/category\/exam-prep"},"img":{"alt_text":"PANCE\u00ae Review Essentials: The Osmosis Ultimate Guide","src":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/55.webp","width":350,"height":200,"srcset":"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/55.webp 1x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/55.webp 1.5x, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/55.webp 2x"},"classes":[]}],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/10372","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/users\/208"}],"replies":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/comments?post=10372"}],"version-history":[{"count":3,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/10372\/revisions"}],"predecessor-version":[{"id":10475,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/posts\/10372\/revisions\/10475"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media\/10376"}],"wp:attachment":[{"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/media?parent=10372"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/categories?post=10372"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.osmosis.org\/blog\/wp-json\/wp\/v2\/tags?post=10372"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}