PGIM MD Family Medicine flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

CURB-65

Pneumonia severity score: Confusion, Urea >7 mmol/L, Respiratory rate >=30/min, low Blood pressure, Age >=65. Each item scores one point; >=3 suggests severe disease and consideration of intensive care.

CHA2DS2-VASc

Stroke risk score in atrial fibrillation: congestive heart failure, hypertension, age >=75 (2 points), diabetes, stroke (2 points), vascular disease, age 65-74, female sex. Score >=2 in men or >=3 in women supports anticoagulation.

SMART asthma therapy

Single maintenance and reliever therapy using low-dose inhaled corticosteroid plus formoterol as both regular controller and as-needed reliever. It reduces severe exacerbations compared with short-acting beta-agonist-only reliever strategies.

PHQ-9 scoring

Nine-item depression severity measure. Scores 5-9 indicate mild, 10-14 moderate, 15-19 moderately severe, and 20 or more severe depression. A score of 10 or above usually prompts treatment consideration.

Red flags in low back pain

Features suggesting serious pathology: saddle anaesthesia, bladder or bowel dysfunction, fever, unexplained weight loss, cancer history, significant trauma, or progressive neurological deficit. Their presence requires urgent imaging and referral.

Sensitivity formula

Sensitivity equals true positives divided by true positives plus false negatives, or TP/(TP+FN). It is the proportion of people with disease correctly identified by the test.

Positive predictive value

PPV equals true positives divided by all positives, TP/(TP+FP). Unlike sensitivity, it depends on disease prevalence and rises when prevalence in the tested population is higher.

Herd immunity threshold

The proportion of a population needing immunity to interrupt transmission, calculated as 1 minus 1/R0. Measles with R0 of 12-18 needs roughly 92-95% coverage; influenza needs far less.

Levels of prevention

Primordial prevents risk-factor emergence in society, primary acts before disease onset, secondary detects early disease, tertiary limits disability, and quaternary avoids unnecessary medical intervention.

Incidence versus prevalence

Incidence counts new cases per population at risk per unit time. Prevalence counts all existing cases at a point. For stable disease, prevalence approximately equals incidence multiplied by average duration.

Wilson-Jungner criteria

Classic screening criteria: the condition is important, has a recognizable latent stage, and has accepted treatment; the test is suitable and acceptable; and policy exists on whom to treat.

Intention-to-treat analysis

All randomized participants are analyzed in their assigned group regardless of adherence or crossover. It preserves randomization and avoids attrition bias but dilutes the estimated treatment effect toward the null.

Allocation concealment

The process preventing investigators from knowing or predicting upcoming treatment assignments before enrolment. It differs from blinding and protects against selection bias in randomized trials.

Number needed to treat

NNT equals 1 divided by the absolute risk reduction. It estimates how many patients must be treated to prevent one additional adverse outcome; smaller values indicate greater clinical benefit.

Confounding definition

A variable associated with both exposure and outcome but not on the causal pathway, distorting the observed association. It is addressed by randomization, restriction, matching, stratification, or multivariable regression adjustment.

Case-control study

Participants with the outcome are compared with controls without it, and past exposures are compared. It is efficient for rare diseases but cannot directly estimate incidence and is prone to recall bias.

Confidence interval meaning

A 95% confidence interval is the range that would contain the true parameter in 95% of repeated samples. Wider intervals indicate less precision; intervals excluding the null match p < 0.05.

Sample size for proportions

Per-group n equals (z-alpha/2 plus z-beta) squared times [p1(1-p1)+p2(1-p2)] divided by the squared difference in proportions. Larger effects or smaller variability reduce the required sample.

Publication bias

The tendency for studies with positive or statistically significant results to be published and cited more often. It inflates apparent effect sizes in systematic reviews and is assessed with funnel plots.

Four ethical principles

Autonomy respects informed patient choice, beneficence promotes welfare, non-maleficence avoids harm, and justice ensures fair distribution of benefits and burdens across patients and society.

Informed consent elements

Valid consent requires patient capacity, adequate disclosure of material information, comprehension, voluntary choice, and authorization. Emergency treatment may proceed without consent when delay risks serious harm.

Capacity assessment

A patient must understand relevant information, retain it, weigh it in reasoning, and communicate a choice. The resulting decision need not appear reasonable to the clinician to be considered capacitous.

QALY definition

Quality-adjusted life-year equals years of life multiplied by a utility weight from 0 (death) to 1 (perfect health). It is used to compare cost-effectiveness across interventions and conditions.

Confidentiality exceptions

Disclosure without consent may be justified by statute (notifiable diseases), patient consent, or serious imminent risk to identifiable others. Disclosure should be limited to the minimum necessary information.

Clinical governance pillars

Framework for quality: clinical effectiveness, patient safety, patient experience, audit and quality improvement, staff development, and risk management. It holds organizations accountable for continuously improving care standards.

Duty of candour

An obligation to inform patients promptly and honestly when a safety incident caused or may have caused harm, to apologize, explain what happened, and document the discussion and follow-up.

SGLT2 inhibitor indications

In type 2 diabetes with heart failure, chronic kidney disease, or established atherosclerotic cardiovascular disease, these agents reduce hospitalization and progression independent of glucose lowering, and are added early.

Cervical cancer screening

Human papillomavirus testing every five years is recommended from around age 25-30, with cytology alternatives where HPV testing is unavailable. Screening intervals lengthen after negative results.

Lead-time bias

Apparent survival gain from earlier diagnosis that does not actually prolong life. Screening studies must measure disease-specific mortality rather than survival time to avoid this distortion.

Blinding types

Single, double, and triple blinding refer to masking of participants, investigators, and outcome assessors. Blinding reduces performance and detection bias but is often impossible in surgical or behavioural trials.

Best interests decision

When a patient lacks capacity and has no valid advance directive or proxy, clinicians decide using the patient's known values, least restrictive option, and benefit-harm balance.

Cost-effectiveness ratio

Incremental cost divided by incremental health gain, often expressed as cost per QALY gained. Lower ratios indicate better value; thresholds vary by health system and jurisdiction.