PGIM MD Medicine flashcards

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

CURB-65 components

Confusion, urea above 7 mmol/L, respiratory rate 30 or more, systolic BP below 90 or diastolic 60 or less, and age 65 or older. Each scores one point.

Anion gap formula

Sodium minus the sum of chloride and bicarbonate, normally 8 to 12 mmol/L. A raised gap with acidosis suggests ketoacidosis, lactate, renal failure, or toxin ingestion.

Septic shock criteria

Sepsis with persistent hypotension needing vasopressors to keep mean arterial pressure at 65 mmHg or above, plus lactate above 2 mmol/L despite adequate fluid resuscitation.

KDIGO AKI stage 3

Creatinine rise to 3 times baseline or more, or 353.6 micromol/L or higher, or initiation of renal replacement therapy, or urine output below 0.3 mL/kg/h for 24 hours.

Winter's formula

Expected PaCO2 equals 1.5 times bicarbonate plus 8, with a range of plus or minus 2. Values outside this range indicate a second respiratory acid-base disorder.

Anaphylaxis first-line treatment

Intramuscular adrenaline 0.5 mg of 1:1000 solution into the anterolateral thigh for adults, repeated every five minutes if needed. Antihistamines and steroids are adjuncts only.

HbA1c diagnostic threshold

An HbA1c of 6.5 percent (48 mmol/mol) or above meets criteria for diabetes, alongside fasting glucose 7.0 mmol/L or higher or two-hour OGTT 11.1 mmol/L or higher.

Anti-CCP antibody utility

Anti-cyclic citrullinated peptide antibody is more specific than rheumatoid factor for rheumatoid arthritis and predicts more erosive disease, aiding early diagnosis.

Berlin ARDS definition

Onset within one week of a known insult, bilateral opacities not fully explained by cardiac failure, and PaO2/FiO2 ratio of 300 mmHg or less on PEEP of 5 or more.

Corrected sodium in hyperglycaemia

Add 2.4 mmol/L to measured sodium for every 5.5 mmol/L that glucose exceeds 5.5 mmol/L. This estimates the true sodium before hyperglycaemic dilution.

HFrEF four pillars

For heart failure with reduced ejection fraction, combine an ACE inhibitor, ARB or ARNI, a beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor; each lowers mortality.

CHA2DS2-VASc anticoagulation threshold

Anticoagulation is generally recommended at a score of 2 or more in men and 3 or more in women with atrial fibrillation; DOACs are preferred in non-valvular disease.

Post-cardiac-arrest targeted temperature

Maintain a constant temperature between 32 and 37.5 degrees Celsius for at least 24 hours, actively avoiding fever, alongside normoxia and normocapnia.

Calculated serum osmolality

Twice the sodium plus glucose plus urea, all in mmol/L. A measured value more than 10 mOsm/kg above calculated suggests an osmolar gap from toxic alcohols.

Nephrotic syndrome criteria

Proteinuria above 3.5 g per day, serum albumin below 30 g/L, generalised oedema, and hyperlipidaemia. Red cell casts and hypertension suggest a nephritic picture instead.

CURB-65 score interpretation

Scores of 0 to 1 support outpatient management, 2 suggests inpatient admission, and 3 or more indicates severe pneumonia warranting critical care assessment.

Acute severe asthma adjunct

Intravenous magnesium sulphate is considered in severe asthma not responding to inhaled bronchodilators and steroids. A rising PaCO2 signals impending respiratory failure.

Spirometry obstruction pattern

Obstruction shows a reduced FEV1/FVC ratio below 0.70. Restriction shows reduced FVC with a preserved or raised ratio, confirmed by reduced lung volumes.

Primary hypothyroidism pattern

Raised TSH with low free T4 indicates primary hypothyroidism. Raised TSH with normal free T4 is subclinical disease. Low free T4 with low or normal TSH suggests central hypothyroidism.

Spontaneous bacterial peritonitis threshold

An ascitic fluid neutrophil count of 250 cells per cubic millimetre or greater establishes the diagnosis; start empirical antibiotics immediately while awaiting culture.

Sepsis-3 operational definition

Life-threatening organ dysfunction caused by a dysregulated host response to infection, operationalised as an acute rise in SOFA score of 2 points or more.

Troponin kinetics in infarction

High-sensitivity troponin rises within 3 to 6 hours, peaks at 12 to 24 hours, and stays elevated 7 to 14 days. A rise-and-fall pattern above the 99th percentile defines infarction.

Heart failure with preserved ejection fraction

Diagnosed when ejection fraction is 50 percent or above with evidence of raised filling pressures, such as elevated natriuretic peptides or diastolic dysfunction on echocardiography.

Stroke thrombectomy window

Mechanical thrombectomy is offered up to 24 hours after onset in selected large-vessel occlusion with salvageable brain tissue, while intravenous thrombolysis is generally limited to 4.5 hours.

DKA potassium replacement rule

Start potassium replacement once serum potassium is below 5.5 mmol/L, since total body potassium is depleted even when serum values appear normal or high.

MCV anaemia classification

Microcytic anaemia below 80 fL suggests iron deficiency, thalassaemia, or chronic disease. Macrocytic anaemia above 100 fL suggests B12 or folate deficiency, alcohol, or hypothyroidism.

GOLD ABE grouping

COPD is grouped by exacerbation history and symptoms: A low symptoms and low risk, B high symptoms and low risk, E two or more moderate exacerbations or one hospitalisation.

Nephritic syndrome features

Haematuria with red cell casts, hypertension, oliguria, and proteinuria below nephrotic range. Causes include post-infectious glomerulonephritis and IgA nephropathy.

qSOFA bedside criteria

Respiratory rate 22 or more, altered mentation with Glasgow Coma Scale below 15, and systolic blood pressure 100 mmHg or less. Two or more points flag high mortality risk in suspected infection.

AST to ALT ratio clue

A ratio above 2 suggests alcoholic liver disease. Most other chronic liver diseases, including viral hepatitis and steatosis, produce ratios below 1.

Subclinical hypothyroidism

Raised TSH with normal free T4. Treatment is usually considered when TSH exceeds 10 mIU/L, or when symptoms or cardiovascular risk are present.

Ascites first-line diuretics

Spironolactone with or without furosemide, combined with dietary sodium restriction, is first-line therapy for cirrhotic ascites; monitor weight and renal function closely.