PANCE flashcards

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

Beck triad

In cardiac tamponade, the combination of hypotension, elevated jugular venous pressure, and muffled heart sounds; pulsus paradoxus and electrical alternans on ECG may also be present.

HFrEF guideline-directed therapy

For symptomatic heart failure with reduced ejection fraction, combine an ARNI (or ACE inhibitor/ARB), an evidence-based beta blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor unless contraindicated.

CHA2DS2-VASc score

Atrial fibrillation stroke risk score: congestive failure, hypertension, age ≥75 (2 points), diabetes, stroke or TIA (2 points), vascular disease, age 65-74, female sex. Anticoagulate at ≥2 in men or ≥3 in women.

Light criteria exudate

Pleural fluid is exudative when the pleural-to-serum protein ratio exceeds 0.5, the pleural-to-serum LDH ratio exceeds 0.6, or pleural LDH exceeds two-thirds the upper limit of normal serum LDH.

CURB-65 components

Pneumonia severity score of one point each for confusion, urea (BUN) >19 mg/dL, respiratory rate ≥30, blood pressure <90 systolic or ≤60 diastolic, and age ≥65 years.

Obstructive spirometry pattern

Airflow obstruction is a post-bronchodilator FEV1/FVC below 0.70, with severity graded by FEV1 percent predicted; restriction instead shows reduced FVC with a normal or increased ratio.

Lachman test

The most sensitive examination maneuver for anterior cruciate ligament disruption: with the knee flexed about 30 degrees, the tibia is translated anteriorly and a soft or absent endpoint indicates a tear.

Compartment syndrome pressure threshold

Acute compartment syndrome is suggested by pain out of proportion and pain with passive stretch; fasciotomy is indicated when intracompartmental pressure exceeds 30 mmHg or lies within 30 mmHg of diastolic pressure.

Gout crystal appearance

Gout produces needle-shaped, negatively birefringent monosodium urate crystals; pseudogout from calcium pyrophosphate deposition produces rhomboid, positively birefringent crystals, commonly in the knee.

Serum-ascites albumin gradient

Serum albumin minus ascitic fluid albumin. A gradient of 1.1 g/dL or more indicates portal hypertension from cirrhosis or heart failure; a lower gradient suggests peritoneal malignancy or tuberculosis.

SBP diagnostic threshold

Spontaneous bacterial peritonitis is diagnosed when ascitic fluid polymorphonuclear cells reach 250/mm³ or more; treat with a third-generation cephalosporin and add intravenous albumin to reduce renal failure.

Celiac disease serology

Screen with tissue transglutaminase IgA plus a total IgA level because IgA deficiency causes false negatives; confirm with duodenal biopsy showing villous blunting and crypt hyperplasia while on a gluten-containing diet.

Fractional excretion of sodium

FENa equals (urine sodium × plasma creatinine) divided by (plasma sodium × urine creatinine), times 100. Values below 1% favor prerenal azotemia; values above 2% favor acute tubular necrosis.

Nephrotic syndrome criteria

Nephrotic syndrome requires proteinuria above 3.5 g per day, hypoalbuminemia, edema, and hyperlipidemia; it lacks the red cell casts and active urinary sediment characteristic of nephritic syndrome.

Preeclampsia definition

New hypertension of 140/90 mmHg or higher after 20 weeks of gestation with proteinuria or end-organ dysfunction; delivery is definitive treatment and magnesium sulfate prevents and treats associated seizures.

RhoGAM administration timing

Give anti-D immune globulin to Rh-negative unsensitized mothers at about 28 weeks, within 72 hours of delivering an Rh-positive infant, and after amniocentesis, abortion, or antepartum bleeding.

Rotterdam PCOS criteria

Polycystic ovary syndrome is diagnosed by two of three findings: oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology, after excluding other causes.

DKA potassium rule

Total body potassium is depleted in diabetic ketoacidosis; if serum potassium is below 3.3 mEq/L, hold insulin and replete potassium first, because insulin shifts potassium intracellularly and can precipitate arrhythmia.

Thyroid storm treatment order

Treat thyroid storm with a beta blocker, then propylthiouracil, then iodine given at least one hour after the thionamide, along with supportive care and treatment of the precipitating illness.

Primary hyperparathyroidism calcium

It is the most common outpatient cause of hypercalcemia and shows an inappropriately normal or elevated parathyroid hormone level; malignancy is the most common inpatient cause and shows suppressed parathyroid hormone.

Alteplase stroke window

Intravenous alteplase is given within 4.5 hours of ischemic stroke onset when blood pressure is below 185/110 mmHg and head imaging shows no hemorrhage, with no other contraindication present.

Subarachnoid hemorrhage workup

Thunderclap headache warrants a noncontrast head CT first; if CT is negative and suspicion persists beyond six hours, lumbar puncture demonstrating xanthochromia confirms subarachnoid hemorrhage.

Myasthenia gravis antibodies

Myasthenia gravis causes fatigable ptosis and diplopia; acetylcholine receptor antibodies are most common and chest imaging should exclude thymoma. Treatment includes pyridostigmine and immunotherapy.

Serotonin syndrome features

Caused by serotonergic drugs, it features agitation, autonomic instability, hyperthermia, tremor, clonus (especially at the ankle), and hyperreflexia; stop the offending agents and consider cyproheptadine.

Neuroleptic malignant syndrome

Rigidity, hyperthermia, altered mental status, and elevated creatine kinase after dopamine antagonist exposure; treatment is stopping the drug plus dantrolene or bromocriptine and supportive care.

Heparin-induced thrombocytopenia

An immune reaction occurring 5-10 days after heparin exposure, with platelet count falling more than 50% and high thrombosis risk; stop heparin and start a non-heparin anticoagulant such as argatroban.

TTP pentad

Thrombotic thrombocytopenic purpura shows microangiopathic hemolytic anemia with schistocytes, thrombocytopenia, neurologic symptoms, renal injury, and fever from ADAMTS13 deficiency; treat with urgent plasma exchange.

Iron deficiency labs

Iron deficiency anemia is microcytic with low ferritin, low serum iron, high total iron-binding capacity, and low transferrin saturation; anemia of chronic disease instead shows low TIBC and normal or elevated ferritin.

Acute angle-closure glaucoma

Presents with severe eye pain, headache, halos, nausea, and a mid-dilated fixed pupil with hazy cornea; lower intraocular pressure with a topical beta blocker, pilocarpine, and systemic agents, then perform laser iridotomy.

SJS versus TEN

Drug-related epidermal necrolysis: Stevens-Johnson syndrome detaches less than 10% of body surface area, toxic epidermal necrolysis more than 30%, and overlap cases 10-30%; stop the drug and give supportive care.

Septic shock bundle

Septic shock is sepsis requiring vasopressors to maintain mean arterial pressure of 65 mmHg or more with lactate above 2 mmol/L despite fluids; obtain cultures and give broad-spectrum antibiotics within one hour.

Tuberculin skin test thresholds

Purified protein derivative induration of 5 mm or more for HIV, immunosuppression, or recent contact; 10 mm or more for high-risk groups; 15 mm or more for low-risk patients. Interferon-gamma release assays are alternatives.