PANRE-LA flashcards

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

CHA2DS2-VASc anticoagulation threshold

Anticoagulation is recommended for atrial fibrillation when the score is 2 or higher in men and 3 or higher in women; a score of 1 in men or 2 in women is reasonable to consider.

HFrEF quadruple therapy

Guideline-directed medical therapy for heart failure with reduced ejection fraction combines an ARNI, ACE inhibitor, or ARB with an evidence-based beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor.

Aortic stenosis severity criteria

Severe aortic stenosis is defined by an aortic valve area of 1.0 cm² or less, a mean gradient of 40 mmHg or more, or a peak velocity of 4 m/s or greater.

Light's criteria exudate

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

Tension pneumothorax management

Immediate needle decompression without waiting for imaging, followed by tube thoracostomy; place the needle at the second intercostal space midclavicular line or fifth space anterior axillary line.

CURB-65 components

One point each for confusion, urea nitrogen above 19 mg/dL, respiratory rate 30 or more, blood pressure below 90 systolic or 60 diastolic, and age 65 or older.

Spontaneous bacterial peritonitis threshold

Ascitic fluid polymorphonuclear count of 250 cells/mm³ or greater establishes the diagnosis; start empiric ceftriaxone and give intravenous albumin to reduce renal failure risk.

Pancreatitis lipase criterion

Acute pancreatitis requires two of three features: characteristic epigastric pain radiating to the back, lipase or amylase greater than three times the upper limit of normal, and imaging findings.

Celiac disease serology

Tissue transglutaminase IgA with total IgA is the preferred screen; confirm with duodenal biopsy showing villous blunting, and treat with a lifelong gluten-free diet.

Gout versus pseudogout crystals

Gout shows needle-shaped, negatively birefringent monosodium urate crystals; pseudogout shows rhomboid, positively birefringent calcium pyrophosphate crystals; both provoke acute monoarthritis.

Septic arthritis empiric treatment

Aspirate the joint before antibiotics; start empiric intravenous vancomycin plus ceftriaxone, then tailor to culture; gonococcal infection is common in young sexually active adults.

Osteoporosis T-score definition

A T-score of -2.5 or lower at the hip or spine defines osteoporosis; scores between -1.0 and -2.5 indicate osteopenia; a fragility fracture alone also establishes osteoporosis.

KDIGO acute kidney injury criteria

AKI is a creatinine rise of 0.3 mg/dL or more within 48 hours, a rise to 1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/h for 6 hours.

Nephrotic syndrome triad

Nephrotic syndrome is defined by proteinuria above 3.5 g per day, hypoalbuminemia, and edema, with hyperlipidemia; minimal change disease is the most common cause in children.

Nitrofurantoin renal cutoff

Avoid nitrofurantoin for cystitis when creatinine clearance is below 30 mL/min because inadequate urinary concentrations reduce efficacy and increase toxicity; choose an alternative such as fosfomycin.

Alteplase window ischemic stroke

Intravenous thrombolysis is given within 4.5 hours of symptom onset after noncontrast head CT excludes hemorrhage; blood pressure must be below 185/110 mmHg before treatment.

Status epilepticus first-line

Give a benzodiazepine such as lorazepam or midazolam first, then a second-line antiseizure medication such as levetiracetam, fosphenytoin, or valproate if seizures continue.

Subarachnoid hemorrhage diagnosis

Thunderclap headache warrants noncontrast CT, which is highly sensitive within 6 hours; if negative and suspicion persists, perform lumbar puncture for xanthochromia or CT angiography.

DKA diagnostic triad

Diabetic ketoacidosis requires hyperglycemia above 250 mg/dL, ketonemia or ketonuria, and anion gap metabolic acidosis; treatment is isotonic fluids, insulin infusion, and potassium replacement.

Thyroid storm treatment sequence

Give a thionamide first, then iodine at least one hour later, plus a beta-blocker and glucocorticoids; treat precipitating illness and provide supportive care in an intensive setting.

Primary aldosteronism screening

Screen with a plasma aldosterone-to-renin ratio when hypertension is resistant or accompanied by hypokalemia; confirm with salt loading, then use adrenal CT and adrenal vein sampling.

Heparin-induced thrombocytopenia features

Platelets fall more than 50 percent typically 5 to 10 days after heparin exposure and thrombosis occurs rather than bleeding; stop heparin and start a non-heparin anticoagulant such as argatroban.

Febrile neutropenia empiric therapy

Fever of 38.3°C once or 38.0°C sustained with absolute neutrophil count below 500 cells/mm³ requires antipseudomonal beta-lactam antibiotics within 60 minutes of presentation.

Iron deficiency laboratory pattern

Iron deficiency shows low ferritin, low serum iron, high total iron binding capacity, and low transferrin saturation; ferritin is an acute phase reactant and may be normal in inflammation.

Melanoma ABCDE criteria

Asymmetry, irregular Border, variegated Color, Diameter above 6 mm, and Evolution are warning signs; Breslow thickness is the strongest prognostic factor and guides margins and staging.

Cellulitis versus purulent abscess

Nonpurulent cellulitis is treated with cephalexin or dicloxacillin; a fluctuant abscess needs incision and drainage, with MRSA-active antibiotics added for systemic signs or extensive disease.

Sepsis one-hour bundle

Measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics, and give 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or higher.

Clostridioides difficile first-line therapy

Oral fidaxomicin or oral vancomycin treats initial episodes; stop the inciting antibiotic when possible, and reserve fecal microbiota transplantation for recurrent disease after appropriate courses.

Serotonin syndrome features

Clonus, hyperreflexia, agitation, diaphoresis, and hyperthermia after serotonergic drugs define the syndrome; stop the agents, give supportive care, and use cyproheptadine in moderate cases.

Alcohol withdrawal treatment

Use symptom-triggered benzodiazepines guided by the CIWA-Ar scale, give thiamine before glucose, and monitor for delirium tremens, which peaks 48 to 96 hours after the last drink.

Preeclampsia severe features

Blood pressure of 160/110 mmHg or higher, platelets below 100,000, elevated liver enzymes, creatinine above 1.1 mg/dL, pulmonary edema, or new cerebral or visual symptoms define severe disease.

Ectopic pregnancy methotrexate criteria

Methotrexate is an option when the patient is hemodynamically stable, unruptured, hCG is low and rising, mass is small without fetal cardiac activity, and follow-up is reliable.