PANRE cheat sheet

ACC/AHA BP categories: normal <120/<80; elevated 120-129/<80; stage 1 130-139 or 80-89; stage 2 >=140 or >=90 mmHg.

CHA2DS2-VASc points: CHF, hypertension, age >=75 (2), diabetes, stroke/TIA (2), vascular disease, age 65-74, female sex; anticoagulate at >=2 in men, >=3 in women.

STEMI reperfusion: primary PCI within 90 minutes of first medical contact, or fibrinolysis within 30 minutes when PCI is unavailable and symptoms began <12 hours.

HFrEF (EF <=40%) four pillars: ARNI or ACE inhibitor, evidence-based beta-blocker, mineralocorticoid receptor antagonist, SGLT2 inhibitor.

Pericarditis: positional pleuritic pain relieved by leaning forward, diffuse concave ST elevation with PR depression; treat with NSAID plus colchicine.

Aortic stenosis triad of exertional angina, syncope, and dyspnea; crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids with delayed carotid upstroke.

HOCM murmur gets louder with Valsalva and standing and softer with squatting and handgrip, reflecting dynamic outflow obstruction.

Digoxin toxicity: nausea, visual halos or yellow-green vision, and bradyarrhythmias; risk rises with hypokalemia and renal impairment; Fab fragments for severe cases.

ASCVD secondary prevention: high-intensity statin targeting >=50% LDL reduction and LDL cholesterol <70 mg/dL.

COPD is confirmed by a post-bronchodilator FEV1/FVC ratio <0.70.

Asthma reversibility: >=12% and >=200 mL increase in FEV1 after inhaled bronchodilator.

Light criteria define an exudate if any one holds: pleural/serum protein >0.5, pleural/serum LDH >0.6, or pleural LDH >2/3 the upper limit of normal serum LDH.

CURB-65: confusion, urea >7 mmol/L (BUN >19 mg/dL), respiratory rate >=30, SBP <90 or DBP <=60, age >=65; score >=2 favors inpatient care.

PE workup: PERC to exclude in low pretest probability, D-dimer for low or intermediate probability, CT pulmonary angiography for high probability or positive D-dimer, V/Q scan if contrast is contraindicated.

ABG rules: pH <7.35 with PaCO2 >45 mmHg is respiratory acidosis; pH >7.45 with PaCO2 <35 mmHg is respiratory alkalosis.

Tension pneumothorax: hypotension, distended neck veins, absent breath sounds, and tracheal deviation away from the affected side; decompress before imaging.

STOP-BANG score >=3 indicates high risk for obstructive sleep apnea; confirm with polysomnography or home sleep testing.

AST:ALT ratio >2:1 suggests alcohol-related liver injury; ALT > AST favors viral or metabolic steatohepatitis.

Acute pancreatitis requires two of three: characteristic epigastric pain radiating to the back, lipase >3x upper limit of normal, and imaging findings.

Variceal upper GI bleeding: octreotide plus prophylactic ceftriaxone with endoscopy within 12 hours; band ligation is preferred over sclerotherapy.

H. pylori: urea breath test or stool antigen detects active infection (hold PPI for 2 weeks); serology cannot confirm eradication.

Celiac disease: IgA tissue transglutaminase with total IgA; duodenal biopsy is confirmatory, and gluten must not be withdrawn before testing.

Ulcerative colitis is continuous and begins in the rectum; Crohn disease is transmural with skip lesions, fistulas, and perianal involvement.

Child-Pugh variables: bilirubin, albumin, INR, ascites, encephalopathy; class A 5-6, class B 7-9, class C 10-15.

Refeeding syndrome: hypophosphatemia with hypokalemia and hypomagnesemia; start at 10-20 kcal/kg/day, give thiamine, and replete electrolytes.

Enteral nutrition targets in critical illness: 25-30 kcal/kg/day with protein 1.2-2.0 g/kg/day.

Ottawa ankle rules: radiograph if malleolar pain plus bone tenderness at the posterior edge of either malleolus or inability to bear weight four steps.

Septic arthritis: synovial WBC >50,000/mm3 with >90% neutrophils, positive Gram stain or culture; urgent drainage plus empiric IV antibiotics.

Gout crystals are needle-shaped and negatively birefringent; pseudogout crystals are rhomboid and positively birefringent under polarized light.

Compartment syndrome: pain out of proportion and pain on passive stretch; delta pressure (diastolic minus compartment) <30 mmHg warrants fasciotomy.

Osteoporosis: DEXA T-score <=-2.5; osteopenia is -1.0 to -2.5; FRAX estimates 10-year major fracture risk.

Carpal tunnel syndrome: median nerve symptoms sparing the palm, worse at night, with positive Tinel and Phalen signs; splinting and steroid injection first.

Rotator cuff tear: painful arc with weakness in abduction; a positive drop-arm sign suggests a full-thickness supraspinatus tear.

Cauda equina syndrome: saddle anesthesia, urinary retention, bilateral leg weakness and areflexia; emergent MRI and surgical decompression.

Acute otitis media: bulging, opaque, erythematous tympanic membrane; high-dose amoxicillin first line; observe 48-72 hours in selected children 6-23 months without severe signs.

Otitis externa is usually Pseudomonas or S. aureus; treat with topical fluoroquinolone plus steroid drops; consider malignant otitis externa in diabetics with severe pain.

BPPV: positive Dix-Hallpike maneuver treated with the Epley canalith repositioning procedure; imaging is unnecessary when the presentation is classic.

HINTS exam in acute vestibular syndrome: a normal head impulse test, direction-changing nystagmus, or skew deviation points to a central cause.

Epiglottitis: drooling, muffled voice, tripod positioning, high fever; do not use a tongue blade, and secure the airway in a controlled setting.

Centor criteria: tonsillar exudates, tender anterior cervical adenopathy, fever, absence of cough; penicillin or amoxicillin for confirmed group A strep.

Acute angle-closure glaucoma: severe eye pain, halos, mid-dilated fixed pupil, nausea, IOP often >40 mmHg; lower IOP emergently and refer to ophthalmology.

Sudden sensorineural hearing loss: >=30 dB loss across three contiguous frequencies within 72 hours; start high-dose corticosteroids urgently.

Anterior epistaxis arises from Kiesselbach plexus and responds to pressure, topical vasoconstrictor, and cautery; posterior bleeding from the sphenopalatine artery needs packing and ENT.

Naegele rule: estimated due date = first day of last menstrual period + 280 days (LMP minus 3 months plus 7 days).

Transvaginal ultrasound discriminatory zone is hCG 1,500-3,500 mIU/mL; an empty uterus above this level raises concern for ectopic pregnancy.

Preeclampsia: BP >=140/90 after 20 weeks plus proteinuria or end-organ dysfunction; severe features include BP >=160/110, platelets <100,000, AST/ALT >2x normal, creatinine >1.1, pulmonary edema, and visual symptoms.

Severe preeclampsia: labetalol, hydralazine, or nifedipine for blood pressure; magnesium sulfate for seizure prophylaxis; delivery is definitive therapy.

Gestational diabetes screening at 24-28 weeks with a 50-g one-hour glucose challenge; a value >=140 mg/dL triggers a 3-hour oral glucose tolerance test.

Cervical cancer screening: age 21-29 cytology every 3 years; age 30-65 co-testing with cytology plus HPV every 5 years or cytology alone every 3 years.

Estrogen-containing contraceptives are contraindicated with migraine with aura, smoking at age >=35, prior VTE, and breastfeeding <3 weeks postpartum.

PCOS Rotterdam criteria require 2 of 3: oligo-ovulation or anovulation, hyperandrogenism, polycystic ovaries, after excluding thyroid, prolactin, and adrenal disease.

Anti-D immune globulin is given at 28 weeks and within 72 hours postpartum when the infant is Rh-positive, plus after any sensitizing event.

DKA: glucose >250 mg/dL, pH <7.3, bicarbonate <18 mEq/L, elevated anion gap, positive ketones; give isotonic fluids, replace potassium, then start IV insulin.

HHS: glucose often >600 mg/dL, serum osmolality >320 mOsm/kg, minimal ketosis, and profound dehydration.

Primary hypothyroidism: elevated TSH with low free T4; subclinical disease is high TSH with normal free T4; levothyroxine about 1.6 mcg/kg/day.

Thyroid storm: fever, tachycardia, agitation, heart failure; give beta-blocker, then PTU, then iodine at least 1 hour after PTU, plus glucocorticoids.

Primary adrenal insufficiency: hyponatremia, hyperkalemia, hypotension, hyperpigmentation; confirm with cosyntropin stimulation testing.

Primary hyperaldosteronism: elevated aldosterone with suppressed renin; screen with the aldosterone-to-renin ratio in resistant hypertension.

Diabetes diagnosis: A1c >=6.5%, fasting glucose >=126 mg/dL, 2-hour OGTT >=200 mg/dL, or random glucose >=200 mg/dL with symptoms.

Metformin is first-line therapy; add a GLP-1 receptor agonist or SGLT2 inhibitor when ASCVD, heart failure, or chronic kidney disease is present.

Prolactinoma: dopamine agonist (cabergoline) is first-line; surgery is reserved for intolerance, resistance, or compressive symptoms.

Ischemic stroke: IV thrombolysis within 4.5 hours of onset and mechanical thrombectomy up to 24 hours in selected large-vessel occlusion; exclude hemorrhage on CT first.

Thunderclap headache: noncontrast CT within 6 hours is highly sensitive for subarachnoid hemorrhage; if negative with ongoing suspicion, perform LP for xanthochromia.

Bacterial meningitis: vancomycin plus ceftriaxone, add ampicillin if age >50 or immunocompromised; give dexamethasone with or before the first antibiotic dose.

Status epilepticus: benzodiazepine first (IV lorazepam or IM midazolam), then levetiracetam, fosphenytoin, or valproate if seizures persist.

Parkinson disease: asymmetric resting tremor, cogwheel rigidity, bradykinesia, postural instability; carbidopa-levodopa is the most effective treatment.

Myasthenia gravis: fatigable weakness with ptosis and diplopia, positive ice pack test and anti-acetylcholine receptor antibodies; watch for respiratory failure.

Triptans are contraindicated in coronary artery disease, uncontrolled hypertension, and within 24 hours of ergotamine use.

Multiple sclerosis: McDonald criteria require dissemination in space and time; CSF oligoclonal bands support the diagnosis.

Major depression: >=5 of 9 symptoms for >=2 weeks including depressed mood or anhedonia; SSRIs are first line and response is judged at 4-6 weeks.

Bipolar I mania: >=1 week of elevated or irritable mood plus 3 (4 if irritable) of grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased activity, risky behavior.

Antidepressant monotherapy in bipolar disorder can precipitate mania; pair with a mood stabilizer, often plus an atypical antipsychotic.

Alcohol withdrawal: benzodiazepines titrated to CIWA-Ar; give thiamine before or with glucose; delirium tremens peaks at 48-96 hours.

Serotonin syndrome: clonus, hyperreflexia, hyperthermia, and agitation after serotonergic agents; stop the drugs, provide supportive care, use cyproheptadine for moderate-severe cases.

Neuroleptic malignant syndrome: rigidity, fever >38 C, altered mental status, elevated CK after dopamine antagonists; stop the drug and use dantrolene or bromocriptine.

Delirium screening: acute onset with fluctuating course and inattention; the CAM and 4AT are validated bedside tools.

Panic attacks peak within 10 minutes; exertional chest pain or syncope should prompt cardiac evaluation before an anxiety diagnosis.

OCD first-line treatment is an SSRI combined with cognitive behavioral therapy using exposure and response prevention.

AKI by KDIGO: creatinine rise >=0.3 mg/dL within 48 hours, >=1.5x baseline within 7 days, or urine output <0.5 mL/kg/hour for 6 hours.

FeNa <1% suggests prerenal azotemia and >2% suggests intrinsic injury; use the fractional excretion of urea when diuretics are active.

Hyperkalemia with ECG changes: IV calcium first, then insulin with glucose, albuterol, and sodium bicarbonate; dialysis for refractory or severe cases.

CKD stages by GFR: G1 >=90, G2 60-89, G3a 45-59, G3b 30-44, G4 15-29, G5 <15 mL/min/1.73 m2.

Nephrotic syndrome: proteinuria >3.5 g/day, albumin <3.5 g/dL, edema, hyperlipidemia; minimal change disease in children responds to corticosteroids.

Nephritic syndrome: hematuria with RBC casts, hypertension, oliguria, and proteinuria; consider post-streptococcal glomerulonephritis and IgA nephropathy.

Uncomplicated cystitis: nitrofurantoin for 5 days or TMP-SMX for 3 days when local resistance is <20%; avoid nitrofurantoin when CrCl <30 mL/min.

BPH: alpha blocker such as tamsulosin for rapid symptom relief; a 5-alpha reductase inhibitor shrinks glands >30 mL over months.

Testicular torsion: sudden severe pain, absent cremasteric reflex, high-riding testis; surgical exploration within 6 hours to preserve the testis.