PNA (Internato Médico) cheat sheet

Cardiac output = heart rate × stroke volume; mean arterial pressure ≈ diastolic + 1/3 (systolic − diastolic).

Anion gap = Na⁺ − (Cl⁻ + HCO₃⁻); normal 8–12 mEq/L; raised gap implies added acids (ketoacidosis, lactate, uremia, toxins).

Corrected sodium for hyperglycemia: add 1.6 mEq/L to measured Na⁺ per 100 mg/dL glucose above 100.

Wells score for DVT/PE and CURB-65 for pneumonia are pretest-probability tools; they stratify, they do not confirm diagnosis.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); a highly sensitive test is best for ruling out (SnNout).

Survival analysis: Kaplan-Meier estimates survival; log-rank test compares curves; hazard ratio from Cox model.

Randomized controlled trial phases: I safety/dosing, II efficacy signal, III comparative efficacy, IV post-marketing surveillance.

Notifiable diseases in Portugal include tuberculosis, measles, meningococcal disease, and legionellosis; notification is mandatory and timely.

Ethical pillars: autonomy, beneficence, non-maleficence, justice; informed consent requires capacity, information, and voluntariness.

Acute coronary syndrome: serial high-sensitivity troponin with 0/1h or 0/3h algorithms; ST elevation mandates reperfusion (PCI within 120 min of first medical contact).

Acute heart failure: IV loop diuretic for congestion; avoid beta-blockers in decompensation; monitor K⁺ and renal function.

Diabetic ketoacidosis: isotonic saline, insulin infusion after K⁺ ≥3.3 mEq/L, add dextrose when glucose <200–250 mg/dL, replace potassium.

Sepsis: cultures before antibiotics, broad-spectrum antibiotics within 1 hour of recognition, 30 mL/kg crystalloid for hypotension or lactate ≥4.

Stroke: non-contrast CT excludes hemorrhage; IV thrombolysis window up to 4.5 h; thrombectomy up to 24 h in selected large-vessel occlusion.

Community-acquired pneumonia: CURB-65 ≥2 suggests admission; severity plus oxygenation guides site of care.

Upper GI bleeding: Glasgow-Blatchford score identifies very-low-risk patients suitable for outpatient management; pre-endoscopic PPI.

Pulmonary embolism: hemodynamic instability warrants systemic thrombolysis; stable patients use risk stratification (sPESI, RV strain) to choose home vs ward vs ICU.

Hyperkalemia with ECG changes: IV calcium gluconate first for membrane stabilization, then insulin/dextrose and salbutamol to shift K⁺ intracellularly.