- Beck's triad
- Hypotension + jugular venous distension + muffled heart sounds = cardiac tamponade.
- STEMI
- ST elevation at least 1 mm in at least 2 contiguous leads (or new LBBB); transmural occlusion → emergent reperfusion (primary PCI).
- NSTEMI
- Elevated troponin with ST depression/T inversion but no ST elevation; partial occlusion → medical therapy + early angiography (no lytics).
- Unstable angina
- Ischemic chest pain at rest/crescendo with a NORMAL troponin (no necrosis yet).
- Troponin
- Cardiac biomarker of myocyte injury; elevated separates MI (STEMI/NSTEMI) from unstable angina.
- STEMI treatment
- Emergent reperfusion — primary PCI preferred; fibrinolysis if PCI unavailable within the time window.
- Most common cause of sudden cardiac death in young athletes
- Hypertrophic cardiomyopathy (asymmetric septal hypertrophy).
- Aortic dissection clue
- Tearing chest pain radiating to the back + unequal arm blood pressures; widened mediastinum on CXR.
- HFrEF four pillars
- ACE inhibitor/ARB or ARNI, beta-blocker, mineralocorticoid antagonist (MRA), and an SGLT2 inhibitor.
- HFrEF vs HFpEF
- HFrEF = ejection fraction up to 40% (systolic); HFpEF = preserved EF (diastolic dysfunction).
- Left-sided heart failure signs
- Pulmonary congestion: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles.
- Right-sided heart failure signs
- Systemic congestion: peripheral edema, JVD, hepatomegaly, ascites.
- BNP
- Natriuretic peptide elevated in heart failure; helps distinguish cardiac from pulmonary dyspnea.
- Stage 1 hypertension (ACC/AHA)
- Systolic 130–139 mmHg or diastolic 80–89 mmHg.
- Stage 2 hypertension (ACC/AHA)
- Systolic at least 140 mmHg or diastolic at least 90 mmHg.
- First-line antihypertensives
- Thiazide diuretic, ACE inhibitor/ARB, or calcium channel blocker.
- Atrial fibrillation ECG
- Irregularly irregular rhythm with NO discrete P waves.
- CHA₂DS₂-VASc
- Stroke-risk score in non-valvular AFib guiding anticoagulation (CHF, HTN, Age, DM, Stroke, Vascular, Age 65–74, Sex).
- Warfarin monitoring
- PT/INR; target INR 2–3 for most indications including AFib.
- Aortic stenosis murmur
- Crescendo–decrescendo systolic murmur radiating to the carotids; triad of syncope, angina, dyspnea.
- Mitral regurgitation murmur
- Holosystolic murmur best at the apex, radiating to the axilla.
- Mitral stenosis murmur
- Mid-diastolic rumble with an opening snap; often from rheumatic heart disease.
- Acute pericarditis
- Pleuritic chest pain relieved by sitting forward; diffuse ST elevation + PR depression; friction rub.
- Cardiac tamponade physiology
- Pericardial fluid → impaired filling; pulsus paradoxus, Beck's triad, electrical alternans.
- Wolff-Parkinson-White
- Accessory pathway → short PR, delta wave, wide QRS; risk of tachyarrhythmias.
- Stable angina treatment
- Sublingual nitroglycerin for symptoms; beta-blocker and risk-factor control to prevent.
- Deep vein thrombosis
- Unilateral leg swelling/pain; diagnose with compression ultrasound; anticoagulate.
- Peripheral arterial disease
- Intermittent claudication, ↓ ankle-brachial index (ABI < 0.9), diminished pulses.
- Cardiogenic shock
- Pump failure (often post-MI): ↓ cardiac output, ↑ preload, ↑ SVR, cold/clammy.
- Hypovolemic shock
- Volume loss (hemorrhage/dehydration): ↓ preload, ↑ SVR, cold; treat the cause + fluids.
- Distributive shock
- Sepsis/anaphylaxis/neurogenic: vasodilation, ↓ SVR, warm early; norepinephrine for sepsis.
- Obstructive shock
- Tamponade, tension pneumothorax, or massive PE block flow; relieve the obstruction.
- Anaphylaxis treatment
- Intramuscular epinephrine FIRST, then airway, fluids, antihistamines, and steroids.
- Ventricular fibrillation
- Pulseless, chaotic rhythm — immediate defibrillation + CPR.
- Third-degree (complete) heart block
- AV dissociation (P waves and QRS independent); needs a pacemaker.
- Pulmonary hypertension
- Elevated pulmonary pressures → right heart strain; loud P2, dyspnea on exertion.
- Statin indication
- Lower LDL in clinical ASCVD, LDL at least 190, diabetes 40–75, or elevated 10-year risk.
- Asthma vs COPD reversibility
- Asthma reverses (FEV₁ ↑ at least 12% and at least 200 mL post-bronchodilator); COPD obstruction is fixed.
- Obstructive pattern on spirometry
- FEV₁/FVC ratio < 0.70.
- COPD risk factor
- Cigarette smoking.
- Asthma stepwise therapy
- Inhaled corticosteroids are the controller backbone; add LABA as needed.
- CURB-65
- Pneumonia severity: Confusion, Urea, Respiratory rate, Blood pressure, age at least 65.
- Pulmonary embolism workup
- Low Wells + negative D-dimer rules out; high Wells → CT pulmonary angiography.
- Wells criteria
- Pretest probability score for pulmonary embolism (and DVT).
- Tension pneumothorax
- Hypotension, absent breath sounds, tracheal deviation away — immediate needle decompression.
- Spontaneous pneumothorax
- Tall, thin young smokers; sudden pleuritic pain and dyspnea.
- Tuberculosis presentation
- Apical disease, chronic cough, night sweats, weight loss, hemoptysis.
- ARDS
- Acute bilateral infiltrates + hypoxemia not from heart failure; low-tidal-volume ventilation.
- Pleural effusion (Light's criteria)
- Distinguishes exudate from transudate using protein and LDH ratios.
- Obstructive sleep apnea
- Snoring, daytime sleepiness, witnessed apneas; diagnose with polysomnography.
- Lung cancer (small cell)
- Central, aggressive, strongly smoking-related; paraneoplastic syndromes (SIADH).
- Croup
- Barking cough and inspiratory stridor in young children; 'steeple sign' on X-ray.
- Bronchiolitis
- RSV in infants; wheezing and respiratory distress; supportive care.
- Sarcoidosis
- Bilateral hilar lymphadenopathy + noncaseating granulomas; often in young Black adults.
- Right lower lobe pneumonia mimic
- Can present as RUQ/abdominal pain — consider CXR with abdominal complaints.
- Foreign body aspiration
- Sudden choking, unilateral wheeze; often right mainstem in adults.
- Peptic ulcer disease causes
- H. pylori and NSAIDs are the two most common causes.
- H. pylori treatment
- Triple/quadruple therapy: PPI + antibiotics (e.g., clarithromycin + amoxicillin).
- GERD treatment
- Lifestyle change + proton-pump inhibitor; alarm features (dysphagia, weight loss, bleeding) → endoscopy.
- Crohn disease
- Transmural inflammation, skip lesions, mouth-to-anus; fistulas; non-bloody diarrhea common.
- Ulcerative colitis
- Continuous mucosal inflammation limited to the colon; bloody diarrhea; ↑ colon cancer risk.
- Appendicitis
- Periumbilical pain migrating to McBurney point (RLQ), rebound tenderness, low-grade fever.
- Acute cholecystitis
- RUQ pain after fatty meals, positive Murphy sign; gallstones; ultrasound first.
- Diverticulitis
- LLQ pain and fever in older adults; CT shows inflamed diverticula.
- Acute pancreatitis
- Epigastric pain radiating to the back; elevated lipase; gallstones or alcohol.
- Pancreatitis causes (mnemonic)
- 'GET SMASHED' — Gallstones and Ethanol are the two most common.
- Cirrhosis complications
- Portal hypertension → varices, ascites, hepatic encephalopathy, hepatorenal syndrome.
- Hepatitis B serology (HBsAg)
- Surface antigen positive = active infection (acute or chronic).
- Hepatitis A transmission
- Fecal–oral; self-limited; prevented by vaccine.
- Celiac disease
- Gluten-triggered autoimmune enteropathy; anti-tissue transglutaminase antibodies; villous atrophy.
- Colorectal cancer screening
- Begin at age 45 (average risk) — colonoscopy or stool-based testing (USPSTF).
- Upper vs lower GI bleed
- Upper = melena/hematemesis (above ligament of Treitz); lower = hematochezia.
- Small bowel obstruction
- Crampy pain, vomiting, distension, 'tinkling' or absent bowel sounds; air-fluid levels on X-ray.
- Acute mesenteric ischemia
- Pain out of proportion to exam in an older patient with vascular disease — surgical emergency.
- Vitamin B₁₂ deficiency
- Macrocytic anemia + neurologic signs (subacute combined degeneration).
- Diverticulosis vs diverticulitis
- Diverticulosis = asymptomatic outpouchings (painless bleeding); diverticulitis = inflamed/infected.
- Cholangitis (Charcot triad)
- Fever, jaundice, and RUQ pain from biliary obstruction + infection.
- Hemorrhoids vs anal fissure
- Hemorrhoids = painless bright-red bleeding; fissure = painful bleeding with defecation.
- Hernia (incarcerated vs strangulated)
- Incarcerated = irreducible; strangulated = ischemic (tender, systemic signs) — surgery.
- Diabetes A1c threshold
- Hemoglobin A1c at least 6.5% diagnoses diabetes.
- Diabetes fasting glucose threshold
- Fasting plasma glucose at least 126 mg/dL on two occasions.
- Prediabetes A1c
- Hemoglobin A1c 5.7–6.4%.
- Type 1 vs type 2 diabetes
- Type 1 = autoimmune insulin deficiency (insulin required); type 2 = insulin resistance (metformin first-line).
- First-line type 2 diabetes drug
- Metformin (plus lifestyle change).
- DKA
- Type 1; hyperglycemia + ketosis + anion-gap metabolic acidosis; treat with IV fluids, insulin, K⁺ repletion.
- HHS
- Type 2; profound hyperglycemia (> 600 mg/dL) + high osmolality + minimal ketosis; altered mental status.
- Thyroid screening test
- TSH — high TSH = hypothyroidism; low TSH = hyperthyroidism.
- Hypothyroidism treatment
- Levothyroxine; symptoms include fatigue, weight gain, cold intolerance, constipation.
- Graves disease
- Most common hyperthyroidism; TSH-receptor antibodies; exophthalmos, goiter, pretibial myxedema.
- Adrenal insufficiency (Addison)
- Fatigue, hypotension, hyperpigmentation, hyponatremia, hyperkalemia; low cortisol.
- Cushing syndrome
- Cortisol excess: central obesity, moon facies, striae, hyperglycemia, hypertension.
- Hyperparathyroidism
- High PTH + high calcium; 'stones, bones, groans, psychiatric overtones'.
- Hypocalcemia signs
- Chvostek (facial tap) and Trousseau (cuff-induced spasm) signs; perioral numbness.
- Pheochromocytoma
- Catecholamine-secreting tumor: episodic headache, palpitations, sweating, hypertension.
- Diabetic neuropathy
- Stocking-glove distal sensory loss; tight glucose control slows progression.
- SIADH
- Excess ADH → euvolemic hyponatremia with concentrated urine.
- Diabetes insipidus
- ADH deficiency (central) or resistance (nephrogenic) → polyuria, dilute urine.
- Hypothyroidism in pregnancy
- Increase levothyroxine; untreated risks fetal neurodevelopment.
- Thyroid storm
- Life-threatening hyperthyroidism: fever, tachyarrhythmia, agitation — emergency.
- Acute angle-closure glaucoma
- Painful red eye, fixed mid-dilated pupil, halos, hard globe, nausea — emergency, lower IOP immediately.
- Otitis media
- Bulging, immobile tympanic membrane; first-line amoxicillin.
- Otitis externa
- Pain on tragus traction ('swimmer's ear'); topical antibiotic drops.
- Bacterial vs viral conjunctivitis
- Bacterial = purulent discharge; viral = watery, often with URI; allergic = itchy/bilateral.
- Centor criteria
- Group A strep score: exudate, tender anterior nodes, fever, no cough, plus age.
- Strep throat treatment
- Penicillin or amoxicillin to prevent rheumatic fever (cephalosporin/macrolide if allergic).
- Epistaxis (anterior)
- Most common at Kiesselbach plexus; direct pressure first-line.
- Acute bacterial sinusitis
- Symptoms > 10 days or worsening after improvement; most resolve without antibiotics.
- Peritonsillar abscess
- Severe sore throat, muffled 'hot potato' voice, uvular deviation; needs drainage.
- Central retinal artery occlusion
- Sudden painless monocular vision loss; 'cherry-red spot' — emergency.
- Retinal detachment
- Flashes, floaters, and a 'curtain' over vision; urgent ophthalmology referral.
- Open-angle glaucoma
- Painless, gradual peripheral vision loss with ↑ cup-to-disc ratio; chronic.
- Cataract
- Painless, gradual clouding of the lens → blurred vision and glare.
- Hordeolum (stye)
- Acute, tender, localized eyelid abscess; warm compresses.
- Vertigo (peripheral, BPPV)
- Brief positional vertigo from otolith displacement; Dix-Hallpike test, Epley maneuver.
- Macular degeneration
- Central vision loss in older adults; dry (drusen) and wet (neovascular) forms.
- Ottawa ankle rules
- Decision rule that identifies which ankle/foot injuries actually need an X-ray.
- Salter-Harris classification
- Grades pediatric growth-plate (physeal) fractures, types I–V.
- Osteoarthritis
- Non-inflammatory wear; morning stiffness < 30 min; Heberden (DIP) and Bouchard (PIP) nodes.
- Rheumatoid arthritis
- Symmetric inflammatory polyarthritis; stiffness > 1 h; positive RF/anti-CCP; spares DIP.
- Gout
- Acute monoarthritis (classically first MTP); NEGATIVELY birefringent needle-shaped crystals.
- Pseudogout (CPPD)
- POSITIVELY birefringent rhomboid crystals; often the knee.
- Septic arthritis
- Hot, swollen, painful joint with fever; arthrocentesis (WBC often > 50,000) — emergency.
- Cauda equina syndrome
- Saddle anesthesia + bowel/bladder dysfunction + bilateral leg weakness — surgical emergency.
- Low back pain red flags
- Fever, weight loss, cancer history, neuro deficit, bowel/bladder changes → imaging.
- Compartment syndrome
- Pain out of proportion + pain on passive stretch; the 6 P's — emergency fasciotomy.
- Scaphoid fracture
- Snuffbox tenderness after fall on outstretched hand; risk of avascular necrosis.
- Anterior shoulder dislocation
- Most common dislocation; arm abducted/externally rotated; check axillary nerve.
- Osteoporosis screening
- DEXA scan in women at least 65; T-score up to −2.5 defines osteoporosis.
- Carpal tunnel syndrome
- Median nerve compression; numbness in thumb–middle fingers; positive Phalen/Tinel.
- ACL tear
- 'Pop' with pivoting injury, effusion, positive Lachman test.
- Rotator cuff tear
- Shoulder pain and weakness with abduction; supraspinatus most common.
- Gout treatment (acute)
- NSAIDs, colchicine, or steroids acutely; urate-lowering therapy (allopurinol) later.
- Osteomyelitis
- Bone infection; MRI is most sensitive; often S. aureus; prolonged antibiotics.
- De Quervain tenosynovitis
- Radial wrist pain; positive Finkelstein test.
- Major depressive disorder
- at least 5 of 9 symptoms at least 2 weeks; depressed mood or anhedonia required.
- SIGECAPS
- Depression symptoms: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality.
- Depression first-line treatment
- SSRI plus psychotherapy.
- Bipolar I disorder
- At least one manic episode; treat with mood stabilizers (lithium, valproate) — not an SSRI alone.
- Generalized anxiety disorder
- Excessive worry most days at least 6 months; SSRI/SNRI and CBT.
- Panic disorder
- Recurrent unexpected panic attacks + fear of future attacks.
- Schizophrenia
- at least 6 months of psychosis; positive (hallucinations/delusions) and negative symptoms.
- Serotonin syndrome
- Autonomic instability, hyperreflexia/clonus, agitation; from serotonergic drug excess.
- Neuroleptic malignant syndrome
- Fever, 'lead-pipe' rigidity, altered mental status, autonomic instability; from antipsychotics.
- Alcohol withdrawal / DTs
- Tremor, autonomic hyperactivity, seizures, delirium tremens; benzodiazepines.
- Opioid overdose
- Respiratory depression + pinpoint pupils; reverse with naloxone.
- PTSD
- Re-experiencing, avoidance, hyperarousal, and negative cognition after trauma > 1 month.
- Anorexia nervosa
- Restriction with low body weight and intense fear of weight gain; medical complications.
- ADHD
- Inattention and/or hyperactivity-impulsivity; stimulants first-line.
- OCD
- Intrusive obsessions and compulsions; SSRI (often higher dose) and CBT/ERP.
- Suicide risk factors (SAD PERSONS)
- Older age, male, prior attempt, substance use, and a specific plan raise risk.
- Substance use screening
- Use validated tools (e.g., CAGE for alcohol) and offer brief intervention.
- Lithium toxicity
- Tremor, confusion, ataxia; narrow therapeutic index — monitor levels and renal function.
- Sepsis
- Life-threatening organ dysfunction from a dysregulated response to infection.
- Septic shock
- Sepsis with persistent hypotension requiring vasopressors + elevated lactate.
- Sepsis bundle priorities
- Cultures before antibiotics, early broad-spectrum antibiotics, fluids, and lactate measurement.
- First-line septic-shock vasopressor
- Norepinephrine, to maintain MAP at least 65 mmHg.
- HIV screening
- 4th-generation antigen/antibody combination immunoassay; confirm with differentiation assay.
- AIDS definition
- HIV with CD4 count < 200 cells/µL or an AIDS-defining illness.
- Influenza treatment
- Oseltamivir, most effective within 48 hours of symptom onset.
- Meningitis empiric treatment
- Do not delay empiric antibiotics for the LP; add steroids in suspected bacterial meningitis.
- CSF in bacterial meningitis
- High neutrophils, high protein, LOW glucose, high opening pressure.
- Tuberculosis treatment (RIPE)
- Rifampin, Isoniazid, Pyrazinamide, Ethambutol.
- Lyme disease
- Erythema migrans (early); doxycycline; can progress to carditis and arthritis.
- Cellulitis vs abscess
- Cellulitis = diffuse spreading infection (antibiotics); abscess = walled-off collection (drain).
- Most common community-acquired pneumonia organism
- Streptococcus pneumoniae.
- Infective endocarditis
- Fever + new murmur; Duke criteria; blood cultures + echocardiography.
- C. difficile colitis
- Antibiotic-associated watery diarrhea; treat with oral vancomycin or fidaxomicin.
- Adult immunization (influenza)
- Annual influenza vaccine recommended for everyone at least 6 months (CDC).
- Pertussis
- Paroxysmal cough with inspiratory 'whoop'; treat with a macrolide.
- ABCDEs of melanoma
- Asymmetry, Border irregularity, Color variation, Diameter > 6 mm, Evolution.
- Melanoma prognosis
- Breslow depth (thickness of invasion) is the most important prognostic factor.
- Basal cell carcinoma
- Pearly papule with telangiectasias; most common skin cancer; rarely metastasizes.
- Squamous cell carcinoma
- Scaly, ulcerated lesion on sun-damaged skin; can arise from actinic keratosis.
- Psoriasis
- Well-demarcated silvery scaly plaques on extensor surfaces; Auspitz sign.
- Atopic dermatitis (eczema)
- Pruritic, flexural rash; part of the atopic triad with asthma and allergic rhinitis.
- Cellulitis
- Warm, tender, spreading erythema of skin/subcutaneous tissue; usually strep or staph.
- Stevens-Johnson syndrome / TEN
- Drug-induced mucocutaneous emergency with skin sloughing; stop the offending drug.
- Tinea (dermatophyte)
- Annular scaly patch with central clearing; KOH prep shows hyphae; topical antifungals.
- Impetigo
- Honey-colored crusted lesions, common in children; topical or oral antibiotics.
- Acne pathophysiology
- Follicular plugging, Cutibacterium acnes, sebum, and inflammation.
- Seborrheic keratosis
- Benign, waxy, 'stuck-on' pigmented papule in older adults.
- Erythema migrans
- Expanding target-shaped rash of early Lyme disease.
- Contact dermatitis
- Localized eczematous reaction to an allergen (e.g., poison ivy) or irritant.
- Urticaria (hives)
- Transient, pruritic wheals from histamine release; treat with antihistamines.
- Pressure injury staging
- Stage 1 non-blanchable erythema → Stage 4 full-thickness with exposed bone/tendon.
- Testicular torsion
- Sudden severe testicular pain, high-riding testis, ABSENT cremasteric reflex — surgery within ~6 h.
- Nephrolithiasis
- Colicky flank pain radiating to the groin + hematuria; non-contrast CT is the test of choice.
- Most common kidney stone
- Calcium oxalate.
- Uncomplicated UTI treatment
- Nitrofurantoin or trimethoprim-sulfamethoxazole (per local resistance).
- Pyelonephritis
- Flank pain, fever, costovertebral angle tenderness with UTI symptoms.
- Benign prostatic hyperplasia
- Older men with obstructive urinary symptoms; alpha-blockers and 5-alpha-reductase inhibitors.
- Prostate cancer screening
- Shared decision-making on PSA testing (USPSTF) ages 55–69.
- Epididymitis
- Gradual testicular pain, positive Prehn sign (pain relief with elevation); often STI in young men.
- Erectile dysfunction first-line
- PDE-5 inhibitors (e.g., sildenafil); avoid with nitrates.
- Bladder cancer clue
- Painless gross hematuria in an older smoker.
- Varicocele
- 'Bag of worms' scrotal mass, usually left-sided; can affect fertility.
- Acute urinary retention
- Inability to void with a distended bladder; immediate catheterization.
- FAST stroke
- Face drooping, Arm weakness, Speech difficulty, Time to call emergency services.
- Ischemic vs hemorrhagic stroke
- Non-contrast CT first: no blood = ischemic (thrombolysis window); blood = hemorrhagic (no lytics).
- Ischemic stroke treatment
- IV thrombolysis within the window; mechanical thrombectomy for large-vessel occlusion.
- TIA
- Transient focal deficit without infarction; warns of impending stroke — urgent workup.
- Subarachnoid hemorrhage
- 'Worst headache of my life' (thunderclap); CT then LP (xanthochromia).
- Bacterial meningitis triad
- Fever, neck stiffness (nuchal rigidity), and altered mental status.
- Seizure first-line (status epilepticus)
- IV benzodiazepine (lorazepam), then a longer-acting agent.
- Parkinson disease
- Resting tremor, rigidity, bradykinesia, postural instability; dopamine deficiency.
- Multiple sclerosis
- Demyelination 'disseminated in time and space'; MRI plaques; optic neuritis common.
- Guillain-Barré syndrome
- Ascending symmetric weakness after infection; albuminocytologic dissociation in CSF.
- Bell palsy
- Acute unilateral facial paralysis INCLUDING the forehead (lower motor neuron).
- Migraine vs tension headache
- Migraine = unilateral, throbbing, photophobia, nausea; tension = bilateral, band-like, dull.
- Giant cell (temporal) arteritis
- New headache > 50, jaw claudication, ↑ ESR; steroids immediately to prevent blindness.
- Myasthenia gravis
- Fatigable weakness worse with use; ptosis, diplopia; anti-AChR antibodies.
- Delirium vs dementia
- Delirium = acute, fluctuating, reversible; dementia = chronic, progressive decline.
- Cushing's triad
- Hypertension, bradycardia, and irregular respirations — sign of rising intracranial pressure.
- Concussion management
- Cognitive/physical rest then graded return; watch for worsening (intracranial bleed).
- Trigeminal neuralgia
- Brief, severe, shock-like unilateral facial pain; carbamazepine first-line.
- Ectopic pregnancy
- First-trimester pain/bleeding + positive β-hCG + empty uterus on ultrasound — emergency.
- Preeclampsia
- New hypertension + proteinuria after 20 weeks; severe features need magnesium and delivery.
- Eclampsia
- Preeclampsia plus seizures; magnesium sulfate and delivery.
- Magnesium toxicity sign
- Loss of deep tendon reflexes (then respiratory depression); reverse with calcium gluconate.
- Cervical cancer screening
- Begin at age 21; cytology q3y (21–29); cytology/HPV q3–5y (30–65) per USPSTF.
- Chlamydia/gonorrhea treatment
- Treat both (ceftriaxone + doxycycline) due to co-infection; report and treat partners.
- Syphilis stages
- Primary (painless chancre), secondary (rash incl. palms/soles), tertiary; treat with penicillin.
- PCOS
- Oligomenorrhea, hyperandrogenism, polycystic ovaries; insulin resistance; lifestyle + OCPs/metformin.
- Placenta previa
- Painless third-trimester vaginal bleeding; no digital exam — ultrasound.
- Placental abruption
- Painful third-trimester bleeding with a rigid, tender uterus.
- Pelvic inflammatory disease
- Lower abdominal pain + cervical motion tenderness; risk of infertility; treat empirically.
- Menopause
- 12 months of amenorrhea; ↑ FSH; hot flashes; consider risks before hormone therapy.
- Gestational diabetes screening
- Oral glucose tolerance test at 24–28 weeks.
- Breast cancer screening
- Mammography; USPSTF recommends starting at age 40 (biennial through 74).
- Endometrial cancer clue
- Postmenopausal vaginal bleeding — evaluate with endometrial biopsy.
- Ovarian torsion
- Sudden severe unilateral pelvic pain with an adnexal mass — surgical emergency.
- Mastitis
- Painful, erythematous breast in a lactating woman; continue breastfeeding + antibiotics.
- Postpartum hemorrhage
- Most common cause is uterine atony; massage, uterotonics (oxytocin).
- Bacterial vaginosis
- Thin gray discharge, clue cells, positive whiff test; treat with metronidazole.
- Anemia by MCV
- Microcytic (< 80), normocytic (80–100), macrocytic (> 100).
- Iron deficiency anemia
- Microcytic, low ferritin; most common anemia worldwide.
- Anemia of chronic disease
- Normocytic (or microcytic); low iron with NORMAL/high ferritin.
- Macrocytic anemia causes
- Vitamin B₁₂ deficiency (neuro signs) and folate deficiency (no neuro signs).
- B₁₂ vs folate deficiency
- B₁₂ deficiency has neurologic signs; folate deficiency does not.
- Reticulocyte count use
- High = blood loss/hemolysis (good marrow response); low = hypoproliferative anemia.
- Hemolysis labs
- ↑ reticulocytes, ↑ LDH, ↑ indirect bilirubin, ↓ haptoglobin.
- Sickle cell crisis
- Vaso-occlusive pain; treat with hydration, oxygen, and analgesia; hydroxyurea prevents.
- PT/INR
- Tests the extrinsic pathway; monitors warfarin.
- aPTT
- Tests the intrinsic pathway; monitors unfractionated heparin.
- ITP
- Isolated thrombocytopenia (low platelets) with normal coagulation; immune platelet destruction.
- Heparin-induced thrombocytopenia (HIT)
- Platelets drop at least 50% with paradoxical clotting; stop heparin, start a non-heparin anticoagulant.
- DIC
- Widespread clotting + bleeding; ↓ platelets, ↑ PT/aPTT, ↓ fibrinogen, ↑ D-dimer.
- Acute leukemia clue
- Rapid onset of fatigue, infections, and bleeding with blasts on smear.
- Hodgkin lymphoma
- Reed-Sternberg cells; often a contiguous nodal spread; good prognosis.
- Von Willebrand disease
- Most common inherited bleeding disorder; mucocutaneous bleeding, prolonged bleeding time.
- AKI categories
- Prerenal (hypoperfusion), intrinsic (acute tubular necrosis), and postrenal (obstruction).
- Prerenal AKI clue
- BUN:creatinine ratio > 20:1; responds to volume.
- Chronic kidney disease
- GFR < 60 mL/min/1.73 m2 for at least 3 months; slow progression with ACEi/ARB.
- Hyperkalemia first step
- IV calcium (gluconate/chloride) to stabilize the myocardium.
- Hyperkalemia ECG
- Peaked T waves → widened QRS → sine wave; can cause fatal arrhythmia.
- Hyperkalemia shift therapy
- Insulin with glucose (and a beta-agonist) shift K⁺ into cells.
- Hyponatremia approach
- Assess volume status; correct slowly to avoid osmotic demyelination.
- Nephrotic syndrome
- Proteinuria > 3.5 g/day, hypoalbuminemia, edema, hyperlipidemia.
- Nephritic syndrome
- Hematuria, RBC casts, hypertension, mild proteinuria; glomerular inflammation.
- Acute tubular necrosis
- Most common intrinsic AKI; 'muddy brown' granular casts; from ischemia or toxins.
- Metabolic acidosis (anion gap)
- MUDPILES causes (e.g., DKA, lactic acidosis, toxins).
- Indications for emergent dialysis (AEIOU)
- Acidosis, Electrolytes (K⁺), Intoxication, Overload, Uremia.
- Diabetic nephropathy
- Leading cause of CKD/ESRD; screen with urine albumin; ACEi/ARB protective.
- Contrast-induced nephropathy
- AKI 48–72 h after iodinated contrast; hydrate and minimize contrast in at-risk patients.
- Hypertensive emergency
- Severe BP elevation WITH end-organ damage; lower BP in a controlled, gradual way.
- Rhabdomyolysis
- Muscle breakdown → ↑ CK, myoglobinuria, AKI, hyperkalemia; aggressive IV fluids.
- Informed consent
- Capacity + disclosure of risks/benefits/alternatives + voluntariness, documented before a procedure.
- Decision-making capacity
- Ability to understand, appreciate, reason, and communicate a choice — task-specific.
- HIPAA
- Protects patient health information; disclose only the minimum necessary with authorization.
- Medical ethics principles
- Autonomy, beneficence, nonmaleficence, and justice.
- USPSTF
- Issues graded preventive-service recommendations (screening, counseling, prevention).
- Sensitivity vs specificity
- Sensitivity = true positives (rules out, SnNout); specificity = true negatives (rules in, SpPin).
- Positive predictive value
- Probability that a positive test is a true positive; rises with disease prevalence.
- Number needed to treat (NNT)
- 1 / absolute risk reduction — patients treated to prevent one bad outcome.
- Levels of evidence
- Systematic reviews/RCTs rank highest; expert opinion/case reports lowest.
- Sentinel event
- Unexpected occurrence causing death or serious harm — triggers root-cause analysis.
- PA scope of practice
- PAs practice in a team-based model; scope is set by state law and practice agreement.
- Negligence (malpractice) elements
- Duty, breach (deviation from standard), causation, and damages.
- EMTALA
- Requires a medical screening exam and stabilization of emergencies regardless of ability to pay.
- Advance directive
- Documents a patient's wishes (living will) or surrogate (healthcare proxy) for future care.
- Tobacco cessation counseling (5 A's)
- Ask, Advise, Assess, Assist, Arrange — the USPSTF-recommended framework.
- Reportable conditions
- Certain infectious diseases must be reported to public-health authorities (CDC/state).
- PANRE-LA
- PANRE Longitudinal Assessment — recertify by answering ~25 questions online each quarter over the cycle, with immediate rationale and open resources, instead of one standard PANRE exam.
- PANRE passing score
- A scaled score of about 379 on a 200–800 scale; not a fixed percent-correct (verify the current standard on nccpa.net).
- HIPAA Breach Notification Rule
- After a breach of unsecured protected health information, a covered entity must notify the affected individuals and the Secretary of Health and Human Services.
- Implied consent
- In a true emergency, when a patient cannot consent and no surrogate is available, the law presumes a reasonable person would consent to life- or limb-saving treatment.
- Colorectal cancer screening start age
- Age 45 for average-risk adults (USPSTF) — a high-yield recert update lowered from 50.