Free PANRE Exam Flashcards

Guideline-directed therapy combines an ARNI (or ACE inhibitor/ARB), an evidence-based beta blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor. These four pillars reduce mortality; loop diuretics relieve congestion but do not improve survival.

CHA2DS2-VASc scores stroke risk in nonvalvular atrial fibrillation. Higher scores favor anticoagulation; the decision weighs thromboembolic risk against bleeding risk (estimated with tools like HAS-BLED), not the rhythm pattern alone.

Lower blood pressure and provide renal and cardiac protection. Key adverse effects: dry cough, hyperkalemia, angioedema, and acute kidney injury in bilateral renal artery stenosis. Contraindicated in pregnancy.

Lifestyle modification is foundational. Pharmacologic therapy is recommended when blood pressure exceeds guideline thresholds, especially with elevated cardiovascular risk; first-line agents include thiazide diuretics, ACE inhibitors/ARBs, and calcium channel blockers.

High-intensity statins are indicated for clinical atherosclerotic cardiovascular disease, LDL ≥190 mg/dL, and diabetes with high risk. The decision is risk-based using estimated 10-year ASCVD risk rather than LDL level alone.

Asthma airflow obstruction is largely reversible with bronchodilators; COPD obstruction is persistent and only partially reversible. Spirometry showing a reduced FEV1/FVC ratio that does not normalize supports COPD.

Treatment escalates from as-needed bronchodilator/ICS to scheduled inhaled corticosteroids and then add-on long-acting bronchodilators based on symptom control and exacerbation frequency. Frequent rescue inhaler use signals inadequate control.

Severity tools such as CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65) guide outpatient versus inpatient decisions. Empiric antibiotics are chosen by setting and risk for resistant organisms.

In low-probability patients, a negative D-dimer can exclude PE without imaging. In higher-probability patients, proceed directly to CT pulmonary angiography; anticoagulation is started promptly when PE is likely and bleeding risk is acceptable.

Lifestyle changes plus a trial of acid suppression (proton pump inhibitor) is first-line. Alarm features—dysphagia, weight loss, GI bleeding, anemia, persistent vomiting—warrant endoscopy rather than empiric therapy alone.

The two leading causes are Helicobacter pylori infection and NSAID use. H. pylori testing and eradication is indicated for confirmed ulcers; stopping NSAIDs and starting a PPI addresses NSAID-related ulcers.

Average-risk screening is recommended starting at the guideline-defined age using colonoscopy or stool-based tests. A positive noninvasive test requires follow-up colonoscopy; family history may move the start age earlier.

Diagnosis requires two of three: characteristic epigastric pain radiating to the back, lipase or amylase elevated more than three times the upper limit, and confirmatory imaging. Gallstones and alcohol are the most common causes.

Acute otitis media is a middle-ear infection with a bulging, immobile tympanic membrane. Otitis externa is an outer-canal infection with pain on tragus manipulation; treatment differs (systemic vs. topical antibiotics).

Viral: watery discharge, often bilateral, highly contagious. Bacterial: purulent discharge. Allergic: itching with bilateral watery eyes. Pain, photophobia, or vision change suggests a more serious process needing referral.

Suspect bacterial sinusitis when symptoms persist beyond about 10 days, are severe at onset, or worsen after initial improvement (double sickening). Most acute rhinosinusitis is viral and resolves without antibiotics.

Metformin plus lifestyle modification is typically first-line. Agents with proven cardiovascular or renal benefit (GLP-1 receptor agonists, SGLT2 inhibitors) are prioritized when those comorbidities are present, regardless of A1c.

Primary hypothyroidism shows elevated TSH with low free T4. Treatment is levothyroxine titrated to normalize TSH. Subclinical hypothyroidism has elevated TSH with normal free T4 and is treated selectively.

DKA features ketosis and metabolic acidosis, more common in type 1 diabetes. Hyperosmolar hyperglycemic state has severe hyperglycemia and hyperosmolarity with minimal ketosis, typically in type 2 diabetes. Both require fluids and insulin with potassium monitoring.

Fatigue, hypotension, hyponatremia, hyperkalemia, and hyperpigmentation (in primary disease). Adrenal crisis is life-threatening and treated with immediate stress-dose glucocorticoids and fluids before confirmatory testing.

Acute flares are treated with NSAIDs, colchicine, or corticosteroids. Urate-lowering therapy (e.g., allopurinol) is for long-term prevention and is not started to treat an acute flare, though established therapy is continued through one.

Rheumatoid arthritis is symmetric, inflammatory, with prolonged morning stiffness and systemic features. Osteoarthritis is degenerative with brief stiffness and activity-related pain. Early RA requires DMARD therapy to prevent joint damage.

Most acute low back pain is self-limited and managed conservatively. Imaging is reserved for red flags: significant trauma, neurologic deficit, suspected infection or malignancy, or cauda equina signs (saddle anesthesia, bladder/bowel dysfunction).

SSRIs are typically first-line, with onset of benefit taking several weeks. Assess suicide risk at baseline and follow-up, monitor for activation early in treatment, and combine pharmacotherapy with psychotherapy when feasible.

Antidepressant monotherapy can precipitate mania in bipolar disorder. Mood stabilizers or atypical antipsychotics are foundational, so screening for prior manic or hypomanic episodes before treating depression is essential.

Excess serotonergic activity, often from drug combinations, causing autonomic instability, neuromuscular hyperactivity (clonus, hyperreflexia), and altered mental status. Treatment is stopping the offending agents and supportive care.

A positive screening test (TST or IGRA) with no active disease indicates latent TB. Treatment with an approved regimen prevents progression to active disease; active TB must be excluded before starting latent treatment.

Suspect sepsis with infection plus organ dysfunction or hypoperfusion. Early management includes obtaining cultures, lactate, prompt broad-spectrum antibiotics, and fluid resuscitation—time to antibiotics affects outcomes.

Use the narrowest effective agent for the shortest appropriate duration, guided by likely pathogen and local resistance. Avoiding antibiotics for viral infections reduces resistance and adverse effects such as C. difficile colitis.

Uncomplicated cystitis in healthy nonpregnant women is treated empirically with a short course of a first-line agent based on local resistance. Urine culture is reserved for complicated, recurrent, or treatment-failure cases.

Alpha-blockers relieve obstructive symptoms quickly; 5-alpha-reductase inhibitors shrink the prostate over months and are useful for larger glands. Acute urinary retention requires catheterization and evaluation.

Establishing last-known-well time determines eligibility for time-dependent reperfusion therapy. Sudden focal deficit prompts urgent neuroimaging to distinguish ischemic from hemorrhagic stroke before treatment.

Most headaches are primary (migraine, tension, cluster). Warning features—thunderclap onset, neurologic deficit, fever with neck stiffness, new headache after age 50, or headache with immunosuppression—require urgent workup.

Postictal confusion, tongue biting (lateral), and prolonged recovery favor seizure. Rapid full recovery with a clear trigger favors syncope. First unprovoked seizure warrants neuroimaging and evaluation for an underlying cause.

Microcytic anemia with low ferritin indicates iron deficiency. In adults, especially older men and postmenopausal women, occult GI blood loss must be evaluated rather than treating with iron alone.

Vitamin K (with prothrombin complex concentrate for urgent reversal) counters warfarin. Specific reversal agents exist for certain direct oral anticoagulants. Knowing the agent and indication guides safe reversal during bleeding.

Prerenal (hypoperfusion), intrinsic (tubular, glomerular, interstitial), and postrenal (obstruction). Differentiating them—using volume status, urine studies, and imaging—directs management; relieving obstruction is key in postrenal AKI.

Staged by estimated GFR and albuminuria. Management focuses on slowing progression—blood pressure control, RAAS blockade, SGLT2 inhibitors, and avoiding nephrotoxins—and preparing for renal replacement in advanced disease.

When ECG changes or severe elevation are present, IV calcium stabilizes the myocardium first; insulin with glucose and beta-agonists shift potassium intracellularly; and removal therapies lower total body potassium.

Melanoma warning signs: Asymmetry, Border irregularity, Color variation, Diameter, and Evolving lesion. A suspicious pigmented lesion warrants biopsy rather than observation alone.

Cellulitis is a spreading soft-tissue infection treated with antibiotics. A fluctuant abscess requires incision and drainage as primary treatment; antibiotics are adjunctive. Distinguishing them changes management.

Combined hormonal contraceptives are contraindicated with significant venous thromboembolism risk, such as smoking over age 35 or migraine with aura. Progestin-only methods are preferred alternatives in these patients.

Screening combines cytology and/or HPV testing at guideline-defined intervals based on age and prior results. Routine screening generally stops at an upper age limit with adequate prior negative screening.

Recertification commonly tests current adult schedules—influenza, Tdap, pneumococcal, shingles, and others by age and risk. Recommendations change, so review the latest schedule rather than relying on memory.

Grade A and B recommendations indicate net benefit and are generally offered; D recommendations advise against a service; I indicates insufficient evidence. Knowing grade-based screening guidance is high-yield for recertification.

Valid consent requires capacity, disclosure of the nature, risks, benefits, and alternatives, voluntariness, and patient understanding. Documentation supports but does not replace the conversation.

When a patient poses a serious, identifiable threat to another person, clinicians may have a legal and ethical duty to take protective action, which can override usual confidentiality. Specific obligations vary by jurisdiction.

Intramuscular epinephrine is the first-line, time-critical treatment for anaphylaxis. Antihistamines and corticosteroids are adjuncts and do not replace epinephrine; delay in epinephrine is associated with worse outcomes.

The number of patients who must receive an intervention for one to benefit; it is the reciprocal of the absolute risk reduction. A lower NNT indicates a more effective intervention for that outcome.

Sensitivity is the ability to correctly identify those with disease (few false negatives, good for ruling out). Specificity is the ability to correctly identify those without disease (few false positives, good for ruling in).