ABIM Internal Medicine flashcards

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

Anaphylaxis first-line treatment

Intramuscular epinephrine 0.3 to 0.5 mg of 1 mg/mL solution into the anterolateral thigh is first-line; repeat every 5 to 15 minutes as needed.

Hereditary angioedema

C1 inhibitor deficiency causing recurrent nonpruritic swelling without urticaria; C4 is low, tryptase is normal, and antihistamines or epinephrine do not relieve attacks.

Chronic urticaria

Urticaria lasting more than six weeks; second-generation H1 antihistamines are first-line and may be uptitrated, with omalizumab added if uncontrolled; chronic corticosteroids are avoided.

STEMI reperfusion timing

Primary PCI is preferred within 90 minutes of first medical contact; fibrinolysis within 30 minutes is used when PCI cannot be achieved within 120 minutes and symptoms are under 12 hours.

HFrEF four pillars

Guideline therapy includes an ARNI or ACE inhibitor/ARB, an evidence-based beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor; all four reduce mortality in reduced ejection fraction.

Aortic stenosis severity

Severe aortic stenosis has aortic valve area below 1.0 cm2, mean gradient above 40 mm Hg, or peak velocity above 4 m/s; symptoms warrant valve intervention.

DKA insulin initiation

Start IV insulin infusion after potassium is above 3.3 mEq/L; add dextrose when glucose falls below 200 to 250 mg/dL while continuing insulin until ketoacidosis resolves.

Thyroid storm treatment

Treat with beta-blockade, a thionamide such as PTU, iodine given at least one hour after the thionamide, glucocorticoids, and supportive care for fever and volume depletion.

Adrenal crisis

Suspect in hypotension unresponsive to fluids; give hydrocortisone 100 mg IV then 50 mg every six hours plus isotonic saline without waiting for confirmatory tests.

Acute pancreatitis diagnosis

Requires two of three features: characteristic epigastric pain, lipase above three times the upper limit of normal, and imaging findings; early care is aggressive IV fluids.

SAAG interpretation

Serum-ascites albumin gradient of 1.1 g/dL or greater indicates portal hypertension, whereas a lower gradient suggests peritoneal malignancy, tuberculosis, pancreatitis, or nephrotic syndrome.

Spontaneous bacterial peritonitis

Ascitic fluid polymorphonuclear cell count of 250/mm3 or more establishes the diagnosis; treat with IV cefotaxime and add albumin for renal impairment or bilirubin above 4.

Delirium features

Acute fluctuating disturbance of attention and awareness, often with disorientation or hallucinations; identify and treat the underlying cause and reserve antipsychotics for severe distress.

Preeclampsia diagnosis

New hypertension after 20 weeks with proteinuria or maternal organ dysfunction; severe features include platelets below 100,000, elevated liver enzymes, renal insufficiency, pulmonary edema, or visual symptoms.

Heparin-induced thrombocytopenia

Platelets fall by more than 50 percent five to ten days after heparin exposure and thrombosis may occur; stop all heparin and start a non-heparin anticoagulant such as argatroban.

TTP diagnosis

Thrombotic microangiopathy with microangiopathic hemolytic anemia, thrombocytopenia, neurologic or renal findings, and ADAMTS13 activity below 10 percent; urgent plasma exchange is required.

Neutropenic fever

Fever of 38.3 C once or 38.0 C sustained with absolute neutrophil count below 500/mcL requires empiric anti-pseudomonal beta-lactam antibiotics within one hour.

Septic shock initial therapy

Obtain cultures, measure lactate, and give broad-spectrum antibiotics within one hour; give 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or greater.

Latent tuberculosis

Positive interferon-gamma release assay or tuberculin skin test without active disease; treat with rifampin for four months or isoniazid for nine months after excluding active tuberculosis.

Bacterial meningitis empiric

Start vancomycin plus ceftriaxone immediately, add ampicillin for age over 50 or immunocompromise, and give dexamethasone before or with the first antibiotic dose for pneumococcal suspicion.

AKI KDIGO definition

Increase in serum creatinine by 0.3 mg/dL or more within 48 hours, increase to 1.5 times baseline within seven days, or urine output below 0.5 mL/kg/hour for six hours.

Nephrotic syndrome

Proteinuria above 3.5 g per day with hypoalbuminemia, edema, and hyperlipidemia; minimal change disease is steroid-responsive and common in adults with nephrotic syndrome.

Ischemic stroke thrombolysis

IV alteplase or tenecteplase is given within 4.5 hours of onset after CT excludes hemorrhage; blood pressure must be below 185/110 mm Hg before treatment.

Status epilepticus

Continuous seizure lasting five minutes or repeated seizures without recovery; give a benzodiazepine first, then levetiracetam, fosphenytoin, or valproate if seizures continue.

Tumor lysis syndrome

Hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia from rapid tumor cell breakdown; treat with aggressive hydration and allopurinol or rasburicase.

Spinal cord compression

Back pain with weakness, sensory loss, or bowel dysfunction in cancer; give dexamethasone immediately and obtain MRI, then radiation or surgery for decompression.

COPD diagnosis

Post-bronchodilator FEV1/FVC ratio below 0.70 confirms persistent airflow obstruction in a patient with symptoms and risk exposure, usually tobacco smoke.

ARDS Berlin criteria

Acute onset within one week, bilateral opacities not fully explained by heart failure, and PaO2/FiO2 ratio of 300 or less on positive pressure; use low tidal volume ventilation.

Light criteria

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

Giant cell arteritis

Age over 50 with headache, jaw claudication, visual symptoms, and elevated ESR; start high-dose corticosteroids immediately and confirm with temporal artery biopsy or ultrasound.

Rheumatoid arthritis treatment

Methotrexate is first-line disease-modifying therapy for active rheumatoid arthritis; anti-CCP and symmetric small-joint synovitis support the diagnosis, and treatment targets remission.

Septic arthritis

Acute monoarthritis with fever; aspirate the joint for Gram stain and culture, start IV antibiotics, and drain the joint promptly to prevent cartilage destruction.