ABIM Internal Medicine key terms

A rapidly developing, life-threatening systemic hypersensitivity reaction marked by airway swelling, bronchospasm, and hypotension. It is diagnosed clinically and treated first with intramuscular epinephrine, not antihistamines or corticosteroids alone.

A delayed severe drug hypersensitivity reaction appearing weeks after starting a culprit drug, with rash, facial edema, eosinophilia, and internal organ injury. Management is stopping the drug and giving systemic corticosteroids.

A primary antibody deficiency causing recurrent sinopulmonary infections with low IgG, low IgA or IgM, and poor vaccine responses. It also predisposes to autoimmunity, granulomatous disease, and lymphoma.

Heart failure with a left ventricular ejection fraction of 40 percent or less. Guideline-directed therapy combines an ARNI or ACE inhibitor, beta blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor to reduce mortality.

An irregularly irregular supraventricular arrhythmia generated by chaotic atrial activity. Management centers on anticoagulation guided by stroke risk and on rate or rhythm control, with urgent cardioversion when the patient is unstable.

Calcific narrowing of the aortic valve producing exertional dyspnea, angina, or syncope. Severe symptomatic disease carries high mortality and requires valve replacement; medical therapy does not alter the natural history.

Complete coronary artery occlusion causing ST elevation and myocardial necrosis. Emergent reperfusion by primary percutaneous coronary intervention or fibrinolysis, plus dual antiplatelet therapy and anticoagulation, limits infarct size.

A hyperglycemic emergency defined by ketonemia, metabolic acidosis, and absolute insulin deficiency, often precipitated by infection or medication nonadherence. Treatment is intravenous fluids, continuous insulin, and aggressive potassium repletion.

A hyperglycemic emergency with marked hyperosmolality and profound dehydration but little ketosis, typical of older patients with type 2 diabetes. Treatment is fluid resuscitation followed by insulin and careful electrolyte correction.

Euvolemic hypotonic hyponatremia caused by inappropriate antidiuretic hormone release, with concentrated urine and high urine sodium. Treatment is fluid restriction plus correction of the underlying cause, such as pulmonary or central nervous system disease.

Autonomous aldosterone production causing hypertension, often with hypokalemia and suppressed renin. Screening uses the aldosterone-to-renin ratio; treatment is a mineralocorticoid receptor antagonist or surgical adrenalectomy for unilateral disease.

A decompensated thyrotoxic state with fever, tachycardia, agitation, and heart failure, usually triggered by infection, surgery, or iodine load. Treatment is beta blockade, a thionamide, iodine given after the thionamide, and glucocorticoids.

Infection of ascitic fluid in cirrhosis, defined by an ascitic neutrophil count of at least 250 per microliter. It presents with fever or unexplained encephalopathy and is treated with a third-generation cephalosporin plus albumin.

Sudden pancreatic inflammation diagnosed by two of three criteria: characteristic epigastric pain, lipase greater than three times the upper limit, and compatible imaging. Treatment is aggressive intravenous fluids, analgesia, and early enteral feeding.

Chronic continuous mucosal inflammation of the colon beginning in the rectum, causing bloody diarrhea, urgency, and tenesmus. Treatment is mesalamine, corticosteroids, biologics, and colectomy for refractory disease or dysplasia.

Reversible neuropsychiatric dysfunction arising from hepatic failure and portosystemic shunting. Ammonia contributes, and lactulose titrated to soft stools is first-line therapy alongside correction of precipitants such as bleeding or infection.

An acute, fluctuating disturbance of attention and awareness, commonly triggered by infection, medications, or metabolic derangement in hospitalized older adults. Management is treating the cause plus nonpharmacologic measures, reserving antipsychotics for severe distress.

Use of multiple medications, conventionally five or more, which raises the risk of interactions, adverse drug events, and falls in older adults. Periodic review with deprescribing, guided by explicit criteria such as the Beers list, improves safety.

Microcytic anemia best confirmed by a low ferritin or low transferrin saturation. It requires identifying the source of blood loss, especially gastrointestinal, and treatment with oral or intravenous iron replacement.

An immune-mediated fall in platelets occurring days after heparin exposure that paradoxically causes thrombosis rather than bleeding. Heparin must be stopped immediately and a non-heparin anticoagulant started.

A thrombotic microangiopathy from severe ADAMTS13 deficiency causing microangiopathic hemolytic anemia, thrombocytopenia, neurologic findings, and kidney injury. Treatment is urgent plasma exchange with corticosteroids.

Life-threatening organ dysfunction caused by a dysregulated host response to infection and identified by a rising SOFA score. It is treated with prompt cultures, early broad-spectrum antibiotics, and fluid resuscitation.

Infection of the endocardial surface, usually a valve, presenting with fever and a new or changing murmur. Diagnosis rests on blood cultures and echocardiography; treatment is prolonged intravenous antibiotics, with surgery for complications.

Diarrhea caused by toxin-producing Clostridioides difficile, usually after antibiotic exposure. Diagnosis is by stool toxin testing; treatment is oral vancomycin or fidaxomicin, and recurrent disease may require fecal microbiota transplantation.

Antiretroviral medication taken by HIV-negative people to prevent acquiring HIV. Tenofovir-based regimens require documented negative HIV testing and periodic monitoring of kidney function and sexually transmitted infections while in use.

An abrupt decline in glomerular filtration over hours to days, staged by creatinine rise and urine output. Common causes are prerenal hypoperfusion, obstruction, and acute tubular necrosis; management targets the cause and hemodynamics.

Glomerular disease with proteinuria above 3.5 grams daily, hypoalbuminemia, edema, and hyperlipidemia. Complications include venous thrombosis and infection, and treatment depends on the histologic diagnosis.

Elevated serum potassium that depolarizes cardiac membranes. Peaked T waves and a widened QRS herald cardiac arrest, so treatment is intravenous calcium plus insulin with glucose, a beta agonist, and potassium removal.

Acute focal neurologic deficit from cerebral arterial occlusion. Noncontrast head imaging excludes hemorrhage, and reperfusion by thrombolysis or thrombectomy is time-dependent, with blood pressure thresholds governing eligibility.

Continuous seizure activity, or repeated seizures without recovery, lasting five minutes or more. It is treated in sequence with a benzodiazepine, then a second-line agent such as levetiracetam, valproate, or fosphenytoin.

Fever with an absolute neutrophil count below 500 cells per microliter after chemotherapy. It is a medical emergency requiring immediate empiric antipseudomonal beta-lactam antibiotics before cultures and imaging results return.

Rapid breakdown of malignant cells after starting chemotherapy, releasing potassium, phosphate, and uric acid and causing hyperkalemia, acute kidney injury, and arrhythmia. Prevention is hydration with rasburicase or allopurinol in high-risk patients.

Chronic airflow obstruction from emphysema and small airway disease, causing dyspnea, chronic bronchitis, and exacerbations. Treatment is inhaled bronchodilators, tobacco cessation, vaccination, and long-term oxygen for chronic hypoxemia.

Thrombus obstructing pulmonary arteries, causing acute dyspnea, pleuritic chest pain, and hypoxemia. Pretest probability combined with D-dimer testing or CT angiography guides diagnosis, and anticoagulation is the mainstay of therapy.

A symmetric inflammatory polyarthritis of small joints with morning stiffness, anti-cyclic citrullinated peptide antibodies, and extra-articular disease. Early disease-modifying antirheumatic drugs such as methotrexate prevent erosive joint destruction.

Crystal arthritis from monosodium urate deposition, classically producing a red, swollen first metatarsophalangeal joint. Acute flares are treated with NSAIDs, colchicine, or glucocorticoids, and urate-lowering therapy prevents recurrence.

Large-vessel vasculitis in patients older than 50 causing headache, jaw claudication, and risk of irreversible vision loss. High-dose corticosteroids are started immediately while diagnosis is confirmed by temporal artery biopsy or vascular imaging.

Low bone mineral density with microarchitectural deterioration and increased fragility fracture risk. It is diagnosed by a DXA T-score of minus 2.5 or lower and treated with calcium, vitamin D, and antiresorptive or anabolic agents.