ABPS Hospital Medicine flashcards

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

Revised Cardiac Risk Index

A perioperative risk tool scoring six predictors (ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine >2.0, high-risk surgery); higher scores predict major cardiac events.

Functional capacity 4 METs

A perioperative threshold: patients able to climb a flight of stairs or do heavy housework generally have adequate functional capacity and may proceed to surgery without further cardiac testing.

ARDS Berlin definition

Acute onset within one week with bilateral opacities not fully explained by effusion, collapse, or nodule, not primarily cardiogenic, and PaO2/FiO2 ≤300 on PEEP ≥5 cm H2O.

Lung-protective ventilation targets

Tidal volume of 6 mL/kg predicted body weight (range 4–8), plateau pressure ≤30 cm H2O, and permissive hypercapnia; reduces ventilator-induced lung injury and mortality in ARDS.

Septic shock definition

Sepsis with persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg and lactate >2 mmol/L despite adequate fluid resuscitation; norepinephrine is first-line vasopressor.

Prone positioning in ARDS

For moderate-severe ARDS with PaO2/FiO2 <150, prone positioning for at least 16 hours per day combined with lung-protective ventilation reduces mortality.

STEMI reperfusion window

Primary PCI should be achieved within 90 minutes of first medical contact; fibrinolysis within 30 minutes when PCI is unavailable within 120 minutes and no contraindication exists.

Hypertensive emergency management

BP >180/120 with end-organ damage; use titratable IV agents and lower mean arterial pressure by no more than about 25% in the first hour to preserve organ perfusion.

Type A aortic dissection

Dissection involving the ascending aorta; a surgical emergency. Type B, confined to the descending aorta without complications, is managed medically with heart rate and blood pressure control.

Massive pulmonary embolism

PE with hemodynamic instability (hypotension or shock); treated with systemic thrombolysis or catheter/surgical embolectomy in addition to anticoagulation and supportive care.

Type 2 respiratory failure

Hypoxemia accompanied by PaCO2 >45 mmHg, typically from alveolar hypoventilation; common causes include COPD exacerbation, neuromuscular weakness, and opioid toxicity.

Alveolar-arterial oxygen gradient

PAO2 minus PaO2, where PAO2 = FiO2 × (atmospheric pressure − 47) − (PaCO2 / 0.8); a normal gradient with hypoxemia suggests hypoventilation.

NIV in COPD exacerbation

Noninvasive ventilation is preferred for acute hypercapnic respiratory failure in COPD exacerbation; contraindicated with altered mental status, vomiting, or hemodynamic instability.

Light criteria for exudate

Pleural fluid is exudative when pleural/serum protein >0.5, pleural/serum LDH >0.6, or pleural LDH exceeds two-thirds the upper limit of normal serum LDH.

Sepsis antibiotic timing

For septic shock or high likelihood of sepsis, obtain blood cultures then give broad-spectrum antibiotics within one hour, along with lactate measurement and fluid resuscitation.

Asymptomatic bacteriuria treatment

Generally not treated except in pregnancy or before urologic procedures with mucosal trauma; treating it promotes antimicrobial resistance and Clostridioides difficile infection.

MRSA nasal PCR utility

A negative MRSA nasal PCR has high negative predictive value and supports de-escalation of empiric anti-MRSA therapy in patients with suspected pneumonia.

Antimicrobial de-escalation

Narrowing empiric broad-spectrum therapy based on culture and susceptibility results, with a defined stop date or prospective audit at 48–72 hours.

Status epilepticus sequence

First-line benzodiazepine (lorazepam or midazolam), followed by a second-line antiseizure drug such as levetiracetam, fosphenytoin, or valproate; refractory cases need continuous infusion.

CAM delirium criteria

Confusion Assessment Method requires acute onset with fluctuating course plus inattention, and either disorganized thinking or altered level of consciousness.

Stroke thrombolysis window

IV thrombolysis with alteplase or tenecteplase is indicated within 4.5 hours of last known well in eligible patients; thrombectomy may extend to 24 hours in selected cases.

Bacterial meningitis dexamethasone

Dexamethasone given before or with the first antibiotic dose reduces hearing loss and neurologic sequelae, particularly in pneumococcal meningitis.

AKI KDIGO staging

Stage 1: creatinine rise ≥0.3 mg/dL in 48 hours or 1.5–1.9× baseline; stage 2: 2.0–2.9×; stage 3: ≥3×, creatinine ≥4.0, or renal replacement therapy.

Fractional excretion of urea

FEUrea <35% suggests prerenal azotemia and is useful when diuretics are in use, since FENa may be unreliable in that setting.

Dialysis indications AEIOU

Acidosis, Electrolyte disturbance (refractory hyperkalemia), Intoxication, Overload (refractory volume), and Uremia (encephalopathy or pericarditis) indicate renal replacement therapy.

Hyperkalemia emergency sequence

IV calcium for membrane stabilization, then insulin with glucose and beta-agonist to shift potassium intracellularly, then elimination via diuretics, binders, or dialysis.

SIADH diagnosis

Euvolemic hyponatremia with urine osmolality >100 mOsm/kg and urine sodium >30 mEq/L; first-line treatment is fluid restriction with correction ≤8–10 mEq/L per day.

Winter's formula

Expected PaCO2 in metabolic acidosis = 1.5 × bicarbonate + 8 ± 2; a measured value outside this range indicates a concurrent respiratory disorder.

DKA insulin and potassium

In diabetic ketoacidosis, withhold insulin until potassium >3.3 mEq/L and replace potassium, since total body potassium is depleted despite normal or high serum values.

Thyroid storm treatment

Beta-blocker, a thionamide (PTU or methimazole), iodine given after the thionamide, and glucocorticoid, with supportive care for fever and hemodynamic instability.

Spontaneous bacterial peritonitis

Ascitic fluid polymorphonuclear cell count ≥250 cells/mm³; treat with a third-generation cephalosporin and add albumin when creatinine >1 mg/dL or bilirubin >4 mg/dL.

I-PASS handoff

A standardized handoff structure: Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by the receiver.