ABPS Internal Medicine cheat sheet

STEMI: reperfusion with primary PCI within 120 minutes of first medical contact; fibrinolysis within 30 minutes if PCI is unavailable and symptoms began under 12 hours.

NSTEMI/unstable angina: risk stratify with TIMI or GRACE; early invasive strategy within 24 hours for high-risk features such as dynamic ST changes, rising troponin, or hemodynamic instability.

Acute decompensated heart failure: IV loop diuretic for congestion; noninvasive ventilation for respiratory distress; avoid routine beta-blocker initiation during decompensation.

HFrEF: quadruple therapy with ARNI/ACEi/ARB, evidence-based beta-blocker, MRA, and SGLT2 inhibitor reduces mortality; hydralazine/isosorbide dinitrate for self-identified Black patients.

Atrial fibrillation: anticoagulate if CHA2DS2-VASc is 2 or more in men or 3 or more in women; DOAC preferred over warfarin except mechanical valve or moderate-severe mitral stenosis.

Hypertension: stage 1 is 130-139/80-89 mmHg; stage 2 is 140/90 mmHg or higher; first-line agents include thiazide diuretics, ACEi/ARB, and dihydropyridine calcium channel blockers.

Aortic stenosis: severe if aortic valve area under 1.0 cm2, mean gradient 40 mmHg or higher, or peak velocity 4 m/s or higher; symptomatic severe AS warrants valve replacement.

Acute pericarditis: pleuritic chest pain, friction rub, diffuse ST elevation with PR depression; treat with NSAIDs plus colchicine.

Asthma exacerbation: repeated inhaled SABA plus ipratropium, systemic corticosteroids, and oxygen to SpO2 93-95%; add magnesium sulfate for severe exacerbation.

COPD: post-bronchodilator FEV1/FVC under 0.70 confirms persistent airflow limitation; GOLD groups use symptoms and exacerbation history.

PE: use Wells score or PERC to estimate pretest probability; D-dimer for low or intermediate probability; CT pulmonary angiography for high probability or positive D-dimer.

Community-acquired pneumonia: CURB-65 (confusion, urea over 7 mmol/L, respiratory rate 30 or more, low blood pressure, age 65 or older) guides site of care.

ARDS: lung-protective ventilation with tidal volume 6 mL/kg predicted body weight and plateau pressure 30 cmH2O or less reduces mortality.

Sepsis: give broad-spectrum antibiotics within 1 hour for septic shock or high likelihood; 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L or higher.

ABG: anion gap = Na - (Cl + HCO3); normal 8-12; Winter formula expected PaCO2 = 1.5 x HCO3 + 8 +/- 2.

Ventilator weaning: rapid shallow breathing index (respiratory rate divided by tidal volume) under 105 predicts successful spontaneous breathing trial.

Upper GI bleeding: IV proton pump inhibitor after endoscopic hemostasis for high-risk ulcers; variceal bleeding needs octreotide, antibiotics, and band ligation.

Acute pancreatitis: diagnosis requires 2 of 3 findings-typical pain, lipase over 3 times upper limit, or imaging; early lactated Ringer 5-10 mL/kg/hr.

Cirrhosis: Child-Pugh and MELD score prognosis; ascites first-line spironolactone plus furosemide; paracentesis with albumin for large-volume removal.

SBP: ascitic PMN 250/mm3 or higher; treat with cefotaxime and albumin; prophylaxis with norfloxacin or trimethoprim-sulfamethoxazole after recovery.

H. pylori: test with urea breath test or stool antigen off PPI 2 weeks and antibiotics 4 weeks; treat with bismuth quadruple therapy for 14 days.

Ulcerative colitis: continuous mucosal inflammation from rectum; mild-moderate distal disease treated with topical mesalamine; severe colitis needs IV steroids.

Crohn disease: skip lesions, transmural inflammation, fistulas; ileocolonoscopy with biopsy; treat with steroids for flares and biologics for moderate-severe disease.

Hepatitis B: HBsAg positive over 6 months is chronic; treat with tenofovir or entecavir when HBV DNA high, ALT elevated, or cirrhosis.

DKA: glucose over 250 mg/dL, pH under 7.30, bicarbonate under 18, anion gap over 10, ketones positive; total body potassium depleted despite normal serum K.

HHS: glucose over 600 mg/dL, effective osmolarity over 320 mOsm/kg, minimal ketosis; mortality higher than DKA; correct volume first.

Thyroid storm: Burch-Wartofsky score 45 or higher; treat with thionamide, iodine after 1 hour, beta blocker, hydrocortisone, and supportive care.

Hypothyroidism: elevated TSH with low free T4; levothyroxine dosing 1.6 mcg/kg/day; reduce starting dose in older adults or coronary disease.

Primary adrenal insufficiency: low cortisol with elevated ACTH; give hydrocortisone and fludrocortisone; adrenal crisis requires IV hydrocortisone and saline.

Hypercalcemia: corrected calcium = measured Ca + 0.8 x (4.0 - albumin g/dL); severe over 14 mg/dL or symptomatic needs IV saline and calcitonin.

Diabetes: A1c 6.5% or higher, fasting glucose 126 mg/dL or higher, 2-hour OGTT 200 mg/dL or higher, or random 200 mg/dL or higher with symptoms diagnose diabetes.

Metformin: first-line for type 2 diabetes unless eGFR under 30; hold before iodinated contrast if eGFR 30-59 and restart 48 hours later.

Sepsis: obtain cultures before antibiotics if no delay; start empiric broad-spectrum within 1 hour for shock; narrow based on cultures.

Bacterial meningitis: dexamethasone 10 mg IV before or with first antibiotic dose in suspected pneumococcal meningitis; continue if confirmed.

Infective endocarditis: modified Duke criteria use blood cultures and echocardiography; surgery for heart failure, uncontrolled infection, or vegetation over 10 mm with emboli.

HIV: start antiretroviral therapy for all regardless of CD4; screen with fourth-generation antigen/antibody test; viral load confirms and monitors.

Latent TB: IGRA or tuberculin skin test; treat with 3HP, 4R, or 9H; exclude active TB before treatment.

C. difficile: watery diarrhea plus positive toxin or PCR; stop offending antibiotics; oral vancomycin or fidaxomicin for initial episode.

Cellulitis: nonpurulent, warm, tender, erythematous plaque; treat with cephalexin or dicloxacillin; mark borders and reassess at 48-72 hours.

Influenza: oseltamivir within 48 hours of symptoms for high-risk or severe illness; do not wait for test results in hospitalized patients.

AKI: increase in creatinine 0.3 mg/dL or more in 48 hours or 1.5 times baseline or more in 7 days; urine output under 0.5 mL/kg/hr for 6 hours.

Hyperkalemia ECG: peaked T waves, widened QRS, sine wave; give IV calcium for instability, insulin/glucose, albuterol, then removal.

Hyponatremia: assess volume status and urine osmolality; correct 8-10 mmol/L/day or less; hypertonic saline for seizures or coma.

CKD: eGFR under 60 for 3 months or more or markers of kidney damage; stage G1-G5; avoid NSAIDs and adjust renally cleared drugs.

Nephrotic syndrome: proteinuria over 3.5 g/day, albumin under 3.0 g/dL, edema, hyperlipidemia; complications include thrombosis and infection.

Metabolic acidosis: Winter formula; if PaCO2 higher than expected, concomitant respiratory acidosis; if lower, respiratory alkalosis.

Dialysis indications: AEIOU-acidosis, electrolyte disturbance (refractory hyperkalemia), intoxication, overload, uremia (encephalopathy, pericarditis).

Iron deficiency anemia: low ferritin, low MCV, high RDW; ferritin under 30 ng/mL diagnostic; treat with oral iron and evaluate for blood loss.

B12 deficiency: macrocytic anemia with hypersegmented neutrophils and neurologic symptoms; check methylmalonic acid and homocysteine; replace B12.

Neutropenic fever: ANC under 500/mcL and fever 38.3 C or higher or 38.0 C or higher for 1 hour; start anti-pseudomonal beta-lactam within 60 minutes.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia; IV hydration and rasburicase for high uric acid.

Hypercalcemia of malignancy: treat with IV saline, calcitonin, and bisphosphonate or denosumab; monitor renal function.

Warfarin reversal: major bleeding-vitamin K 5-10 mg IV plus 4-factor PCC; INR 4.5-10 without bleeding-hold warfarin, no routine vitamin K.

Heparin-induced thrombocytopenia: platelet drop over 50% at 5-10 days; stop heparin, start argatroban or bivalirudin; do not give platelets.

Febrile nonhemolytic transfusion reaction: fever and chills during transfusion; stop transfusion, give antipyretic, evaluate for hemolysis.

Falls: annual screening for adults 65 and older; multifactorial assessment and exercise intervention reduce falls.

Delirium: acute fluctuating attention and cognition; identify and treat precipitating causes; avoid antipsychotics unless dangerous agitation.

Polypharmacy: Beers criteria identify potentially inappropriate medications in older adults; review anticholinergics, benzodiazepines, and sulfonylureas.

USPSTF: colorectal cancer screening ages 45-75; mammography 50-74 every 2 years; cervical cancer screening 21-65.

Immunizations: influenza annually; COVID-19 per schedule; pneumococcal for 65 and older or high risk; shingles recombinant vaccine at 50 and older.

Advance care planning: ask about health care proxy and code status; document goals of care; POLST for serious illness.

Pressure ulcers: stage 1 nonblanchable erythema; stage 2 partial-thickness; stage 3 full-thickness; stage 4 to bone or tendon; unstageable eschar.

Osteoporosis: DEXA T-score -2.5 or lower; treat with bisphosphonate, denosumab, or anabolic agent; ensure calcium and vitamin D.

RA: symmetric polyarthritis of small joints, morning stiffness over 1 hour; check RF and anti-CCP; treat with methotrexate early.

SLE: ANA positive; anti-dsDNA and anti-Smith specific; treat with hydroxychloroquine, steroids, and immunosuppressants by organ involvement.

Gout: negatively birefringent needle-shaped crystals; acute treatment with NSAIDs, colchicine, or steroids; urate-lowering for recurrent or tophaceous disease.

Giant cell arteritis: age over 50, headache, jaw claudication, elevated ESR; temporal artery biopsy; high-dose steroids immediately.

ANCA vasculitis: c-ANCA with PR3 in GPA; p-ANCA with MPO in MPA; treat with steroids plus rituximab or cyclophosphamide.

Systemic sclerosis: Raynaud, skin thickening, esophageal dysmotility; check anti-centromere (limited) and anti-Scl-70 (diffuse).

Anaphylaxis: epinephrine IM 0.3-0.5 mg of 1:1000 into thigh; repeat every 5-15 minutes; fluids and adjuncts.

Stroke: noncontrast CT excludes hemorrhage; IV alteplase within 4.5 hours; thrombectomy up to 24 hours for selected large-vessel occlusion.

Seizure: first-line benzodiazepine; second-line levetiracetam, fosphenytoin, or valproate; status epilepticus over 5 minutes.

Migraine: unilateral throbbing headache, nausea, photophobia; treat with triptan or NSAID; prophylaxis with topiramate, propranolol, or amitriptyline.

Multiple sclerosis: demyelinating plaques disseminated in time and space; MRI with gadolinium; treat acute relapse with IV methylprednisolone.

Parkinson disease: resting tremor, bradykinesia, rigidity; treat with levodopa-carbidopa; avoid dopamine antagonists.

Myasthenia gravis: fatigable weakness, ptosis, diplopia; check anti-acetylcholine receptor antibody; treat with pyridostigmine and immunosuppression.

Subarachnoid hemorrhage: thunderclap headache; CT then LP if CT negative; nimodipine for vasospasm.

Melanoma: ABCDE; biopsy with 1-2 mm margins; Breslow thickness determines wide local excision and sentinel node biopsy.

Basal cell carcinoma: pearly papule with telangiectasia; treat with excision, Mohs, or topical imiquimod for superficial.

Squamous cell carcinoma: scaly, ulcerated nodule; risk factors include sun and immunosuppression; excise with margins.

SJS/TEN: mucosal erosions, blistering, positive Nikolsky; stop culprit drug, supportive care in burn unit; mortality high.

Psoriasis: well-demarcated silvery plaques on extensor surfaces; treat with topical steroids, phototherapy, or biologics.

Cellulitis vs stasis dermatitis: cellulitis is unilateral, warm, tender with sharp borders; stasis is bilateral, chronic, with varicosities.

Scabies: intense nocturnal itch, burrows in web spaces; treat with permethrin 5% cream and treat contacts.

Major depression: 5 or more symptoms for 2 weeks or more including depressed mood or anhedonia; treat with SSRI and psychotherapy.

Bipolar mania: elevated mood or irritability with increased energy, decreased sleep, grandiosity; treat with mood stabilizer and antipsychotic.

Schizophrenia: delusions, hallucinations, disorganized speech for 6 months or more; treat with antipsychotics; clozapine for refractory.

Serotonin syndrome: altered mental status, autonomic instability, clonus; stop serotonergic drugs; cyproheptadine for moderate-severe.

Alcohol withdrawal: tremor, anxiety, seizures, delirium tremens; use benzodiazepines and thiamine; CIWA-Ar guides treatment.

Suicide risk: ask directly about ideation, plan, intent, means; high risk warrants immediate safety evaluation and psychiatric hospitalization.

Anxiety: panic attacks, worry; first-line SSRIs and cognitive behavioral therapy; avoid benzodiazepines long term.