Arab Board Internal Medicine Part 1 cheat sheet

STEMI reperfusion: primary PCI within 120 minutes of first medical contact is preferred; fibrinolysis if PCI unavailable and symptom onset <12 hours without contraindication.

Acute decompensated heart failure: IV loop diuretic for congestion; nitrates plus noninvasive ventilation for hypertensive pulmonary edema; inotropes reserved for hypoperfusion with adequate filling.

Atrial fibrillation stroke risk: CHA2DS2-VASc score >=2 in men or >=3 in women supports oral anticoagulation; score 0 requires no antithrombotic therapy.

Aortic stenosis severity on echocardiography: peak velocity >=4 m/s, mean gradient >=40 mmHg, or valve area <=1.0 cm2 indicates severe disease.

Pericarditis: diffuse ST elevation with PR depression and pleuritic pain; first-line therapy is NSAID plus colchicine.

Infective endocarditis: three sets of blood cultures from separate sites before antibiotics; surgery indicated for heart failure from valve dysfunction, uncontrolled infection, or large vegetation.

Hypertrophic cardiomyopathy: dynamic left ventricular outflow obstruction worsened by dehydration and vasodilators; beta-blockers are first-line for symptomatic obstruction.

Acute pericardial tamponade: hypotension, elevated JVP, pulsus paradoxus; treat with urgent pericardiocentesis, not diuretics.

COPD spirometry: post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow obstruction; GOLD grading uses FEV1 percent predicted.

Asthma control: short-acting beta-agonist use >2 days per week, night waking, or activity limitation indicates inadequate control requiring step-up therapy.

Pulmonary embolism: Wells score plus D-dimer to exclude in low/intermediate probability; CT pulmonary angiography is diagnostic test of choice in stable patients.

Pleural fluid Light criteria: exudate if protein ratio >0.5, LDH ratio >0.6, or pleural LDH >2/3 upper normal serum limit.

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

Tuberculosis: sputum acid-fast smear has low sensitivity; nucleic acid amplification testing is preferred initial microbiologic test; latent infection treated with isoniazid-based regimens.

Obstructive sleep apnea: diagnosis by polysomnography or home sleep testing; apnea-hypopnea index >=5 with symptoms or >=15 alone defines disease.

ARDS Berlin definition: acute onset within 1 week, bilateral opacities, no cardiogenic cause, PaO2/FiO2 <=300 mmHg on PEEP >=5 cmH2O.

Upper GI bleeding: IV proton pump inhibitor after endoscopic hemostasis reduces rebleeding in high-risk peptic ulcers; variceal bleeding requires vasoactive drug plus prophylactic antibiotics.

Hepatitis B serology: HBsAg positive with IgM anti-HBc indicates acute infection; isolated anti-HBs indicates immunity; HBeAg positivity reflects high replicative activity.

Ascites: serum-ascites albumin gradient >=1.1 g/dL indicates portal hypertension; spontaneous bacterial peritonitis diagnosed at ascitic neutrophil count >=250/mm3.

Acute pancreatitis: diagnosis requires two of three (typical pain, lipase >3x upper limit, imaging); early fluid resuscitation and enteral nutrition when tolerated.

Wilson disease: low ceruloplasmin, elevated 24-hour urinary copper, Kayser-Fleischer rings; treat with chelation and avoid copper.

Inflammatory bowel disease: ulcerative colitis involves continuous colonic mucosa from rectum; Crohn disease shows skip lesions, transmural inflammation, and granulomas.

Hepatocellular carcinoma surveillance: ultrasound with or without alpha-fetoprotein every 6 months in cirrhosis; diagnosis can be made by multiphasic imaging showing arterial hyperenhancement with washout.

Celiac disease: tissue transglutaminase IgA with total IgA level for screening; duodenal biopsy showing villous atrophy confirms diagnosis while on gluten-containing diet.

Acute kidney injury KDIGO: creatinine rise >=0.3 mg/dL in 48 hours or >=1.5x baseline in 7 days, or urine output <0.5 mL/kg/h for 6 hours.

Fractional excretion of urea <35% suggests prerenal azotemia, useful when diuretics confound fractional excretion of sodium.

Hyperkalemia with ECG changes: IV calcium for membrane stabilization, insulin with glucose and beta-agonist to shift potassium intracellularly, then removal via diuretics or dialysis.

Hyponatremia: assess serum osmolality and volume status; correct chronic hyponatremia by <=8-10 mmol/L per 24 hours to avoid osmotic demyelination.

Metabolic acidosis: calculate anion gap (Na - [Cl + HCO3]); high-gap causes include ketoacidosis, lactate, uremia, toxins; normal-gap suggests bicarbonate loss or renal tubular acidosis.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipidemia; minimal change disease is the commonest cause in adults with sudden onset.

Hypercalcemia: corrected calcium = measured calcium + 0.8 x (4.0 - albumin g/dL); volume repletion followed by calcitonin and bisphosphonate for severe cases.

Dialysis indications: refractory acidosis, electrolyte disturbance, intoxication, volume overload, uremic complications (AEIOU).

Hypothyroidism: elevated TSH with low free T4 confirms primary hypothyroidism; levothyroxine dosing approximately 1.6 mcg/kg/day in young adults, lower in elderly or coronary disease.

Thyroid storm: clinical diagnosis with fever, tachycardia, agitation, GI symptoms; treat with beta-blocker, thionamide, iodine after thionamide, and glucocorticoid.

Primary aldosteronism: screen with aldosterone-to-renin ratio when hypertension is resistant, hypokalemic, or associated with adrenal incidentaloma; confirm before imaging.

Cushing syndrome: 24-hour urinary free cortisol, late-night salivary cortisol, or overnight dexamethasone suppression test as initial screening; ACTH level localizes cause.

Pheochromocytoma: plasma free metanephrines or 24-hour urinary fractionated metanephrines are first-line biochemical tests; alpha-blockade before beta-blockade.

Diabetic ketoacidosis: IV fluid resuscitation, insulin infusion after potassium >=3.3 mmol/L, and potassium replacement; bicarbonate only for pH <6.9.

Hyperosmolar hyperglycemic state: marked hyperglycemia with high effective osmolality and minimal ketosis; fluid deficit often 8-10 L, correct slowly.

Osteoporosis: dual-energy x-ray absorptiometry T-score <= -2.5 defines disease; treat with bisphosphonate, denosumab, or anabolic agent in high-risk patients.

Iron deficiency anemia: low ferritin is most specific; ferritin may be normal in inflammation, so transferrin saturation <20% supports diagnosis.

Anemia of chronic disease: normocytic with low serum iron, normal or high ferritin, and low total iron-binding capacity.

Vitamin B12 deficiency: macrocytic anemia with elevated methylmalonic acid and homocysteine; treat with intramuscular or high-dose oral replacement; check for pernicious anemia.

Microangiopathic hemolytic anemia: schistocytes, thrombocytopenia, elevated LDH, low haptoglobin; urgent plasma exchange for TTP, supportive care for typical HUS.

Heparin-induced thrombocytopenia: platelet drop >50% at 5-10 days with thrombosis; stop heparin, start non-heparin anticoagulant, avoid platelet transfusion.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia after cytotoxic therapy; prevention with hydration and allopurinol or rasburicase.

Neutropenic fever: absolute neutrophil count <500/mm3 with fever >=38.3 C once or >=38.0 C sustained; start empiric antipseudomonal beta-lactam within 1 hour.

Multiple myeloma CRAB criteria: hypercalcemia, renal insufficiency, anemia, bone lesions; diagnosis requires clonal plasma cells plus myeloma-defining event.

Sepsis: suspected infection plus organ dysfunction; start broad-spectrum antibiotics within 1 hour of recognition and obtain cultures before antibiotics when feasible.

Meningitis: dexamethasone before or with first antibiotic dose in suspected pneumococcal meningitis; empiric therapy includes vancomycin plus ceftriaxone.

Endocarditis prophylaxis: indicated for prosthetic valves, prior endocarditis, and certain congenital heart disease before dental procedures involving gingival manipulation.

HIV: antiretroviral therapy recommended for all regardless of CD4 count; post-exposure prophylaxis started within 72 hours for 28 days.

Tuberculosis treatment: 2 months isoniazid, rifampin, pyrazinamide, ethambutol followed by 4 months isoniazid plus rifampin for drug-susceptible pulmonary disease.

Clostridioides difficile: oral vancomycin or fidaxomicin for initial episode; avoid antiperistaltic agents; soap-and-water handwashing because alcohol gel does not kill spores.

Malaria: thick and thin smears plus rapid antigen test; severe disease treated with IV artesunate; uncomplicated falciparum with artemisinin-based combination therapy.

Urinary tract infection in pregnancy: asymptomatic bacteriuria requires treatment to prevent pyelonephritis; avoid fluoroquinolones.

Rheumatoid arthritis: anti-cyclic citrullinated peptide is highly specific; methotrexate is anchor therapy; treat to target with low disease activity or remission as goal.

Systemic lupus erythematosus: anti-dsDNA and anti-Smith are specific; complement C3 and C4 fall with active disease; hydroxychloroquine recommended for most patients.

Gout: joint aspiration showing negatively birefringent needle-shaped crystals is diagnostic; treat acute flare with NSAID, colchicine, or glucocorticoid; urate-lowering therapy target <6 mg/dL.

Giant cell arteritis: elevated ESR and CRP with headache, jaw claudication, or visual symptoms; start high-dose glucocorticoid immediately and confirm with temporal artery biopsy.

Ankylosing spondylitis: sacroiliitis on imaging plus inflammatory back pain; HLA-B27 supportive; first-line therapy is NSAID with physiotherapy.

Antiphospholipid syndrome: thrombosis or pregnancy morbidity with lupus anticoagulant, anticardiolipin, or anti-beta2-glycoprotein antibodies; long-term anticoagulation for thrombosis.

Scleroderma renal crisis: new hypertension with rising creatinine in diffuse systemic sclerosis; treat with ACE inhibitor.

Polymyalgia rheumatica: age >50, shoulder and hip girdle pain with elevated ESR; rapid response to low-dose prednisone.

Acute ischemic stroke: noncontrast CT excludes hemorrhage; IV thrombolysis within 4.5 hours of onset; thrombectomy for large-vessel occlusion up to 24 hours in selected patients.

Status epilepticus: benzodiazepine first-line, then second-line antiseizure drug; refractory cases need anesthetic infusion and airway protection.

Guillain-Barre syndrome: ascending symmetric weakness with areflexia; cerebrospinal fluid shows albuminocytologic dissociation; treat with IV immunoglobulin or plasma exchange.

Myasthenia gravis: fatigable weakness, ptosis, and diplopia; anti-acetylcholine receptor antibodies; treat with pyridostigmine and immunomodulation; avoid aminoglycosides.

Multiple sclerosis: dissemination in space and time; MRI shows periventricular, juxtacortical, infratentorial, and spinal cord lesions; high-dose steroid for acute relapse.

Meningitis versus encephalitis: meningitis shows meningeal signs; encephalitis shows altered consciousness, seizures, or focal deficits and requires acyclovir empirically.

Subarachnoid hemorrhage: sudden thunderclap headache; CT within 6 hours is highly sensitive; xanthochromia in cerebrospinal fluid if CT negative.

Delirium versus dementia: delirium has acute onset, fluctuating course, and inattention; dementia is chronic progressive cognitive decline.

Syncope: history, orthostatic vitals, and ECG are first-line; high-risk features include exertional syncope, structural heart disease, and abnormal ECG requiring admission.

Venous thromboembolism prophylaxis: assess bleeding risk and use pharmacologic prophylaxis in acutely ill medical patients with reduced mobility unless contraindicated.

Hypertension: stage 1 is systolic 130-139 or diastolic 80-89 mmHg; lifestyle plus medication based on cardiovascular risk; ACE inhibitor or ARB contraindicated in pregnancy.

Perioperative risk: stop smoking and optimize comorbidity; continue beta-blockers if already prescribed; hold metformin only if contrast or significant renal dysfunction.

Anemia workup: mean corpuscular volume classifies microcytic, normocytic, macrocytic; order ferritin, B12, folate, reticulocyte count, and peripheral smear.

Alcohol withdrawal: use symptom-triggered benzodiazepines with CIWA protocol; give thiamine before glucose in malnourished patients.

Fever of unknown origin: prolonged fever without source; workup includes cultures, imaging, and biopsy; consider malignancy, infection, and autoimmune disease.

Pressure injury prevention: repositioning, moisture management, and nutrition; staging uses depth of tissue involvement.

Beers criteria: avoid benzodiazepines, anticholinergics, and long-acting sulfonylureas in older adults due to falls, delirium, and hypoglycemia risks.

Polypharmacy: reconcile medications at transitions of care; use STOPP/START criteria to identify potentially inappropriate prescriptions.

Renal dosing: estimate creatinine clearance with Cockcroft-Gault for drug dosing; adjust renally cleared drugs and avoid nephrotoxins in chronic kidney disease.

Warfarin: monitor INR; target 2.0-3.0 for most indications; drug interactions common with antibiotics and amiodarone; vitamin K reverses over-anticoagulation.

Digoxin toxicity: nausea, visual changes, arrhythmias; risk with hypokalemia and renal impairment; use digoxin-specific antibody for severe toxicity.

Falls in older adults: multifactorial assessment including vision, gait, medications, and home hazards; vitamin D supplementation and exercise reduce risk.

Acetaminophen hepatotoxicity: dose limit 3-4 g/day in adults; N-acetylcysteine is antidote and most effective when given early.

Opioid prescribing: co-prescribe naloxone for high-risk patients; assess for sedation and respiratory depression; avoid concurrent benzodiazepines.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value depends on disease prevalence; a highly sensitive test is useful for ruling out disease when negative.

Relative risk used in cohort studies; odds ratio approximates relative risk when outcome is rare.

Confidence interval width narrows with larger sample size; a 95% CI excluding the null value corresponds to p <0.05.

Type I error is rejecting a true null hypothesis; type II error is failing to reject a false null hypothesis; power = 1 - type II error.

Number needed to treat = 1 / absolute risk reduction; number needed to harm = 1 / absolute risk increase.

Intention-to-treat analysis preserves randomization and avoids bias from dropout; per-protocol analysis estimates efficacy under adherence.

Mean, median, and mode: median is robust to outliers; standard deviation describes spread for normally distributed data.

Incidence measures new cases per population at risk per time; prevalence measures all existing cases at a point in time.

Randomized controlled trials provide strongest evidence for causality; systematic reviews with meta-analysis synthesize trials and assess heterogeneity.

Levels of evidence: systematic reviews and randomized trials rank above cohort, case-control, and case series.

Bias types: selection bias, information bias, confounding; randomization and blinding reduce bias in trials.

Screening test criteria: important disease, acceptable test, effective early treatment, and favorable benefit-harm balance; lead-time bias inflates apparent survival.

Herd immunity reduces transmission when a sufficient proportion of the population is immune; threshold varies by pathogen transmissibility.

Case-control studies estimate odds ratios and are efficient for rare diseases; recall bias is a key limitation.

Critical appraisal: assess validity, results, and applicability; check randomization, allocation concealment, and completeness of follow-up.

Stages of change: precontemplation, contemplation, preparation, action, maintenance; interventions should match the patient's stage.

Motivational interviewing uses open questions, reflective listening, and affirmation to strengthen intrinsic motivation without confrontation.

Grief stages are not linear; normal bereavement typically resolves over months and differs from major depressive disorder.

Substance use disorder: DSM criteria include tolerance, withdrawal, craving, and continued use despite harm; severity is based on number of criteria met.

Cognitive behavioral therapy targets maladaptive thoughts and behaviors; effective in depression, anxiety, and insomnia.

Delirium risk factors: older age, cognitive impairment, sensory deprivation, and polypharmacy; nonpharmacologic prevention is first-line.

Somatic symptom disorder: distressing symptoms with excessive thoughts or behaviors about them, not explained by another medical condition.

Doctor-patient communication: use teach-back to confirm understanding and shared decision-making to align care with patient values.

Informed consent requires capacity, disclosure of risks and alternatives, comprehension, and voluntariness; document the discussion.

Decision-making capacity: patient can understand information, appreciate consequences, reason, and express a choice; capacity is decision-specific.

Confidentiality may be breached when required by law, to prevent serious harm, or with patient consent; disclose minimum necessary information.

Advance directives and durable power of attorney for healthcare guide care when the patient lacks capacity.

Medical errors: disclose to the patient, document, and report according to institutional policy; apology and transparency support professionalism.

Conflict of interest: disclose financial or personal interests and recuse when objectivity is compromised.

Research ethics: institutional review board approval, informed consent, and equipoise are required; vulnerable populations need additional protections.

Futility and resource allocation: distinguish interventions that cannot achieve the patient's goals from those that are merely burdensome.