AOBIM Internal Medicine cheat sheet

Acute coronary syndrome: ST-elevation MI requires immediate reperfusion (PCI within 90 minutes of first medical contact at a PCI-capable center); aspirin 162-325 mg chewed is given before reperfusion.

Heart failure with reduced ejection fraction (HFrEF, EF ≤40%) guideline-directed therapy: ARNI/ACEi/ARB + evidence-based beta-blocker + MRA + SGLT2 inhibitor; add loop diuretic for congestion.

Diabetic ketoacidosis: isotonic saline resuscitation, insulin infusion (0.1 units/kg/h), and potassium replacement once K <5.2 mEq/L; total body potassium is depleted despite normal serum values.

Community-acquired pneumonia severity: CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30, blood pressure low, age ≥65) - 0-1 outpatient, 2 short inpatient stay, ≥3 consider ICU.

Thyroid storm: beta-blocker (propranolol) first to control adrenergic symptoms, then thionamide (PTU or methimazole), iodine at least 1 hour after thionamide, plus glucocorticoid.

Hyperkalemia with ECG changes: intravenous calcium gluconate first for membrane stabilization, then insulin/glucose and beta-agonist to shift potassium intracellularly; dialysis for refractory cases.

Anion gap = Na − (Cl + HCO3); normal 8-12 mEq/L. Elevated gap acidosis differential: methanol, uremia, DKA, paraldehyde, INH, lactic acidosis, ethylene glycol, salicylates (MUDPILES).

Sepsis-3: sepsis = life-threatening organ dysfunction from infection, defined by SOFA increase ≥2; septic shock = vasopressor need to maintain MAP ≥65 plus lactate >2 mmol/L despite fluids.

OCC requires continuous certification through longitudinal assessment (e.g., annual question-based modules) rather than a single high-stakes recertification exam; complete the required number of assessment questions each cycle.

Maintain an active, unrestricted state license and full privileges at participating institutions; report any license restriction or adverse action promptly to the certifying board.

Complete the required continuing medical education credits per cycle, including AOA Category 1 credits and any specified opioid/ethics/patient-safety hours.

Participate in practice performance/quality improvement activities (e.g., OPPI or equivalent) as required by the certifying board each cycle.

Osteopathic continuous certification includes an osteopathic continuous certification examination component and attestation to professional standing; verify current cycle requirements directly with the AOA Board of Internal Medicine.

Failure to complete longitudinal assessment requirements within the cycle can result in loss of board certification status; remediation pathways exist and should be initiated early.

Keep documentation of CME, QI participation, and licensure readily retrievable; the assessment platform tracks completion but audits may require source documents.

Acute coronary syndrome: ST-elevation MI requires immediate reperfusion (PCI within 90 minutes of first medical contact at a PCI-capable center); aspirin 162-325 mg chewed is given before reperfusion.

Heart failure with reduced ejection fraction (HFrEF, EF ≤40%) guideline-directed therapy: ARNI/ACEi/ARB + evidence-based beta-blocker + MRA + SGLT2 inhibitor; add loop diuretic for congestion.

Diabetic ketoacidosis: isotonic saline resuscitation, insulin infusion (0.1 units/kg/h), and potassium replacement once K <5.2 mEq/L; total body potassium is depleted despite normal serum values.

Community-acquired pneumonia severity: CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30, blood pressure low, age ≥65) - 0-1 outpatient, 2 short inpatient stay, ≥3 consider ICU.

Thyroid storm: beta-blocker (propranolol) first to control adrenergic symptoms, then thionamide (PTU or methimazole), iodine at least 1 hour after thionamide, plus glucocorticoid.

Hyperkalemia with ECG changes: intravenous calcium gluconate first for membrane stabilization, then insulin/glucose and beta-agonist to shift potassium intracellularly; dialysis for refractory cases.

Anion gap = Na − (Cl + HCO3); normal 8-12 mEq/L. Elevated gap acidosis differential: methanol, uremia, DKA, paraldehyde, INH, lactic acidosis, ethylene glycol, salicylates (MUDPILES).

Sepsis-3: sepsis = life-threatening organ dysfunction from infection, defined by SOFA increase ≥2; septic shock = vasopressor need to maintain MAP ≥65 plus lactate >2 mmol/L despite fluids.

OCC requires continuous certification through longitudinal assessment (e.g., annual question-based modules) rather than a single high-stakes recertification exam; complete the required number of assessment questions each cycle.

Maintain an active, unrestricted state license and full privileges at participating institutions; report any license restriction or adverse action promptly to the certifying board.

Complete the required continuing medical education credits per cycle, including AOA Category 1 credits and any specified opioid/ethics/patient-safety hours.

Participate in practice performance/quality improvement activities (e.g., OPPI or equivalent) as required by the certifying board each cycle.

Osteopathic continuous certification includes an osteopathic continuous certification examination component and attestation to professional standing; verify current cycle requirements directly with the AOA Board of Internal Medicine.

Failure to complete longitudinal assessment requirements within the cycle can result in loss of board certification status; remediation pathways exist and should be initiated early.

Keep documentation of CME, QI participation, and licensure readily retrievable; the assessment platform tracks completion but audits may require source documents.