Arab Board Internal Medicine Clinical Exam cheat sheet

COPD exacerbation: controlled oxygen targeting SpO2 88-92%, short-acting bronchodilators, systemic corticosteroids 5 days, antibiotics if increased sputum purulence.

Asthma severity: severe exacerbation if talks in words, RR >30, HR >120, SpO2 <90%; give repeated salbutamol, ipratropium, systemic steroids, and consider magnesium.

Community-acquired pneumonia severity: CURB-65 (confusion, urea >7 mmol/L, RR ≥30, SBP <90 or DBP ≤60, age ≥65); score ≥2 consider admission.

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

Pulmonary embolism: Wells score plus age-adjusted D-dimer for low/intermediate probability; high probability or positive imaging proceeds to CT pulmonary angiography.

Obstructive sleep apnea: diagnosis by apnea-hypopnea index ≥5 with symptoms or ≥15 regardless of symptoms on polysomnography; CPAP is first-line therapy.

Tuberculosis: sputum AFB smear and culture plus NAAT; four-drug regimen (isoniazid, rifampicin, pyrazinamide, ethambutol) for 2 months followed by 4 months of isoniazid and rifampicin.

Upper GI bleed: pre-endoscopy Glasgow-Blatchford score guides need for intervention; IV proton pump inhibitor and endoscopy within 24 h for non-variceal bleeding.

Variceal hemorrhage: octreotide plus prophylactic antibiotics (ceftriaxone), and endoscopic band ligation; consider balloon tamponade or TIPS for refractory bleeding.

Acute pancreatitis: diagnosis requires 2 of 3 (typical pain, lipase >3× upper limit, imaging); early aggressive isotonic fluid resuscitation and enteral feeding when tolerated.

Spontaneous bacterial peritonitis: ascitic neutrophil count ≥250/mm³ is diagnostic; treat with third-generation cephalosporin and give albumin for creatinine >1 mg/dL.

Hepatorenal syndrome: functional renal failure in cirrhosis; terlipressin plus albumin is first-line; avoid nephrotoxins and perform volume challenge to exclude hypovolemia.

Inflammatory bowel disease: acute severe ulcerative colitis defined by ≥6 bloody stools/day plus systemic toxicity; IV corticosteroids first-line, rescue infliximab or colectomy.

Celiac disease: tissue transglutaminase IgA with total IgA level while on gluten; duodenal biopsy shows villous atrophy and crypt hyperplasia.

Acute kidney injury: KDIGO stages by creatinine rise (1.5-1.9×, 2.0-2.9×, ≥3× or ≥354 µmol/L) or urine output (<0.5 mL/kg/h for 6, 12, ≥24 h).

Hyperkalemia: ECG changes (peaked T, widened QRS); give IV calcium for membrane stabilization, insulin-glucose and salbutamol to shift potassium, and remove potassium with binders or dialysis.

Hyponatremia: assess volume status and urine osmolality; correct chronic hyponatremia by ≤8-10 mmol/L per 24 h to avoid osmotic demyelination.

Metabolic acidosis: calculate anion gap (Na − [Cl + HCO3]); high gap suggests ketoacidosis, lactic acidosis, renal failure, or toxins; normal gap suggests diarrhea or renal tubular acidosis.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipidemia; common causes include minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy.

Hypercalcemia: correct for albumin (add 0.02 mmol/L per g/L albumin below 40); IV fluids plus bisphosphonate for malignancy-associated hypercalcemia.

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

Diabetic ketoacidosis: IV fluids, insulin infusion at 0.1 U/kg/h, and potassium replacement once K <5.5 mmol/L; add dextrose when glucose <14 mmol/L to continue insulin.

Hyperosmolar hyperglycemic state: profound hyperglycemia and hyperosmolality with minimal ketosis; fluid resuscitation is the priority, then insulin.

Thyroid storm: Burch-Wartofsky score ≥45 suggests storm; treat with beta-blocker, thionamide, iodine after thionamide, and corticosteroids.

Hypothyroidism: levothyroxine dosing 1.6 µg/kg/day in young adults; start low (25-50 µg) in elderly or coronary disease and titrate by TSH.

Adrenal crisis: give IV hydrocortisone immediately (100 mg then 50 mg every 6 h) plus saline; do not delay for cortisol results if clinically suspected.

Pheochromocytoma: diagnose with plasma free metanephrines; alpha-blockade (phenoxybenzamine) before beta-blockade to avoid hypertensive crisis.

Primary hyperaldosteronism: elevated aldosterone with suppressed renin; adrenal vein sampling to distinguish unilateral adenoma from bilateral hyperplasia.

Iron deficiency anemia: low ferritin is most specific; ferritin can be falsely normal in inflammation, so check transferrin saturation (<20% suggests deficiency).

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

Vitamin B12 deficiency: macrocytic anemia with neurological signs; check methylmalonic acid if borderline; treat with intramuscular or high-dose oral replacement.

Heparin-induced thrombocytopenia: occurs 5-10 days after heparin; platelet count falls ≥50% and thrombosis risk is high; stop heparin and start non-heparin anticoagulant.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia; prevent with hydration and allopurinol or rasburicase in high-risk patients.

Neutropenic fever: single oral temperature ≥38.3°C or ≥38.0°C sustained over 1 h; obtain cultures and start empirical antipseudomonal beta-lactam within 1 h.

Multiple myeloma: CRAB features (hyperCalcemia, Renal failure, Anemia, Bone lesions); diagnosis requires ≥10% clonal plasma cells plus myeloma-defining event.

Sepsis: use qSOFA (RR ≥22, altered mentation, SBP ≤100) for risk stratification; start broad-spectrum antibiotics within 1 h for septic shock and obtain cultures first.

Meningitis: give dexamethasone with or before first antibiotic dose in suspected pneumococcal meningitis; do not delay antibiotics for lumbar puncture if signs of raised ICP.

HIV: initiate antiretroviral therapy for all regardless of CD4; post-exposure prophylaxis within 72 h using a 3-drug regimen for 28 days.

Malaria: thick and thin films plus rapid diagnostic test; severe falciparum malaria (parasitemia >5%, acidosis, cerebral involvement) requires IV artesunate.

Endocarditis prophylaxis: indicated before dental procedures only for high-risk patients (prosthetic valve, prior endocarditis, certain congenital heart disease).

Clostridioides difficile: oral vancomycin or fidaxomicin for initial episode; avoid antiperistaltic agents; recurrent disease may need fecal microbiota transplantation.

Tuberculosis infection: latent TB treated with isoniazid plus rifapentine weekly for 3 months or rifampicin for 4 months; screen for active disease first.

Rheumatoid arthritis: anti-CCP has higher specificity than rheumatoid factor; methotrexate is first-line disease-modifying therapy with folic acid supplementation.

Systemic lupus erythematosus: anti-dsDNA and anti-Smith are specific; hydroxychloroquine for all patients unless contraindicated, plus steroids for flares.

Gout: diagnose with negatively birefringent needle-shaped crystals; treat acute flare with NSAID, colchicine, or corticosteroids; urate-lowering therapy targets serum urate <360 µmol/L.

Giant cell arteritis: start high-dose corticosteroids immediately when suspected to prevent vision loss; temporal artery biopsy confirms but does not delay treatment.

Ankylosing spondylitis: sacroiliitis on imaging plus inflammatory back pain; TNF inhibitors or IL-17 inhibitors for inadequate response to NSAIDs.

Antiphospholipid syndrome: thrombosis or pregnancy morbidity plus lupus anticoagulant, anticardiolipin, or anti-beta-2-glycoprotein antibodies; long-term anticoagulation for thrombosis.

Anaphylaxis: intramuscular adrenaline 0.5 mg (1:1000) into the anterolateral thigh, repeated every 5 min as needed; adjuncts include antihistamines and corticosteroids.

Acute ischemic stroke: non-contrast CT excludes hemorrhage; IV thrombolysis within 4.5 h of onset if no contraindication; thrombectomy for large vessel occlusion up to 24 h in selected patients.

Status epilepticus: benzodiazepine first-line (IV lorazepam or IM midazolam), then second-line (levetiracetam, valproate, or phenytoin); refractory cases need anesthetic infusion.

Guillain-Barré syndrome: progressive ascending weakness with areflexia; treat with IV immunoglobulin or plasma exchange; monitor vital capacity for respiratory failure.

Myasthenia gravis: fatigable weakness, ptosis, diplopia; anti-acetylcholinesterase for symptoms, steroids and steroid-sparing agents for maintenance; myasthenic crisis needs IVIG or plasma exchange.

Multiple sclerosis: McDonald criteria combine clinical attacks with MRI dissemination in space and time; acute relapse treated with high-dose corticosteroids.

Bacterial meningitis: neck stiffness, fever, altered mental status; CSF shows neutrophilic pleocytosis, low glucose, high protein; start empirical antibiotics immediately.

Migraine: triptans for acute attacks; prophylaxis with beta-blockers, topiramate, amitriptyline, or CGRP monoclonal antibodies if frequent or disabling.

Acute respiratory distress syndrome: Berlin criteria - onset within 1 week, bilateral infiltrates, not explained by cardiac failure, PaO2/FiO2 ≤300 mmHg on PEEP ≥5 cmH2O.

Septic shock: fluids 30 mL/kg crystalloid within first 3 h, then vasopressors (norepinephrine first-line) to target MAP ≥65 mmHg.

Acute coronary syndrome: aspirin 300 mg chewed plus P2Y12 inhibitor and anticoagulation; monitor for cardiogenic shock and arrhythmia.

Anaphylaxis: IM adrenaline 0.5 mg (1:1000) into the anterolateral thigh, repeated every 5 min; adjuncts include fluids, antihistamines, and corticosteroids.

Diabetic ketoacidosis: IV fluids, insulin infusion, and potassium replacement; monitor for cerebral edema and hypokalemia during treatment.

Trauma: primary survey ABCDE; permissive hypotension in hemorrhagic shock until hemorrhage control; massive transfusion protocol with balanced ratios.

Poisoning: activated charcoal within 1 h for ingestions of adsorbable toxins in a protected airway; specific antidotes include naloxone, flumazenil, and N-acetylcysteine.

Hypertension: confirm with ambulatory or home monitoring; first-line agents include ACE inhibitors/ARBs, calcium channel blockers, and thiazide diuretics.

Hyperlipidemia: statin intensity based on ASCVD risk; high-intensity statin for established atherosclerotic disease targeting LDL <1.8 mmol/L.

Venous thromboembolism: anticoagulation for 3 months for provoked events; extended therapy for unprovoked or recurrent events based on bleeding risk.

Community-acquired pneumonia: assess severity with CURB-65; empirical antibiotics according to local resistance patterns and severity.

Delirium: use the Confusion Assessment Method; identify and treat underlying causes and avoid antipsychotics unless severe agitation.

Perioperative medication: continue beta-blockers and statins; hold ACE inhibitors on morning of surgery in high-risk patients; bridge anticoagulation only in selected high-risk cases.

Alcohol withdrawal: use a symptom-triggered benzodiazepine regimen guided by the CIWA-Ar score; give thiamine before glucose to prevent Wernicke encephalopathy.

Frailty: assess with gait speed, grip strength, and unintentional weight loss; frailty predicts postoperative complications and mortality.

Polypharmacy: use the Beers criteria to identify potentially inappropriate medications in older adults; deprescribe anticholinergics, benzodiazepines, and long-acting sulfonylureas.

Falls: multifactorial assessment including vision, gait, medications, and home hazards; vitamin D supplementation and exercise reduce recurrence.

Delirium: common postoperative complication in older adults; prevent with orientation, sleep hygiene, early mobilization, and hearing/vision aids.

Perioperative risk: use the Revised Cardiac Risk Index and functional capacity; consider cardiopulmonary exercise testing for high-risk surgery.

Advance care planning: document resuscitation preferences and goals of care; reassess at transitions of care and after major illness.

Osteoporosis: DXA T-score ≤−2.5 defines osteoporosis; bisphosphonates first-line with calcium and vitamin D and fall prevention.

Cellulitis: diagnose clinically; cover streptococci and staphylococci; elevate limb and treat tinea pedis to prevent recurrence.

Urinary tract infection: uncomplicated cystitis treated with nitrofurantoin or fosfomycin; avoid fluoroquinolones for uncomplicated cases.

Infective endocarditis: obtain three sets of blood cultures before antibiotics; echocardiography guides diagnosis and surgery timing.

COVID-19: assess severity with oxygen saturation and respiratory rate; corticosteroids for hypoxemic patients, antivirals for high-risk early disease.

Hepatitis B: screen with HBsAg, anti-HBc, and anti-HBs; vaccinate non-immune individuals; treat with tenofovir or entecavir when indicated.

Hepatitis C: cure with direct-acting antivirals; check sustained virologic response 12 weeks after therapy.

Tetanus: clean wounds and give toxoid booster; human tetanus immunoglobulin for contaminated wounds in unvaccinated patients.

Heart failure with reduced ejection fraction: four pillars - ARNI/ACEi, evidence-based beta-blocker, MRA, and SGLT2 inhibitor - reduce mortality.

Atrial fibrillation rate control: beta-blockers or non-dihydropyridine calcium channel blockers; digoxin for sedentary patients or added rate control.

Hypertension emergency: lower mean arterial pressure by no more than 25% in first hour, then gradually, to avoid organ hypoperfusion.

Aortic dissection: sudden tearing chest pain with pulse deficit; CT angiography confirms; IV beta-blocker to target heart rate <60 then surgery for type A.

Stable angina: beta-blocker first-line for symptom control; long-acting nitrate and calcium channel blocker as add-on; revascularization for refractory symptoms.

Valvular heart disease: mitral stenosis often rheumatic; balloon valvuloplasty for symptomatic severe stenosis with suitable valve morphology.

Cardiac arrest: high-quality CPR with minimal interruptions; defibrillate shockable rhythms; epinephrine every 3-5 min; target temperature management after ROSC.

Asthma control: assess with symptom frequency, night waking, reliever use, and activity limitation; step up or down therapy accordingly.

COPD: confirm with post-bronchodilator FEV1/FVC <0.70; long-acting bronchodilators are cornerstone; pulmonary rehabilitation improves symptoms and exercise capacity.

Pneumothorax: tension pneumothorax is a clinical diagnosis - immediate needle decompression then chest tube; do not wait for imaging.

Pleural effusion: thoracentesis for diagnosis; large symptomatic effusion may need drainage; malignant effusion managed with pleurodesis or indwelling catheter.

Interstitial lung disease: high-resolution CT is key; idiopathic pulmonary fibrosis treated with antifibrotics (pirfenidone or nintedanib).

Pulmonary hypertension: right heart catheterization confirms; treat group 1 with pulmonary vasodilators; group 3 focuses on underlying lung disease.

Lung cancer: staging with CT and PET; small cell is chemosensitive; non-small cell may be resectable or treated with targeted therapy based on molecular markers.

Cirrhosis: assess with Child-Pugh or MELD score; screen for varices with endoscopy and hepatocellular carcinoma with ultrasound every 6 months.

Hepatic encephalopathy: lactulose first-line; rifaximin added for recurrent episodes; identify and treat precipitating factors (infection, bleeding, constipation).

Acute liver failure: coagulopathy (INR ≥1.5) plus encephalopathy in a patient without cirrhosis; N-acetylcysteine for acetaminophen toxicity; consider transplant.

Peptic ulcer disease: test for H. pylori with urea breath test or stool antigen; eradication with proton pump inhibitor-based triple or quadruple therapy.

Gallstone disease: cholecystitis presents with right upper quadrant pain and fever; ultrasound shows stones and wall thickening; treat with antibiotics and cholecystectomy.

Colorectal cancer screening: start at age 45-50; colonoscopy every 10 years or stool-based testing annually; earlier for family history or hereditary syndromes.

Chronic hepatitis B: treat when HBV DNA elevated with ALT rise, fibrosis, or cirrhosis; monitor with HBV DNA and liver enzymes.

Hyponatremia: check serum osmolality first; hypotonic hyponatremia classified by urine osmolality and volume status; SIADH has urine osmolality >100 and euvolemia.

Hypernatremia: usually water deficit; correct slowly (no more than 10 mmol/L per 24 h) to avoid cerebral edema.

Hypokalemia: ECG changes include U waves and flattened T; replace potassium and check magnesium, since hypomagnesemia causes refractory hypokalemia.

Metabolic alkalosis: assess urine chloride; low urine chloride suggests vomiting or diuretics; high suggests mineralocorticoid excess.

Nephritic syndrome: hematuria, hypertension, edema, and oliguria; common causes include post-streptococcal glomerulonephritis and IgA nephropathy.

Chronic kidney disease: stage by eGFR (G1-G5) and albuminuria (A1-A3); treat with ACE inhibitor/ARB, blood pressure control, and SGLT2 inhibitor for progression.

Contrast-induced nephropathy: risk factors include CKD and diabetes; use iso-osmolar contrast and hydration; avoid repeat contrast within 48-72 h.

Type 2 diabetes: metformin first-line unless contraindicated; add SGLT2 inhibitor or GLP-1 receptor agonist for cardiorenal protection or weight loss.

Hypoglycemia: check glucose, give oral glucose if conscious, IV dextrose or IM glucagon if not; identify and treat cause.

Cushing syndrome: screen with 24-h urine free cortisol, late-night salivary cortisol, or overnight dexamethasone suppression test; then ACTH to localize.

Hyperthyroidism: TSH low with elevated free T4/T3; Graves disease shows diffuse uptake and TSH receptor antibodies; treat with antithyroid drugs, radioiodine, or surgery.

Hyperparathyroidism: elevated calcium with inappropriately normal or high PTH; primary causes include adenoma; surgery for symptomatic or severe disease.

Osteoporosis: DXA T-score ≤−2.5; bisphosphonates first-line; ensure calcium and vitamin D intake and fall prevention.

Diabetic foot: assess with monofilament and pulses; treat ulcers with debridement and offloading; antibiotics for infection; revascularization if ischemia.

Acute myeloid leukemia: blasts ≥20% in marrow or blood; cytogenetics and molecular markers guide risk and treatment; induction chemotherapy then consolidation or transplant.

Chronic myeloid leukemia: Philadelphia chromosome t(9;22) with BCR-ABL1; treat with tyrosine kinase inhibitors (imatinib first-line).

Lymphoma: Hodgkin shows Reed-Sternberg cells; non-Hodgkin includes diffuse large B-cell (chemotherapy) and follicular (indolent).

Thrombotic thrombocytopenic purpura: microangiopathic hemolytic anemia, thrombocytopenia, neurological and renal involvement, fever; treat with plasma exchange urgently.

Disseminated intravascular coagulation: prolonged PT/APTT, low fibrinogen, elevated D-dimer; treat the underlying cause and support with blood products.

Sickle cell disease: painful crisis treated with hydration and opioids; acute chest syndrome needs oxygen, antibiotics, and transfusion; hydroxyurea reduces crises.

Transfusion reactions: febrile non-hemolytic is most common; acute hemolytic from ABO incompatibility needs immediate stopping of transfusion and supportive care.

Tuberculosis: active disease requires multidrug therapy; monitor for hepatotoxicity and visual changes (ethambutol); adherence support is essential.

HIV opportunistic infections: Pneumocystis jirovecii pneumonia prophylaxis with co-trimoxazole when CD4 <200; treat with co-trimoxazole and steroids if hypoxemic.

Malaria: uncomplicated falciparum treated with artemisinin-based combination therapy; severe disease requires IV artesunate.

Dengue: warning signs include abdominal pain, persistent vomiting, bleeding, and fluid accumulation; monitor hematocrit and platelets; avoid NSAIDs.

Brucellosis: zoonotic infection with fever, arthralgia, and hepatosplenomegaly; treat with doxycycline plus rifampicin or streptomycin.

Typhoid fever: stepwise fever, abdominal pain, and relative bradycardia; treat with ceftriaxone or azithromycin based on resistance.

Measles: airborne precautions; vitamin A for children; post-exposure prophylaxis with vaccine or immunoglobulin for susceptible contacts.

Osteoarthritis: weight loss, exercise, and acetaminophen or NSAIDs; intra-articular steroids for flares; joint replacement for severe disease.

Psoriatic arthritis: methotrexate or TNF inhibitors; screen for tuberculosis before biologics.

Polymyalgia rheumatica: proximal muscle pain and stiffness with elevated ESR/CRP; low-dose prednisolone with rapid response.

Vasculitis: ANCA-associated (granulomatosis with polyangiitis, microscopic polyangiitis) treated with steroids plus rituximab or cyclophosphamide.

Systemic sclerosis: Raynaud phenomenon and skin thickening; screen for pulmonary hypertension and interstitial lung disease; avoid steroids in renal crisis.

Sjögren syndrome: dry eyes and mouth with anti-Ro/SSA antibodies; treat sicca symptoms and monitor for lymphoma.

Immunodeficiency: screen with immunoglobulin levels and lymphocyte subsets; replace immunoglobulins in antibody deficiency.

Parkinson disease: bradykinesia plus rigidity or tremor; levodopa-carbidopa is most effective; monitor for dyskinesia and motor fluctuations.

Alzheimer disease: progressive memory loss; cholinesterase inhibitors for mild-moderate disease; memantine for moderate-severe disease.

Epilepsy: diagnose with ≥2 unprovoked seizures or one with high recurrence risk; choose antiseizure medication by seizure type and comorbidities.

Multiple sclerosis: MRI shows periventricular, juxtacortical, infratentorial, and spinal cord lesions; disease-modifying therapy reduces relapses.

Raised intracranial pressure: headache, vomiting, papilledema, and decreased consciousness; avoid lumbar puncture if signs present; treat with head elevation and osmotic therapy.

Peripheral neuropathy: evaluate with glucose, B12, and medication review; treat underlying cause and manage neuropathic pain with gabapentin or duloxetine.

Subarachnoid hemorrhage: sudden severe headache; CT within 6 h is highly sensitive; lumbar puncture for xanthochromia if CT negative; treat with nimodipine and aneurysm securing.

Mechanical ventilation: lung-protective strategy with tidal volume 6 mL/kg predicted body weight and plateau pressure ≤30 cmH2O in ARDS.

Vasopressors: norepinephrine first-line for septic shock; add vasopressin or epinephrine for refractory shock; target MAP ≥65 mmHg.

Acute kidney injury in ICU: avoid nephrotoxins, optimize perfusion, and consider renal replacement therapy for refractory acidosis, hyperkalemia, or volume overload.

Sedation: target light sedation with daily interruption; use propofol or dexmedetomidine; avoid benzodiazepines when possible.

Trauma: primary survey ABCDE; permissive hypotension in hemorrhagic shock until hemorrhage control; massive transfusion protocol with balanced ratios.

Poisoning: activated charcoal within 1 h for ingestions of adsorbable toxins in a protected airway; specific antidotes include naloxone, flumazenil, and N-acetylcysteine.

Cardiac arrest: high-quality CPR with minimal interruptions; defibrillate shockable rhythms; epinephrine every 3-5 min; target temperature management after ROSC.

Hypertension: confirm with ambulatory or home monitoring; first-line agents include ACE inhibitors/ARBs, calcium channel blockers, and thiazide diuretics.

Hyperlipidemia: statin intensity based on ASCVD risk; high-intensity statin for established atherosclerotic disease targeting LDL <1.8 mmol/L.

Venous thromboembolism: anticoagulation for 3 months for provoked events; extended therapy for unprovoked or recurrent events based on bleeding risk.

Community-acquired pneumonia: assess severity with CURB-65; empirical antibiotics according to local resistance patterns and severity.

Delirium: use the Confusion Assessment Method; identify and treat underlying causes and avoid antipsychotics unless severe agitation.

Perioperative medication: continue beta-blockers and statins; hold ACE inhibitors on morning of surgery in high-risk patients; bridge anticoagulation only in selected high-risk cases.

Alcohol withdrawal: use a symptom-triggered benzodiazepine regimen guided by the CIWA-Ar score; give thiamine before glucose to prevent Wernicke encephalopathy.

Frailty: assess with gait speed, grip strength, and unintentional weight loss; frailty predicts postoperative complications and mortality.

Polypharmacy: use the Beers criteria to identify potentially inappropriate medications in older adults; deprescribe anticholinergics, benzodiazepines, and long-acting sulfonylureas.

Falls: multifactorial assessment including vision, gait, medications, and home hazards; vitamin D supplementation and exercise reduce recurrence.

Delirium: common postoperative complication in older adults; prevent with orientation, sleep hygiene, early mobilization, and hearing/vision aids.

Perioperative risk: use the Revised Cardiac Risk Index and functional capacity; consider cardiopulmonary exercise testing for high-risk surgery.

Advance care planning: document resuscitation preferences and goals of care; reassess at transitions of care and after major illness.

Osteoporosis: DXA T-score ≤−2.5 defines osteoporosis; bisphosphonates first-line with calcium and vitamin D and fall prevention.