Arab Board Internal Medicine Clinical Exam flashcards

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

STEMI reperfusion window

Primary PCI is preferred within 120 minutes of first medical contact; fibrinolysis is an alternative when PCI is unavailable and symptom onset is under 12 hours without contraindications.

CHA2DS2-VASc anticoagulation threshold

Oral anticoagulation is recommended for atrial fibrillation when the score is at least 2 in men or 3 in women; DOACs are preferred except with mechanical valves or moderate-severe mitral stenosis.

Light criteria exudate

Pleural fluid is exudative if protein ratio exceeds 0.5, LDH ratio exceeds 0.6, or pleural LDH exceeds two-thirds the upper normal serum limit.

CURB-65 components

Confusion, urea above 7 mmol/L, respiratory rate at least 30, systolic BP below 90 or diastolic at most 60, and age at least 65; a score of 2 or more supports admission.

Spontaneous bacterial peritonitis threshold

An ascitic fluid neutrophil count of at least 250 per cubic millimeter is diagnostic; treat with a third-generation cephalosporin and add albumin when creatinine exceeds 1 mg/dL.

Acute severe ulcerative colitis

Defined by at least six bloody stools per day plus systemic toxicity; intravenous corticosteroids are first-line with rescue infliximab or colectomy for nonresponse.

KDIGO AKI creatinine criteria

AKI is a creatinine rise of 1.5 to 1.9 times baseline, 2.0 to 2.9 times, or at least 3 times, or a rise to at least 354 micromol/L.

Hyponatremia correction limit

Correct chronic hyponatremia by no more than 8 to 10 mmol/L in 24 hours to avoid osmotic demyelination; acute symptomatic cases may need faster initial correction.

Diabetic ketoacidosis potassium rule

Replace potassium once serum potassium is below 5.5 mmol/L; add dextrose when glucose falls below 14 mmol/L so the insulin infusion can continue.

Thyroid storm treatment sequence

Give a beta-blocker, then a thionamide, then iodine after the thionamide, plus corticosteroids; a Burch-Wartofsky score of 45 or more suggests thyroid storm.

Heparin-induced thrombocytopenia

Platelet count falls by at least 50 percent typically 5 to 10 days after heparin exposure with high thrombosis risk; stop heparin and start a non-heparin anticoagulant.

Neutropenic fever definition

A single oral temperature of at least 38.3 degrees Celsius, or at least 38.0 sustained over one hour, in a neutropenic patient; start antipseudomonal antibiotics within one hour.

Sepsis antibiotic timing

Obtain cultures then give broad-spectrum antibiotics within one hour for septic shock; for possible sepsis without shock, complete evaluation within three hours.

Severe falciparum malaria treatment

Severe disease with parasitemia above 5 percent, acidosis, or cerebral involvement requires intravenous artesunate; uncomplicated cases use artemisinin-based combination therapy.

Gout crystal finding

Negatively birefringent needle-shaped monosodium urate crystals confirm gout; urate-lowering therapy targets serum urate below 360 micromol/L.

Giant cell arteritis urgency

Start high-dose corticosteroids immediately when giant cell arteritis is suspected to prevent vision loss; temporal artery biopsy confirms but must not delay treatment.

Status epilepticus sequence

Give a benzodiazepine first, then a second-line agent such as levetiracetam, valproate, or phenytoin; refractory cases require anesthetic infusion.

Berlin ARDS criteria

Onset within one week, bilateral infiltrates not explained by cardiac failure, and PaO2/FiO2 of 300 mmHg or less on PEEP of at least 5 cmH2O.

Septic shock initial resuscitation

Give 30 mL/kg crystalloid within the first three hours, then start norepinephrine to target a mean arterial pressure of at least 65 mmHg.

Statin target in ASCVD

High-intensity statin therapy for established atherosclerotic cardiovascular disease, targeting LDL cholesterol below 1.8 mmol/L.

Beers criteria purpose

Identifies potentially inappropriate medications in older adults, including anticholinergics, benzodiazepines, and long-acting sulfonylureas, to guide deprescribing.

Heart failure four pillars

For reduced ejection fraction, combine an ARNI or ACE inhibitor, an evidence-based beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor to reduce mortality.

Tension pneumothorax management

Tension pneumothorax is a clinical diagnosis; perform immediate needle decompression followed by chest tube insertion without waiting for imaging.

Hepatorenal syndrome treatment

Functional renal failure in cirrhosis treated first-line with terlipressin plus albumin; exclude hypovolemia with a volume challenge and avoid nephrotoxins.

Metabolic acidosis anion gap

Anion gap equals sodium minus the sum of chloride and bicarbonate; a high gap suggests ketoacidosis, lactic acidosis, renal failure, or toxins.

Adrenal crisis treatment

Give intravenous hydrocortisone immediately, 100 mg then 50 mg every six hours, with saline; do not delay treatment for cortisol results when suspected.

Tumor lysis syndrome features

Hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia; prevent with hydration and allopurinol, or rasburicase in high-risk patients.

HIV post-exposure prophylaxis

Start a three-drug antiretroviral regimen within 72 hours of exposure and continue for 28 days; test the source and baseline serology.

Anaphylaxis first-line drug

Intramuscular adrenaline 0.5 mg of 1:1000 solution into the anterolateral thigh, repeated every five minutes as needed; adjuncts include fluids and antihistamines.

Ischemic stroke thrombolysis window

Intravenous thrombolysis within 4.5 hours of onset if non-contrast CT excludes hemorrhage and no contraindication exists; thrombectomy for large vessel occlusion in selected patients.

Hyperkalemia emergency sequence

Give intravenous calcium for membrane stabilization, then insulin-glucose and salbutamol to shift potassium, and remove potassium with binders or dialysis.

Alcohol withdrawal treatment

Use symptom-triggered benzodiazepines guided by the CIWA-Ar score, and give thiamine before glucose to prevent Wernicke encephalopathy.