Arab Board Internal Medicine Clinical Exam key terms

The difference between measured serum sodium and the sum of measured chloride and bicarbonate, used to classify metabolic acidosis; a raised value suggests accumulation of unmeasured acids such as ketones, lactate or uremic toxins.

The difference between measured and calculated serum osmolality; an increased gap indicates the presence of unmeasured osmotically active substances such as methanol, ethylene glycol or isopropanol.

A metabolic acidosis with elevated anion gap caused by addition of non-volatile acids; common causes include ketoacidosis, lactic acidosis, renal failure and ingestion of toxins such as salicylate or methanol.

Deep, rapid, regular breathing that represents respiratory compensation for severe metabolic acidosis; classically seen in diabetic ketoacidosis and other high anion gap states.

The percentage of filtered sodium that appears in urine, calculated from paired serum and urine sodium and creatinine; a low value in oliguric renal failure favours a prerenal cause.

Acute kidney injury caused by ischaemic or toxic injury to tubular epithelial cells, typically with muddy brown casts and a high fractional excretion of sodium; often follows hypotension, sepsis or nephrotoxins.

A reversible fall in glomerular filtration due to reduced renal perfusion, such as from hypovolaemia or heart failure; characterised by a bland urine sediment, low fractional excretion of sodium and rapid improvement with volume restoration.

Euvolaemic hyponatraemia caused by excessive antidiuretic hormone action, with concentrated urine and continued urinary sodium excretion; requires exclusion of hypothyroidism and adrenal insufficiency and treatment by fluid restriction.

Serum sodium below the normal reference range; assessment requires measurement of osmolality and volume status because rapid correction risks osmotic demyelination, while too-slow correction in symptomatic patients risks cerebral oedema.

Neurological injury, classically central pontine myelinolysis, caused by overly rapid correction of chronic hyponatraemia; presents with dysarthria, dysphagia, quadriparesis or altered consciousness days after sodium rises.

A hyperglycaemic emergency with ketonaemia, high anion gap metabolic acidosis and total body potassium depletion; managed with intravenous fluids, insulin infusion and replacement of potassium and other electrolytes.

Severe hyperglycaemia with marked hyperosmolality and profound dehydration, usually without significant ketosis, occurring mainly in older patients with type 2 diabetes; mortality is higher than in ketoacidosis.

Haemoglobin with glucose irreversibly attached, reflecting average blood glucose over roughly the preceding two to three months; used to diagnose and monitor diabetes, though it is unreliable in haemoglobinopathies and abnormal red cell turnover.

Abnormally low blood glucose causing autonomic and neuroglycopenic symptoms; in a patient on insulin or sulfonylureas it is a medical emergency treated with oral glucose or intravenous dextrose, with glucagon as an alternative.

Acute myocardial infarction with persistent ST elevation in contiguous leads, indicating transmural injury from coronary occlusion; requires emergency reperfusion by primary percutaneous coronary intervention or fibrinolysis.

A cardiac structural protein released into blood when myocytes are injured; high-sensitivity assays are the preferred biomarker for diagnosing myocardial infarction, interpreted with serial change and the clinical context.

The spectrum of myocardial ischaemia from plaque rupture or erosion, comprising unstable angina, non-ST-elevation myocardial infarction and ST-elevation myocardial infarction; managed with antiplatelet therapy and risk-stratified revascularisation.

Heart failure with left ventricular ejection fraction of 40 percent or less; guideline-directed therapy with renin-angiotensin system inhibition, beta-blockade, mineralocorticoid receptor antagonism and SGLT2 inhibition improves survival.

Hormones such as BNP and NT-proBNP released by stretched ventricular myocardium; elevated levels support a diagnosis of heart failure but are affected by age, renal function, obesity and atrial fibrillation.

Inadequate tissue perfusion due to cardiac pump failure, with hypotension, cool peripheries, raised filling pressures and elevated lactate; most often caused by extensive myocardial infarction and carries high mortality.

A supraventricular arrhythmia with disorganised atrial electrical activity and an irregularly irregular ventricular rhythm; management centres on rate or rhythm control and stroke prevention with anticoagulation according to thromboembolic risk.

A clinical score estimating stroke risk in non-valvular atrial fibrillation from factors including heart failure, hypertension, age, diabetes and prior stroke; it guides the decision to start oral anticoagulation.

Emergency catheter-based reopening of an occluded coronary artery with balloon angioplasty and stenting; the preferred reperfusion strategy for ST-elevation myocardial infarction when it can be delivered promptly.

Persistent airflow obstruction from airway and parenchymal disease, usually related to tobacco smoke; exacerbations are managed with bronchodilators, corticosteroids, antibiotics when indicated and controlled oxygen therapy.

Hypoxaemia with hypercapnia, caused by alveolar hypoventilation or ventilation-perfusion mismatch; common causes include severe COPD exacerbation, obesity hypoventilation and neuromuscular weakness.

Delivery of ventilatory support through a mask, most often bilevel positive airway pressure; it reduces intubation and mortality in hypercapnic exacerbations of COPD and is used in acute cardiogenic pulmonary oedema.

Occlusion of pulmonary arteries by thrombus, usually from deep vein thrombosis, causing dyspnoea, chest pain and right ventricular strain; diagnosis uses pretest probability, D-dimer and CT pulmonary angiography.

A validated clinical prediction tool that estimates the pretest probability of pulmonary embolism or deep vein thrombosis from history, examination and likelihood of alternative diagnoses; it determines whether D-dimer testing is appropriate.

Bleeding proximal to the ligament of Treitz, usually from peptic ulcer disease or oesophageal varices; initial management prioritises resuscitation, risk scoring and endoscopy within 24 hours after stabilisation.

A score using blood urea, haemoglobin, systolic pressure, pulse and clinical features to stratify risk in upper gastrointestinal bleeding; a very low score identifies patients suitable for outpatient management.

Bleeding from portosystemic collaterals, typically oesophageal or gastric varices, in patients with portal hypertension; managed with vasoactive drugs, prophylactic antibiotics and endoscopic band ligation.

Reversible neuropsychiatric dysfunction in liver disease caused by accumulation of gut-derived toxins such as ammonia; precipitated by infection, bleeding, constipation or electrolyte disturbance and treated with lactulose and rifaximin.

Infection of ascitic fluid in cirrhosis without an intra-abdominal surgical source; diagnosed by an ascitic neutrophil count of 250 cells per microlitre or more and treated with intravenous antibiotics plus albumin.

A prognostic score in cirrhosis combining bilirubin, albumin, prothrombin time, ascites and encephalopathy; it grades severity and informs prognosis and surgical risk.

Life-threatening infection during severe neutropenia, often after chemotherapy; presents with fever or hypotension and requires immediate empirical broad-spectrum antibiotics, ideally within one hour of recognition.

Fever in a patient with an absolute neutrophil count below 0.5 cells times 10 to the ninth per litre, or expected to fall below that level; a medical emergency requiring prompt cultures and empirical antibiotics.

Life-threatening organ dysfunction caused by a dysregulated host response to infection, operationalised as a rise in the SOFA score; requires early antibiotics, source control and haemodynamic support.

Sepsis with persistent hypotension requiring vasopressors to maintain mean arterial pressure and a raised lactate despite adequate fluid resuscitation; mortality is high and management includes noradrenaline and source control.

The fall in blood lactate over time during resuscitation; failure to clear lactate indicates ongoing tissue hypoperfusion and predicts worse outcome in sepsis and shock states.

Acute hypoxaemic respiratory failure with bilateral infiltrates not explained by cardiac failure, arising within a week of a known insult; managed with lung-protective ventilation and treatment of the underlying cause.

Autoantibodies directed against nuclear components, used as a screening test for systemic lupus erythematosus; a positive result is common in healthy people, so specificity depends on titre and clinical context.

A multisystem autoimmune disease with autoantibodies and immune complex deposition, affecting skin, joints, kidneys, blood and nervous system; managed with hydroxychloroquine, corticosteroids and immunosuppression.

A prothrombotic autoimmune disorder defined by vascular thrombosis or pregnancy morbidity together with persistent antiphospholipid antibodies; long-term anticoagulation is the mainstay of treatment.

An autoantibody, usually IgM, directed against the Fc portion of IgG; it supports a diagnosis of rheumatoid arthritis but is also found in other autoimmune diseases, chronic infections and healthy older adults.

An autoantibody with high specificity for rheumatoid arthritis that often precedes clinical disease; its presence predicts more erosive joint damage.

A chronic symmetrical inflammatory polyarthritis that can erode joints and cause extra-articular disease; early treatment with conventional or biologic disease-modifying drugs prevents disability.

Immune-complex glomerulonephritis in systemic lupus erythematosus, presenting with proteinuria, haematuria and declining renal function; classification by renal biopsy guides immunosuppressive therapy.

Acute focal neurological deficit from cerebral infarction due to arterial occlusion; time-critical management includes imaging, thrombolysis or thrombectomy in eligible patients and secondary prevention.

Transient focal neurological dysfunction without infarction on imaging, caused by temporary cerebral ischaemia; it signals high early stroke risk and requires urgent investigation and preventive treatment.

Pharmacological dissolution of thrombus using agents such as alteplase; in ischaemic stroke it is given within a narrow time window after excluding haemorrhage, and in myocardial infarction when primary angioplasty is unavailable.

A score from 3 to 15 combining eye opening, verbal response and motor response, used to grade level of consciousness and to detect neurological deterioration.

An acute fluctuating disturbance of attention and cognition caused by underlying illness, drugs or withdrawal; common in older hospitalised patients and managed by treating the cause and non-pharmacological measures.

A multidimensional evaluation of an older person's medical, functional, psychological and social status, leading to a coordinated care plan; it improves outcomes and reduces hospitalisation.

A syndrome of reduced physiological reserve and increased vulnerability to stressors in older adults; recognition helps guide treatment intensity, rehabilitation and perioperative risk.

Estimation of the likelihood of cardiac or other complications after surgery using clinical factors, functional capacity and, where appropriate, cardiac testing or risk indices; it informs shared decisions about surgery.

An abrupt decline in renal function defined by a rise in serum creatinine or fall in urine output; causes are classified as prerenal, intrinsic renal or postrenal, and management targets the cause and complications.

The concentration of osmotically active particles in a fluid, measured or calculated; serum and urine osmolality help distinguish causes of hyponatraemia and hyperglycaemic emergencies.

Poisoning with substances such as methanol or ethylene glycol, causing high anion gap metabolic acidosis with an osmolal gap and end-organ toxicity; treated with antidotes and haemodialysis.

Echocardiographic or electrocardiographic signs of right ventricular pressure overload, such as dilatation, hypokinesis or T-wave inversion; in pulmonary embolism it identifies higher-risk patients.