Arab Board IM Final Written cheat sheet

STEMI: ST elevation ≥1 mm in two contiguous limb leads, ≥2 mm in V2–V3 (men ≥40), ≥1.5 mm V2–V3 (women), or ≥2 mm in other precordial leads; new LBBB with symptoms is equivalent.

Acute decompensated HF: IV furosemide 1–2.5× home dose; add vasodilators (nitroglycerin) if SBP >110 mmHg; inotropes (dobutamine) if SBP <90 mmHg with hypoperfusion.

Atrial fibrillation anticoagulation: CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) → anticoagulate; score of 1 (men) or 2 (women) → consider. HAS-BLED ≥3 = high bleeding risk but not a reason to withhold anticoagulation.

Heart failure with reduced EF: four pillars - ARNI/ACEi/ARB, beta-blocker (bisoprolol, carvedilol, metoprolol succinate), MRA (spironolactone/eplerenone), SGLT2 inhibitor (dapagliflozin/empagliflozin).

Aortic stenosis severity: severe if aortic valve area <1.0 cm², mean gradient ≥40 mmHg, or peak velocity ≥4.0 m/s; symptomatic severe AS → valve replacement.

Infective endocarditis: modified Duke criteria - 2 major, 1 major + 3 minor, or 5 minor. Major: positive blood cultures (typical organism in 2 separate cultures) and imaging (echo vegetation/abscess).

Hypertrophic cardiomyopathy: asymmetric septal hypertrophy, systolic anterior motion of mitral valve, dynamic LVOT obstruction; avoid vasodilators/diuretics that worsen obstruction; beta-blockers first-line.

Pericarditis: diffuse ST elevation with PR depression; treat with NSAIDs + colchicine; avoid anticoagulation. Tamponade: Beck triad (hypotension, JVD, muffled heart sounds) + pulsus paradoxus.

Wide-complex tachycardia: assume VT until proven otherwise; unstable → synchronized cardioversion; stable → amiodarone or procainamide; avoid verapamil/diltiazem in suspected VT.

COPD: post-bronchodilator FEV1/FVC <0.70 confirms airflow obstruction; GOLD 1: FEV1 ≥80%, GOLD 2: 50–79%, GOLD 3: 30–49%, GOLD 4: <30% predicted.

Asthma control: well controlled = daytime symptoms ≤2 days/week, no night waking, reliever ≤2 days/week, no activity limitation, normal FEV1. Uncontrolled = any of these in past 4 weeks.

Pulmonary embolism: Wells score >4 = likely; D-dimer for low/intermediate probability; CTPA is diagnostic; high-risk (shock/hypotension) → systemic thrombolysis.

Pneumonia severity: CURB-65 (Confusion, Urea >7 mmol/L, RR ≥30, BP <90/60, age ≥65); 0–1 = outpatient, 2 = short admission, ≥3 = severe, consider ICU.

Pleural effusion: Light's criteria - exudate if pleural protein/serum protein >0.5, pleural LDH/serum LDH >0.6, or pleural LDH >2/3 upper limit of normal serum LDH.

Obstructive sleep apnea: STOP-BANG ≥3 = intermediate risk; diagnosis with polysomnography or home sleep apnea test; AHI ≥5 with symptoms or ≥15 alone defines OSA.

Tuberculosis: latent TB (positive IGRA/TST, no symptoms, normal CXR) → 3HP (isoniazid+rifapentine weekly ×12) or 4R rifampicin daily ×4 months; active TB → RIPE 2 months + RI 4 months.

ARDS (Berlin): acute onset ≤1 week, bilateral opacities not fully explained by effusion/collapse, PaO₂/FiO₂ ≤300 mmHg with PEEP ≥5 cmH₂O; mild 200–300, moderate 100–200, severe <100.

Lung cancer: small-cell → platinum + etoposide; non-small-cell → stage I–II surgery; advanced → targeted therapy if EGFR/ALK/ROS1 positive, otherwise chemoimmunotherapy.

Upper GI bleed: pre-endoscopy Glasgow-Blatchford score ≤1 = low risk for outpatient; variceal bleed → octreotide + ceftriaxone + endoscopic band ligation within 12 h.

H. pylori eradication: PPI + amoxicillin + clarithromycin ×14 days (or bismuth quadruple if clarithromycin resistance >15%); confirm eradication ≥4 weeks after therapy with urea breath test/stool antigen.

Acute pancreatitis: diagnosis requires 2 of 3 - characteristic pain, lipase/amylase >3× ULN, imaging findings. Fluid resuscitation with lactated Ringer's; no prophylactic antibiotics.

Cirrhosis: Child-Pugh (bilirubin, albumin, INR, ascites, encephalopathy) and MELD-Na (bilirubin, INR, creatinine, sodium) for prognosis/transplant. Ascites → spironolactone + furosemide, sodium restriction.

Spontaneous bacterial peritonitis: ascitic PMN ≥250/mm³; treat with IV cefotaxime 2 g q8h ×5 days; give albumin 1.5 g/kg day 1 and 1 g/kg day 3 if creatinine >1 mg/dL or bilirubin >4 mg/dL.

Hepatorenal syndrome: functional renal failure in cirrhosis; terlipressin + albumin first-line; avoid NSAIDs, ACE inhibitors, and nephrotoxins.

Inflammatory bowel disease: ulcerative colitis involves rectum continuously; Crohn's is transmural, skip lesions, fistulas. Acute severe UC: ≥6 bloody stools/day + systemic toxicity → IV hydrocortisone; rescue infliximab or colectomy.

Celiac disease: anti-tTG IgA with total IgA level; duodenal biopsy shows villous atrophy, crypt hyperplasia; treatment is lifelong gluten-free diet.

Wilson disease: low ceruloplasmin, high urinary copper, Kayser-Fleischer rings, Coombs-negative hemolysis; treat with penicillamine or trientine + zinc.

AKI KDIGO: increase in serum creatinine ≥0.3 mg/dL within 48 h, or ≥1.5× baseline within 7 days, or urine output <0.5 mL/kg/h for 6 h. Stage 3: creatinine ≥3× baseline or ≥4.0 mg/dL, or RRT.

Hyperkalemia with ECG changes: IV calcium gluconate 10% 10–30 mL; insulin 10 U + dextrose 25 g; salbutamol nebulized; sodium bicarbonate if acidosis; dialysis for refractory cases.

Hyponatremia: assess volume status and urine osmolality; SIADH = euvolemic, urine osmolality >100 mOsm/kg, urine Na >30 mmol/L, normal thyroid/adrenal. Correct Na ≤8–10 mmol/L/24 h to avoid osmotic demyelination.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia <3.0 g/dL, edema, hyperlipidemia. Minimal change disease → steroids; membranous → rituximab or cyclophosphamide + steroids.

Glomerulonephritis: nephritic syndrome = hematuria, RBC casts, hypertension, oliguria. IgA nephropathy = synpharyngitic hematuria; post-streptococcal GN = 1–3 weeks after infection, low C3.

CKD staging by eGFR: G1 ≥90, G2 60–89, G3a 45–59, G3b 30–44, G4 15–29, G5 <15 mL/min/1.73 m². Albuminuria A1 <30, A2 30–300, A3 >300 mg/g.

Dialysis indications (AEIOU): Acidosis refractory, Electrolyte (K⁺) refractory, Intoxication (dialyzable), Overload refractory, Uremia (pericarditis, encephalopathy).

Renal artery stenosis: flash pulmonary edema, worsening renal function after ACEi/ARB, abdominal bruit; diagnose with Doppler or CTA/MRA; treat with statin, antiplatelet, BP control; revascularization selected cases.

Diabetes diagnosis: fasting glucose ≥7.0 mmol/L (126 mg/dL), 2-h OGTT ≥11.1 mmol/L (200 mg/dL), HbA1c ≥6.5%, or random ≥11.1 with symptoms. Repeat to confirm unless unequivocal.

DKA management: IV 0.9% saline, insulin infusion 0.1 U/kg/h after K⁺ ≥3.3 mmol/L, add 5% dextrose when glucose <13.9 mmol/L (250 mg/dL); check K⁺, venous pH, anion gap every 2–4 h.

Thyroid: primary hypothyroidism = high TSH, low free T4 → levothyroxine 1.6 µg/kg/day; subclinical = high TSH, normal FT4 → treat if TSH >10 or symptomatic. Graves = low TSH, high FT4, diffuse goiter, TSH-receptor antibodies.

Thyroid storm: Burch-Wartofsky score ≥45; treat with propylthiouracil, iodine (≥1 h after PTU), beta-blocker, hydrocortisone, supportive care.

Adrenal insufficiency: morning cortisol <140 nmol/L (5 µg/dL) suggests deficiency; cosyntropin stimulation test - peak cortisol <500 nmol/L (18 µg/dL) diagnostic. Treat with hydrocortisone 15–25 mg/day divided; stress dose.

Primary hyperaldosteronism: aldosterone/renin ratio >20–30 with high aldosterone; confirm with saline suppression; adrenal CT then adrenal vein sampling; treat with spironolactone or adrenalectomy.

Cushing syndrome: 24-h urinary free cortisol, late-night salivary cortisol, or 1 mg overnight dexamethasone suppression test (cortisol >50 nmol/L = failure). ACTH-dependent → pituitary MRI; ectopic → chest/abdominal imaging.

Pheochromocytoma: plasma free metanephrines first-line; 24-h urinary fractionated metanephrines; alpha-blockade (phenoxybenzamine) before beta-blockade to avoid hypertensive crisis.

Osteoporosis: T-score ≤−2.5; treat with bisphosphonates, denosumab, or anabolic agents (teriparatide/romosozumab) for severe disease; ensure calcium and vitamin D.

Iron deficiency anemia: low ferritin (<30 ng/mL) is most specific; low MCV, low serum iron, high TIBC, low transferrin saturation (<20%). Treat with oral iron; investigate GI loss in men and postmenopausal women.

Anemia of chronic disease: normocytic, low serum iron, low TIBC, high ferritin, normal/high transferrin saturation; treat underlying disease; erythropoietin if indicated.

B12 deficiency: macrocytic anemia, hypersegmented neutrophils, low B12, high methylmalonic acid and homocysteine; neurologic symptoms require parenteral B12.

Acute leukemia: ALL = lymphoblasts, CD19/CD10/TdT; AML = myeloblasts, Auer rods, MPO positive. APL (M3) = t(15;17) PML-RARA → ATRA + arsenic trioxide.

CML: Philadelphia chromosome t(9;22) BCR-ABL; treat with imatinib (first-line TKI); monitor BCR-ABL transcript levels.

Multiple myeloma: CRAB criteria - Calcium elevated, Renal insufficiency, Anemia, Bone lesions; plus M-protein, marrow plasma cells ≥10%. Treat with bortezomib, lenalidomide, dexamethasone.

Lymphoma: Hodgkin = Reed-Sternberg cells (CD15+, CD30+), contiguous spread; non-Hodgkin diffuse large B-cell → R-CHOP. Staging with PET-CT.

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

Neutropenic fever: ANC <0.5 ×10⁹/L + fever ≥38.3°C once or ≥38.0°C sustained → start empirical anti-pseudomonal beta-lactam (piperacillin-tazobactam or cefepime) within 1 h.

Sepsis: life-threatening organ dysfunction from infection; qSOFA ≥2 (RR ≥22, altered mentation, SBP ≤100) = high risk. Septic shock = vasopressors to maintain MAP ≥65 + lactate >2 mmol/L despite fluids.

Meningitis: adults → ceftriaxone 2 g q12h + vancomycin + dexamethasone before/with first antibiotic dose if pneumococcal suspected; add ampicillin if Listeria risk (age >50, immunocompromised).

Endocarditis prophylaxis: only for highest-risk (prosthetic valve, prior IE, congenital heart disease) before dental procedures; amoxicillin 2 g 30–60 min pre-procedure.

HIV: start ART for all regardless of CD4; first-line tenofovir/emtricitabine + dolutegravir or bictegravir. PCP prophylaxis with co-trimoxazole if CD4 <200; MAC prophylaxis if CD4 <50.

Malaria: severe = parasitemia >5%, impaired consciousness, acidosis, hypoglycemia, renal failure, ARDS; treat with IV artesunate. Uncomplicated falciparum → artemether-lumefantrine.

Dengue: warning signs = abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement >2 cm, rising hematocrit with falling platelets.

Clostridioides difficile: watery diarrhea + positive toxin/PCR; first episode → oral vancomycin 125 mg q6h ×10 days or fidaxomicin; recurrent → fidaxomicin or vancomycin taper/pulse or fecal microbiota transplant.

Tuberculosis treatment: 2 months isoniazid + rifampicin + pyrazinamide + ethambutol, then 4 months isoniazid + rifampicin; add pyridoxine to prevent isoniazid neuropathy.

COVID-19: severe/hypoxic → dexamethasone + remdesivir; mild high-risk → nirmatrelvir/ritonavir; avoid in severe renal impairment.

Rheumatoid arthritis: symmetric small-joint polyarthritis; RF and anti-CCP (anti-CCP more specific); treat with methotrexate first-line, add biologics (anti-TNF, abatacept, tocilizumab) if inadequate response.

SLE: ANA sensitive; anti-dsDNA and anti-Smith specific; complement low during flares; treat with hydroxychloroquine for all, steroids, mycophenolate or cyclophosphamide for lupus nephritis.

Gout: negatively birefringent needle-shaped monosodium urate crystals; acute flare → NSAIDs, colchicine, or steroids; urate-lowering (allopurinol) target <6 mg/dL (<360 µmol/L).

Giant cell arteritis: age >50, headache, jaw claudication, visual loss, ESR >50; start high-dose prednisolone immediately; temporal artery biopsy or ultrasound.

ANCA vasculitis: c-ANCA/PR3 = GPA (upper airway, lung, kidney); p-ANCA/MPO = MPA or EGPA. Treat with cyclophosphamide or rituximab + steroids.

Antiphospholipid syndrome: arterial/venous thrombosis or pregnancy morbidity + lupus anticoagulant, anticardiolipin, or anti-β2-glycoprotein I antibodies on two occasions ≥12 weeks apart; treat with warfarin (INR 2–3).

Ankylosing spondylitis: inflammatory back pain, sacroiliitis on MRI/X-ray, HLA-B27; first-line NSAIDs, then TNF inhibitors or IL-17 inhibitors.

Polymyalgia rheumatica: age >50, shoulder/hip girdle pain, morning stiffness, ESR/CRP elevated, rapid response to low-dose prednisolone (15–20 mg/day).

Acute ischemic stroke: IV alteplase within 4.5 h of onset (0.9 mg/kg, max 90 mg); thrombectomy for large vessel occlusion up to 24 h with selected imaging. BP <185/110 before thrombolysis.

Status epilepticus: benzodiazepine first-line (IV lorazepam 4 mg or IM midazolam 10 mg); second-line IV levetiracetam, valproate, or phenytoin; refractory → intubation and anesthetic (propofol/midazolam).

Myasthenia gravis: fatigable weakness, ptosis, diplopia; anti-AChR antibodies; treat with pyridostigmine, steroids, azathioprine; crisis → IVIG or plasma exchange.

Guillain-Barré syndrome: ascending areflexic weakness, albuminocytologic dissociation (high CSF protein, normal cells); treat with IVIG or plasma exchange; monitor vital capacity.

Multiple sclerosis: McDonald criteria - dissemination in space and time; CSF oligoclonal bands; acute relapse → IV methylprednisolone; disease-modifying therapy for relapsing-remitting.

Migraine: moderate/severe → triptan + NSAID; prophylaxis if ≥4 attacks/month → propranolol, topiramate, amitriptyline, or CGRP monoclonal antibody.

Subarachnoid hemorrhage: thunderclap headache, CT within 6 h sensitive; if CT negative and suspicion high → lumbar puncture for xanthochromia; nimodipine to prevent vasospasm.

Parkinson disease: bradykinesia + rigidity or resting tremor; treat with levodopa/carbidopa; avoid dopamine antagonists; deep brain stimulation for refractory motor fluctuations.

Hypertension: target <130/80 mmHg for most adults; first-line ACEi/ARB, calcium channel blocker, or thiazide; add second agent if uncontrolled.

Delirium: acute fluctuating confusion and inattention; identify and treat precipitating cause (infection, drugs, pain, constipation, hypoxia); avoid antipsychotics unless severe agitation.

Falls in older adults: multifactorial assessment - gait/balance, vision, medications, orthostatic BP, home hazards; vitamin D supplementation; deprescribe sedatives.

Polypharmacy: use STOPP/START criteria or Beers criteria to identify potentially inappropriate medications; review anticholinergics, benzodiazepines, NSAIDs.

Perioperative risk: revised cardiac risk index (RCRI) - ischemic heart disease, heart failure, cerebrovascular disease, diabetes on insulin, creatinine >2 mg/dL, high-risk surgery; ≥2 points = elevated risk.

Syncope: check orthostatic BP, ECG; high-risk features = exertional syncope, structural heart disease, abnormal ECG, family history sudden death → admit and evaluate.

Pressure ulcers: Braden scale for risk; stage 1 = non-blanchable erythema; stage 2 = partial-thickness loss; stage 3 = full-thickness; stage 4 = exposed bone/tendon. Reposition every 2 h.

Advance care planning: discuss goals of care, substitute decision-maker, and code status; document in medical record.

Stevens-Johnson syndrome/TEN: <10% BSA detachment = SJS, 10–30% = overlap, >30% = TEN; stop culprit drug, supportive care, IVIG or cyclosporine considered.

Psoriasis: chronic plaque → topical steroids + vitamin D analogue; severe → methotrexate, cyclosporine, biologics (anti-TNF, IL-17, IL-23).

Cellulitis: non-purulent → cephalexin or flucloxacillin; purulent/abscess → incision and drainage + anti-staphylococcal coverage; consider MRSA risk factors.

Drug-induced lupus: hydralazine, procainamide, isoniazid, minocycline; anti-histone antibodies, low complement; resolves after stopping drug.

Pharmacokinetics: half-life determines dosing interval; steady state after 4–5 half-lives; loading dose = (Vd × target concentration)/bioavailability.

Cytochrome P450: CYP3A4 inhibitors (macrolides, azoles, grapefruit) increase drug levels; inducers (rifampicin, carbamazepine, St John's wort) decrease levels.

Warfarin: monitor INR; target 2–3 for most indications (2.5–3.5 for mechanical mitral valve); vitamin K for reversal; avoid in pregnancy (use LMWH).

Adverse drug reactions: Type A (dose-dependent, predictable), Type B (idiosyncratic, unpredictable); report serious reactions to pharmacovigilance.

ABCDE approach: Airway (assess patency, secure if needed), Breathing (oxygen, ventilation), Circulation (IV access, fluids, blood), Disability (GCS, pupils, glucose), Exposure (temperature, rash, trauma).

Anaphylaxis: intramuscular adrenaline 0.5 mg (1:1000) in anterolateral thigh, repeat every 5 min; IV fluids; adjuncts (antihistamine, steroid) do not replace adrenaline.

Cardiac arrest: high-quality CPR 100–120/min, depth 5–6 cm, minimize interruptions; shockable rhythms (VF/pVT) → defibrillate; non-shockable (asystole/PEA) → adrenaline 1 mg every 3–5 min.

Acute coronary syndrome: aspirin 300 mg + P2Y12 inhibitor + anticoagulation; STEMI → primary PCI within 90 min of first medical contact; fibrinolysis if PCI unavailable within 120 min.

Shock: MAP = (CO × SVR) + CVP; types - hypovolemic, cardiogenic, distributive (septic, anaphylactic), obstructive (tamponade, tension pneumothorax, PE).

Tension pneumothorax: immediate needle decompression (2nd intercostal space midclavicular line or 5th intercostal space anterior axillary line) followed by chest drain.

Sepsis bundle: measure lactate, blood cultures before antibiotics, broad-spectrum antibiotics within 1 h, 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L, vasopressors for MAP <65.

Poisoning: activated charcoal within 1 h for select toxins; naloxone for opioids; N-acetylcysteine for paracetamol; sodium bicarbonate for tricyclic overdose; dialysis for lithium, methanol, ethylene glycol.