Egyptian Board Internal Medicine cheat sheet

COPD: post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow limitation; GOLD ABE grouping guides inhaled therapy, with LABA+LAMA for group B and add ICS for group E with eosinophils ≥300.

Asthma control: assess symptoms, reliever use, activity limitation, and exacerbations; step up when uncontrolled and step down after three months of stability.

Community-acquired pneumonia severity: CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30, BP <90/60, age ≥65) - 0-1 outpatient, 2 short admission, ≥3 consider ICU.

Pleural effusion: Light criteria classify exudate when pleural/serum protein >0.5, pleural/serum LDH >0.6, or pleural LDH >2/3 upper normal serum limit.

Pulmonary embolism: use Wells or Geneva score with age-adjusted D-dimer; high-risk PE with hypotension requires systemic thrombolysis or embolectomy.

Obstructive sleep apnea: apnea-hypopnea index ≥5 with symptoms or ≥15 alone defines disease; CPAP is first-line for symptomatic moderate-severe OSA.

Tuberculosis: sputum AFB smear and culture plus nucleic acid amplification; treat drug-susceptible disease with 2 months HRZE then 4 months HR.

ARDS: Berlin definition requires onset within 1 week, bilateral opacities, and PaO2/FiO2 ≤300 on PEEP ≥5; use low tidal volume 6 mL/kg predicted body weight.

Upper GI bleeding: give IV proton pump inhibitor after endoscopic hemostasis for high-risk stigmata; transfuse to hemoglobin ~7-8 g/dL unless cardiovascular disease.

Acute pancreatitis: diagnose with two of three-typical pain, lipase >3× upper limit, or imaging; early care is aggressive isotonic fluids and enteral nutrition, not prophylactic antibiotics.

Cirrhosis ascites: sodium restriction plus spironolactone with furosemide; perform diagnostic paracentesis with neutrophil count ≥250/mm³ indicating spontaneous bacterial peritonitis.

Hepatorenal syndrome: functional renal failure in cirrhosis with no response to volume expansion; terlipressin plus albumin is first-line vasoconstrictor therapy.

Inflammatory bowel disease: ulcerative colitis is continuous and mucosal; Crohn disease is transmural, skip lesions, and may involve any GI segment; biologics target moderate-severe disease.

Hepatitis B: HBsAg positive >6 months defines chronic infection; treatment thresholds use HBV DNA, ALT, fibrosis stage, and cirrhosis status.

Celiac disease: check tissue transglutaminase IgA with total IgA; duodenal biopsy shows villous atrophy and crypt hyperplasia; strict gluten-free diet is the only treatment.

Colorectal cancer screening: start at age 45 in average-risk adults using colonoscopy every 10 years or annual fecal immunochemical testing.

Acute kidney injury: KDIGO stages by serum creatinine rise (≥0.3 mg/dL in 48 hours or ≥1.5× baseline in 7 days) or urine output <0.5 mL/kg/h for 6 hours.

Fractional excretion of urea <35% suggests prerenal azotemia, especially when diuretics make FENa unreliable.

Hyperkalemia: ECG changes (peaked T waves, widened QRS) require IV calcium; then shift potassium intracellularly with insulin-dextrose and salbutamol, and remove with binders or dialysis.

Hyponatremia: correct chronic hyponatremia by ≤8-10 mmol/L in 24 hours to avoid osmotic demyelination; hypertonic saline is for severe symptoms.

Metabolic acidosis: anion gap = Na − (Cl + HCO3); normal gap 8-12 mEq/L; elevated gap suggests ketoacidosis, lactate, renal failure, or toxins.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipidemia; biopsy guides therapy in adults.

Chronic kidney disease: classify by GFR category (G1-G5) and albuminuria category (A1-A3); ACE inhibitors or ARBs reduce progression in albuminuric CKD.

Dialysis indications: refractory hyperkalemia, acidosis, pulmonary edema, uremic pericarditis or encephalopathy, and certain toxin ingestions.

Diabetic ketoacidosis: IV isotonic saline, insulin infusion, and potassium replacement once K <5.5 mmol/L; add dextrose when glucose <200-250 mg/dL to continue insulin.

Thyroid storm: clinical diagnosis with fever, tachycardia, CNS disturbance; treat with beta-blocker, thionamide, iodine after thionamide, and glucocorticoid.

Primary hypothyroidism: elevated TSH with low free T4; levothyroxine dosing is weight-based in young adults and lower in elderly or coronary disease.

Primary hyperaldosteronism: elevated aldosterone with suppressed renin; screen with aldosterone-renin ratio in resistant hypertension or hypokalemia.

Cushing syndrome: screen with late-night salivary cortisol, 24-hour urinary free cortisol, or overnight dexamethasone suppression test.

Pheochromocytoma: plasma free metanephrines are the best screen; alpha-blockade before beta-blockade to avoid hypertensive crisis.

Osteoporosis: T-score ≤−2.5 defines disease; treat with bisphosphonate or denosumab and ensure calcium and vitamin D adequacy.

Hypercalcemia: IV isotonic saline plus calcitonin for acute severe cases; bisphosphonates for sustained control, especially malignancy-associated.

Iron deficiency anemia: low ferritin is the most specific test; if ferritin is normal but suspicion high, check transferrin saturation <20% and soluble transferrin receptor.

Anemia of chronic disease: low serum iron with normal or high ferritin and low transferrin saturation; treat the underlying disease, not iron routinely.

Microangiopathic hemolytic anemia: schistocytes with thrombocytopenia suggests TTP; urgent plasma exchange is indicated when ADAMTS13 activity is <10%.

Acute myeloid leukemia: diagnosis requires ≥20% blasts in marrow or blood; APL (t(15;17)) is a medical emergency treated with ATRA.

Chronic myeloid leukemia: t(9;22) BCR-ABL1; tyrosine kinase inhibitors are first-line and response is monitored by quantitative PCR.

Multiple myeloma: CRAB features (hypercalcemia, renal failure, anemia, bone lesions) plus clonal plasma cells; use serum free light chains and electrophoresis for monitoring.

Heparin-induced thrombocytopenia: occurs 5-10 days after heparin with platelet drop >50%; stop heparin and start a non-heparin anticoagulant.

Transfusion: restrictive threshold of hemoglobin 7 g/dL is appropriate for most stable patients; 8 g/dL for active cardiovascular disease.

Rheumatoid arthritis: anti-CCP is more specific than rheumatoid factor; treat early with methotrexate as anchor disease-modifying drug.

Gout: joint aspiration showing needle-shaped negatively birefringent crystals is diagnostic; treat acute flare with NSAIDs, colchicine, or glucocorticoids.

Systemic lupus erythematosus: anti-dsDNA and anti-Smith are highly specific; monitor anti-dsDNA and complement during flares.

ANCA-associated vasculitis: c-ANCA with anti-PR3 favors granulomatosis with polyangiitis; p-ANCA with anti-MPO favors microscopic polyangiitis.

Giant cell arteritis: age ≥50 with new headache, jaw claudication, or visual symptoms; start high-dose glucocorticoid immediately and confirm with temporal artery biopsy.

Anaphylaxis: intramuscular epinephrine 0.3-0.5 mg of 1:1000 into the lateral thigh is first-line; antihistamines and steroids are adjuncts only.

Hereditary angioedema: C4 is low with normal C1 inhibitor function or level; treat with C1 inhibitor concentrate or icatibant, not epinephrine.

Antiphospholipid syndrome: persistent lupus anticoagulant, anticardiolipin, or anti-beta2-glycoprotein I antibodies with thrombosis or pregnancy loss; anticoagulate with warfarin.

Sepsis: give broad-spectrum antibiotics within 1 hour of recognition in septic shock; obtain cultures before antibiotics when this does not delay therapy.

Meningitis: dexamethasone before or with first antibiotic dose in suspected pneumococcal meningitis; empiric therapy is ceftriaxone plus vancomycin.

HIV: start antiretroviral therapy regardless of CD4 count; screen for tuberculosis and hepatitis before or alongside initiation.

Infective endocarditis: staphylococcal bacteremia with prosthetic material or persistent fever warrants echocardiography and prolonged IV therapy.

Clostridioides difficile: oral vancomycin or fidaxomicin is first-line for initial episodes; avoid metronidazole as preferred therapy.

Malaria: severe disease (parasitemia >5%, cerebral involvement, hypoglycemia, acidosis) requires IV artesunate.

Tuberculosis latent infection: isoniazid plus rifapentine weekly for 12 weeks or isoniazid for 6-9 months; screen for hepatitis and HIV first.

Antimicrobial stewardship: de-escalate based on culture and susceptibility results and set a defined duration to reduce resistance and toxicity.

Acute ischemic stroke: IV thrombolysis with alteplase or tenecteplase within 4.5 hours of onset; mechanical thrombectomy up to 24 hours in selected large-vessel occlusion.

Transient ischemic attack: urgent evaluation with brain imaging, carotid imaging, and ECG; start antiplatelet and statin early because stroke risk is highest in the first days.

Status epilepticus: first-line benzodiazepine; then second-line levetiracetam, valproate, or phenytoin; refractory cases require anesthetic infusion.

Multiple sclerosis: MRI showing dissemination in space and time; acute relapse treated with high-dose glucocorticoids; disease-modifying therapy reduces relapse rate.

Myasthenia gravis: fatigable weakness, ptosis, and dysphagia; anti-acetylcholinesterase receptor antibody is most specific; thymectomy for thymoma.

Guillain-Barré syndrome: ascending symmetric weakness with areflexia; cerebrospinal fluid shows albuminocytologic dissociation; treat with IVIG or plasma exchange.

Subarachnoid hemorrhage: sudden severe thunderclap headache; CT is highly sensitive early; if CT is negative after 6 hours, perform lumbar puncture for xanthochromia.

Raised intracranial pressure: headache, vomiting, papilledema with bradycardia and hypertension; avoid lumbar puncture before imaging when signs of herniation exist.

Therapeutic index: drugs with narrow index (digoxin, warfarin, lithium, phenytoin, aminoglycosides) need drug-level monitoring.

CYP450 interactions: CYP3A4 inhibitors (macrolides, azoles, grapefruit) raise levels of statins, calcium channel blockers, and many immunosuppressants; inducers lower them.

Warfarin: monitor INR; target 2-3 for most indications and 2.5-3.5 for mechanical mitral valves; vitamin K reverses excessive anticoagulation.

Digoxin toxicity: nausea, visual disturbances, and arrhythmias; risk increases with hypokalemia and renal impairment; antidote is digoxin-specific antibody.

Acetaminophen overdose: N-acetylcysteine is the antidote; use the Rumack-Matthew nomogram when timing of ingestion is known.

Beta-blocker toxicity: bradycardia and hypotension; treat with atropine, glucagon, and high-dose insulin-dextrose for refractory shock.

Vancomycin: monitor trough or AUC-guided dosing to reduce nephrotoxicity; infusion reaction (red man syndrome) is rate-related, not allergy.

Renal dose adjustment: reduce doses of renally cleared drugs such as metformin, nitrofurantoin, and direct oral anticoagulants in advanced CKD.

Cardiac arrest: high-quality chest compressions at 100-120/min, depth 5-6 cm, with minimal interruptions; shock shockable rhythms immediately.

Post-arrest care: target temperature control and avoid hyperthermia; maintain normoxia and normocapnia; treat the cause and provide hemodynamic support.

Septic shock: 30 mL/kg crystalloid within the first 3 hours and norepinephrine as first-line vasopressor to target MAP ≥65 mmHg.

Acute respiratory failure: noninvasive ventilation for COPD exacerbation or cardiogenic pulmonary edema; intubate for worsening mental status or failure of noninvasive support.

Anaphylaxis: intramuscular epinephrine, supine positioning, oxygen, and fluids; repeat epinephrine every 5 minutes if needed.

Trauma resuscitation: permissive hypotension in hemorrhagic shock, tranexamic acid within 3 hours of injury, and massive transfusion protocol.

Delirium in ICU: use nonpharmacologic prevention (orientation, sleep, mobility) and treat pain; antipsychotics do not shorten delirium.

Poisoning: activated charcoal is useful within 1 hour for selected ingestions; hemodialysis for lithium, salicylate, methanol, and ethylene glycol toxicity.

Polypharmacy: use Beers criteria to identify potentially inappropriate medications in older adults, including benzodiazepines, anticholinergics, and sulfonylureas.

Falls in older adults: assess gait, vision, medications, and orthostatic blood pressure; multifactorial intervention reduces recurrence.

Delirium versus dementia: delirium has acute onset and fluctuating attention; dementia is chronic and progressive; both may coexist.

Advance care planning: discuss goals of care early; document preferences and identify a surrogate decision-maker.

Perioperative risk: use validated tools such as the Revised Cardiac Risk Index and functional capacity assessment before noncardiac surgery.

Hypertension in older adults: treat to systolic <130 mmHg when tolerated, but avoid orthostatic hypotension and monitor renal function.

Venous thromboembolism prophylaxis: use risk assessment models; mechanical prophylaxis for high bleeding risk, pharmacologic prophylaxis otherwise.

Vaccination in adults: influenza annually, pneumococcal per age and risk, and zoster and RSV per current recommendations.