Egyptian Board Internal Medicine flashcards

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

Primary PCI window

Primary percutaneous coronary intervention is preferred for STEMI when it can be delivered within 120 minutes of first medical contact; otherwise fibrinolysis is considered.

CHA2DS2-VASc threshold

In atrial fibrillation, oral anticoagulation is recommended when the score is at least 2 in men or 3 in women; DOACs are preferred over warfarin in most patients.

CURB-65

Pneumonia severity score using confusion, urea above 7 mmol/L, respiratory rate at least 30, blood pressure below 90/60, and age at least 65.

Light criteria

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

ARDS Berlin criteria

ARDS requires onset within one week, bilateral opacities not fully explained by effusion or collapse, and PaO2/FiO2 of 300 or less on PEEP of at least 5.

Spontaneous bacterial peritonitis

Ascitic fluid neutrophil count of at least 250 per cubic millimeter in a patient with cirrhosis; treat with third-generation cephalosporin and albumin.

Hepatorenal syndrome

Functional renal failure in cirrhosis with ascites, unresponsive to volume expansion, diagnosed after excluding other causes; terlipressin plus albumin is first-line therapy.

KDIGO AKI criteria

Acute kidney injury defined by creatinine rise of at least 0.3 mg/dL within 48 hours, at least 1.5 times baseline within 7 days, or urine output below 0.5 mL/kg/h for 6 hours.

Anion gap formula

Anion gap equals sodium minus the sum of chloride and bicarbonate; normal is 8-12 mEq/L, and an elevated gap suggests ketoacidosis, lactate, uremia, or toxins.

DKA management order

Give isotonic saline, start an insulin infusion, and replace potassium once the level is below 5.5 mmol/L; add dextrose when glucose falls below 200-250 mg/dL to continue insulin.

Thyroid storm treatment

Give a beta-blocker, then a thionamide, then iodine after the thionamide, plus glucocorticoid; treat fever and the precipitating cause.

Pheochromocytoma blockade order

Alpha-blockade must precede beta-blockade in pheochromocytoma to avoid unopposed alpha stimulation and hypertensive crisis; plasma free metanephrines are the best screening test.

Iron deficiency ferritin

Low serum ferritin is the most specific test for iron deficiency; when ferritin is normal but suspicion is high, check transferrin saturation below 20%.

TTP diagnostic threshold

Thrombotic thrombocytopenic purpura is suggested by schistocytes and thrombocytopenia with ADAMTS13 activity below 10 percent; urgent plasma exchange is indicated.

Heparin-induced thrombocytopenia

Platelet count falls by more than 50 percent five to ten days after heparin exposure; stop heparin and start a non-heparin anticoagulant such as argatroban.

Anti-CCP antibody

Anti-cyclic citrullinated peptide antibody is more specific than rheumatoid factor for rheumatoid arthritis and may predict more erosive disease.

Gout crystal finding

Joint aspiration showing needle-shaped, negatively birefringent monosodium urate crystals confirms gout; treat the acute flare with NSAIDs, colchicine, or glucocorticoids.

Anaphylaxis first-line drug

Intramuscular epinephrine 0.3-0.5 mg of 1:1000 solution into the lateral thigh is first-line; antihistamines and glucocorticoids are adjuncts only.

Sepsis antibiotic timing

In septic shock, broad-spectrum antibiotics should be given within one hour of recognition; cultures are obtained first when this does not delay therapy.

Severe malaria treatment

Severe malaria with high parasitemia, cerebral involvement, hypoglycemia, or acidosis requires intravenous artesunate rather than oral therapy.

Stroke thrombolysis window

Intravenous thrombolysis is given within 4.5 hours of ischemic stroke onset; mechanical thrombectomy is possible up to 24 hours in selected large-vessel occlusion.

Status epilepticus sequence

First-line therapy is a benzodiazepine, followed by levetiracetam, valproate, or phenytoin; refractory cases require anesthetic infusion such as propofol or midazolam.

Subarachnoid hemorrhage workup

Sudden thunderclap headache warrants CT, which is highly sensitive early; if CT is negative after 6 hours, lumbar puncture is performed to look for xanthochromia.

Narrow therapeutic index drugs

Digoxin, warfarin, lithium, phenytoin, and aminoglycosides require drug-level monitoring because small changes in concentration cause toxicity.

Acetaminophen overdose antidote

N-acetylcysteine is the antidote for acetaminophen overdose; the Rumack-Matthew nomogram guides treatment when the time of ingestion is known.

Vancomycin red man syndrome

Flushing from rapid vancomycin infusion is rate-related, not an allergy; slow the infusion and premedicate rather than avoiding the drug.

Septic shock vasopressor

Norepinephrine is the first-line vasopressor in septic shock, targeting mean arterial pressure of at least 65 mmHg after initial crystalloid resuscitation.

Cardiac arrest compression rate

High-quality chest compressions are delivered at 100-120 per minute, depth 5-6 cm, with full recoil and minimal interruptions.

Dialysis-removable toxins

Hemodialysis is effective for lithium, salicylate, methanol, and ethylene glycol poisoning because these substances are small and poorly protein bound.

Beers criteria

A list of potentially inappropriate medications for older adults, including benzodiazepines, anticholinergics, and long-acting sulfonylureas, used to reduce polypharmacy harm.

Delirium versus dementia

Delirium has acute onset with fluctuating attention and impaired awareness; dementia is chronic and progressive; the two frequently coexist in older hospitalized patients.

Revised Cardiac Risk Index

A perioperative tool using history of ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine above 2 mg/dL, and high-risk surgery.