Iraqi Board Internal Medicine cheat sheet

STEMI: primary PCI is preferred if achievable within 120 minutes of first medical contact; fibrinolysis is used within 12 hours of symptom onset when PCI is unavailable and no contraindication exists.

Acute decompensated heart failure with congestion: intravenous loop diuretic is first-line; routine inotropes are reserved for cardiogenic shock or low-output states.

Atrial fibrillation: CHA2DS2-VASc ≥2 in men or ≥3 in women supports oral anticoagulation; HAS-BLED estimates bleeding risk but a high score alone does not contraindicate anticoagulation.

Hypertensive emergency: severe blood pressure with acute end-organ damage requires controlled intravenous reduction, generally 20–25% of mean arterial pressure in the first hour, with condition-specific exceptions.

Severe aortic stenosis: aortic valve area <1.0 cm², mean gradient ≥40 mmHg, or peak velocity ≥4.0 m/s defines severe disease.

Acute pericarditis: diffuse ST elevation and PR depression are typical; first-line treatment is an NSAID plus colchicine, with admission for high-risk features.

Stable supraventricular tachycardia: vagal maneuvers followed by intravenous adenosine; synchronized cardioversion is used if unstable.

Acute asthma: inhaled short-acting beta-2 agonist plus ipratropium, systemic corticosteroid, and oxygen; intravenous magnesium sulfate is added for severe exacerbations not responding to initial therapy.

COPD exacerbation: target oxygen saturation 88–92%, give short-acting bronchodilators and systemic corticosteroid; antibiotics are indicated with increased sputum purulence or ventilatory support.

CURB-65: one point each for confusion, urea >7 mmol/L, respiratory rate ≥30/min, low systolic or diastolic blood pressure, and age ≥65 years; score ≥3 indicates severe pneumonia.

Pleural fluid is exudative by Light criteria when pleural/serum protein >0.5, pleural/serum LDH >0.6, or pleural LDH > two-thirds the upper normal serum LDH.

Pulmonary embolism: D-dimer is useful in low or intermediate pretest probability; CT pulmonary angiography is used when pretest probability is high or D-dimer is positive; hemodynamic instability indicates thrombolysis.

Obstructive sleep apnea: diagnosis requires apnea-hypopnea index ≥5 with symptoms or ≥15 without symptoms; CPAP is first-line for symptomatic moderate-to-severe disease.

Tension pneumothorax: immediate needle decompression is performed before imaging, followed by chest tube insertion; waiting for a chest radiograph is inappropriate.

Upper gastrointestinal bleeding: intravenous proton pump inhibitor is given after endoscopic therapy for high-risk stigmata; variceal bleeding is treated with terlipressin plus prophylactic antibiotics.

Acute pancreatitis: diagnosis requires two of typical pain, lipase or amylase >3 times upper limit of normal, and characteristic imaging; early enteral nutrition is used when tolerated.

Ascites: serum-ascites albumin gradient ≥1.1 g/dL indicates portal hypertension; first-line diuretics are spironolactone plus furosemide, and large-volume paracentesis requires albumin replacement.

Spontaneous bacterial peritonitis: ascitic polymorphonuclear cells ≥250/mm³ define infection; treat with a third-generation cephalosporin, adding albumin when renal impairment is present.

Helicobacter pylori: active infection is detected by urea breath test, stool antigen, or rapid urease test; eradication is confirmed at least 4 weeks after antibiotic completion.

Inflammatory bowel disease: ulcerative colitis causes continuous mucosal inflammation from the rectum; Crohn disease causes transmural skip lesions; acute severe colitis requires intravenous steroid and rescue therapy or surgery.

Hepatic encephalopathy: lactulose is titrated to two or three soft stools daily; rifaximin is an adjunct; precipitants such as infection, bleeding, constipation, and electrolyte disturbance are identified and corrected.

KDIGO acute kidney injury: serum creatinine rise ≥0.3 mg/dL within 48 hours, ≥1.5 times baseline within 7 days, or urine output <0.5 mL/kg/hour for 6 hours.

Hyperkalemia with ECG changes: intravenous calcium stabilizes the myocardium; insulin with glucose, inhaled salbutamol, and sodium bicarbonate shift potassium into cells; dialysis is used for refractory or severe renal failure.

Symptomatic hyponatremia: hypertonic 3% saline is used for severe symptoms; sodium correction is limited to 8–10 mmol/L in 24 hours to reduce osmotic demyelination risk.

Chronic kidney disease: eGFR <60 mL/min/1.73 m² or markers of kidney damage for ≥3 months define CKD; stage is assigned by eGFR and albuminuria.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia, edema, and hyperlipidemia; minimal change disease is common in children and membranous nephropathy in adults.

Metabolic acidosis: anion gap = Na − (Cl + HCO3); normal is 8–12 mmol/L; high gap occurs with ketones, lactate, renal failure, and toxins.

Dialysis indications: refractory acidosis, electrolyte disturbance, intoxication, fluid overload, and uremic complications; urgent dialysis is needed when these threaten life.

Diabetic ketoacidosis: glucose usually >250 mg/dL, ketones present, pH <7.3, and bicarbonate <18 mmol/L; treatment is intravenous fluid, insulin infusion, and potassium replacement.

Hyperosmolar hyperglycemic state: glucose >600 mg/dL, osmolality >320 mOsm/kg, and minimal ketosis; fluid resuscitation and insulin are required, and mortality is higher than in DKA.

Hypoglycemia: glucose <70 mg/dL; conscious patients receive oral glucose; unconscious patients receive intravenous dextrose or intramuscular glucagon.

Thyroid storm: beta-blocker, thionamide, iodine given at least one hour after thionamide, glucocorticoid, and supportive care; the precipitating illness is treated.

Myxedema coma: hypothermia, bradycardia, and altered mentation; intravenous levothyroxine plus hydrocortisone is given until adrenal insufficiency is excluded.

Diabetes diagnosis: HbA1c ≥6.5%, fasting glucose ≥126 mg/dL, 2-hour OGTT ≥200 mg/dL, or random glucose ≥200 mg/dL with symptoms; a single diagnostic test is confirmed unless unequivocal.

Primary aldosteronism: hypertension with hypokalemia suggests screening by aldosterone-to-renin ratio; confirmation and adrenal imaging or adrenal vein sampling follow.

Iron deficiency: low ferritin, low MCV, transferrin saturation <20%, and high TIBC; ferritin can be normal in inflammation because it is an acute-phase reactant.

Vitamin B12 deficiency: macrocytic anemia, hypersegmented neutrophils, and neurologic signs; methylmalonic acid and homocysteine are elevated; treatment replaces B12 and folate when both are deficient.

Acute myeloid leukemia: ≥20% blasts in marrow or blood defines AML; acute promyelocytic leukemia with t(15;17) requires immediate all-trans retinoic acid.

Chronic myeloid leukemia: t(9;22) BCR-ABL fusion is diagnostic; tyrosine kinase inhibitors are first-line therapy.

Hemolytic anemia: reticulocytosis, elevated LDH, low haptoglobin, and indirect hyperbilirubinemia; direct antiglobulin test identifies immune hemolysis.

Transfusion thresholds: stable adults receive red cells at hemoglobin <7 g/dL; <8 g/dL is used in acute coronary syndrome; prophylactic platelets are given below 10,000/mm³.

Neutropenic fever: absolute neutrophil count <500/mm³ with temperature ≥38.3°C once or ≥38.0°C for one hour; empiric antipseudomonal beta-lactam starts within 60 minutes.

Systemic lupus erythematosus: antinuclear antibody is sensitive; anti-double-stranded DNA and anti-Smith are specific; complement falls in active disease; lupus nephritis requires biopsy for classification.

Rheumatoid arthritis: symmetric small-joint polyarthritis with morning stiffness; anti-cyclic citrullinated peptide is specific; methotrexate is first-line disease-modifying therapy.

Gout: needle-shaped, negatively birefringent monosodium urate crystals confirm gout; acute flares are treated with NSAID, colchicine, or glucocorticoid; urate-lowering targets serum urate <6 mg/dL.

Giant cell arteritis: age ≥50 years, new headache, jaw claudication, and elevated ESR; high-dose glucocorticoid is started immediately and temporal artery biopsy is arranged.

Anaphylaxis: intramuscular epinephrine 0.5 mg of 1:1000 solution into the anterolateral thigh is first-line, repeated every 5–15 minutes; intravenous fluid is given for hypotension.

Hereditary angioedema: C1 inhibitor deficiency causes recurrent angioedema without urticaria; C1 inhibitor concentrate or icatibant is used; epinephrine is less effective.

Scleroderma renal crisis: sudden hypertension and acute kidney injury in diffuse systemic sclerosis; an ACE inhibitor is started promptly.

Sepsis: suspected infection plus acute SOFA increase ≥2 points; septic shock requires vasopressors to maintain MAP ≥65 mmHg and lactate >2 mmol/L despite fluid resuscitation.

Bacterial meningitis: cerebrospinal fluid shows low glucose, high protein, and neutrophil predominance; empiric ceftriaxone plus vancomycin is started, with dexamethasone in pneumococcal disease.

Latent tuberculosis: positive interferon-gamma release assay or tuberculin skin test without active disease; treatment options include rifampin for 4 months or isoniazid plus rifapentine weekly for 3 months.

HIV: diagnosis by HIV-1/2 antigen-antibody assay with confirmation; antiretroviral therapy starts regardless of CD4 count; co-trimoxazole prophylaxis begins when CD4 <200/mm³.

Severe falciparum malaria: intravenous artesunate is first-line; uncomplicated malaria is treated with an artemisinin-based combination therapy.

Infective endocarditis: blood cultures are drawn before antibiotics; modified Duke criteria use positive cultures and echocardiographic findings; Staphylococcus aureus native valve is treated with flucloxacillin or vancomycin.

Clostridioides difficile infection: watery diarrhea with positive toxin or nucleic acid test; culprit antibiotics are stopped; oral vancomycin or fidaxomicin is used for severe disease.

Ischemic stroke: intravenous thrombolysis is considered within 4.5 hours of onset after CT excludes hemorrhage; blood pressure is lowered below 185/110 mmHg before thrombolysis; thrombectomy is considered for large-vessel occlusion.

Status epilepticus: a benzodiazepine is first-line; if seizures persist, levetiracetam, fosphenytoin, or valproate is given; refractory status requires intubation and continuous propofol or midazolam.

Myasthenia gravis: fatigable ptosis, diplopia, and proximal weakness; anti-acetylcholine receptor antibodies support diagnosis; pyridostigmine is symptomatic therapy; crisis is treated with IVIG or plasma exchange.

Guillain-Barré syndrome: ascending flaccid weakness and areflexia with albuminocytologic dissociation; IVIG or plasma exchange is given; vital capacity is monitored for respiratory failure.

Parkinson disease: bradykinesia plus rigidity or rest tremor; levodopa-carbidopa is the most effective symptomatic therapy; dopamine antagonists are avoided.

Multiple sclerosis: dissemination in space and time; MRI supports diagnosis; acute relapse is treated with intravenous methylprednisolone; disease-modifying therapy reduces relapses.

Subarachnoid hemorrhage: thunderclap headache; CT is sensitive within 6 hours; if CT is negative and suspicion persists, lumbar puncture shows xanthochromia; nimodipine is given and aneurysm secured.

Syncope: cardiac features such as exertional onset, supine occurrence, structural heart disease, or abnormal ECG indicate high risk and warrant admission; vasovagal syncope is most common.

Delirium: acute fluctuating inattention caused by medical illness, medication, or withdrawal; treatment targets the cause; antipsychotics are reserved for severe distress and are not routine.

Alcohol withdrawal: symptom-triggered benzodiazepines guided by a withdrawal scale; thiamine is given before glucose in malnourished patients to prevent Wernicke encephalopathy.

Venous thromboembolism prophylaxis: Padua risk score identifies medical inpatients at risk; low-molecular-weight heparin is used unless contraindicated; mechanical prophylaxis is used with active bleeding.

Osteoporosis: dual-energy x-ray absorptiometry T-score ≤−2.5 defines osteoporosis; calcium and vitamin D plus bisphosphonate are used; FRAX guides treatment in osteopenia.

Perioperative cardiac risk: revised cardiac risk index uses ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, renal impairment, and high-risk surgery; routine revascularization before surgery is not recommended.

Falls in older adults: multifactorial assessment includes medication review, vision, gait, footwear, home hazards, and vitamin D; exercise programs reduce recurrent falls.

Shock: mean arterial pressure <65 mmHg with tissue hypoperfusion; septic shock receives 30 mL/kg crystalloid and norepinephrine is first-line vasopressor to maintain MAP ≥65 mmHg.

Cardiac arrest with ventricular fibrillation or pulseless ventricular tachycardia: immediate defibrillation, CPR, epinephrine 1 mg every 3–5 minutes, and amiodarone after the third shock.

Acute respiratory distress syndrome: acute onset within one week, bilateral opacities, non-cardiogenic edema, and PaO2/FiO2 ≤300 on PEEP ≥5 cmH2O; low tidal volume ventilation uses 6 mL/kg predicted body weight.

Raised intracranial pressure: head elevation, normocapnia, osmotherapy with mannitol or hypertonic saline, and avoidance of hypotension and hypoxia; intubation is considered for GCS ≤8.

Burn resuscitation: Parkland formula gives 4 mL/kg/% total body surface area lactated Ringer in 24 hours, with half in the first 8 hours from injury.

Poisoning: activated charcoal is considered within 1 hour if the airway is protected; naloxone reverses opioid toxicity; sodium bicarbonate is used for salicylate or tricyclic toxicity in selected cases.

Trauma primary survey: airway with cervical spine protection, breathing, circulation with hemorrhage control, disability, and exposure; tension pneumothorax is treated by immediate needle decompression.