Iraqi Board Internal Medicine flashcards

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

STEMI reperfusion window

Primary percutaneous coronary intervention is preferred if it can be delivered within 120 minutes of first medical contact; otherwise fibrinolysis is given within 12 hours of symptom onset when no contraindication exists.

CHA2DS2-VASc anticoagulation threshold

In atrial fibrillation, oral anticoagulation is indicated when the CHA2DS2-VASc score is at least 2 in men or at least 3 in women, after considering bleeding risk.

Severe aortic stenosis criteria

Severe aortic stenosis is defined by an aortic valve area below 1.0 cm², a mean gradient of at least 40 mmHg, or a peak velocity of at least 4.0 m/s.

CURB-65 score components

CURB-65 assigns one point each for confusion, urea above 7 mmol/L, respiratory rate at least 30/min, low systolic or diastolic blood pressure, and age at least 65 years.

Light criteria exudate

Pleural fluid is an exudate if pleural/serum protein exceeds 0.5, pleural/serum lactate dehydrogenase exceeds 0.6, or pleural lactate dehydrogenase exceeds two-thirds the upper normal serum value.

Tension pneumothorax management

Tension pneumothorax requires immediate needle decompression without waiting for imaging, followed by tube thoracostomy; hypotension and tracheal deviation may be present.

SAAG in ascites

Serum-ascites albumin gradient of at least 1.1 g/dL indicates portal hypertension, whereas a lower gradient suggests peritoneal carcinomatosis, tuberculosis, pancreatitis, or nephrotic ascites.

Spontaneous bacterial peritonitis threshold

Spontaneous bacterial peritonitis is diagnosed when ascitic fluid polymorphonuclear cell count is at least 250 cells per mm³; empiric third-generation cephalosporin is started and albumin added for renal impairment.

Acute pancreatitis diagnostic rule

Acute pancreatitis is diagnosed when at least two of three are present: typical epigastric pain, lipase or amylase above three times the upper limit, and characteristic imaging findings.

KDIGO acute kidney injury

Acute kidney injury is defined by a serum 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/hour for 6 hours.

Hyperkalemia emergency treatment

Intravenous calcium stabilizes the myocardium; insulin with glucose, inhaled salbutamol, and sodium bicarbonate shift potassium intracellularly; dialysis removes potassium in refractory or renal failure cases.

SIADH diagnostic pattern

SIADH causes euvolemic hypotonic hyponatremia with urine osmolality above 100 mOsm/kg and urine sodium usually above 30 mmol/L, after excluding hypothyroidism, adrenal insufficiency, and diuretics.

Diabetic ketoacidosis diagnostic triad

Diabetic ketoacidosis requires hyperglycemia, ketonemia or ketonuria, and metabolic acidosis with pH below 7.3 or bicarbonate below 18 mmol/L; fluids, insulin, and potassium replacement are core treatment.

Thyroid storm treatment sequence

Thyroid storm is treated with a beta-blocker, a thionamide, iodine at least one hour after the thionamide, glucocorticoids, supportive care, and treatment of the precipitating illness.

Primary aldosteronism screening

Primary aldosteronism is screened by an elevated plasma aldosterone-to-renin ratio in hypertension, especially with hypokalemia; confirmatory testing and adrenal imaging or vein sampling follow.

Iron deficiency laboratory pattern

Iron deficiency shows low ferritin, low mean corpuscular volume, low transferrin saturation below 20 percent, and high total iron-binding capacity; ferritin may be normal during inflammation.

Neutropenic fever definition

Neutropenic fever is a single temperature of at least 38.3°C or at least 38.0°C for one hour in a patient with absolute neutrophil count below 500 cells/mm³; empiric antibiotics start within 60 minutes.

Heparin-induced thrombocytopenia features

Heparin-induced thrombocytopenia causes a platelet fall exceeding 50 percent, often with thrombosis, typically 5 to 10 days after heparin; heparin is stopped and a non-heparin anticoagulant started.

SLE specific autoantibodies

Anti-double-stranded DNA and anti-Smith antibodies are highly specific for systemic lupus erythematosus; antinuclear antibody is sensitive but not specific, and complement levels fall during active disease.

Gout crystal finding

Gout is confirmed by needle-shaped, negatively birefringent monosodium urate crystals in joint fluid; pseudogout shows rhomboid, positively birefringent calcium pyrophosphate crystals.

Anaphylaxis first-line treatment

Anaphylaxis is treated first with intramuscular epinephrine 0.5 mg of 1:1000 solution into the anterolateral thigh, repeated every 5 to 15 minutes as needed, plus fluids.

Septic shock definition

Septic shock is sepsis with vasopressor need to maintain mean arterial pressure at least 65 mmHg and lactate above 2 mmol/L despite adequate fluid resuscitation.

Bacterial meningitis CSF pattern

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

HIV opportunistic prophylaxis thresholds

When CD4 count is below 200 cells/mm³, co-trimoxazole prevents Pneumocystis pneumonia; below 50 cells/mm³, azithromycin prevents disseminated Mycobacterium avium complex; antiretroviral therapy starts regardless of CD4.

Stroke thrombolysis eligibility

Intravenous thrombolysis is considered within 4.5 hours of ischemic stroke onset after excluding hemorrhage and lowering blood pressure below 185/110 mmHg; thrombectomy is considered for large vessel occlusion.

Status epilepticus treatment ladder

Status epilepticus is treated first with a benzodiazepine, then levetiracetam, fosphenytoin, or valproate; refractory cases require intubation and continuous propofol or midazolam.

Guillain-Barré syndrome features

Guillain-Barré syndrome causes ascending flaccid weakness and areflexia with albuminocytologic dissociation in cerebrospinal fluid; treatment is intravenous immunoglobulin or plasma exchange, with monitoring of vital capacity.

Delirium core features

Delirium is an acute, fluctuating disturbance of attention and awareness caused by an underlying medical condition, medication, or withdrawal; treatment targets the cause, with antipsychotics reserved for severe distress.

Alcohol withdrawal treatment

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

ARDS Berlin definition

Acute respiratory distress syndrome is acute onset within one week, bilateral opacities not fully explained by heart failure, and PaO2/FiO2 ratio at most 300 on positive end-expiratory pressure at least 5.

ACLS shockable rhythm sequence

For ventricular fibrillation or pulseless ventricular tachycardia, deliver immediate defibrillation, start CPR, give epinephrine 1 mg every 3 to 5 minutes, and consider amiodarone after the third shock.

Parkland burn formula

The Parkland formula gives 4 mL of lactated Ringer per kg body weight per percent total body surface area burned in 24 hours, with half given in the first 8 hours from injury.