Iran Specialty Board - Internal Medicine flashcards

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

CHA2DS2-VASc score

Estimates stroke risk in nonvalvular atrial fibrillation using congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex categories. Scores ≥2 in men or ≥3 in women generally warrant oral anticoagulation.

Light's criteria

Classifies pleural fluid as exudate when pleural protein to serum protein ratio exceeds 0.5, pleural to serum LDH exceeds 0.6, or pleural LDH exceeds two-thirds the upper normal serum LDH.

Serum-ascites albumin gradient

Difference between serum and ascitic albumin. A gradient of 1.1 g/dL or greater indicates portal hypertension, while lower values suggest peritoneal carcinomatosis, tuberculosis, or pancreatitis-related ascites.

Fractional excretion of urea

Calculated from urine and serum urea and creatinine. Values below 35% suggest prerenal azotemia and remain useful when diuretics make fractional excretion of sodium unreliable.

Diabetic ketoacidosis management

Isotonic saline resuscitation, insulin infusion at 0.1 units/kg/hour, and potassium replacement. Add dextrose when glucose falls below 200 to 250 mg/dL to allow continued insulin while avoiding hypoglycemia.

Tumor lysis syndrome

Metabolic emergency from rapid cell breakdown with hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Prevent with hydration and allopurinol or rasburicase in high-risk hematologic malignancies.

qSOFA criteria

Bedside screen for sepsis using respiratory rate 22 or higher, altered mentation, and systolic blood pressure 100 mmHg or lower. Two or more criteria identify patients at higher risk of poor outcome.

Temporal artery biopsy timing

Suspected giant cell arteritis requires immediate high-dose glucocorticoids before biopsy. Steroids do not prevent histologic diagnosis for up to two weeks and should never be delayed for visual symptoms.

McDonald criteria

Diagnostic framework for multiple sclerosis requiring disseminated lesions in space and time, with no better explanation. Cerebrospinal fluid oligoclonal bands can substitute for dissemination in time.

Stevens-Johnson syndrome

Severe mucocutaneous reaction with epidermal detachment under 10% of body surface area. Stop the culprit drug and provide supportive burn-unit care; prophylactic antibiotics are not routinely recommended.

Beers criteria

List of potentially inappropriate medications for older adults, including benzodiazepines, anticholinergics, and long-acting sulfonylureas. Used to guide deprescribing and reduce falls and delirium.

ARDS Berlin definition

Acute hypoxemic respiratory failure within one week of a known insult, bilateral opacities not fully explained by heart failure, and PaO2/FiO2 of 300 or less on PEEP of at least 5 cmH2O.

Primary PCI window

Reperfusion strategy for ST-elevation myocardial infarction aiming for device time within 90 minutes of first medical contact. Fibrinolysis is used when PCI cannot be achieved within 120 minutes.

CURB-65

Pneumonia severity score using confusion, urea above 7 mmol/L, respiratory rate 30 or more, low blood pressure, and age 65 or older. Scores of 2 or more generally support hospital admission.

Spontaneous bacterial peritonitis

Ascitic fluid polymorphonuclear count of 250 cells/mm³ or greater in cirrhosis. Treat empirically with a third-generation cephalosporin and give albumin to reduce renal failure risk.

KDIGO AKI stages

Stage 1 is creatinine 1.5 to 1.9 times baseline, stage 2 is 2.0 to 2.9 times, and stage 3 is 3 times baseline or 4 mg/dL or more, with urine output criteria.

Subclinical hypothyroidism

Elevated thyroid-stimulating hormone with normal free thyroxine. Treatment is generally considered when TSH exceeds 10 mIU/L or when symptoms and cardiovascular risk favor therapy.

Thrombotic thrombocytopenic purpura

Microangiopathic hemolytic anemia with schistocytes, thrombocytopenia, neurologic or renal involvement, and fever. ADAMTS13 below 10% confirms diagnosis and urgent plasma exchange is indicated.

Neutropenic fever empiric therapy

Absolute neutrophil count below 500/µL with fever requires antipseudomonal beta-lactam within 60 minutes. Add vancomycin for catheter infection, skin infection, or hemodynamic instability.

Antiphospholipid syndrome

Persistent lupus anticoagulant, anticardiolipin, or anti-beta-2 glycoprotein I antibodies with thrombosis or pregnancy morbidity. Thrombotic events require long-term anticoagulation, usually with warfarin.

Status epilepticus protocol

Give a benzodiazepine immediately, then a second-line agent such as levetiracetam, valproate, or fosphenytoin. Refractory cases require anesthetic infusion and continuous electroencephalographic monitoring.

Anaphylaxis first-line treatment

Intramuscular epinephrine 0.3 to 0.5 mg of 1:1000 solution into the lateral thigh, repeated every 5 to 15 minutes as needed. Antihistamines and corticosteroids are adjuncts, not primary therapy.

SPIKES framework

Six-step approach to breaking bad news: setting, perception, invitation, knowledge, empathy, and strategy. Used in palliative care to align communication with patient goals and understanding.

Septic shock initial resuscitation

Give 30 mL/kg crystalloid within three hours for hypotension or lactate 4 mmol/L or higher. Start norepinephrine to maintain mean arterial pressure of at least 65 mmHg.

Heart failure four pillars

For reduced ejection fraction, combine an ARNI or ACE inhibitor or ARB, an evidence-based beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor. Each class improves survival.

Helicobacter pylori eradication

Bismuth quadruple therapy for 14 days is preferred where clarithromycin resistance exceeds 15%. Confirm eradication with a urea breath test or stool antigen at least four weeks after therapy.

Hyponatremia correction limit

Chronic hyponatremia should be corrected by no more than 8 mmol/L in 24 hours. Faster correction risks osmotic demyelination, especially in malnourished or alcoholic patients.

Adrenal crisis treatment

Draw cortisol and ACTH but give dexamethasone or hydrocortisone and saline immediately. Do not delay glucocorticoid administration while awaiting laboratory confirmation.

Iron deficiency anemia diagnosis

Low serum ferritin is the most specific test. Ferritin rises with inflammation, so transferrin saturation and soluble transferrin receptor help when chronic disease coexists.

Bacterial meningitis empiric therapy

Adults receive ceftriaxone plus vancomycin, with ampicillin added when Listeria risk is present. Obtain blood cultures and give dexamethasone before or with the first antibiotic dose.

Gout crystal identification

Negatively birefringent needle-shaped monosodium urate crystals under polarized light confirm gout. Calcium pyrophosphate crystals are positively birefringent and rhomboid, indicating pseudogout.

Guillain-Barré syndrome monitoring

Ascending symmetric weakness with areflexia and cerebrospinal fluid albuminocytologic dissociation. Monitor vital capacity and negative inspiratory force; treat with IVIG or plasma exchange.