Kuwait Board Internal Medicine flashcards

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

Likelihood ratio interpretation

A positive likelihood ratio above 10 or a negative likelihood ratio below 0.1 substantially shifts post-test probability and often changes management, while ratios near 1 leave probability essentially unchanged.

Number needed to treat

The reciprocal of the absolute risk reduction; it estimates how many patients must receive a treatment for one additional patient to benefit compared with control over the study period.

Corrected calcium formula

Measured calcium in mg/dL plus 0.8 times (4.0 minus serum albumin in g/dL). Use it when albumin is abnormal, though ionized calcium is preferred in critical illness.

Primary PCI window

For ST-elevation myocardial infarction, primary percutaneous coronary intervention is preferred when achievable within 120 minutes of first medical contact; otherwise fibrinolysis is given within 12 hours of symptom onset.

Right ventricular infarction caution

In inferior STEMI with hypotension, right-sided leads may show ST elevation; nitrates and other preload reducers can cause profound hypotension and should be avoided, with fluids used instead.

CHA2DS2-VASc anticoagulation threshold

Anticoagulation is recommended for atrial fibrillation when the score is at least 2 in men or at least 3 in women; a score of 1 in men or 2 in women warrants individualized consideration.

Light criteria exudate

A pleural effusion is exudative if pleural-to-serum protein ratio exceeds 0.5, pleural-to-serum LDH ratio exceeds 0.6, or pleural LDH exceeds two-thirds the upper limit of normal serum LDH.

Age-adjusted D-dimer

For patients older than 50 years with low or intermediate pretest probability of pulmonary embolism, the cutoff is age multiplied by 10 mcg/L, reducing unnecessary CT pulmonary angiography.

Asthma reversibility criterion

A post-bronchodilator increase in forced expiratory volume in one second of at least 12 percent and at least 200 mL supports the diagnosis of asthma when symptoms are compatible.

Spontaneous bacterial peritonitis threshold

An ascitic fluid polymorphonuclear neutrophil count of at least 250 cells per microliter establishes the diagnosis; treatment is a third-generation cephalosporin, with albumin added if creatinine is elevated.

Hepatorenal syndrome treatment

Terlipressin plus albumin is used for functional renal failure in cirrhosis after excluding other causes and after albumin challenge; it improves renal function and serves as a bridge to transplantation.

Celiac disease serology

Tissue transglutaminase IgA with a total IgA level is the preferred initial test, performed while the patient still eats gluten; duodenal biopsy confirms villous atrophy and intraepithelial lymphocytosis.

Fractional excretion of sodium

A value below 1 percent suggests prerenal azotemia and above 2 percent suggests intrinsic renal injury, but diuretics invalidate it, so fractional excretion of urea below 35 percent is an alternative.

Hyponatremia correction limit

For chronic hyponatremia, raise serum sodium by no more than 8 to 10 mmol/L in 24 hours, because faster correction risks osmotic demyelination with irreversible neurologic injury.

Urine anion gap meaning

Calculated as sodium plus potassium minus chloride; a negative value indicates adequate ammonium excretion, typical of diarrhea, whereas a positive value suggests distal renal tubular acidosis.

Diabetic ketoacidosis criteria

Glucose above 250 mg/dL with pH below 7.30, bicarbonate below 18 mmol/L, and ketonemia. Treatment is isotonic saline, intravenous insulin, and potassium replacement when potassium is below 5.2 mmol/L.

Thyroid storm management

Treat with a beta-blocker, a thionamide, iodine given at least one hour after the thionamide, and corticosteroid, plus supportive care; a Burch-Wartofsky score of 45 or more is highly suggestive.

Primary aldosteronism screening

An elevated aldosterone-to-renin ratio, typically with aldosterone above 15 ng/dL, is the screen; confirmatory saline suppression or captopril challenge precedes adrenal imaging and adrenal vein sampling.

Heparin-induced thrombocytopenia

Suspect when platelets fall by more than 50 percent at 5 to 10 days after heparin exposure, often with thrombosis rather than bleeding; stop heparin and start a non-heparin anticoagulant such as argatroban.

Neutropenic fever definition

A single oral temperature of at least 38.3 C, or at least 38.0 C sustained over one hour, with an absolute neutrophil count below 500 per microliter; start antipseudomonal antibiotics within one hour.

Tumor lysis syndrome features

Hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia occur after rapid tumor cell breakdown; prevention uses hydration and allopurinol, with rasburicase reserved for high-risk patients.

Septic shock definition

Sepsis with persistent hypotension requiring vasopressors to maintain mean arterial pressure of at least 65 mmHg and a lactate above 2 mmol/L despite adequate fluid resuscitation.

HIV post-exposure prophylaxis

A three-drug antiretroviral regimen started within 72 hours, ideally within 2 hours, of exposure and continued for 28 days, with baseline and follow-up testing of the exposed person.

Gout crystal finding

Negatively birefringent needle-shaped monosodium urate crystals under polarized light confirm gout; positively birefringent rhomboid calcium pyrophosphate crystals indicate pseudogout.

Giant cell arteritis urgency

In a patient over 50 with new temporal headache, jaw claudication, or visual symptoms and elevated ESR, give high-dose glucocorticoid immediately to prevent blindness, then confirm with biopsy or ultrasound.

Anaphylaxis first-line drug

Intramuscular epinephrine 0.5 mg of the 1 mg/mL concentration into the anterolateral thigh, repeated every 5 to 15 minutes as needed; antihistamines and steroids are adjuncts only.

Stroke thrombolysis window

Intravenous thrombolysis is given within 4.5 hours of symptom onset after noncontrast CT excludes hemorrhage; mechanical thrombectomy is used for large vessel occlusion in selected patients up to 24 hours.

Status epilepticus sequence

A benzodiazepine such as lorazepam or midazolam is first-line, followed by a second-line agent such as levetiracetam, valproate, or phenytoin; refractory cases require anesthetic infusion.

Stevens-Johnson versus toxic epidermal necrolysis

Both are severe drug reactions distinguished by epidermal detachment: less than 10 percent of body surface area is Stevens-Johnson syndrome, and more than 30 percent is toxic epidermal necrolysis.

Tension pneumothorax action

It is a clinical diagnosis with hypotension, distended neck veins, and absent breath sounds; immediate needle decompression followed by chest tube placement is required without waiting for imaging.

ARDS Berlin definition

Onset within one week with bilateral opacities not fully explained by heart failure and a PaO2/FiO2 ratio of 300 mmHg or less on positive end-expiratory pressure of at least 5 cmH2O.

Revised Cardiac Risk Index

Six predictors of perioperative cardiac events: ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine above 2 mg/dL, and high-risk surgery.