Kuwait Board Internal Medicine key terms

The difference between measured serum cations and anions, calculated as sodium minus chloride minus bicarbonate. It flags unmeasured acids such as ketones, lactate, or toxins and guides the workup of metabolic acidosis.

The difference between measured and calculated serum osmolality. A raised gap suggests unmeasured osmoles such as ethanol, methanol, ethylene glycol, or isopropanol, and helps in the assessment of suspected poisoning.

The change in anion gap divided by the change in bicarbonate from normal values. It helps distinguish pure high anion gap metabolic acidosis from a mixed disorder with concurrent metabolic alkalosis or normal gap acidosis.

The percentage of filtered sodium excreted in urine, calculated from paired serum and urine sodium and creatinine. Values below one percent typically suggest prerenal azotemia rather than intrinsic renal injury.

An estimate of renal potassium handling derived from urine and serum potassium and osmolality. It helps separate renal potassium wasting from extrarenal losses in hypokalemia and aids evaluation of hyperkalemia.

Intrinsic kidney injury from ischemic or nephrotoxic insults causing tubular cell damage. It produces muddy brown casts, impaired concentrating ability, and often a fractional excretion of sodium above two percent.

A reversible rise in creatinine from reduced renal perfusion without structural tubular damage. Urine is concentrated, sodium is avidly reabsorbed, and it corrects with restoration of volume and perfusion.

A clinical heart failure syndrome with normal or near-normal left ventricular ejection fraction and evidence of diastolic dysfunction or raised filling pressures. It predominates in older patients and those with hypertension, obesity, or atrial fibrillation.

Hormones such as BNP and NT-proBNP released by stretched ventricular myocardium. Elevated levels support the diagnosis of heart failure but are confounded by age, renal impairment, obesity, and atrial fibrillation.

Acute coronary occlusion causing transmural ischemia with ST elevation in contiguous leads. It is a time-critical emergency requiring prompt reperfusion by primary percutaneous coronary intervention or fibrinolysis.

A preinfarction electrocardiographic pattern of deeply inverted or biphasic T waves in anterior leads during a pain-free interval. It signals critical proximal left anterior descending stenosis and warrants urgent angiography.

A myocardial contractile protein released into blood after cardiomyocyte injury. High-sensitivity assays detect small elevations, so interpretation requires serial sampling and correlation with the clinical ischemic picture.

Pericardial fluid raising intrapericardial pressure enough to impair ventricular filling. It causes hypotension, raised jugular venous pressure, muffled heart sounds, pulsus paradoxus, and echocardiographic diastolic chamber collapse.

An exaggerated fall in systolic blood pressure during inspiration, typically more than ten millimeters of mercury. It is classically seen in cardiac tamponade and severe obstructive airway disease.

Circulatory failure from mechanical obstruction to ventricular filling or ejection, as in tamponade, tension pneumothorax, or massive pulmonary embolism. It requires urgent mechanical or procedural relief alongside vasopressor support.

Repetitive upper airway collapse during sleep causing intermittent hypoxemia and arousals. It is associated with resistant hypertension, atrial fibrillation, and daytime somnolence, and is diagnosed by sleep study.

Chronic daytime hypercapnia in a patient with obesity and no other explanation for hypoventilation. It commonly coexists with obstructive sleep apnea and improves with weight loss and positive airway pressure therapy.

An elevated arterial partial pressure of carbon dioxide, reflecting alveolar hypoventilation when not metabolically compensated. Causes include airway obstruction, neuromuscular weakness, and central respiratory depression.

Pleural fluid protein and lactate dehydrogenase ratios used to classify an effusion as exudative or transudative. Exudative fluid meets at least one threshold, prompting evaluation for infection, malignancy, or inflammation.

An abnormal accumulation of fluid in the pleural space. Classification by protein content and lactate dehydrogenase helps separate transudates from exudates and guides thoracentesis and further investigation.

Frank pus within the pleural space, usually complicating pneumonia. It requires prompt drainage, appropriate antibiotics, and sometimes surgical decortication because it rarely resolves with antibiotics alone.

Acute hypoxemic respiratory failure with bilateral radiographic opacities not fully explained by cardiac failure, following a known trigger. Management emphasizes lung-protective ventilation and treatment of the underlying cause.

Placing a patient face down to improve oxygenation in severe acute respiratory distress syndrome by recruiting dorsal lung regions and reducing ventilation-perfusion mismatch. Prolonged sessions reduce mortality in moderate to severe cases.

Positive pressure support of breathing through an endotracheal tube or tracheostomy. Key concepts include tidal volume, positive end-expiratory pressure, plateau pressure, and lung-protective strategies to limit ventilator-induced injury.

Infection of ascitic fluid without an obvious intra-abdominal source, common in advanced cirrhosis. Diagnosis requires ascitic neutrophil count of at least 250 per microliter, and treatment is with third-generation cephalosporins.

Functional renal impairment in advanced liver disease from splanchnic vasodilation and renal vasoconstriction, without structural kidney damage. It is diagnosed after excluding other causes and treated with vasoconstrictors and albumin.

Pathological fluid accumulation in the peritoneal cavity, most often from portal hypertension in cirrhosis. Diagnostic paracentesis with cell count and albumin gradient distinguishes portal hypertensive from other causes.

Bleeding from esophageal or gastric varices caused by portal hypertension. Management combines resuscitation, vasoactive drugs, prophylactic antibiotics, and endoscopic band ligation, with early transjugular shunt consideration in refractory cases.

A metabolic emergency of insulin deficiency causing hyperglycemia, ketonemia, and high anion gap metabolic acidosis. Treatment requires intravenous fluids, insulin infusion, and careful potassium replacement with monitoring for cerebral edema.

Severe hyperglycemia with marked hyperosmolality, profound dehydration, and minimal ketosis, typically in older patients with type 2 diabetes. It carries high mortality and requires gradual fluid and insulin correction.

Euvolemic hypotonic hyponatremia from excessive antidiuretic hormone activity, with concentrated urine and continued renal sodium excretion. Causes include lung and central nervous system disease, malignancy, and drugs.

Neurological injury, often central pontine, from overly rapid correction of chronic hyponatremia. It presents with dysarthria, dysphagia, quadriparesis, or altered consciousness days after correction and is largely preventable by slow correction.

Serum sodium below the normal range, classified by volume status and tonicity. Assessment requires history, examination, urine osmolality, and urine sodium to identify the cause and guide safe correction.

Low serum potassium from reduced intake, gastrointestinal loss, or renal wasting. It causes weakness, arrhythmias, and electrocardiographic changes, and correction requires addressing the cause and replacing magnesium when deficient.

Elevated serum potassium that risks fatal arrhythmias. Emergency management includes membrane stabilization with calcium, intracellular shift with insulin and beta agonists, and definitive removal via binders or dialysis.

Metabolic derangement after rapid cancer cell breakdown, producing hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. It risks acute kidney injury and arrhythmia and is prevented with hydration and urate-lowering therapy.

Fever in a patient with severe chemotherapy-induced neutropenia. It is a medical emergency requiring immediate empiric broad-spectrum antibiotics and cultures, because infection can progress rapidly.

Life-threatening organ dysfunction from a dysregulated host response to infection. Recognition relies on clinical signs, lactate, and organ dysfunction markers, and management requires early antibiotics, fluids, and source control.

Sepsis with persistent hypotension requiring vasopressors and raised lactate despite adequate fluid resuscitation. It carries high mortality and demands rapid source control, antimicrobials, and hemodynamic support.

Infection of the endocardial surface, usually valves, presenting with fever, new murmur, and embolic phenomena. Blood cultures and echocardiography are central, and treatment requires prolonged targeted antibiotics and sometimes surgery.

A chronic infection by Mycobacterium tuberculosis, most often pulmonary, causing cough, fever, night sweats, and weight loss. Diagnosis uses sputum microscopy, culture, and nucleic acid amplification, with multidrug therapy for months.

An autoantibody directed against nuclear antigens, used as a screening test for systemic lupus erythematosus and other connective tissue disease. A positive result is common in healthy people, so specificity depends on titer and pattern.

An autoimmune disorder with arterial or venous thrombosis or pregnancy morbidity plus persistent antiphospholipid antibodies. Long-term anticoagulation is often required, and it can occur with lupus or independently.

A multisystem autoimmune disease with diverse manifestations including rash, arthritis, nephritis, and cytopenias. Diagnosis combines clinical features with autoantibodies, and treatment is tailored to organ severity.

Large vessel vasculitis of older adults affecting cranial arteries, causing headache, jaw claudication, and visual loss. It is treated urgently with high-dose glucocorticoids, and temporal artery biopsy confirms the diagnosis.

An inflammatory syndrome of older adults with proximal muscle pain and stiffness, raised inflammatory markers, and rapid response to low-dose glucocorticoids. It often coexists with temporal arteritis.

Sudden neurological deficit from cerebral artery occlusion. Rapid imaging and thrombolysis or thrombectomy within defined time windows can limit brain injury, so immediate assessment is essential.

Administration of a clot-dissolving drug to restore perfusion in acute ischemic stroke or myocardial infarction. It requires careful exclusion of bleeding risks and close monitoring for hemorrhage.

A brief episode of neurological dysfunction from focal brain ischemia without infarction. It signals high short-term stroke risk and requires urgent evaluation and secondary prevention.

Prolonged or repeated seizures without recovery between them, constituting a neurological emergency. Management follows a stepwise protocol from benzodiazepines to second-line antiseizure drugs and then anesthetic agents.

A severe mucocutaneous reaction, usually drug-induced, with epidermal detachment and mucosal involvement. It is a dermatological emergency requiring withdrawal of the culprit drug and supportive or intensive care.

The most severe form of epidermal necrolysis, with extensive skin detachment and high mortality. It is usually drug-induced and requires immediate withdrawal of the trigger and specialized supportive care.

A rapid, severe systemic hypersensitivity reaction with airway, breathing, or circulatory compromise. Intramuscular epinephrine is the first-line treatment, followed by airway support and adjunctive therapies.

Decompensated severe hypothyroidism with altered consciousness, hypothermia, and bradycardia. It is an endocrine emergency treated with thyroid hormone replacement, glucocorticoids, and supportive care.

Severe thyrotoxicosis with fever, tachycardia, agitation, and multiorgan dysfunction. It is a life-threatening emergency managed with beta blockade, thionamide drugs, iodine, and supportive care.

Acute glucocorticoid deficiency causing hypotension, weakness, and electrolyte disturbance, often precipitated by illness. It is treated immediately with intravenous hydrocortisone and fluids without waiting for confirmatory tests.

Structured estimation of a patient's risk of cardiac and other complications before surgery, using clinical factors, functional capacity, and validated indices. It guides testing, optimization, and shared decision-making about proceeding.

Managing anticoagulant therapy around surgery, balancing bleeding risk against thrombotic risk. Decisions include whether to bridge with heparin, when to stop and restart agents, and coordination with neuraxial procedures.

Metabolic acidosis with elevated unmeasured anions, classically from ketoacidosis, lactic acidosis, renal failure, or toxins. The gap and delta ratio help identify the cause and detect mixed acid-base disorders.

Poisoning by methanol, ethylene glycol, or similar alcohols causing high anion gap metabolic acidosis and organ toxicity. Treatment includes blocking alcohol dehydrogenase with fomepizole or ethanol and considering hemodialysis.