OMSB Internal Medicine (OEIM) cheat sheet

Acute coronary syndrome: serial high-sensitivity troponin at 0 and 1-3 hours with delta change; ST-elevation on ECG mandates immediate reperfusion, not wait for troponin.

Heart failure with reduced ejection fraction: four pillars - ARNI/ACEi/ARB, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor - started early unless contraindicated by renal function, potassium, or hypotension.

Atrial fibrillation stroke risk: CHA2DS2-VASc ≥2 in men or ≥3 in women supports anticoagulation; DOACs preferred over warfarin except in mechanical valves or moderate-severe mitral stenosis.

Community-acquired pneumonia: CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30, blood pressure low, age ≥65) guides site of care; score 0-1 outpatient, 2 short admission, ≥3 consider intensive care.

Diabetic ketoacidosis: isotonic saline first, then insulin infusion only after potassium is ≥3.3 mmol/L; add dextrose when glucose <11-14 mmol/L to continue insulin and clear ketones.

Hyponatremia: assess serum osmolality and volume status first; correct chronic hyponatremia by ≤8-10 mmol/L in 24 hours to avoid osmotic demyelination.

Acute upper GI bleed: pre-endoscopy proton pump inhibitor plus restrictive transfusion threshold (hemoglobin ~7 g/dL), and endoscopy within 24 hours after resuscitation.

Venous thromboembolism: use risk stratification (sPESI) and, when stable, direct oral anticoagulants; thrombolysis reserved for hemodynamic instability in pulmonary embolism.

Sepsis: sepsis-3 defines sepsis as suspected infection plus SOFA increase ≥2; start broad-spectrum antibiotics within 1 hour of septic shock and give 30 mL/kg crystalloid for hypotension or lactate ≥4.

Thyroid: primary hypothyroidism shows high TSH with low free T4; subclinical shows high TSH with normal free T4; treat overt disease with levothyroxine titrated to TSH.

Acute kidney injury: use KDIGO staging by creatinine rise and urine output; distinguish prerenal (fractional excretion of urea <35%, FeNa <1%) from intrinsic and postrenal causes with bladder scan and urinalysis.

Cirrhosis: ascites managed with spironolactone plus furosemide and sodium restriction; spontaneous bacterial peritonitis diagnosed by ascitic neutrophil count ≥250/mm³, treated with a third-generation cephalosporin plus albumin.

Anemia workup: classify by mean corpuscular volume; iron deficiency shows low ferritin with high total iron-binding capacity, while anemia of chronic disease shows normal-high ferritin with low TIBC.

Asthma versus COPD: asthma shows reversible airflow limitation with bronchodilator and eosinophilic inflammation; COPD shows persistent post-bronchodilator FEV1/FVC <0.70 with neutrophilic pattern.

Hyperkalemia with ECG changes: give intravenous calcium gluconate for membrane stabilization, then insulin with glucose and beta-2 agonist to shift potassium intracellularly; dialysis for refractory cases.

Rheumatology: gout shows negatively birefringent needle-shaped crystals, pseudogout positively birefringent rhomboid crystals; do not start urate-lowering therapy during an acute flare without coverage.

Stroke: noncontrast CT excludes hemorrhage before thrombolysis; intravenous alteplase or tenecteplase within 4.5 hours of onset, and mechanical thrombectomy up to 24 hours in selected large-vessel occlusion.

Diabetes: metformin first-line unless contraindicated; add SGLT2 inhibitor or GLP-1 receptor agonist when atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease is present regardless of HbA1c.

Hypertension: stage 2 or high-risk patients start two agents, typically ACEi/ARB plus calcium channel blocker or thiazide; avoid ACEi and ARB combination due to renal harm.

Adrenal crisis: draw cortisol and ACTH, then give dexamethasone or hydrocortisone immediately with saline; do not wait for laboratory confirmation when hypotension and hyperkalemia suggest it.

Pleural effusion: Light criteria (pleural protein/serum >0.5, pleural LDH/serum >0.6, or pleural LDH >2/3 upper normal serum) classify exudate; low glucose and pH suggest empyema or malignancy.

Tuberculosis: latent infection treated with rifampin-based short regimens or isoniazid; active disease requires multidrug therapy, and drug susceptibility guides regimen adjustment.

Delirium: use the Confusion Assessment Method; identify and treat precipitating causes (infection, medications, metabolic derangement, pain, urinary retention) before adding antipsychotics.

Anticoagulation reversal: vitamin K plus four-factor prothrombin complex concentrate for warfarin-related major bleeding; idarucizumab for dabigatran; andexanet alfa or PCC for factor Xa inhibitors.

Electrolyte formulas: corrected sodium = measured sodium + 0.024 × (glucose − 5.5 mmol/L); anion gap = sodium − (chloride + bicarbonate), normal 8-12 mmol/L, add 2.5 for every 1 g/dL low albumin.

Acid-base: calculate expected compensation - Winter's formula for metabolic acidosis is PaCO2 = 1.5 × bicarbonate + 8 ± 2; a normal PaCO2 with low bicarbonate indicates a mixed disorder.

Liver disease: Child-Pugh and MELD scores estimate prognosis; in acute liver failure, N-acetylcysteine is given regardless of acetaminophen cause and transfer to transplant center is urgent.

Pancreatitis: diagnosis requires two of three criteria - characteristic pain, lipase >3 times upper normal, or imaging; early aggressive fluids and enteral feeding when tolerated.

Infective endocarditis: draw three sets of blood cultures from separate sites before antibiotics; echocardiography and modified Duke criteria establish diagnosis.

Malignancy screening: colonoscopy from age 45-50, mammography every 1-2 years from 40-50, and low-dose CT for high-risk smokers; cervical cytology plus HPV testing per local schedule.

Immunosuppression: live vaccines contraindicated with severe immunosuppression; screen for latent tuberculosis and hepatitis B before starting biologics or high-dose steroids.

Antimicrobial stewardship: de-escalate based on cultures and local resistance patterns; adjust renal dosing and monitor therapeutic drug levels for vancomycin and aminoglycosides.

Acute respiratory distress syndrome: Berlin definition requires onset within 1 week, bilateral opacities, and PaO2/FiO2 ≤300 on positive end-expiratory pressure ≥5; use low tidal volume 6 mL/kg predicted body weight.

Pulmonary embolism risk: Wells score and D-dimer guide testing; in high pretest probability, proceed to CT pulmonary angiography rather than relying on D-dimer.

Syncope: history and ECG triage; red flags include exertional syncope, structural heart disease, family history of sudden death, and abnormal ECG - admit and evaluate.

Thyroid storm: Burch-Wartofsky score guides diagnosis; treat with beta-blocker, thionamide, iodine load after thionamide, and glucocorticoid.

Hypercalcemia: corrected calcium = measured calcium + 0.02 × (40 − albumin g/L); treat severe cases with intravenous saline, calcitonin, and bisphosphonate.

Transfusion: restrictive strategy (hemoglobin 7-8 g/dL) is noninferior in most stable patients; one unit at a time and reassess.

Antibiotic allergy: label removal after direct oral challenge is safe for low-risk penicillin reactions; avoid unnecessary broad-spectrum alternatives.

Perioperative risk: calculate Revised Cardiac Risk Index; continue beta-blockers and statins, hold DOACs per procedure bleeding risk, and optimize anemia before elective surgery.

Renal replacement: indications include refractory acidosis, electrolyte disturbance, intoxication, overload, and uremia (AEIOU); start early in critically ill patients with AKI and hemodynamic instability.

Nephrotic syndrome: proteinuria >3.5 g/day with hypoalbuminemia and edema; biopsy adults to identify minimal change, membranous, or focal segmental glomerulosclerosis.

Anemia of chronic kidney disease: target hemoglobin 10-11.5 g/dL with iron repletion and erythropoiesis-stimulating agents; avoid higher targets due to cardiovascular risk.

Chronic obstructive pulmonary disease: GOLD group by symptoms (mMRC, CAT) and exacerbation history; long-acting bronchodilator combinations reduce exacerbations, and triple therapy for eosinophilic exacerbators.

Diabetes insipidus: water deprivation test distinguishes central from nephrogenic; desmopressin corrects central form, while nephrogenic requires low-solute diet and thiazide.

Pituitary apoplexy: sudden headache, visual field defect, and ophthalmoplegia with hypotension; urgent imaging and glucocorticoid replacement before surgery.

Screening for hepatocellular carcinoma: ultrasound with or without alpha-fetoprotein every 6 months in cirrhosis; biopsy not required when imaging shows typical arterial enhancement with washout.

Antibiotic prophylaxis: before dental procedures only for high-risk cardiac conditions (prosthetic valve, prior endocarditis, certain congenital lesions).

Acute leukemia: blasts ≥20% in marrow defines acute leukemia; APL is an emergency requiring all-trans retinoic acid plus arsenic trioxide without waiting for genetics.

Tumor lysis syndrome: Cairo-Bishop criteria use uric acid, potassium, phosphate, and calcium; prevent with hydration and allopurinol, treat with rasburicase when uric acid high.

Neutropenic fever: single temperature ≥38.3°C or ≥38.0°C sustained over 1 hour; start antipseudomonal beta-lactam within 60 minutes.

Multiple myeloma: CRAB features (calcium, renal, anemia, bone) plus marrow plasma cells ≥10%; treat with proteasome inhibitor, immunomodulator, and steroid combinations.

Hyperviscosity: plasma exchange is urgent for symptomatic hyperviscosity in Waldenström macroglobulinemia; do not delay for chemotherapy.

Spinal cord compression: back pain with neurologic deficit in cancer requires urgent MRI and dexamethasone; delay causes irreversible deficits.

Vaccination in asplenia: pneumococcal, meningococcal, and Haemophilus influenzae vaccines; asplenia increases risk of encapsulated organism sepsis.

Anticoagulation in cancer: DOACs preferred over low-molecular-weight heparin in most cancer-associated thrombosis, except luminal GI or genitourinary cancers with bleeding risk.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6; score ≤8 indicates need for airway protection and intubation.

Stroke thrombolysis window: 4.5 hours from last known well for intravenous therapy; thrombectomy up to 24 hours with imaging selection in large-vessel occlusion.

Meningitis: do not delay antibiotics for lumbar puncture; give dexamethasone with or before first antibiotic dose in suspected pneumococcal meningitis.

Status epilepticus: benzodiazepine first (lorazepam or midazolam), then second-line levetiracetam, valproate, or phenytoin; refractory cases need anesthetic infusion.

Alcohol withdrawal: use CIWA-Ar to guide symptom-triggered benzodiazepines; give thiamine before glucose to prevent Wernicke encephalopathy.

Opioid overdose: naloxone reverses respiratory depression; titrate to adequate respiration, not full arousal, and observe for renarcotization.

Serotonin syndrome: clonus and hyperreflexia distinguish from neuroleptic malignant syndrome, which shows rigidity and bradyreflexia; stop offending agents and give supportive care.

Acute ischemic stroke blood pressure: permissive hypertension unless thrombolysis planned; target <185/110 mmHg before alteplase and <180/105 after.

Inflammatory bowel disease: ulcerative colitis is continuous from rectum with bloody diarrhea; Crohn disease is transmural, skip lesions, and may involve any GI segment.

Celiac disease: screen with tissue transglutaminase IgA and total IgA; confirm with duodenal biopsy showing villous atrophy while on gluten-containing diet.

Hepatitis B: HBsAg positive >6 months indicates chronic infection; treat with tenofovir or entecavir when HBV DNA high, ALT elevated, or cirrhosis present.

Hepatitis C: direct-acting antivirals achieve cure (sustained virologic response at 12 weeks) in >95%; screen all adults once.

Peptic ulcer disease: test and treat Helicobacter pylori with quadruple therapy; avoid NSAIDs and confirm eradication with urea breath test or stool antigen.

Clostridioides difficile: oral vancomycin or fidaxomicin first-line for initial episode; avoid metronidazole except when neither is available.

Acute mesenteric ischemia: pain out of proportion to exam with elevated lactate; CT angiography is diagnostic and revascularization is urgent.

Pancreatic enzyme replacement: give with meals in exocrine pancreatic insufficiency; monitor fat-soluble vitamins and weight.

Rheumatoid arthritis: anti-cyclic citrullinated peptide is more specific than rheumatoid factor; methotrexate is anchor therapy, with biologics added for inadequate response.

Systemic lupus erythematosus: anti-dsDNA and anti-Smith are specific; monitor complement and urine protein for flares and lupus nephritis.

Giant cell arteritis: age >50 with headache, jaw claudication, and elevated ESR; start high-dose glucocorticoid immediately and confirm with temporal artery biopsy within 2 weeks.

Polymyalgia rheumatica: proximal shoulder and hip girdle pain with elevated ESR; low-dose prednisone gives rapid response.

ANCA vasculitis: c-ANCA with PR3 suggests granulomatosis with polyangiitis; p-ANCA with MPO suggests microscopic polyangiitis; induction with cyclophosphamide or rituximab plus steroids.

Osteoporosis: DXA T-score ≤−2.5 defines osteoporosis; treat with bisphosphonate, denosumab, or anabolic agent based on fracture risk, and correct vitamin D and calcium first.

Scleroderma renal crisis: new hypertension and rising creatinine in diffuse systemic sclerosis; use ACE inhibitor and avoid high-dose steroids.

Antiphospholipid syndrome: recurrent thrombosis or pregnancy loss with persistent lupus anticoagulant, anticardiolipin, or anti-beta-2 glycoprotein antibodies; anticoagulate with warfarin in triple-positive thrombotic disease.

Aortic dissection: sudden tearing chest pain with pulse deficit or blood pressure differential; CT angiography is diagnostic, and beta-blockade to heart rate <60 and blood pressure <120 systolic precedes surgery.

Acute heart failure: classify by congestion and perfusion (wet/dry, warm/cold); give loop diuretic for congestion, inotropes for cardiogenic shock, and noninvasive ventilation for pulmonary edema.

Cardiac tamponade: Beck triad (hypotension, distended neck veins, muffled heart sounds) with electrical alternans; treat with urgent pericardiocentesis.

Hypertrophic cardiomyopathy: systolic murmur increases with Valsalva and decreases with squatting; avoid dehydration and vasodilators, use beta-blockers or disopyramide for obstruction.

Infective endocarditis indications for surgery: heart failure from valve dysfunction, uncontrolled infection, and high risk of embolization with large vegetations.

Valvular disease: severe aortic stenosis shows syncope, angina, and dyspnea; symptomatic severe disease warrants valve replacement.

Atrial flutter: sawtooth flutter waves with atrial rate ~300; treat with rate control and anticoagulation per CHA2DS2-VASc, and catheter ablation for recurrence.

Statin therapy: high-intensity statin for established atherosclerotic cardiovascular disease regardless of baseline LDL; add ezetimibe or PCSK9 inhibitor if LDL remains above target.

Chronic kidney disease staging: G1-G5 by eGFR, with albuminuria A1-A3; eGFR <60 for ≥3 months defines CKD.

Hyperkalemia in CKD: low-potassium diet, loop diuretics, potassium binders, and RAAS inhibitor dose adjustment; dialysis for refractory or life-threatening cases.

Contrast-induced nephropathy: risk factors include CKD, diabetes, and volume depletion; use lowest contrast volume and isotonic saline hydration; no proven benefit from bicarbonate or N-acetylcysteine.

Dialysis disequilibrium: headache, confusion, and seizures after rapid dialysis; prevent with slower initial sessions and mannitol for severe cases.

Renal artery stenosis: flash pulmonary edema and worsening creatinine after ACE inhibitor suggest bilateral disease; avoid RAAS blockade in bilateral stenosis.

Hematuria evaluation: painless gross hematuria in adults requires cystoscopy and upper tract imaging to exclude malignancy.

Nephritic syndrome: hematuria, hypertension, and oliguria with red cell casts; post-streptococcal glomerulonephritis follows pharyngitis 1-2 weeks later and resolves with supportive care.

Diuretic resistance: combine loop diuretic with thiazide or use continuous infusion; monitor electrolytes and renal function.

Diabetes diagnosis: HbA1c ≥6.5%, fasting glucose ≥7.0 mmol/L, or 2-hour glucose ≥11.1 mmol/L; repeat to confirm unless symptoms are unambiguous.

Hypoglycemia: Whipple triad (symptoms, low glucose, relief with correction); treat with oral glucose if conscious, glucagon or intravenous dextrose if not.

Diabetic foot: assess pulses, sensation (10 g monofilament), and skin; treat infection with broad-spectrum antibiotics and offload pressure; osteomyelitis requires prolonged therapy.

Thyroid nodule: ultrasound risk stratification guides fine-needle aspiration; suspicious features include microcalcifications, irregular margins, and taller-than-wide shape.

Pheochromocytoma: plasma free metanephrines are the best initial test; alpha-blockade before beta-blockade to prevent hypertensive crisis.

Cushing syndrome: 24-hour urinary free cortisol, late-night salivary cortisol, or overnight dexamethasone suppression test; then ACTH to localize.

Osteoporosis screening: DXA for women ≥65 and men ≥70, or earlier with risk factors; repeat every 2 years or per risk.

Hyperthyroidism: Graves disease shows diffuse uptake and TSH-receptor antibodies; treat with beta-blocker, thionamide, radioiodine, or surgery based on patient factors.

Tuberculosis treatment: standard regimen is 2 months of isoniazid, rifampin, pyrazinamide, and ethambutol followed by 4 months of isoniazid and rifampin; adjust for resistance.

Pneumonia severity: use CURB-65 or PSI to decide admission; start empiric antibiotics covering typical and atypical organisms, and narrow based on culture.

HIV: start antiretroviral therapy for all diagnosed patients regardless of CD4 count; screen for opportunistic infections and drug interactions.

Infective endocarditis prophylaxis: indicated only for high-risk cardiac conditions before dental procedures; not routine for most patients.

Sepsis bundle: measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics within 1 hour for septic shock, and 30 mL/kg crystalloid for hypotension or lactate ≥4.

Influenza: oseltamivir reduces duration if started within 48 hours; treat severe or high-risk patients regardless of timing.

Malaria: thick and thin smears diagnose; severe falciparum malaria requires intravenous artesunate.

Meningococcal prophylaxis: close contacts receive rifampin, ciprofloxacin, or ceftriaxone; vaccination for outbreak control.

Anemia: transfusion threshold in stable patients is hemoglobin 7-8 g/dL; treat underlying cause and check iron, B12, and folate studies.

Iron deficiency anemia: oral iron is first-line; intravenous iron for malabsorption, intolerance, or ongoing blood loss.

B12 deficiency: causes macrocytic anemia with neurologic symptoms; check methylmalonic acid and homocysteine when borderline; treat with intramuscular or high-dose oral replacement.

Hemolytic anemia: elevated lactate dehydrogenase and indirect bilirubin with low haptoglobin; direct antiglobulin test distinguishes immune from nonimmune causes.

Thrombocytopenia: spontaneous bleeding risk rises when platelets <10-20 ×10⁹/L; transfuse prophylactically at <10 ×10⁹/L in most patients, and treat immune thrombocytopenia with steroids or IVIG.

Heparin-induced thrombocytopenia: platelet drop >50% with thrombosis 5-10 days after heparin; stop heparin and start a non-heparin anticoagulant; do not give platelet transfusions.

Sickle cell crisis: give oxygen, fluids, and opioids for pain; transfuse for acute chest syndrome, stroke, or severe anemia.

Venous thromboembolism prophylaxis: use risk assessment (Caprini); low-molecular-weight heparin or fondaparinux for high-risk medical and surgical patients.

Depression screening: PHQ-9 or PHQ-2; treat with psychotherapy and selective serotonin reuptake inhibitor; assess suicide risk at every visit.

Alcohol use disorder: AUDIT-C screening; treat withdrawal with benzodiazepines and offer naltrexone or acamprosate for maintenance.

Opioid use disorder: buprenorphine or methadone reduces mortality; do not withhold for acute pain.

Smoking cessation: combination of varenicline or nicotine replacement with behavioral counseling is most effective; ask, advise, and assist at every visit.

Obesity: body mass index ≥30 defines obesity; lifestyle plus pharmacotherapy (GLP-1 receptor agonists) or bariatric surgery for eligible patients.

Advance care planning: discuss and document goals of care and code status early; palliative care improves quality of life alongside disease-directed therapy.

Falls in older adults: screen with gait and balance assessment; review medications and home hazards; vitamin D and exercise reduce risk.

Vaccination: annual influenza, pneumococcal per age and risk, and herpes zoster for adults ≥50; adjust for immunocompromise.

Acute pancreatitis: diagnosis requires two of three criteria (characteristic pain, lipase >3× upper normal, imaging); early fluids and enteral nutrition when tolerated.

Upper GI bleeding: resuscitate, start proton pump inhibitor, and perform endoscopy within 24 hours; variceal bleeding needs octreotide and prophylactic antibiotics.

Cirrhosis decompensation: ascites, varices, and encephalopathy define decompensation; treat encephalopathy with lactulose and rifaximin.

Hepatorenal syndrome: functional renal failure in cirrhosis; treat with albumin plus vasoconstrictor (terlipressin or norepinephrine) and consider transplant.

Inflammatory bowel disease: ulcerative colitis is continuous from rectum; Crohn disease is transmural with skip lesions and fistulas; treat with mesalamine, steroids, or biologics.

Diverticulitis: uncomplicated cases can be managed outpatient with or without antibiotics; complicated cases need imaging and possible drainage or surgery.

Celiac disease: tissue transglutaminase IgA with total IgA; confirm with duodenal biopsy showing villous atrophy while on gluten-containing diet.

Colorectal cancer screening: start at age 45-50; colonoscopy every 10 years or stool-based testing annually.

Acute kidney injury: KDIGO stages by creatinine rise and urine output; prerenal state shows FeNa <1% and responds to fluids; intrinsic disease shows muddy brown casts.

Hyperkalemia: ECG changes (peaked T waves, wide QRS) require calcium gluconate; then insulin-glucose, beta-agonist, and potassium removal.

Hyponatremia: assess volume status and urine osmolality; correct chronic hyponatremia by ≤8-10 mmol/L in 24 hours.

Metabolic acidosis: calculate anion gap; high gap from ketoacidosis, lactic acidosis, renal failure, or toxins; normal gap from diarrhea or renal tubular acidosis.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia, edema; adults need biopsy to identify cause.

Chronic kidney disease: stage by eGFR and albuminuria; control blood pressure, use SGLT2 inhibitor for albuminuric CKD, and avoid nephrotoxins.

Dialysis indications: refractory acidosis, electrolyte disturbance, intoxication, fluid overload, and uremia (AEIOU).

Renal cell carcinoma: painless hematuria with flank mass; CT imaging and surgical resection; paraneoplastic syndromes common.

Thyroid storm: Burch-Wartofsky score; treat with beta-blocker, thionamide, iodine after thionamide, and glucocorticoid.

Adrenal insufficiency: hypotension, hyperkalemia, hyponatremia; confirm with morning cortisol and ACTH; treat with hydrocortisone and fluids.

Pheochromocytoma: plasma free metanephrines screen; alpha-blockade before beta-blockade to avoid crisis.

Cushing syndrome: 24-hour urinary free cortisol, late-night salivary cortisol, or overnight dexamethasone suppression; then ACTH to localize.

Hypercalcemia: corrected calcium formula; severe cases need saline, calcitonin, and bisphosphonate.

Diabetes insipidus: water deprivation test distinguishes central from nephrogenic; desmopressin for central.

Osteoporosis: DXA T-score ≤−2.5; treat with bisphosphonate or denosumab, correct vitamin D and calcium.

Pituitary apoplexy: sudden headache, visual field defect, ophthalmoplegia with hypotension; urgent imaging and glucocorticoid.

Ischemic stroke: noncontrast CT excludes hemorrhage; alteplase or tenecteplase within 4.5 hours; thrombectomy up to 24 hours in selected large-vessel occlusion.

Status epilepticus: benzodiazepine first, then levetiracetam, valproate, or phenytoin; refractory cases need anesthetic infusion.

Meningitis: do not delay antibiotics for lumbar puncture; give dexamethasone with or before first antibiotic for suspected pneumococcal meningitis.

Delirium: use Confusion Assessment Method; identify and treat causes before antipsychotics.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6; score ≤8 indicates airway protection and intubation.

Alcohol withdrawal: CIWA-Ar guides symptom-triggered benzodiazepines; give thiamine before glucose.

Opioid overdose: naloxone reverses respiratory depression; titrate to adequate respiration, not full arousal.

Serotonin syndrome: clonus and hyperreflexia distinguish from neuroleptic malignant syndrome, which shows rigidity and bradyreflexia.

Rheumatoid arthritis: anti-CCP more specific than rheumatoid factor; methotrexate anchor therapy, biologics for inadequate response.

Systemic lupus erythematosus: anti-dsDNA and anti-Smith specific; monitor complement and urine protein for flares and nephritis.

Giant cell arteritis: age >50 with headache and jaw claudication; start high-dose glucocorticoid immediately and confirm with temporal artery biopsy within 2 weeks.

ANCA vasculitis: c-ANCA/PR3 suggests granulomatosis with polyangiitis; p-ANCA/MPO suggests microscopic polyangiitis; induction with cyclophosphamide or rituximab plus steroids.

Osteoporosis: DXA T-score ≤−2.5; treat with bisphosphonate or denosumab based on fracture risk.

Scleroderma renal crisis: new hypertension and rising creatinine in diffuse systemic sclerosis; use ACE inhibitor and avoid high-dose steroids.

Antiphospholipid syndrome: recurrent thrombosis or pregnancy loss with persistent antibodies; anticoagulate with warfarin in triple-positive thrombotic disease.

Polymyalgia rheumatica: proximal shoulder and hip girdle pain with elevated ESR; low-dose prednisone gives rapid response.

Acute coronary syndrome: serial high-sensitivity troponin at 0 and 1-3 hours with delta change; ST-elevation mandates immediate reperfusion.

Heart failure with reduced ejection fraction: four pillars - ARNI/ACEi/ARB, beta-blocker, mineralocorticoid receptor antagonist, SGLT2 inhibitor - started early unless contraindicated.

Atrial fibrillation: CHA2DS2-VASc ≥2 in men or ≥3 in women supports anticoagulation; DOACs preferred except mechanical valves or moderate-severe mitral stenosis.

Hypertrophic cardiomyopathy: systolic murmur increases with Valsalva and decreases with squatting; avoid dehydration and vasodilators.

Cardiac tamponade: Beck triad with electrical alternans; urgent pericardiocentesis.

Aortic dissection: sudden tearing chest pain with pulse deficit; CT angiography diagnostic; beta-blockade before surgery.

Infective endocarditis: three sets of blood cultures before antibiotics; modified Duke criteria; surgery for heart failure or uncontrolled infection.

Statin therapy: high-intensity statin for established atherosclerotic cardiovascular disease regardless of baseline LDL.

Community-acquired pneumonia: CURB-65 guides site of care; start empiric antibiotics covering typical and atypical organisms.

Sepsis: sepsis-3 defines sepsis as suspected infection plus SOFA increase ≥2; antibiotics within 1 hour for septic shock and 30 mL/kg crystalloid.

Tuberculosis: standard regimen 2 months isoniazid, rifampin, pyrazinamide, ethambutol then 4 months isoniazid and rifampin; adjust for resistance.

HIV: start antiretroviral therapy for all diagnosed patients regardless of CD4 count; screen for opportunistic infections.

Clostridioides difficile: oral vancomycin or fidaxomicin first-line for initial episode; avoid metronidazole except when neither is available.

Infective endocarditis prophylaxis: only for high-risk cardiac conditions before dental procedures.

Influenza: oseltamivir reduces duration if started within 48 hours; treat severe or high-risk patients regardless of timing.

Malaria: thick and thin smears diagnose; severe falciparum malaria requires intravenous artesunate.

Anemia: transfusion threshold in stable patients is hemoglobin 7-8 g/dL; treat underlying cause and check iron, B12, and folate studies.

Iron deficiency anemia: oral iron first-line; intravenous iron for malabsorption, intolerance, or ongoing blood loss.

B12 deficiency: macrocytic anemia with neurologic symptoms; check methylmalonic acid and homocysteine; treat with intramuscular or high-dose oral replacement.

Hemolytic anemia: elevated LDH and indirect bilirubin with low haptoglobin; direct antiglobulin test distinguishes immune from nonimmune causes.

Heparin-induced thrombocytopenia: platelet drop >50% with thrombosis 5-10 days after heparin; stop heparin and start non-heparin anticoagulant.

Sickle cell crisis: oxygen, fluids, and opioids for pain; transfuse for acute chest syndrome, stroke, or severe anemia.

Venous thromboembolism prophylaxis: Caprini risk assessment; low-molecular-weight heparin or fondaparinux for high-risk patients.

Multiple myeloma: CRAB features plus marrow plasma cells ≥10%; treat with proteasome inhibitor, immunomodulator, and steroid combinations.

Depression screening: PHQ-9 or PHQ-2; treat with psychotherapy and selective serotonin reuptake inhibitor; assess suicide risk at every visit.

Alcohol use disorder: AUDIT-C screening; treat withdrawal with benzodiazepines and offer naltrexone or acamprosate for maintenance.

Opioid use disorder: buprenorphine or methadone reduces mortality; do not withhold for acute pain.

Smoking cessation: combination of varenicline or nicotine replacement with behavioral counseling is most effective.

Obesity: body mass index ≥30 defines obesity; lifestyle plus pharmacotherapy or bariatric surgery for eligible patients.

Advance care planning: discuss and document goals of care and code status early; palliative care improves quality of life alongside disease-directed therapy.

Falls in older adults: screen with gait and balance assessment; review medications and home hazards; vitamin D and exercise reduce risk.

Vaccination: annual influenza, pneumococcal per age and risk, and herpes zoster for adults ≥50; adjust for immunocompromise.