OMSB Internal Medicine (OEIM) key terms

A life-threatening circulation failure caused by infection in which low blood pressure and raised blood lactate persist despite adequate fluid resuscitation and require vasopressor support.

A quick bedside score giving one point each for breathing rate of 22 or more per minute, altered mental state, and systolic blood pressure of 100 mmHg or less, used to flag patients at risk of poor outcome from infection.

A protocol for severe sepsis that targets defined endpoints such as central venous pressure, mean arterial pressure and central venous oxygen saturation within the first hours of resuscitation, now largely superseded by simpler fluid and vasopressor strategies.

The percentage fall in blood lactate over a set period, used as a marker of successful resuscitation because falling values indicate improved tissue perfusion and predict better survival.

A drug that constricts blood vessels to raise mean arterial pressure, used when fluids alone fail to restore perfusion; norepinephrine is first-line in most shock states.

Inadequate tissue perfusion due to pump failure, marked by low cardiac output, raised filling pressures and cool peripheries, commonly after a large myocardial infarction.

Acute hypoxaemic lung injury with bilateral infiltrates not fully explained by cardiac failure, defined by a low ratio of arterial oxygen to inspired oxygen while on positive pressure ventilation.

A ventilator strategy using small tidal volumes around six millilitres per kilogram of predicted body weight with limited plateau pressure, which reduces ventilator-induced injury and mortality in acute respiratory distress syndrome.

Placing a ventilated patient face down for prolonged periods to improve oxygenation and survival in moderate to severe acute respiratory distress syndrome by recruiting dorsal lung regions.

A metabolic emergency of insulin deficiency causing hyperglycaemia, ketonaemia and high-anion-gap metabolic acidosis, managed with fluids, intravenous insulin and careful potassium replacement.

Severe hyperglycaemia with marked hyperosmolality and profound dehydration but little ketosis, typically in older patients with type 2 diabetes, treated mainly with aggressive fluid replacement.

The difference between measured serum sodium and the sum of chloride and bicarbonate, used to classify metabolic acidosis and detect unmeasured acids such as ketones or lactate.

An abrupt fall in kidney function over hours to days, defined by a rise in serum creatinine or reduced urine output, staged by severity and often caused by hypoperfusion, drugs or obstruction.

A calculated percentage comparing sodium filtered and excreted, helping distinguish low-perfusion kidney injury, where it is usually low, from tubular damage, where it is high.

Acute kidney injury occurring within days of iodinated contrast exposure after other causes are excluded, prevented mainly by avoiding dehydration and limiting contrast volume.

A supraventricular arrhythmia with chaotic atrial activity and an irregularly irregular ventricular response, raising stroke risk and managed by rate control, rhythm control and anticoagulation.

A point score for stroke risk in atrial fibrillation based on heart failure, hypertension, age, diabetes, prior stroke and vascular disease, guiding whether anticoagulation is indicated.

An oral agent inhibiting thrombin or factor Xa, used for stroke prevention and venous thrombosis, with fewer food and drug interactions than warfarin but requiring attention to kidney function.

A spectrum of myocardial ischaemia from unstable angina through non-ST-elevation to ST-elevation infarction, diagnosed with symptoms, electrocardiography and serial cardiac troponin measurement.

A blood test detecting small cardiac troponin releases, used with serial sampling and clinical assessment to diagnose or exclude myocardial infarction rapidly.

Acute coronary occlusion producing persistent ST elevation on electrocardiography, requiring urgent reperfusion by primary percutaneous coronary intervention or fibrinolysis when timely intervention is unavailable.

A clinical heart failure syndrome with left ventricular ejection fraction of 40 percent or less, treated with drugs proven to reduce mortality such as renin-angiotensin inhibitors, beta blockers and mineralocorticoid antagonists.

A natriuretic peptide released by stretched ventricular muscle, measured to support or exclude a diagnosis of heart failure, with values interpreted against age and kidney function.

An oral drug blocking renal sodium-glucose reabsorption, lowering glucose and improving cardiovascular and kidney outcomes in heart failure and chronic kidney disease regardless of diabetes status.

Persistent airflow limitation from airway and lung damage, usually from tobacco smoke, with exacerbations treated by bronchodilators, steroids and controlled oxygen targeting a safe saturation range.

Respiratory support through a mask without an artificial airway, used in hypercapnic respiratory failure from exacerbations of obstructive lung disease to reduce intubation and mortality.

Obstruction of pulmonary arteries by thrombus, presenting with breathlessness, chest pain or syncope and assessed using clinical probability, D-dimer testing and computed tomography angiography.

A clinical prediction rule estimating the pre-test probability of pulmonary embolism or deep vein thrombosis, used to decide whether D-dimer testing or imaging is the appropriate next step.

A fibrin degradation product that is sensitive but not specific for venous thrombosis, valuable mainly to exclude pulmonary embolism in patients with low or intermediate pre-test probability.

Acute lung infection acquired outside hospital, diagnosed by compatible symptoms and a new infiltrate, with severity scored to decide between outpatient, ward and intensive care management.

A severity score for pneumonia awarding points for confusion, urea above 7 mmol/L, raised respiratory rate, low blood pressure and age 65 or older, guiding site of care.

Intravenous clot-dissolving treatment for acute ischaemic stroke given within a narrow time window after imaging excludes haemorrhage, improving functional outcome but carrying bleeding risk.

Mechanical removal of an arterial clot, used for large-vessel occlusion stroke and selected patients beyond the thrombolysis window, with benefit dependent on rapid imaging and referral.

A brief episode of focal neurological dysfunction without infarction on imaging, signalling high early stroke risk and prompting urgent investigation and secondary prevention.

Advanced liver fibrosis with architectural distortion causing portal hypertension and impaired synthetic function, complicated by varices, ascites, encephalopathy and infection.

Infection of ascitic fluid without an obvious surgical source, diagnosed by a raised ascitic neutrophil count and treated promptly with antibiotics plus albumin in selected patients.

Reversible brain dysfunction from liver failure and portosystemic shunting, presenting as altered consciousness, asterixis and confusion, treated by correcting precipitants and reducing gut ammonia production.

Bleeding from a source above the ligament of Treitz, often from peptic ulcers or varices, managed by resuscitation, risk scoring, endoscopy and acid suppression or variceal therapy.

A pre-endoscopy score using blood urea, haemoglobin, blood pressure, pulse and clinical features to identify patients with upper gastrointestinal bleeding who are safe for outpatient care.

Acute life-threatening cortisol deficiency causing hypotension, vomiting and electrolyte disturbance, treated immediately with intravenous hydrocortisone and fluid before confirmatory tests.

Serum sodium below the normal range, classified by volume status and urine osmolality, with correction rate limited to avoid osmotic demyelination.