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Titles, high-yield lines, and pearls across all 54 cards.

• Hematology8 min

  Pancytopenia & Anemia classification

  Always ask whether one process unifies all three lines or whether two independent cytopenias coexist.

• Hematology6 min

  IDA, AOCD, megaloblastic anemia, AIHA & HLH

  Oral iron: ferrous sulfate 325 mg every other day (Stoffel 2017) — consecutive dosing raises hepcidin and blocks absorption. Empty stomach ± vitamin C; calcium/antacids block it.

• Hematology8 min

  Thrombocytopenia, ITP, HIT & TMA

  Bleed risk: <50k surgery/active bleed, <30k mild trauma, <10k spontaneous. Confirm with a citrated platelet count to exclude EDTA clumping.

• Hematology6 min

  Hypercoagulable states & coagulopathy

  Do not send thrombophilia labs during acute VTE or on anticoagulation (APS and prothrombin gene are selective exceptions).

• Hematology7 min

  Anticoagulation agents

  Warfarin: INR lags 48 h. Life-threatening bleed: vitamin K 5–10 mg IV + 4F-PCC. INR >10 no bleed: PO vitamin K 2.5–5 mg.

• Hematology7 min

  Choosing & bridging anticoagulation

  VTE: DOAC > warfarin > LMWH for most. Cancer: apixaban/edoxaban/rivaroxaban or LMWH; prefer LMWH if active GI/GU luminal tumor.

• Hematology6 min

  Transfusion medicine

  Restrictive RBC trigger Hb <7 for most (TRICC). Cardiac surgery ~7.5 (TRICS). ACS may warrant 8–10 (MINT signal). Ortho/CAD historically <8.

• Hematology6 min

  Transfusion modifications

  Leukoreduction: ↓ HLA alloimmunization, ↓ CMV, ↓ febrile non-hemolytic reactions. Standard in most US units.

• Hematology5 min

  Transfusion reactions

  Stop the transfusion, keep IV open with saline, check the clerical identity, call the blood bank, send the remaining unit + post-transfusion labs (DAT, hemolysis labs, culture if febrile).

• Pulmonary5 min

  Chest imaging

  ABCDEF: Airways/quality, Bones, Cardiac silhouette, Diaphragm, Effusions, Fields/foreign bodies.

• Pulmonary5 min

  PFTs & asthma

  Diagnosis: variable airflow limitation — BD response ≥12% and 200 mL, PEF variability, methacholine drop ≥20%, or ICS response.

• Pulmonary5 min

  COPD

  Diagnosis: post-BD FEV1/FVC <0.7 (or <LLN) + symptoms. Grade 1–4 by FEV1%; Group A/B/E by symptoms and exacerbations.

• Pulmonary5 min

  Interstitial lung disease

  Progressive dyspnea, dry cough, velcro crackles, clubbing, restriction + low DLCO. History: CTD, drugs, birds/mold, radiation, smoking.

• Pulmonary5 min

  VTE diagnostics

  Pretest probability first: Wells (outpatient), Geneva, PERC (rule-out), YEARS/PEGeD for pregnancy and probability-adjusted D-dimer.

• Pulmonary5 min

  VTE management

  Anticoagulate all except contraindications. DOAC > VKA (APS: VKA) > LMWH (pregnancy, some GI cancers).

• Pulmonary5 min

  Pulmonary hypertension

  PH = mPAP ≥20 mmHg. Precapillary: PVR >2 and PCWP ≤15. Postcapillary: PCWP >15, PVR ≤2. Mixed: both high.

• Pulmonary5 min

  ARDS

  Berlin: ≤7 days, bilateral opacities, not fully explained by HF, PEEP ≥5, P/F ≤300 (mild 200–300, moderate 100–200, severe ≤100).

• Infectious disease5 min

  Empiric antimicrobials

  Meningitis: vanc + CTX 2 g q12; add ampicillin if ≥50 or immunocompromised; acyclovir if HSV possible. Steroids if pneumococcus.

• Infectious disease5 min

  Multidrug-resistant organisms

  AmpC (HECK-Yes: Hafnia, E. cloacae complex, C. freundii, K. aerogenes, Yersinia): can derepress. Serious infections: cefepime (MIC ≤2) or carbapenem. Avoid CTX even if ‘S’.

• Infectious disease5 min

  Community-acquired pneumonia

  Infiltrate + compatible syndrome. CURB-65 0–1 outpatient; PSI more accurate. Severe CAP: 1 major (shock/vent) or 3 minor ATS criteria.

• Infectious disease5 min

  HAP, VAP & aspiration pneumonia

  HAP ≥48 h after admission; VAP ≥48 h after intubation. Cover PsA; add MRSA if risk (prior MRSA, IV abx 90 d, high local rates).

• Infectious disease5 min

  Urinary tract infections

  Cystitis vs pyelo vs CAUTI vs asymptomatic bacteriuria. Symptoms define infection, not the UA alone.

• Infectious disease5 min

  Meningitis & encephalitis

  95% of bacterial meningitis have ≥2 of fever, nuchal rigidity, AMS, headache. Do not delay abx for CT/LP if delay is expected.

• Infectious disease5 min

  C. difficile infection

  CDI = new ≥3 watery stools/day + positive toxin/NAAT interpreted in context (colonization vs disease).

• Infectious disease5 min

  Invasive fungal infections

  Risk: neutropenia, transplant, high-dose steroids, biologics, HIV with low CD4, liver failure, TPN, broad abx, central lines.

• Infectious disease5 min

  Fever of unknown origin

  Classic FUO: T >38.3°C, ≥3 weeks, no diagnosis after reasonable investigation (≥3 hospital days or ≥3 outpatient visits).

• Cardiology5 min

  Heart failure overview & cardiomyopathies

  HF is a clinical diagnosis (congestion + a structural/functional ventricular problem). Cardiomyopathy is an imaging/structural label and does not require volume overload.

• Cardiology6 min

  ADHF management & GDMT

  Triage by Forrester: warm/cold × wet/dry. Cold = hypoperfusion (AMS, lactate, cool extremities, narrow pulse pressure).

• Cardiology5 min

  Cardiogenic shock

  SCAI stages A (at risk) → B (beginning, no hypoperfusion) → C (classic hypoperfusion) → D (deteriorating) → E (extremis).

• Cardiology5 min

  Right ventricular failure

  RV is coupled to a high-compliance, low-resistance circuit and is more afterload-sensitive than the LV. It tolerates volume better than pressure.

• Nephrology5 min

  Acute kidney injury — definition & workup

  KDIGO: Stage 1 Cr ↑0.3 in 48 h or 1.5–1.9×; Stage 2 2–2.9×; Stage 3 3×, Cr ≥4, or RRT. Also UOP criteria.

• Nephrology6 min

  AKI management & renal emergencies

  Fix volume, stop NSAIDs/ACE/ARB if prerenal/AKI, avoid hyperglycemia and unnecessary contrast. Large-volume resuscitation: LR > NS (SMART/SALT-ED).

• Nephrology5 min

  Glomerular disease

  Nephrotic: ≥3.5 g/day + albumin <3. Loop diuretics, salt restriction, statin, ACE/ARB, VTE ppx if albumin <2 (especially membranous).

• Nephrology5 min

  Chronic kidney disease

  CKD: eGFR <60 or kidney damage (albuminuria ≥30 mg/day) for ≥3 months (KDIGO 2024).

• Nephrology5 min

  Advanced diuresis

  Loops have a sigmoidal threshold. If no UOP, double the dose — do not give the same subthreshold dose q6h.

• Nephrology7 min

  Sodium disorders

  Hyponatremia = excess free water relative to sodium. Workup: osmolality, volume, Uosm, UNa.

• Nephrology6 min

  Potassium disorders

  98% of K is intracellular. Insulin and β2 agonists shift K in; acidosis and succinylcholine shift K out.

• Nephrology5 min

  Magnesium & phosphorus

  HypoMg: neuromuscular irritability, prolonged QT/TdP, resistant hypoK and hypoCa (functional hypoparathyroidism). IV Mg if severe or TdP (2 g).

• GI & hepatology5 min

  GERD & peptic ulcer disease

  No alarm features: 8-week once-daily PPI 30 min before breakfast. Alarm (dysphagia, bleed, weight loss, IDA, vomiting, age ≥60) → EGD.

• GI & hepatology5 min

  Diarrhea

  Acute <14 d, mostly viral. Workup if severe, bloody, high-risk, >1 week: BMP, C. diff, stool PCR, O&P if travel/MSM/immunocompromised.

• GI & hepatology5 min

  Upper GI bleeding

  Proximal to ligament of Treitz. Hematemesis/melena; hematochezia if brisk. GBS 0–1 may go home.

• GI & hepatology5 min

  Lower GI bleeding

  Distal to Treitz. Diverticular, angioectasia, colitis, neoplasm, post-polypectomy, hemorrhoids, ischemic colitis (left, painful, bloody).

• GI & hepatology5 min

  Pancreatitis & pancreatic mass

  2 of 3: typical pain, lipase ≥3× ULN, imaging. Gallstones #1 women; alcohol #1 men. TG, drugs, ERCP, hyperCa, post-op, idiopathic.

• GI & hepatology5 min

  Liver chemistry tests

  Hepatocellular: ALT/AST. Cholestatic: ALP/GGT/bili. Mixed is common. ALP from bone vs liver: GGT or fractionation.

• GI & hepatology5 min

  Biliary disease

  Cholelithiasis: often asymptomatic. Biliary colic: episodic RUQ after meals, US first.

• GI & hepatology5 min

  Acute liver injury & failure

  ALF = acute liver injury + INR ≥1.5 + encephalopathy, no prior cirrhosis (except acute Wilson, HBV, AIH flares).

• GI & hepatology5 min

  Viral hepatitis

  HAV: fecal-oral, self-limited, vaccine preventable, no chronicity. Post-exposure: vaccine ± IG.

• GI & hepatology5 min

  Alcohol-related liver disease

  Spectrum: steatosis → AH → cirrhosis. Harmful drinking: ≥3/d men, ≥2/d women (or binge). AUDIT-C screen.

• GI & hepatology5 min

  Metabolic liver disease

  MASLD = hepatic steatosis + cardiometabolic risk without competing etiology. MASH = inflammation + ballooning ± fibrosis.

• GI & hepatology5 min

  Cirrhosis & compensated ESLD

  Compensated vs decompensated (ascites, variceal bleed, HE, jaundice). Decompensation jumps mortality.

• GI & hepatology5 min

  Ascites & SBP

  Diagnostic tap on every admission with ascites. SAAG ≥1.1 = portal hypertension. High protein >2.5: cardiac, Budd-Chiari; low protein: cirrhosis.

• GI & hepatology5 min

  Hepatic encephalopathy

  Clinical diagnosis. Ammonia supports but a normal value does not exclude HE in cirrhosis.

• GI & hepatology5 min

  Hepatocellular carcinoma

  2–4%/year in cirrhosis. Screen US ± AFP q6 months. Diagnose with multiphase CT/MRI (LI-RADS); biopsy if atypical.

• GI & hepatology5 min

  Hepatorenal syndrome

  HRS-AKI: cirrhosis + ascites + KDIGO AKI after 48 h off diuretics + albumin 1 g/kg/day, no shock, no nephrotoxins, no structural kidney disease (bland urine, normal US).