ABPTS CCS cheat sheet

Blood pressure categories (ACC/AHA): normal <120/<80 mm Hg; elevated 120–129/<80; stage 1 130–139 or 80–89; stage 2 ≥140 or ≥90; crisis >180 and/or >120.

Orthostatic hypotension: systolic drop ≥20 mm Hg or diastolic drop ≥10 mm Hg within 3 minutes of standing; measure after 5 minutes supine and at 1 and 3 minutes standing.

Heart sounds: S1 = mitral and tricuspid closure; S2 = aortic and pulmonic closure; S3 = early diastolic ventricular filling (heart failure, volume overload); S4 = late diastolic atrial kick (stiff ventricle).

Pitting edema grading: 1+ = 2 mm, 2+ = 4 mm, 3+ = 6 mm, 4+ = 8 mm depression with slow rebound; assess at a bony prominence such as the tibia.

Jugular venous pressure: with trunk at 30–45°, vertical height >3 cm above the sternal angle suggests elevated right atrial pressure; observe the internal jugular pulsation.

Ankle-brachial index: ABI ≤0.90 = peripheral arterial disease; 0.91–1.00 = borderline; >1.30 = noncompressible calcified vessel; calculate systolic ankle pressure divided by systolic brachial pressure.

Rate-pressure product: RPP = heart rate × systolic blood pressure; an angina threshold is often near 20,000–25,000, and RPP is used to gauge myocardial oxygen demand during activity.

Perfusion signs: capillary refill normally <3 seconds; cyanosis, cool extremities, diminished pulses, and delayed refill suggest poor peripheral perfusion.

Normal adult respiratory rate is 12–20 breaths/min; rates >24 or <8, accessory muscle use, paradoxical breathing, or inability to speak in full sentences signal respiratory distress.

Spirometry: post-bronchodilator FEV1/FVC <0.70 = obstructive pattern; FVC <80% predicted with normal or high ratio = restrictive pattern; severity graded by FEV1 % predicted.

GOLD airflow limitation: GOLD 1 FEV1 ≥80% predicted; GOLD 2 50–79%; GOLD 3 30–49%; GOLD 4 <30%.

Bronchodilator reversibility: an increase in FEV1 of ≥12% and ≥200 mL after a bronchodilator supports asthma; COPD typically shows a smaller, nonreversible change.

Peak cough flow: <270 L/min indicates weak cough and risk of secretion retention; <160 L/min raises concern for inability to clear secretions and for extubation failure.

Respiratory muscle strength: MIP less negative than −60 cmH2O suggests inspiratory weakness; MEP below 60 cmH2O suggests expiratory weakness; normal MIP is roughly −80 to −100 cmH2O.

Auscultation and percussion: crackles suggest fluid or fibrosis; wheeze suggests narrowed airways; hyperresonance suggests hyperinflation (COPD); dullness suggests effusion or consolidation.

Exertional desaturation: a fall in SpO2 ≥4% or any SpO2 <88% during a walk test indicates hypoxemia; verify with good signal quality and consider supplemental oxygen assessment.

Cardiac rehabilitation phases: phase I inpatient education and low-level mobility; phase II supervised outpatient typically 36 sessions over 12 weeks; phases III–IV long-term maintenance.

Post-sternotomy precautions: for 6–8 weeks avoid lifting >5–10 lb, avoid pushing/pulling with arms, and splint the incision with coughing to protect sternal healing.

COPD oxygen target: in patients at risk for hypercapnia, titrate oxygen to SpO2 88–92%; for most other acutely ill patients, target 94–98%.

Airway clearance techniques: active cycle of breathing, PEP, oscillating PEP, postural drainage, and high-frequency chest wall oscillation; avoid with unstable hemodynamics, raised ICP, or recent hemoptysis.

Inspiratory muscle training: commonly 30% of MIP, 15–30 minutes twice daily, with progressive overload; monitor for fatigue and desaturation.

ICU mobilization safety: MAP ≥65 mm Hg, FiO2 ≤0.60, PEEP ≤10 cmH2O, SpO2 ≥90%, no escalating vasopressors, no active arrhythmia, and no acute neurologic instability.

Energy conservation: alternate activity with rest, use pacing and work simplification, and avoid Valsalva maneuvers during transfers or lifting.

Maximal heart rate estimates: 220 − age is common; Tanaka formula is 208 − 0.7 × age; both have error, so use actual peak HR from a test when available.

Karvonen (heart rate reserve) method: target HR = resting HR + [(maximal HR − resting HR) × intensity]; 40–60% HRR is moderate intensity.

MET conversion: 1 MET = 3.5 mL O2/kg/min; light activity <3 METs, moderate 3–6 METs, vigorous >6 METs.

Aerobic prescription: 3–5 days/week, 40–60% VO2 reserve for moderate intensity, 20–60 minutes per session, with warm-up and cool-down.

Resistance prescription: 2–3 days/week, 60–70% 1RM, 8–12 repetitions for major muscle groups; avoid heavy lifting early after sternotomy or unstable cardiac disease.

Borg scales: 6–20 RPE; moderate intensity is 11–13; on the 0–10 category-ratio scale, moderate is 3–5.

Six-minute walk test: record distance, SpO2, HR, BP, and symptoms; a 30 m change is a common minimal clinically important difference.

Exercise test termination: chest pain, ST depression ≥2 mm, sustained ventricular tachycardia, systolic BP fall >10 mm Hg with symptoms, severe dyspnea, dizziness, or SpO2 <80%.

Heart rate from ECG: 300 ÷ number of large boxes between R waves, or 1500 ÷ small boxes; for irregular rhythms count QRS complexes in a 10-second strip and multiply by 6.

Normal intervals: PR 0.12–0.20 s; QRS <0.12 s; QT varies with rate and is corrected as QTc = QT/√RR.

QTc thresholds: normal <440 ms in men and <460 ms in women; QTc >500 ms increases torsades de pointes risk.

STEMI criteria: ST elevation ≥1 mm in two contiguous limb leads or ≥2 mm in two contiguous precordial leads (with sex- and age-specific V2–V3 thresholds).

Ischemia: horizontal or downsloping ST depression ≥1 mm in two contiguous leads; T-wave inversion and dynamic changes also support ischemia.

Atrial fibrillation: irregularly irregular ventricular rhythm, absent P waves, and fibrillatory baseline; rate control and anticoagulation decisions depend on stroke risk.

AV block: first degree PR >0.20 s; Mobitz I progressive PR lengthening; Mobitz II constant PR with dropped beats; third degree complete AV dissociation.

PVC features: wide QRS >0.12 s, premature, no preceding P wave, and a compensatory pause; frequent or multifocal PVCs warrant evaluation.

Mean arterial pressure: MAP = DBP + 1/3(SBP − DBP); a MAP ≥65 mm Hg is a common target for organ perfusion.

qSOFA sepsis screen: respiratory rate ≥22/min, altered mentation, systolic BP ≤100 mm Hg; ≥2 positive items identifies higher risk.

ICU-acquired weakness: MRC sum score <48 of 60 across six bilateral muscle groups; assess after the patient is awake and cooperative.

Lung-protective ventilation: plateau pressure <30 cmH2O and driving pressure <15 cmH2O reduce ventilator-induced lung injury.

ARDS proning: for PaO2/FiO2 <150 mm Hg, prone positioning 12–16 hours/day improves survival in moderate-to-severe ARDS.

Artificial airway cuff: maintain 20–30 cmH2O; check regularly and before transport to prevent aspiration and tracheal ischemia.

Suctioning: use only when indicated by secretions, rising airway pressure, or desaturation; preoxygenate, limit each pass to <15 seconds, and use sterile technique.

Delirium screening: CAM-ICU is positive with acute onset or fluctuation plus inattention and either altered consciousness or disorganized thinking.

Transtheoretical stages: precontemplation, contemplation, preparation, action, maintenance; relapse is common and re-entering earlier stages is expected.

Motivational interviewing: use OARS (open questions, affirmations, reflections, summaries), express empathy, roll with resistance, and support autonomy.

Teach-back: ask the patient to restate the plan in their own words; correct misunderstandings and recheck until accurate.

Plain language: aim for about a 5th–6th grade reading level, short sentences, common words, and limited key points per session.

SMART goals: specific, measurable, achievable, relevant, time-bound; link goals to the patient's valued activities.

Self-efficacy sources: mastery experiences, vicarious experience, verbal persuasion, and interpretation of physiological states; mastery is the strongest.

Shared decision-making: discuss options, benefits, harms, and patient preferences; confirm the choice and document it.

Relapse prevention: identify high-risk situations, rehearse coping responses, build social support, and schedule follow-up.

Evidence-based practice steps: ask a focused question, acquire evidence, appraise validity and applicability, apply with patient values, and assess outcomes.

Sensitivity = TP/(TP + FN); specificity = TN/(TN + FP); PPV and NPV depend on disease prevalence.

Number needed to treat = 1/absolute risk reduction; NNT is the number treated to prevent one additional event.

Evidence hierarchy: systematic reviews/meta-analyses of RCTs at the top, then RCTs, cohort studies, case-control studies, case series, and expert opinion.

Kappa agreement: <0 poor, 0.21–0.40 fair, 0.41–0.60 moderate, 0.61–0.80 substantial, 0.81–1.00 almost perfect; ICC is used for continuous measures.

Type I error = rejecting a true null hypothesis (alpha, usually 0.05); type II error = failing to reject a false null (beta); power = 1 − beta.

Research ethics: IRB approval before data collection, informed consent, privacy protection, and disclosure of conflicts of interest.

Clinical prediction rules: validate in a similar population before applying; consider sensitivity, specificity, and the consequences of false positives and false negatives.