DHA GP Exam cheat sheet

Acute coronary syndrome: chew 162–325 mg aspirin immediately; add a P2Y12 inhibitor and anticoagulation. ST-elevation myocardial infarction requires reperfusion (primary PCI target ≤90 min from first medical contact).

Diabetic ketoacidosis: start 0.9% saline, insulin infusion 0.1 units/kg/hour, add 5% dextrose when glucose falls below 200–250 mg/dL, and replace potassium once K+ is below 5.2 mEq/L with adequate urine output.

Hyperkalemia with ECG changes: IV calcium gluconate or chloride for membrane stabilization first, then insulin plus glucose, inhaled beta-agonist, and dialysis for refractory cases.

Heart failure with reduced ejection fraction (EF ≤40%): four mortality-reducing drug classes - ARNI/ACE inhibitor, evidence-based beta-blocker, mineralocorticoid antagonist, and SGLT2 inhibitor.

COPD exacerbation: titrate oxygen to SpO2 88–92%, nebulized short-acting bronchodilators, systemic corticosteroid for 5 days, and antibiotics when sputum purulence increases.

Acute ischemic stroke: non-contrast CT excludes hemorrhage; IV thrombolysis is licensed to 4.5 hours from last known well, mechanical thrombectomy up to 24 hours in selected large-vessel occlusion.

Hyponatremia: correct by no more than 8–10 mEq/L in 24 hours to prevent osmotic demyelination; 3% saline boluses are reserved for seizures or severe symptoms.

Iron deficiency anemia: serum ferritin below 30 ng/mL is the most sensitive diagnostic marker; ferritin is an acute-phase reactant and may be falsely normal in inflammation.

Prediabetes is defined by HbA1c 5.7–6.4%, fasting glucose 100–125 mg/dL, or 2-hour OGTT glucose 140–199 mg/dL; diabetes requires HbA1c ≥6.5% or fasting glucose ≥126 mg/dL.

Colorectal cancer screening for average-risk adults begins at age 45 and continues to 75; options include colonoscopy every 10 years or annual fecal immunochemical testing.

Cervical cancer screening: cytology alone every 3 years from age 21, or co-testing with HPV every 5 years from age 30 to 65.

Primary prevention statin: adults 40–75 years with at least one risk factor and a 10-year ASCVD risk ≥10% warrant moderate-intensity statin therapy.

Acute otitis media: high-dose amoxicillin 80–90 mg/kg/day is first-line; observation for 48–72 hours is acceptable in children ≥2 years with nonsevere unilateral disease.

Acute low back pain without red flags: no routine imaging in the first 6 weeks; NSAIDs and early activity are first-line, opioids are not.

Adult immunization: Tdap booster every 10 years, annual influenza vaccine, two-dose recombinant zoster vaccine from age 50, and pneumococcal vaccination from age 65.

Group A streptococcal pharyngitis requires a positive rapid antigen test or culture before antibiotics; clinical criteria alone are insufficient in adults.

Febrile infant ≤28 days old with temperature ≥38.0°C: full sepsis evaluation including blood, urine, and cerebrospinal fluid cultures, with empirical parenteral antibiotics regardless of appearance.

Maintenance fluids by Holliday-Segar 4-2-1 rule: 4 mL/kg/hour for the first 10 kg, 2 mL/kg/hour for the next 10 kg, and 1 mL/kg/hour for each kilogram above 20.

Bronchiolitis management is supportive (oxygen, hydration, nasal suction); routine bronchodilators, corticosteroids, and antibiotics are not recommended.

Croup: a single dose of dexamethasone 0.15–0.6 mg/kg; nebulized epinephrine is added for stridor at rest or increased work of breathing.

Kawasaki disease: fever ≥5 days plus 4 of 5 features (conjunctivitis, oral mucosa changes, rash, extremity changes, cervical lymphadenopathy); treat with IVIG and aspirin to prevent coronary aneurysms.

Dehydration in children: oral rehydration solution 50 mL/kg over 4 hours for mild and 100 mL/kg over 4 hours for moderate dehydration; give 20 mL/kg isotonic crystalloid bolus for shock.

Infant growth: birth weight doubles by about 5 months, triples by 12 months; birth length increases by roughly 50% by 12 months.

Routine immunization schedule: DTaP at 2, 4, 6, and 15–18 months with booster at 4–6 years; MMR at 12–15 months and 4–6 years.

Preeclampsia: blood pressure ≥140/90 mmHg after 20 weeks plus proteinuria or maternal end-organ dysfunction; magnesium sulfate prevents and treats eclamptic seizures.

Gestational diabetes screening at 24–28 weeks with a 50-g glucose challenge; a 1-hour value ≥140 mg/dL (or ≥130–135 per local protocol) triggers a 3-hour 100-g diagnostic test.

Rh immune globulin: give anti-D at 28 weeks and within 72 hours of delivery of an Rh-positive infant, plus after amniocentesis, miscarriage, or antepartum bleeding.

Postpartum hemorrhage: blood loss ≥1000 mL or any loss causing hemodynamic instability within 24 hours; uterine atony is the commonest cause - treat with uterine massage and oxytocin, then tranexamic acid.

Ectopic pregnancy: methotrexate is suitable for hemodynamically stable, unruptured cases with hCG <5000 mIU/mL, mass <4 cm, and no fetal cardiac activity; surgery for rupture or instability.

First stage of labor: full dilation from 0 to 10 cm, latent phase up to 6 cm and active phase thereafter; active-phase arrest is diagnosed at ≥6 cm with ruptured membranes and no cervical change over ≥4 hours of adequate contractions.

Prenatal screening panel: complete blood count, blood group and antibody screen, rubella immunity, syphilis, HIV, hepatitis B surface antigen, and urine culture.

Folic acid 400 micrograms daily preconceptionally reduces neural tube defects; 4 mg daily is used for women with a prior affected pregnancy.

ATLS primary survey sequence: airway with cervical spine protection, breathing, circulation with hemorrhage control, disability (neurological), and exposure with environmental control.

Thermal burn resuscitation (Parkland formula): 4 mL × body weight in kg × percent total body surface area of lactated Ringer solution over 24 hours, with half given in the first 8 hours from the time of injury.

Tension pneumothorax is a clinical diagnosis: immediate needle decompression followed by tube thoracostomy, without waiting for imaging.

Anaphylaxis: intramuscular epinephrine 0.3–0.5 mg of 1:1000 solution into the anterolateral thigh, repeated every 5–15 minutes; antihistamines and steroids are adjuncts only.

Septic shock bundle: measure lactate, obtain blood cultures, and give broad-spectrum antibiotics plus 30 mL/kg crystalloid within the first hour.

Acute appendicitis: migratory periumbilical pain, anorexia, right lower quadrant tenderness, and leukocytosis; the Alvarado score ≥7 supports surgical consultation.

Trauma hemorrhage: permissive hypotension (systolic 80–90 mmHg) until hemorrhage control in penetrating trauma, and tranexamic acid within 3 hours of injury.

Open fractures: tetanus prophylaxis, early intravenous antibiotics (within 1 hour), and surgical debridement with stabilization.