DHA Specialist Exam cheat sheet

Informed consent requires capacity, disclosure of material risks/benefits/alternatives, comprehension, and voluntariness; document all four elements.

Hand hygiene per WHO 5 Moments is the single most effective infection-control intervention; alcohol rub for 20-30 s, soap and water 40-60 s.

Universal (standard) precautions apply to all patients regardless of diagnosis: gloves, gown, mask, eye protection based on exposure risk.

Triage acuity scales (e.g., ESI 1-5) assign resources and time targets; ESI 1 = immediate resuscitation, ESI 5 = no resources anticipated.

Pain is the fifth vital sign; reassess after intervention within a defined interval (commonly 30-60 min for IV, 60 min for oral analgesia).

SBAR (Situation, Background, Assessment, Recommendation) structures handoff communication and reduces omission errors.

Time-critical pathways: STEMI door-to-balloon <=90 min; stroke thrombolysis door-to-needle <=60 min; sepsis antibiotics within 1 h of recognition.

Discharge planning begins at admission; medication reconciliation at every transition reduces adverse drug events.

Shock types: hypovolemic, cardiogenic, distributive (septic, anaphylactic, neurogenic), obstructive (tamponade, tension pneumothorax, PE); treat by type.

Anaphylaxis: IM epinephrine 0.01 mg/kg (max 0.5 mg) of 1:1000 into anterolateral thigh; antihistamines and steroids are adjuncts, not first-line.

Acid-base: calculate anion gap = Na - (Cl + HCO3); normal 8-12; delta-delta compares gap rise to bicarbonate fall to detect mixed disorders.

Hyponatremia correction limit ~8-10 mmol/L in 24 h to avoid osmotic demyelination; hyperkalemia treated with calcium, insulin/glucose, beta-agonist, dialysis.

Sepsis-3: suspected infection plus SOFA increase >=2; qSOFA (RR >=22, altered mentation, SBP <=100) flags risk at bedside.

Chest pain: serial troponin with 0/1-3 h algorithms; HEART score stratifies 6-week MACE risk in undifferentiated chest pain.

Diabetes: HbA1c reflects ~3 months glycemia; DKA = glucose >250, pH <7.3, bicarbonate <18, ketones, anion gap; HHS = glucose >600, osmolality >320, minimal ketosis.

Antibiotic de-escalation uses culture and susceptibility data to narrow spectrum, reducing resistance and Clostridioides difficile risk.

Test performance: sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); PPV/NPV depend on prevalence, so they shift with population.

Likelihood ratios: LR+ = sensitivity/(1-specificity); LR- = (1-sensitivity)/specificity; LR >10 or <0.1 substantially changes post-test probability.

Pre-test probability multiplied by LR gives post-test odds; convert odds to probability: p = odds/(1+odds).

Reference standard bias, spectrum bias, and verification bias distort diagnostic accuracy estimates; appraise study design before applying results.

Radiation dose order of magnitude: chest radiograph ~0.1 mSv, CT abdomen/pelvis ~10 mSv; justify every study using ALARA principles.

Screening tests require high sensitivity and acceptable PPV; confirmatory testing follows a positive screen to limit false positives.

Point-of-care testing must be validated against laboratory reference methods and subject to quality control and proficiency testing.

Incidental findings require a documented follow-up plan; structured reporting (e.g., Fleischner criteria for pulmonary nodules) standardizes management.

Swiss cheese model: harm occurs when multiple latent and active failures align; defenses target system layers, not individual blame.

Root cause analysis follows a sentinel event; failure mode and effects analysis (FMEA) is prospective and scores severity x occurrence x detection.

PDSA (Plan-Do-Study-Act) cycles drive iterative improvement; measure with run charts or statistical process control to separate signal from noise.

Six aims of improvement (IOM/NAM): safe, effective, patient-centered, timely, efficient, equitable.

Medication safety: high-alert drugs (insulin, heparin, opioids, concentrated electrolytes) require independent double-checks and standardized concentrations.

Look-alike/sound-alike drug names and abbreviations (e.g., U for units, QD) are on the Do-Not-Use list; use plain, unambiguous orders.

Speak-up and just-culture reporting: near misses are reported without punitive action; disruptive behavior is addressed as a safety threat.

Surgical safety checklist spans sign-in, time-out, and sign-out; wrong-site surgery prevention requires marking and verification of site, side, and procedure.

Four principles: autonomy, beneficence, non-maleficence, justice; when they conflict, autonomy generally prevails for a capacitated adult.

Decision-making capacity is task-specific: patient must understand, appreciate, reason, and express a choice; capacity differs from legal competence.

Surrogate hierarchy when no advance directive: spouse/partner, adult children, parents, siblings, then close friends; must follow substituted judgment.

Confidentiality yields to mandatory reporting (communicable disease, suspected abuse, imminent threat), court order, or public-safety duty.

Breaking bad news: SPIKES (Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary).

Conflict of interest: disclose financial relationships; gifts must be nominal and not influence clinical judgment.

Medical errors are disclosed to patients/families in a timely, honest manner; apology and explanation are expected and often legally protected.

Cultural humility and use of qualified interpreters improve accuracy; family members, especially children, should not serve as interpreters.

Accreditation standards (e.g., JCI/CBAHI) require documented policies, credentialing, and continuous quality monitoring for licensure and payer contracts.

HIPAA-like privacy rules: minimum necessary use, patient access to records within defined timeframes, and breach notification obligations.

Mandatory reporting includes notifiable diseases, adverse drug reactions, device malfunctions, and suspected abuse per local statute.

Scope of practice is defined by licensure and institutional privileging; delegating beyond scope creates liability for both parties.

Informed refusal and against-medical-advice discharge require documented capacity, risk explanation, and follow-up plan.

Reimbursement models: fee-for-service rewards volume; capitation and value-based payment reward outcomes and cost control.

Record retention and documentation: contemporaneous, legible, time-stamped entries; late entries are labeled as such and never altered retrospectively.

Consent for minors generally requires a parent/guardian, with statutory exceptions (emancipation, specific services) varying by jurisdiction.