DOH Doctor Exam cheat sheet

Acute coronary syndrome: ST-elevation MI requires immediate reperfusion; door-to-balloon time target is ≤90 minutes at PCI-capable centers.

Heart failure with reduced ejection fraction: four pillars are ARNI/ACEI/ARB, evidence-based beta-blocker, MRA, and SGLT2 inhibitor, each titrated as tolerated.

Type 2 diabetes: metformin remains first-line unless contraindicated; add SGLT2 inhibitor or GLP-1 receptor agonist when ASCVD, heart failure, or CKD is present.

Diabetic ketoacidosis: initial isotonic saline, insulin infusion after potassium is ≥3.3 mmol/L, and add dextrose when glucose <200–250 mg/dL.

Hypertension: for most adults target <130/80 mmHg; initiate two-drug therapy if BP ≥140/90 and high cardiovascular risk.

COPD: post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow obstruction; GOLD grouping guides inhaled therapy.

Venous thromboembolism: provoked transient risk factors determine anticoagulation duration; cancer-associated VTE favors low-molecular-weight heparin or DOACs.

Hyperkalemia with ECG changes: IV calcium gluconate first for membrane stabilization, then insulin-glucose and beta-agonist to shift potassium intracellularly.

ATLS primary survey sequence: catastrophic hemorrhage control, airway with cervical spine protection, breathing/ventilation, circulation with hemorrhage control, disability, exposure/environment.

Acute appendicitis: migration of periumbilical pain to right lower quadrant, anorexia, and rebound tenderness; Alvarado score ≥7 supports operative evaluation.

Small bowel obstruction: air-fluid levels and dilated loops on plain film; initial management includes NPO, IV fluids, nasogastric decompression, and serial exams.

Postoperative fever: consider atelectasis and pneumonia in first 48 hours, urinary tract infection by day 3–5, and surgical site infection after day 5.

Inguinal hernia: indirect hernias pass lateral to inferior epigastric vessels; direct hernias pass medial and are less likely to strangulate.

Acute cholecystitis: right upper quadrant pain, Murphy sign, and wall thickening on ultrasound; early laparoscopic cholecystectomy is preferred.

Damage-control surgery: prioritize hemorrhage and contamination control, temporary closure, and staged definitive repair in physiologically unstable trauma patients.

Surgical site infection prevention: administer prophylactic antibiotics within 60 minutes before incision and discontinue within 24 hours for most procedures.

Infant developmental milestones: sits without support at 6–8 months, pulls to stand at 9 months, walks independently at 12–15 months.

Pediatric dehydration: mild <5% weight loss, moderate 5–10%, severe >10%; use ORS for mild-moderate and IV isotonic fluids for severe or shock.

Bronchiolitis: most common pathogen is respiratory syncytial virus; routine bronchodilators, corticosteroids, and antibiotics are not recommended.

Acute otitis media: bulging tympanic membrane is key; amoxicillin is first-line for most children, with high-dose amoxicillin-clavulanate for recent antibiotics or severe disease.

Neonatal jaundice: bilirubin rises after 24 hours; jaundice within first 24 hours is pathologic and requires urgent evaluation.

Simple febrile seizure: age 6 months–5 years, generalized, <15 minutes, once in 24 hours; no routine EEG or neuroimaging.

Pediatric growth: calculate BMI-for-age; failure to thrive is weight <5th percentile or crossing two major percentile lines downward.

Kawasaki disease: fever ≥5 days plus 4 of 5 mucocutaneous findings; IVIG and aspirin reduce coronary aneurysm risk.

USPSTF colorectal cancer screening: start at age 45 for average-risk adults; options include colonoscopy every 10 years or annual fecal immunochemical test.

Hypertension screening: measure BP at every primary care visit; confirm elevated readings with out-of-office monitoring before diagnosis.

Type 2 diabetes screening: start at age 35 for overweight/obese adults; repeat every 3 years if normal.

Asthma: diagnose with spirometry showing reversible obstruction; step-up therapy when symptoms are not controlled with low-dose inhaled corticosteroid.

Acute uncomplicated cystitis: nitrofurantoin or trimethoprim-sulfamethoxazole first-line; avoid fluoroquinolones for uncomplicated cases.

Contraceptive counseling: combined oral contraceptives are contraindicated with migraine with aura, smoking age ≥35, and uncontrolled hypertension.

Adult immunization: Tdap every 10 years, annual influenza, and age-appropriate pneumococcal, shingles, and HPV vaccines.

Statin therapy: use moderate-intensity statin for adults 40–75 with diabetes or 10-year ASCVD risk ≥7.5%; high-intensity for ≥20% risk.

Pregnancy dating: crown-rump length before 14 weeks is most accurate; first-trimester ultrasound estimates gestational age ±5–7 days.

Preeclampsia: BP ≥140/90 after 20 weeks plus proteinuria or end-organ dysfunction; delivery is definitive treatment.

Gestational diabetes: screen at 24–28 weeks with 1-hour 50-g glucose challenge; diagnose with 3-hour 100-g OGTT using Carpenter-Coustan or NDDG criteria.

Labor stages: first stage to 10 cm dilation, second stage to delivery, third stage to placental delivery; active phase starts at 6 cm.

Postpartum hemorrhage: uterine atony is most common cause; treat with fundal massage, oxytocin, then additional uterotonics.

Ectopic pregnancy: pregnancy of unknown location with rising hCG; methotrexate if stable, unruptured, and hCG below cutoff.

Cervical cancer screening: start at 21; cytology every 3 years to 29, then co-testing or primary HPV every 5 years to 65.

Pregnancy category avoidance: ACE inhibitors, warfarin, isotretinoin, and methotrexate are contraindicated in pregnancy.

ACLS cardiac arrest: high-quality CPR at 100–120/min, depth 5–6 cm, minimize interruptions; defibrillate VF/pVT as soon as available.

Anaphylaxis: IM epinephrine 0.3–0.5 mg of 1:1000 into anterolateral thigh; repeat every 5–15 minutes as needed.

Acute ischemic stroke: IV alteplase within 4.5 hours of onset if no contraindications; thrombectomy up to 24 hours in selected large-vessel occlusion.

Sepsis: obtain cultures before antibiotics, give broad-spectrum antibiotics within 1 hour for septic shock, and start 30 mL/kg crystalloid for hypotension or lactate ≥4.

Tension pneumothorax: immediate needle decompression in second intercostal space midclavicular line or fourth/fifth space anterior axillary line before imaging.

Opioid overdose: naloxone reverses respiratory depression; titrate to adequate ventilation, not full arousal.

Hyperkalemia with widened QRS: IV calcium chloride or gluconate is first-line stabilization.

Major trauma: permissive hypotension until hemorrhage control in penetrating trauma; avoid aggressive crystalloid.

Major depressive disorder: ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia; first-line treatment is psychotherapy, SSRI, or both.

Bipolar I disorder: manic episode lasting ≥7 days or requiring hospitalization; treat acute mania with mood stabilizer plus antipsychotic.

Schizophrenia: ≥2 core symptoms for ≥1 month with functional decline; antipsychotics are first-line, monitor metabolic effects.

Suicide risk assessment: ask directly about ideation, plan, intent, access to lethal means; high risk requires safety planning and urgent psychiatric evaluation.

Serotonin syndrome: clonus, hyperreflexia, agitation, hyperthermia after serotonergic agents; stop offending drugs and use benzodiazepines.

Alcohol withdrawal: benzodiazepines are first-line; thiamine before glucose to prevent Wernicke encephalopathy.

Delirium: acute fluctuating attention and awareness; identify and treat underlying cause, avoid antipsychotics unless severe agitation.

Capacity: assess understanding, appreciation, reasoning, and choice; capacity is decision-specific and not equivalent to competence.

Arterial blood gas: pH <7.35 is acidemia; calculate anion gap as Na − (Cl + HCO3); normal 8–12 mmol/L.

Hyponatremia: correct slowly, ≤8 mmol/L in 24 hours, to avoid osmotic demyelination; hypertonic saline for severe neurologic symptoms.

Pharmacokinetics: first-order elimination half-life determines steady state in ~4–5 half-lives; loading dose depends on volume of distribution.

Autosomal recessive inheritance: both parents are carriers; recurrence risk is 25% per pregnancy and males and females are equally affected.

Antibody structure: IgG crosses placenta; IgM is first responder; IgA is mucosal; IgE mediates allergy; IgD is B-cell receptor.

Gram-positive cocci in clusters suggest Staphylococcus; in chains suggest Streptococcus; lancet-shaped diplococci suggest Pneumococcus.

Sensitivity and specificity: sensitivity detects disease among diseased; specificity excludes disease among healthy; PPV depends on prevalence.

Cell cycle: checkpoints at G1/S and G2/M; p53 arrests at G1/S for DNA repair and triggers apoptosis if damage is irreparable.

Informed consent: disclose diagnosis, proposed treatment, risks/benefits, alternatives, and consequences of refusal; document patient decision.

Confidentiality: may be breached only with patient consent, legal requirement, or serious imminent harm; share minimum necessary information.

Decision-making capacity: patient must communicate choice, understand, appreciate, and reason; if capable, refuse treatment even if life-saving.

Error disclosure: disclose harmful errors promptly, factually, and apologize; explain what happened and prevent recurrence.

Hand hygiene: WHO five moments include before patient contact, before aseptic task, after body fluid exposure, after contact, and after touching surroundings.

Never events: wrong-site surgery, retained foreign body, and transfusion reaction from ABO incompatibility are reportable serious safety events.

Conflict of interest: disclose financial relationships; recuse from decisions when secondary interests could bias judgment.

Research ethics: require IRB approval, informed consent, equipoise, and special protections for prisoners, children, and pregnant women.

Screening criteria: disease must be important, have detectable preclinical phase, acceptable test, effective early treatment, and favorable cost-benefit.

Adult vaccination: annual influenza; Tdap every 10 years; zoster vaccine ≥50; pneumococcal ≥65; HPV through age 26.

Notifiable diseases: immediate reporting for cholera, plague, anthrax, measles; timely reporting for hepatitis, tuberculosis, and salmonellosis.

Outbreak investigation steps: verify diagnosis, confirm outbreak, define cases, characterize by time/place/person, formulate hypothesis, implement control.

Smoking cessation: brief 5A approach; varenicline, bupropion, and nicotine replacement increase quit rates; combine counseling.

Obesity: BMI ≥30; first-line management is calorie reduction plus ≥150 minutes/week moderate activity; consider pharmacotherapy if BMI ≥30 or ≥27 with comorbidity.

Travel medicine: yellow fever vaccine required for entry to some countries; malaria chemoprophylaxis depends on destination resistance patterns.

Quarantine vs isolation: isolation separates sick persons; quarantine restricts exposed asymptomatic persons during incubation period.