MOHAP Doctor Exam cheat sheet

Acute coronary syndrome: STEMI requires immediate reperfusion (primary PCI within 90 minutes of first medical contact or fibrinolysis within 30 minutes if PCI unavailable); give aspirin 300 mg chewed plus P2Y12 inhibitor and anticoagulation.

Heart failure with reduced ejection fraction (HFrEF): start guideline-directed medical therapy with ARNI/ACEi/ARB, beta-blocker, MRA, and SGLT2 inhibitor; add loop diuretic for congestion.

Diabetic ketoacidosis: treat with IV 0.9% saline, insulin infusion at 0.1 units/kg/h, and potassium replacement once K+ <5.5 mmol/L and urine output adequate; add 10% dextrose when glucose <14 mmol/L.

Community-acquired pneumonia: CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, blood pressure systolic <90 or diastolic ≤60 mmHg, age ≥65) score ≥2 indicates need for hospital admission.

Hypertensive emergency: reduce mean arterial pressure by no more than 25% in the first hour, then to 160/100 mmHg over 2–6 hours, using IV labetalol or nicardipine; avoid rapid normalization.

Acute asthma exacerbation: give oxygen to target SpO2 94–98%, repeated salbutamol and ipratropium nebulizers, systemic corticosteroids (prednisolone 40–50 mg or IV hydrocortisone 100 mg), and consider IV magnesium sulfate 2 g for severe cases.

Stroke thrombolysis: IV alteplase 0.9 mg/kg (max 90 mg) within 4.5 hours of symptom onset after excluding hemorrhage on CT; door-to-needle time target <60 minutes.

Chronic kidney disease staging by eGFR (mL/min/1.73 m²): G1 ≥90, G2 60–89, G3a 45–59, G3b 30–44, G4 15–29, G5 <15; albuminuria category A1 <30 mg/g, A2 30–300, A3 >300.

Acute appendicitis: Alvarado score (migratory pain, anorexia, nausea/vomiting, tenderness RIF, rebound tenderness, fever, leukocytosis, shift to left) ≥7 indicates high probability and surgical consultation.

Bowel obstruction: initial management is nil by mouth, IV fluids, nasogastric decompression, and analgesia; urgent surgery for closed-loop obstruction, strangulation signs (fever, tachycardia, peritonitis), or failure to resolve.

Trauma primary survey follows ABCDE: airway with cervical spine protection, breathing and ventilation, circulation with hemorrhage control, disability (GCS), exposure with prevention of hypothermia.

Burn resuscitation: Parkland formula gives 4 mL/kg/% total body surface area of lactated Ringer's in first 24 hours, half in first 8 hours from injury time; use urine output 0.5–1 mL/kg/h as endpoint.

Acute cholecystitis: early laparoscopic cholecystectomy within 72 hours of presentation is preferred; start IV antibiotics covering gram-negative enteric organisms.

Hernia: strangulation is suggested by severe pain, tenderness, fever, and irreducible mass; requires emergent surgical exploration, not elective repair.

Postoperative fever timing: within 48 hours consider atelectasis; days 3–5 consider urinary tract infection or pneumonia; days 5–10 consider surgical site infection or anastomotic leak; after 7 days consider deep vein thrombosis or abscess.

Thyroidectomy complications: recurrent laryngeal nerve injury causes hoarseness, external branch of superior laryngeal nerve injury causes voice fatigue, and hypocalcemia from parathyroid injury occurs 24–72 hours postoperatively.

Preeclampsia with severe features: blood pressure ≥160/110 mmHg, platelets <100,000/µL, elevated liver enzymes, creatinine >1.1 mg/dL, pulmonary edema, or new cerebral/visual symptoms; deliver at ≥34 weeks after stabilization with magnesium sulfate and antihypertensives.

Postpartum hemorrhage: first-line uterotonic is oxytocin 10 IU IM/IV; if uterine atony persists, give carboprost 250 µg IM (contraindicated in asthma) or misoprostol 800 µg sublingually, then tranexamic acid 1 g IV within 3 hours.

Ectopic pregnancy: treat with methotrexate 50 mg/m² IM if hemodynamically stable, unruptured, mass <3.5–4 cm, no fetal cardiac activity, and hCG <5000 IU/L; surgical management for rupture or instability.

Gestational diabetes screening: 75 g 2-hour oral glucose tolerance test at 24–28 weeks; diagnostic thresholds are fasting ≥92 mg/dL, 1-hour ≥180 mg/dL, or 2-hour ≥153 mg/dL (any one).

Magnesium sulfate for eclampsia prophylaxis: 4–6 g IV loading dose over 20 minutes, then 1–2 g/hour infusion; monitor deep tendon reflexes, respiratory rate >12/min, and urine output >30 mL/h; antidote is calcium gluconate 10% 10 mL IV.

Cervical cancer screening: start at age 21 with cytology every 3 years, or age 30 with co-testing (cytology plus HPV) every 5 years; stop at age 65 if adequate prior negative screening.

Ovarian torsion: presents with sudden severe unilateral pelvic pain and nausea; Doppler may be normal; definitive treatment is laparoscopic detorsion and ovarian preservation, not oophorectomy.

Endometrial cancer risk: unopposed estrogen exposure, obesity, nulliparity, diabetes, and tamoxifen use; postmenopausal bleeding requires endometrial biopsy.

Pediatric basic life support: compression-to-ventilation ratio is 30:2 for single rescuer and 15:2 for two rescuers; compression depth is at least one-third of chest anteroposterior diameter (about 4 cm in infants, 5 cm in children).

Acute otitis media: first-line antibiotic is high-dose amoxicillin 80–90 mg/kg/day; add clavulanate if recent amoxicillin use, treatment failure, or purulent conjunctivitis.

Bronchiolitis: supportive care with oxygen for SpO2 <90–92%, hydration, and nasal suction; routine use of bronchodilators, corticosteroids, or antibiotics is not recommended.

Kawasaki disease: diagnosis requires fever ≥5 days plus 4 of 5 criteria (conjunctivitis, oral mucosa changes, cervical lymphadenopathy, rash, extremity changes); treat with IVIG 2 g/kg and aspirin; risk of coronary artery aneurysms.

Pediatric dehydration: assess using WHO signs; some dehydration (two or more of restlessness, sunken eyes, thirst, skin pinch slow) is treated with oral rehydration solution 75 mL/kg over 4 hours; severe dehydration requires IV Ringer's lactate 100 mL/kg.

Neonatal jaundice: phototherapy threshold depends on age in hours, gestational age, and risk factors; exchange transfusion is indicated for severe hyperbilirubinemia or signs of acute bilirubin encephalopathy.

Febrile seizure: simple febrile seizure lasts <15 minutes, is generalized, and occurs once in 24 hours; no routine lumbar puncture, EEG, or neuroimaging is required in a well-appearing child with normal exam.

Growth assessment: use WHO growth charts for children <2 years and CDC charts for ≥2 years; failure to thrive is weight for age below the 5th percentile or crossing two major percentile lines downward.