Afghanistan Comprehensive Specialization Exam flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Starling equation

Jv = Kf[(Pc − Pi) − σ(πc − πi)] describes capillary fluid movement; increased hydrostatic pressure or permeability, or reduced oncotic pressure, promotes edema.

Anion gap

Anion gap = Na − (Cl + HCO3); a normal value is about 8–12 mEq/L. High-gap acidosis suggests ketones, lactate, uremia, or toxins.

Volume of distribution

Vd = dose / plasma concentration. It estimates the apparent space into which a drug distributes and determines the loading dose needed to reach a target concentration.

Sensitivity and specificity

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP). High sensitivity helps rule out disease when negative; high specificity helps rule in disease when positive.

STEMI reperfusion

ST-elevation myocardial infarction requires urgent reperfusion. Primary PCI is preferred if achievable within 90 minutes; otherwise fibrinolysis should be given within 30 minutes of diagnosis.

HFrEF four pillars

Guideline-directed therapy includes an ARNI or ACE inhibitor/ARB, an evidence-based beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor, each shown to reduce mortality.

CKD eGFR stages

G1 is eGFR ≥90, G2 60–89, G3a 45–59, G3b 30–44, G4 15–29, and G5 <15 mL/min/1.73 m²; albuminuria category adds risk.

DKA diagnostic triad

Diabetic ketoacidosis shows hyperglycemia, metabolic acidosis with pH <7.3 or bicarbonate <18, and ketonemia/ketonuria; total-body potassium is depleted despite normal serum levels.

CURB-65

Scores confusion, urea >7 mmol/L, respiratory rate ≥30, low blood pressure, and age ≥65. Scores 0–1 suit outpatient care; ≥2 need admission assessment.

Tension pneumothorax

A clinical diagnosis with hypotension, distended neck veins, absent breath sounds, and tracheal deviation. Immediate needle decompression is required before any imaging or definitive chest tube.

Parkland burn formula

Give 4 mL/kg body weight per percent total body surface area of lactated Ringer over 24 hours; half is given in the first 8 hours from burn time.

Alvarado score

Scores migration of pain, anorexia, nausea/vomiting, right lower quadrant tenderness, rebound tenderness, fever, and leukocytosis; higher totals increase appendicitis probability.

Postoperative fever causes

Common causes by timing include atelectasis and pneumonia early, urinary infection around day 3–5, wound infection around day 5–7, and deep vein thrombosis later.

Pediatric maintenance fluids

The 4-2-1 rule gives 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 thereafter.

Pediatric dehydration

Mild dehydration is under 5% weight loss, moderate 5–10%, and severe over 10%. Oral rehydration suits mild-moderate cases; shock requires isotonic intravenous fluid boluses.

Neonatal jaundice

Treat with phototherapy according to age, gestational age, and risk; exchange transfusion is for severe hyperbilirubinemia. Check direct bilirubin because conjugated jaundice is always pathologic.

Childhood asthma exacerbation

Give inhaled short-acting beta-agonist plus ipratropium for severe attacks, systemic corticosteroids early, and intravenous magnesium for refractory severe disease; sedatives are contraindicated.

Failure to thrive

Weight below the third percentile or crossing two major growth percentiles downward suggests inadequate nutrition or underlying disease; assess intake, growth velocity, and organic causes.

Naegele's rule

Estimated delivery date = last menstrual period + 7 days − 3 months, assuming a 28-day cycle. First-trimester ultrasound is more accurate for dating when available.

Preeclampsia severe features

Blood pressure ≥160/110, platelets <100,000, liver enzymes over twice normal, creatinine >1.1 mg/dL, pulmonary edema, or cerebral/visual symptoms define severe preeclampsia.

Eclampsia magnesium dose

Magnesium sulfate loading is 4–6 g IV, then 1–2 g/hour infusion; monitor deep tendon reflexes, respiratory rate, and urine output, with calcium gluconate available for toxicity.

Postpartum hemorrhage

Uterine atony is the most common cause. Give oxytocin, then misoprostol, carboprost, or methylergonovine; tranexamic acid should be given within 3 hours of birth.

Gestational diabetes screening

At 24–28 weeks, a 75-g oral glucose tolerance test diagnoses gestational diabetes when fasting is ≥92, one-hour ≥180, or two-hour ≥153 mg/dL.

Incidence and prevalence

Incidence counts new cases among people at risk per unit time; prevalence counts all existing cases in a population. Prevalence approximates incidence multiplied by average disease duration.

Relative risk

Relative risk = incidence in exposed / incidence in unexposed. It measures association strength in cohort studies; a value of 1.0 indicates no difference.

Odds ratio

Odds ratio = (a/c)/(b/d) = ad/bc for a 2×2 table. It approximates relative risk when the outcome is rare and is used in case-control studies.

Herd immunity threshold

Threshold = 1 − 1/R0. For measles with R0 around 12–18, approximately 92–95% population immunity is needed to interrupt sustained transmission.

Screening criteria

A worthwhile screening program needs an important health problem, detectable preclinical phase, acceptable accurate test, effective early treatment, and cost-effective system with follow-up.

Informed consent elements

Valid informed consent requires patient capacity, adequate disclosure of risks and alternatives, comprehension, voluntary choice, and authorization; emergency exceptions may apply.

Confidentiality exceptions

Confidentiality may be breached with patient consent, when required by law, for public health reporting, or to prevent serious harm to an identifiable third party.

Negligence elements

Medical negligence requires a duty of care, breach of the standard of care, causation linking breach to harm, and actual damages; all four elements must be proven.

Advance directive

A written or oral statement made by a capable person about future medical care, including refusal of treatments or appointment of a proxy, used when decision-making capacity is lost.