Provimi i Informatizuar i Mjekësisë cheat sheet

Acute coronary syndrome: ST-elevation MI is diagnosed with ≥1 mm ST elevation in two contiguous leads (≥2 mm in V2–V3 for men, ≥1.5 mm for women); immediate reperfusion is indicated.

Heart failure with reduced ejection fraction (HFrEF): four pillars are ACE inhibitor/ARB/ARNI, beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.

Community-acquired pneumonia severity: CURB-65 scores confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure, and age ≥65; ≥2 points suggests inpatient care.

Diabetic ketoacidosis: anion gap = Na − (Cl + HCO3); elevated gap with ketonemia and pH <7.3 defines DKA; insulin and isotonic fluids are first-line.

Hyponatremia: serum osmolality <275 mOsm/kg with urine osmolality >100 mOsm/kg suggests SIADH; correct sodium slowly to avoid osmotic demyelination.

Acute pancreatitis: diagnosis requires two of three - characteristic pain, lipase/amylase >3× upper limit, or imaging findings.

Anemia classification by MCV: microcytic <80 fL (iron deficiency, thalassemia), normocytic 80–100 fL, macrocytic >100 fL (B12/folate deficiency).

Thyroid: TSH is the first-line screening test; primary hypothyroidism shows high TSH with low free T4.

Acute appendicitis: Alvarado score (MANTRELS) ≥7 supports operative management; migration of pain to right lower quadrant is classic.

Bowel obstruction: air-fluid levels on upright radiograph; strangulation signs include fever, tachycardia, leukocytosis, and continuous pain.

ATLS primary survey order: Airway with cervical spine protection, Breathing, Circulation, Disability, Exposure.

Cholecystitis: Murphy sign and right upper quadrant ultrasound showing wall thickening >3 mm or pericholecystic fluid support diagnosis.

Hernia: strangulation risk rises with irreducible, tender, or painful hernia; urgent surgical exploration is indicated.

Postoperative fever timing: within 48 h consider atelectasis; days 3–5 consider urinary or wound infection; after day 5 consider abscess or anastomotic leak.

Trauma: FAST exam detects free intraperitoneal fluid; sensitivity is highest in hemodynamically unstable patients.

Surgical site infection prevention: preoperative antibiotic prophylaxis within 60 minutes of incision is standard.

Preeclampsia: hypertension after 20 weeks with proteinuria or end-organ dysfunction; delivery is the definitive treatment.

Ectopic pregnancy: quantitative beta-hCG and transvaginal ultrasound; no intrauterine sac with beta-hCG above discriminatory zone suggests ectopic.

Gestational diabetes screening: 75 g oral glucose tolerance test at 24–28 weeks; thresholds vary by guideline.

Labor stages: first stage to full dilatation, second stage to delivery, third stage to placental delivery.

Postpartum hemorrhage: most common cause is uterine atony; management includes uterine massage and uterotonics.

Fetal heart rate monitoring: category III tracing includes absent variability with recurrent decelerations or bradycardia; requires urgent action.

Contraception: combined oral contraceptives are contraindicated with migraine with aura and with history of venous thromboembolism.

Rh incompatibility: anti-D immunoglobulin is given to Rh-negative unsensitized mothers at 28 weeks and within 72 h postpartum.

Pediatric weight estimation: approximately 8 kg at 1 year, 2 × (age in years) + 8 kg for children 1–10 years.

Dehydration in children: WHO uses sunken eyes, skin pinch, and lethargy to classify severe dehydration requiring IV fluids.

Kawasaki disease: fever ≥5 days plus four of five criteria; IVIG and aspirin reduce coronary artery risk.

Neonatal jaundice: pathologic if appearing within 24 h of birth, rising >5 mg/dL/day, or requiring phototherapy beyond expected curves.

Febrile seizures: simple if generalized, <15 minutes, once in 24 h; no routine anticonvulsant prophylaxis is indicated.

Bronchiolitis: most common cause is respiratory syncytial virus; treatment is supportive, with oxygen and hydration.

Vaccination schedule: BCG and hepatitis B at birth; DTP and polio series begin at 2 months.

Pyloric stenosis: projectile nonbilious vomiting at 3–6 weeks with palpable olive mass and hypochloremic metabolic alkalosis.

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

Sensitivity = TP/(TP + FN); specificity = TN/(TN + FP); positive predictive value depends on prevalence.

Herd immunity threshold = 1 − 1/R0; higher R0 requires higher coverage.

Levels of prevention: primary (before disease), secondary (early detection), tertiary (rehabilitation, complication reduction).

Incidence measures new cases over a period; prevalence measures all existing cases at a point or period.

Health systems building blocks: service delivery, workforce, information, medical products, financing, leadership/governance.

Screening test performance: a highly sensitive test is preferred when missing cases is costly; a highly specific test when false positives are harmful.

Relative risk = incidence in exposed / incidence in unexposed; used in cohort studies.

Odds ratio approximates relative risk when disease is rare; used in case-control studies.

Attributable risk = incidence in exposed − incidence in unexposed; reflects excess risk due to exposure.

Confounding: a variable associated with both exposure and outcome, not on the causal pathway; addressed by randomization, stratification, or multivariable models.

Type I error (alpha) is rejecting a true null hypothesis; type II error (beta) is failing to reject a false null; power = 1 − beta.

95% confidence interval for a mean approximates mean ± 1.96 × standard error.

Randomized controlled trial: randomization reduces selection bias and balances confounders; intention-to-treat analysis preserves randomization benefits.

Sensitivity and specificity are independent of prevalence; predictive values are not.

Pharmacokinetics: absorption, distribution, metabolism, excretion; first-pass metabolism reduces oral bioavailability.

Zero-order kinetics: elimination rate is constant and independent of concentration; example includes ethanol and phenytoin at high doses.

Volume of distribution = dose / plasma concentration; high Vd means extensive tissue distribution.

Cytochrome P450: CYP3A4 metabolizes many drugs; inhibitors include macrolides and azoles; inducers include rifampicin and carbamazepine.

Paracetamol overdose: N-acetylcysteine is the antidote; Rumack-Matthew nomogram guides treatment.

Opioid overdose: naloxone is the antidote; titrate to restore respiration.

Warfarin: vitamin K antagonist; monitor INR; major bleeding reversed with vitamin K and prothrombin complex concentrate.

Therapeutic index = toxic dose / therapeutic dose; narrow index drugs require monitoring (e.g., digoxin, lithium).

Cell injury: reversible injury shows swelling and fatty change; irreversible injury shows membrane rupture and mitochondrial damage.

Necrosis types: coagulative (ischemia), liquefactive (brain, abscess), caseous (tuberculosis), fat (pancreatitis).

Apoptosis is energy-dependent, caspase-mediated, and does not trigger inflammation.

Inflammation: acute response involves neutrophils; chronic response involves lymphocytes and macrophages with fibrosis.

Neoplasia: benign tumors are well circumscribed and non-invasive; malignant tumors invade and metastasize.

Tumor suppressor genes (e.g., TP53, RB) require loss of both alleles; oncogenes require gain of function.

Edema mechanisms: increased hydrostatic pressure, decreased oncotic pressure, lymphatic obstruction, sodium retention.

Shock: hypovolemic, cardiogenic, distributive, and obstructive; distributive shock shows low systemic vascular resistance.

Informed consent requires capacity, adequate information, understanding, and voluntariness.

Four principles of biomedical ethics: autonomy, beneficence, non-maleficence, justice.

Confidentiality may be breached when required by law or when there is serious risk to others.

Medical records must be accurate, legible, dated, and signed; they are legal documents.

Minors: consent rules vary; mature minor doctrines and emergency exceptions apply in many jurisdictions.

Negligence requires duty of care, breach, causation, and damages.

End-of-life: advance directives and do-not-resuscitate orders must be documented and respected within legal limits.

Professional duty includes competence maintenance, honesty in certification, and reporting of impaired colleagues where required.

Action potential: resting membrane potential near −70 mV; depolarization from sodium influx; repolarization from potassium efflux.

Cardiac output = heart rate × stroke volume; stroke volume depends on preload, afterload, and contractility.

Glycolysis yields 2 ATP and 2 NADH per glucose; complete oxidation yields about 30–32 ATP.

Krebs cycle occurs in mitochondria; produces NADH, FADH2, and GTP.

Bacterial classification: Gram stain, shape, oxygen requirement, and biochemical tests guide identification.

Antibiotic targets: cell wall (beta-lactams), protein synthesis (aminoglycosides, macrolides), DNA/RNA (quinolones, rifampicin).

Anatomy: brachial plexus roots C5–T1; lesions produce characteristic motor and sensory deficits.

Acid-base: Henderson-Hasselbalch pH = 6.1 + log([HCO3]/[0.03 × PaCO2]).

Cardiac arrest: high-quality CPR at 100–120 compressions/min with depth 5–6 cm; minimize interruptions.

Defibrillation: shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia.

Anaphylaxis: intramuscular adrenaline 0.5 mg (1:1000) into the anterolateral thigh is first-line.

Sepsis: qSOFA includes respiratory rate ≥22, altered mentation, and systolic blood pressure ≤100 mmHg.

Acute asthma: severe features include inability to speak, silent chest, and peak flow <50% predicted.

Trauma triage: airway, breathing, circulation, disability, exposure; reassess after each intervention.

Mechanical ventilation: lung-protective strategy uses tidal volume 6 mL/kg predicted body weight in ARDS.

Poisoning: activated charcoal is considered within 1 hour of ingestion for adsorbable toxins when airway is protected.

Electronic health record functions include clinical documentation, order entry, results review, and decision support.

HL7 and FHIR are standards for health information exchange; FHIR uses RESTful APIs.

Sensitivity, specificity, and predictive values apply to diagnostic decision-support tools.

Data protection: personal health data require lawful basis, purpose limitation, and confidentiality safeguards.

Health management: structure, process, and outcome form the Donabedian quality framework.

Cost-effectiveness analysis compares cost per health outcome; incremental cost-effectiveness ratio = Δcost / Δeffect.

Telemedicine requires secure communication, identity verification, and documentation equivalent to in-person care.

Key performance indicators should be specific, measurable, achievable, relevant, and time-bound.

Donabedian model evaluates quality through structure, process, and outcomes.

Health information systems require interoperability standards such as HL7 and FHIR for data exchange.

Incremental cost-effectiveness ratio = difference in cost / difference in health effect between two interventions.

Electronic prescribing reduces medication errors through decision support and legible orders.

Data privacy principles include lawfulness, purpose limitation, data minimization, and confidentiality.

Telemedicine must provide secure identity verification and documentation comparable to in-person care.

Key performance indicators should be specific, measurable, achievable, relevant, and time-bound.

Clinical decision support is most effective when integrated into workflow and delivered at the point of care.

Electronic health records support documentation, order entry, results review, and clinical decision support.

HL7 and FHIR standards enable health information exchange; FHIR uses RESTful APIs.

Diagnostic decision-support tools are evaluated with sensitivity, specificity, and predictive values.

Health data protection requires lawful basis, purpose limitation, and confidentiality safeguards.

Donabedian quality framework: structure, process, and outcome.

Cost-effectiveness analysis compares cost per health outcome; incremental cost-effectiveness ratio = Δcost / Δeffect.

Telemedicine requires secure communication, identity verification, and documentation equivalent to in-person care.

Key performance indicators should be specific, measurable, achievable, relevant, and time-bound.