AMC CAT MCQ cheat sheet

Acute coronary syndrome: ST-elevation myocardial infarction requires emergency reperfusion (primary PCI if available within 120 minutes of first medical contact); dual antiplatelet therapy plus anticoagulation is standard adjunctive therapy.

Heart failure with reduced ejection fraction: four prognostic drug classes are ACE inhibitors or ARBs/ARNI, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors; each reduces mortality and is titrated to tolerated doses.

Acute severe asthma: give oxygen to target saturation 94-98%, repeated inhaled short-acting beta-2 agonist, ipratropium, and systemic corticosteroids; add magnesium sulfate for refractory cases and consider ICU referral for rising PaCO2 or exhaustion.

Diabetic ketoacidosis: treat with isotonic saline, fixed-rate intravenous insulin, and potassium replacement once potassium is below the upper reference range; add dextrose when glucose falls below roughly 14 mmol/L to allow continued insulin.

Community-acquired pneumonia severity: CURB-65 scores confusion, urea above 7 mmol/L, respiratory rate 30/min or more, blood pressure low, and age 65 or older; scores of 2 or more suggest inpatient or intensive management.

Stroke: thrombolysis is considered within 4.5 hours of symptom onset after excluding haemorrhage on imaging; thrombectomy is offered for large-vessel occlusion within 6 hours (selected patients up to 24 hours).

Hyperkalaemia with ECG changes: give intravenous calcium gluconate or chloride first to stabilise the myocardium, then insulin with dextrose and salbutamol to shift potassium intracellularly, and arrange definitive removal.

Chronic obstructive pulmonary disease: long-acting muscarinic antagonists and long-acting beta-2 agonists are first-line maintenance bronchodilators; smoking cessation and inhaled corticosteroid only for selected exacerbation-prone patients.

Acute appendicitis: Alvarado score components are migratory right iliac fossa pain, anorexia, nausea or vomiting, tenderness, rebound tenderness, fever, leucocytosis, and neutrophilia; higher scores support operative management.

Bowel obstruction: initial management is nil by mouth, intravenous fluids, nasogastric decompression, analgesia, and serial examination; absolute indications for surgery include strangulation, perforation, and closed-loop obstruction.

Shock in trauma: classify by blood loss (class I under 15%, class II 15-30%, class III 30-40%, class IV over 40%); hypotension typically appears in class III, so normal blood pressure does not exclude significant haemorrhage.

Acute pancreatitis: diagnosis needs two of three features (typical pain, serum lipase or amylase above three times the upper limit, characteristic imaging); early management is aggressive intravenous fluids, analgesia, and enteral nutrition when tolerated.

Postoperative fever timing: consider atelectasis and early infection on days 1-2, urinary and wound infection around days 3-5, and deep abscess or anastomotic leak after day 5; investigate according to clinical focus.

Burns: estimate surface area with the rule of nines (each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, head 9%, perineum 1%); Parkland formula gives 4 mL/kg per percent burn of crystalloid in 24 hours, half in the first 8 hours.

Hernia: an irreducible, tender, painful hernia with vomiting and absent flatus suggests strangulation and requires emergency surgery; manual reduction is not attempted when peritonism is present.

Perioperative risk: the revised cardiac risk index counts ischaemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, creatinine above 177 micromol/L, and high-risk surgery; each adds roughly one point.

Pre-eclampsia: defined as new hypertension after 20 weeks with proteinuria or maternal organ dysfunction; delivery is the definitive treatment, and antihypertensives plus magnesium sulfate are used for severe features and seizure prophylaxis.

Postpartum haemorrhage: the four T causes are tone (uterine atony, most common), trauma, tissue (retained placenta), and thrombin (coagulopathy); management follows uterine massage, uterotonics, tranexamic acid, and escalation.

Ectopic pregnancy: a positive pregnancy test with abdominal pain, vaginal bleeding, and an empty uterus on ultrasound is presumed ectopic until proven otherwise; haemodynamic instability mandates urgent surgery.

Gestational diabetes: screen with an oral glucose tolerance test in the second or third trimester; first-line therapy is dietary and lifestyle modification, with insulin added if glucose targets are not met.

Ovarian torsion: sudden severe unilateral pelvic pain with nausea and an adnexal mass on imaging is a surgical emergency; detorsion and ovarian preservation are preferred over oophorectomy when viable.

Menorrhagia: first-line medical treatment in the absence of structural pathology is the levonorgestrel intrauterine system; non-hormonal options include tranexamic acid and non-steroidal anti-inflammatory drugs.

Fetal heart rate monitoring: late decelerations suggest uteroplacental insufficiency, variable decelerations suggest cord compression, and prolonged bradycardia requires intrauterine resuscitation and consideration of expedited delivery.

Shoulder dystocia: perform the McRoberts manoeuvre and suprapubic pressure first, then internal rotational manoeuvres; never apply fundal pressure, and be prepared for postpartum haemorrhage.

Paediatric basic life support: start with five rescue breaths, then compressions at a rate of 100-120 per minute with a compression-to-ventilation ratio of 15:2 for two rescuers (30:2 for one rescuer in lay practice).

Fluid maintenance: the Holliday-Segar 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 thereafter; replace deficits and ongoing losses separately.

Neonatal jaundice: jaundice within the first 24 hours is always pathological; unconjugated hyperbilirubinaemia is treated with phototherapy, and exchange transfusion is reserved for severe or rapidly rising levels.

Acute bronchiolitis: supportive care with oxygen if saturations fall, hydration, and suctioning; routine bronchodilators, corticosteroids, and antibiotics are not recommended.

Kawasaki disease: diagnosis requires fever for 5 days or more plus four of five features (rash, conjunctivitis, oral changes, extremity changes, cervical lymphadenopathy); treat with intravenous immunoglobulin and aspirin to reduce coronary risk.

Intussusception: intermittent colicky abdominal pain with drawing up of legs, vomiting, and redcurrant-jelly stool in a child aged 6 months to 3 years; air or contrast enema is diagnostic and therapeutic if there is no peritonitis.

Febrile seizures: simple febrile seizures are generalised, last under 15 minutes, and occur once in 24 hours; investigations are directed at the source of fever rather than the seizure itself.

Growth: a child's height typically doubles birth length by age 4 years and triples by age 13; crossing two or more centile lines downward warrants investigation for failure to thrive or endocrine disease.