Azerbaijan Medical Residents Final Attestation cheat sheet

Acute coronary syndrome: serial high-sensitivity troponin at 0 and 1-3 hours; a rise/fall pattern with at least one value above the 99th percentile upper reference limit defines acute myocardial injury.

Heart failure with reduced ejection fraction (LVEF ≤40%): quadruple therapy with ARNI/ACE inhibitor, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor reduces mortality and hospitalization.

Community-acquired pneumonia severity: CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, blood pressure systolic <90 or diastolic ≤60 mmHg, age ≥65) - 0-1 outpatient, 2 ward admission, ≥3 consider intensive care.

Diabetic ketoacidosis: correct fluids first, add insulin infusion 0.1 U/kg/h after potassium is ≥3.3 mmol/L, target potassium 4-5 mmol/L, and add dextrose when glucose falls below ~11 mmol/L.

Hyponatremia: assess serum osmolality and urine osmolality/sodium first; correct chronic hyponatremia by ≤8-10 mmol/L in 24 hours to avoid osmotic demyelination.

Anemia classification by MCV: microcytic (<80 fL) - iron deficiency, thalassemia, chronic disease; normocytic (80-100 fL); macrocytic (>100 fL) - B12/folate deficiency, alcohol, hypothyroidism, myelodysplasia.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia <30 g/L, edema, hyperlipidemia; nephritic syndrome features hematuria with red cell casts, hypertension, and oliguria.

Thyroid function interpretation: primary hypothyroidism shows high TSH with low free T4; subclinical hypothyroidism shows high TSH with normal free T4; hyperthyroidism shows suppressed TSH with high free T4/T3.

Cirrhosis complications: ascites managed with sodium restriction plus spironolactone/furosemide; spontaneous bacterial peritonitis diagnosed by ascitic neutrophil count ≥250/mm³ and treated with a third-generation cephalosporin plus albumin.

Acute appendicitis: Alvarado score components are migratory right lower quadrant pain, anorexia, nausea/vomiting, tenderness, rebound, fever, leukocytosis, and left shift; a score ≥7 supports operative management.

Acute cholecystitis: right upper quadrant pain, Murphy sign, fever, leukocytosis, and ultrasound findings of wall thickening >3 mm, pericholecystic fluid, or sonographic Murphy sign; early laparoscopic cholecystectomy is preferred.

Bowel obstruction: air-fluid levels and dilated loops on plain film; initial management is nil per os, nasogastric decompression, intravenous fluids, and correction of electrolytes, with surgery for strangulation signs.

Damage-control surgery principles: control hemorrhage and contamination, temporary abdominal closure, correction of hypothermia, acidosis, and coagulopathy, then planned reoperation.

Shock in trauma: class I-IV hemorrhage based on blood loss; class III (30-40%) shows tachycardia, hypotension, and decreased pulse pressure; massive transfusion protocol with balanced ratios.

Hernia: indirect inguinal hernia passes lateral to inferior epigastric vessels through the deep ring; direct hernia passes medial to them through Hesselbach triangle.

Postoperative fever timing: within 48 hours consider atelectasis; days 3-5 consider urinary or surgical site infection; days 5-7 consider abscess or anastomotic leak; after 7 days consider deep vein thrombosis or drug reaction.

Thyroid surgery complications: recurrent laryngeal nerve injury causes hoarseness; external branch of superior laryngeal nerve injury causes voice fatigue; hypocalcemia from parathyroid injury presents with perioral tingling and Chvostek sign.

Preeclampsia: new hypertension ≥140/90 mmHg after 20 weeks with proteinuria ≥300 mg/24 h or end-organ dysfunction; severe features include blood pressure ≥160/110, platelets <100,000, transaminases >2× normal, creatinine >1.1 mg/dL, pulmonary edema, or visual/cerebral symptoms.

Gestational age estimation: Naegele rule adds 7 days and subtracts 3 months from the first day of the last menstrual period; first-trimester ultrasound crown-rump length is the most accurate dating method.

Fetal heart rate interpretation: baseline 110-160 bpm; late decelerations suggest uteroplacental insufficiency; variable decelerations suggest cord compression; prolonged deceleration >10 minutes is an emergency.

Postpartum hemorrhage: most common cause is uterine atony; management sequence is uterine massage, oxytocin, then ergometrine, carboprost, or misoprostol, and tranexamic acid within 3 hours of birth.

Ectopic pregnancy: risk factors include previous ectopic, tubal surgery, pelvic inflammatory disease, and assisted reproduction; diagnosis by transvaginal ultrasound and serial beta-hCG; methotrexate for stable cases without fetal cardiac activity.

Ovarian torsion: sudden unilateral pelvic pain with nausea and vomiting; Doppler may be normal; laparoscopy with detorsion and ovarian preservation is the standard.

Cervical cancer screening: start at age 21-25 with cytology every 3 years or HPV testing every 5 years; colposcopy for abnormal results; HPV vaccination prevents types 16 and 18.

Endometriosis: dysmenorrhea, dyspareunia, and infertility; definitive diagnosis by laparoscopy; first-line medical therapy includes combined oral contraceptives or progestins.

Neonatal resuscitation: initial steps are warmth, drying, stimulation, and airway positioning; positive pressure ventilation for apnea, gasping, or heart rate <100 bpm; chest compressions if heart rate <60 bpm after effective ventilation.

APGAR score: appearance, pulse, grimace, activity, respiration, each 0-2, assessed at 1 and 5 minutes; a score of 0-3 indicates severe distress and need for immediate resuscitation.

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

Pediatric dehydration: mild <5% weight loss, moderate 5-10%, severe >10%; oral rehydration solution 50-100 mL/kg over 3-4 hours for mild-moderate dehydration; intravenous fluids for severe cases or shock.

Pediatric dosing: weight-based dosing in mg/kg; verify maximum adult dose; use ideal or adjusted body weight for obese children when appropriate.

Kawasaki disease: fever ≥5 days plus 4 of 5 criteria (conjunctivitis, oral changes, rash, extremity changes, cervical lymphadenopathy); treat with intravenous immunoglobulin and aspirin to prevent coronary aneurysms.

Growth assessment: plot weight, length/height, and head circumference on age- and sex-specific charts; crossing two major percentiles suggests failure to thrive or endocrine disorder.

Bronchiolitis: most common cause is respiratory syncytial virus; supportive care with oxygen and hydration; routine bronchodilators and corticosteroids are not recommended.

Advanced cardiac life support: high-quality chest compressions at 100-120/min, depth 5-6 cm, full recoil, minimal interruptions; shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia; defibrillate immediately, then resume compressions for 2 minutes.

Anaphylaxis: intramuscular epinephrine 0.01 mg/kg (max 0.5 mg) of 1:1000 solution into the anterolateral thigh; repeat every 5-15 minutes; adjuncts include oxygen, fluids, antihistamines, and corticosteroids.

Sepsis: suspected infection plus organ dysfunction; obtain cultures and lactate, give broad-spectrum antibiotics within 1 hour, and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Acute stroke: activate stroke pathway; noncontrast CT to exclude hemorrhage; intravenous thrombolysis within 4.5 hours of onset if no contraindications; thrombectomy up to 24 hours in selected large-vessel occlusion.

Opioid overdose: pinpoint pupils, respiratory depression, and decreased consciousness; give naloxone and support ventilation; titrate to restore adequate breathing, not full arousal.

Status epilepticus: benzodiazepine first-line (lorazepam or diazepam); if seizures persist, second-line antiepileptic such as levetiracetam, valproate, or phenytoin; refractory cases require intubation and anesthetic agents.

Acute respiratory distress syndrome: Berlin criteria - onset within 1 week, bilateral opacities, not fully explained by heart failure, and PaO2/FiO2 ≤300 mmHg with positive end-expiratory pressure ≥5 cmH2O; lung-protective ventilation with tidal volume 6 mL/kg predicted body weight.

Hyperkalemia with ECG changes: calcium gluconate for membrane stabilization, insulin with glucose and beta-2 agonists to shift potassium intracellularly, and dialysis or potassium binders for elimination.

Incidence is the number of new cases per population at risk per time; prevalence is the total number of existing cases at a point in time; prevalence ≈ incidence × duration for stable diseases.

Sensitivity is the proportion of true positives detected; specificity is the proportion of true negatives correctly identified; positive predictive value depends on prevalence.

Relative risk is used in cohort studies; odds ratio approximates relative risk when the disease is rare and is used in case-control studies.

Attributable risk is incidence in exposed minus incidence in unexposed; it estimates the excess disease burden due to exposure.

Tuberculosis: latent infection diagnosed by interferon-gamma release assay or tuberculin skin test; active disease requires sputum smear, culture, or nucleic acid amplification testing; standard regimen is 2 months of isoniazid, rifampicin, pyrazinamide, and ethambutol followed by 4 months of isoniazid and rifampicin.

HIV: screen with fourth-generation antigen/antibody test; confirm with differentiation assay; viral load for monitoring; post-exposure prophylaxis within 72 hours with a 28-day three-drug regimen.

Hepatitis B serology: HBsAg indicates infection; anti-HBs indicates immunity; anti-HBc IgM indicates acute infection; HBeAg indicates high infectivity.

Malaria: thick and thin blood films or rapid antigen test; severe malaria features include impaired consciousness, acidosis, hypoglycemia, severe anemia, and renal failure; treat severe cases with intravenous artesunate.

Hand hygiene: alcohol-based hand rub for routine decontamination; soap and water when hands are visibly soiled or after exposure to spore-forming organisms such as Clostridioides difficile.

Crude mortality rate = (number of deaths in a year / mid-year population) × 1000; infant mortality rate = deaths under age 1 per 1000 live births in the same year.

Maternal mortality ratio = maternal deaths per 100,000 live births; measure with the denominator restricted to live births, not total population.

Life expectancy at birth is the average number of years a newborn would live under current age-specific mortality rates; it is not a prediction for an individual.

Screening criteria: the disease must be important, have a detectable preclinical phase, an acceptable test with adequate sensitivity and specificity, and effective early treatment.

Lead time bias occurs when screening advances diagnosis without extending life; length bias occurs when screening preferentially detects slower-growing disease; selection bias occurs when screened volunteers differ from the population.

Herd immunity threshold depends on the basic reproduction number R0: threshold = 1 − 1/R0; for measles with R0 of 12-18, the threshold is about 92-95%.

Levels of prevention: primordial (risk factor reduction in society), primary (prevent disease before onset), secondary (early detection and treatment), tertiary (limit disability and rehabilitation).

Outbreak investigation steps: verify the diagnosis, confirm the outbreak, define and count cases, describe by person/place/time, generate hypotheses, test hypotheses, implement control, and communicate findings.

Informed consent requires disclosure of diagnosis, nature and purpose of the proposed intervention, risks and benefits, alternatives, and consequences of refusal; it must be voluntary and given by a competent patient.

Medical confidentiality may be breached only with patient consent, legal obligation, or a serious public health risk; disclose the minimum necessary information.

Medical records must be accurate, contemporaneous, legible, signed, and retained for the period set by national regulation; they are the primary evidence in malpractice claims.

Negligence requires four elements: duty of care, breach of duty, causation, and damages; the standard of care is that of a reasonably competent physician in the same circumstances.

Emergency care: treatment may be provided without consent when the patient is unable to consent and delay would risk life or serious harm, unless a valid advance directive prohibits it.

Referral and consultation: document the reason, the information shared, and the receiving clinician; the referring physician retains responsibility until care is formally transferred.

Prescription law: controlled substances require a valid prescription with prescriber identification, patient details, drug, dose, and duration; forged or altered prescriptions must be reported.

Patient rights include access to records, second opinion, privacy, and complaint mechanisms; healthcare institutions must have an ethics committee and incident reporting system.

Pharmacokinetics: bioavailability is the fraction of an administered dose reaching systemic circulation; volume of distribution relates dose to plasma concentration; clearance is the volume of plasma cleared of drug per unit time.

Half-life = 0.693 × volume of distribution / clearance; steady state is reached after about 4-5 half-lives; loading dose = volume of distribution × target concentration / bioavailability.

Cytochrome P450 interactions: inhibitors include macrolides, azole antifungals, and grapefruit; inducers include rifampicin, carbamazepine, and St John's wort; warfarin and statins are common victims.

Aminoglycosides and vancomycin are nephrotoxic and ototoxic; monitor trough levels and renal function; once-daily dosing is preferred for aminoglycosides.

NSAIDs: inhibit cyclooxygenase; adverse effects include gastrointestinal ulceration, renal impairment, and increased cardiovascular risk; avoid in third-trimester pregnancy and in heart failure.

Beta-blockers: nonselective agents can cause bronchospasm; cardioselective agents are preferred in asthma; abrupt withdrawal can precipitate angina or tachycardia.

Anticoagulation: heparin is monitored by activated partial thromboplastin time; warfarin by INR; direct oral anticoagulants do not require routine monitoring but need renal dose adjustment.

Antimicrobial stewardship: prescribe only when indicated, obtain cultures before starting antibiotics, choose the narrowest effective agent, and review therapy at 48-72 hours.

Chest X-ray: air appears black, bone white, and soft tissue gray; silhouetting of the heart border localizes opacity to the adjacent lobe; the right hemidiaphragm is higher than the left.

Pneumothorax on chest X-ray: visible pleural line with absent lung markings peripherally; tension pneumothorax shows mediastinal shift away from the affected side and requires immediate decompression.

CT is preferred for acute intracranial hemorrhage, renal colic, and pulmonary embolism; MRI is preferred for soft tissue, spinal cord, and posterior fossa lesions.

Ultrasound is first-line for gallbladder disease, obstetric assessment, and suspected deep vein thrombosis; it is operator-dependent and limited by obesity and bowel gas.

Laboratory quality: sensitivity and specificity describe the test; predictive values depend on prevalence; the reference interval covers the central 95% of a healthy population.

Arterial blood gas interpretation: determine pH, then PaCO2 (respiratory), then bicarbonate (metabolic); compensation never fully corrects the primary disorder.

Liver enzymes: ALT is more liver-specific than AST; an AST/ALT ratio >2 suggests alcoholic liver disease; alkaline phosphatase and bilirubin rise in cholestasis.

Urinalysis: nitrite and leukocyte esterase suggest urinary tract infection; red cell casts indicate glomerulonephritis; white cell casts indicate pyelonephritis or interstitial nephritis.

Document a structured clinical assessment: history of present illness, past medical history, medications, allergies, family and social history, review of systems, examination, differential diagnosis, and plan.

Use a prioritized differential diagnosis organized by likelihood and by must-not-miss conditions; state the evidence for and against each diagnosis.

Apply evidence-based guidelines from recognized bodies for the chosen specialty; note the guideline version and the strength of recommendation.

Perform procedure documentation: indication, consent, technique, findings, complications, and post-procedure instructions; record supervision level.

Use clinical audit and quality improvement cycles: define a standard, measure current practice, implement change, and re-measure to demonstrate improvement.

Communicate with patients using plain language, confirm understanding with teach-back, and involve them in shared decision-making.

Recognize the limits of competence: request senior review for unfamiliar, deteriorating, or complex cases, and document the discussion.

Maintain a learning portfolio with case reflections, procedure logs, and assessment feedback to meet continuing professional development requirements.

Acute coronary syndrome: serial high-sensitivity troponin at 0 and 1-3 hours; a rise/fall pattern with at least one value above the 99th percentile upper reference limit defines acute myocardial injury.

Heart failure with reduced ejection fraction (LVEF ≤40%): quadruple therapy with ARNI/ACE inhibitor, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor reduces mortality and hospitalization.

Community-acquired pneumonia severity: CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, blood pressure systolic <90 or diastolic ≤60 mmHg, age ≥65) - 0-1 outpatient, 2 ward admission, ≥3 consider intensive care.

Diabetic ketoacidosis: correct fluids first, add insulin infusion 0.1 U/kg/h after potassium is ≥3.3 mmol/L, target potassium 4-5 mmol/L, and add dextrose when glucose falls below ~11 mmol/L.

Hyponatremia: assess serum osmolality and urine osmolality/sodium first; correct chronic hyponatremia by ≤8-10 mmol/L in 24 hours to avoid osmotic demyelination.

Anemia classification by MCV: microcytic (<80 fL) - iron deficiency, thalassemia, chronic disease; normocytic (80-100 fL); macrocytic (>100 fL) - B12/folate deficiency, alcohol, hypothyroidism, myelodysplasia.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia <30 g/L, edema, hyperlipidemia; nephritic syndrome features hematuria with red cell casts, hypertension, and oliguria.

Thyroid function interpretation: primary hypothyroidism shows high TSH with low free T4; subclinical hypothyroidism shows high TSH with normal free T4; hyperthyroidism shows suppressed TSH with high free T4/T3.

Cirrhosis complications: ascites managed with sodium restriction plus spironolactone/furosemide; spontaneous bacterial peritonitis diagnosed by ascitic neutrophil count ≥250/mm³ and treated with a third-generation cephalosporin plus albumin.