Azerbaijan Healthcare Certification cheat sheet

Acute myocardial infarction: ST-elevation in two contiguous leads; troponin rises 3-6 h after onset, peaks at 12-24 h, remains elevated 7-10 days.

Community-acquired pneumonia: CURB-65 score (confusion, urea >7 mmol/L, respiratory rate ≥30/min, blood pressure <90/60, age ≥65) - 0-1 outpatient, 2 ward, ≥3 consider ICU.

Acute pancreatitis diagnosis requires two of: characteristic epigastric pain radiating to back, serum lipase/amylase ≥3× upper limit, imaging findings.

Pediatric dehydration: mild <5% weight loss, moderate 5-10%, severe >10%; use ORS 50-100 mL/kg over 3-4 h for moderate dehydration.

Preeclampsia: blood pressure ≥140/90 after 20 weeks plus proteinuria ≥300 mg/24 h or end-organ dysfunction; delivery is definitive treatment.

Appendicitis: migration of pain to right lower quadrant, McBurney point tenderness, leukocytosis; Alvarado score ≥7 supports operative management.

Stroke: non-contrast CT excludes hemorrhage; intravenous thrombolysis window 4.5 h from symptom onset; door-to-needle target ≤60 min.

Neonatal jaundice: pathologic if onset <24 h, bilirubin rise >5 mg/dL/day, total >15 mg/dL, or direct fraction >20%.

Adult cardiac arrest: compression rate 100-120/min, depth 5-6 cm, ratio 30:2, minimize interruptions <10 s; defibrillate VF/pVT at 200 J biphasic.

Anaphylaxis: intramuscular epinephrine 0.3-0.5 mg (1:1000) in mid-outer thigh, repeat every 5-15 min; adjuncts are antihistamine and corticosteroid.

Sepsis bundle: measure lactate, obtain blood cultures before antibiotics, broad-spectrum antibiotics within 1 h, 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Acute asthma: inhaled salbutamol 2.5-5 mg nebulized every 20 min ×3, ipratropium, systemic corticosteroid; consider magnesium sulfate 2 g IV for severe attacks.

Opioid overdose: naloxone 0.4-2 mg IV/IM/IN, repeat every 2-3 min; titrate to respiratory rate >12/min, not full consciousness.

Tension pneumothorax: clinical diagnosis - immediate needle decompression at 2nd intercostal space midclavicular line or 5th intercostal anterior axillary line, then chest tube.

Hypoglycemia: conscious patient 15-20 g oral glucose; unconscious 50 mL 50% dextrose IV or 1 mg glucagon IM; recheck glucose in 15 min.

Mass casualty triage: START - immediate (red), delayed (yellow), minor (green), expectant (black); reassess after each transport cycle.

Azerbaijan national immunization schedule includes BCG at birth, hepatitis B at birth, DTaP at 2/3/4/18 months, MMR at 12 and 6 years, OPV/IPV per schedule.

Incidence rate = new cases in period / population at risk × 100,000; prevalence = all existing cases / total population × 100,000.

Case fatality rate = deaths from disease / confirmed cases × 100%; attack rate = new cases / exposed population × 100%.

Herd immunity threshold = 1 − 1/R0; measles R0 12-18 requires ≥95% two-dose coverage; diphtheria R0 6-7 requires ≥85%.

Cold chain: +2 to +8 °C for most vaccines; freeze-sensitive vaccines (hepatitis B, DTaP, IPV) must not be frozen; monitor with vaccine vial monitors.

Tuberculosis: sputum smear and GeneXpert MTB/RIF for diagnosis; DOTS regimen 2HRZE/4HR for drug-susceptible pulmonary TB.

Notifiable disease reporting in Azerbaijan: immediate notification for plague, cholera, anthrax, measles; weekly aggregate reporting for other infections.

Post-exposure rabies prophylaxis: wound washing with soap and water 15 min, then vaccine on days 0,3,7,14,28; add immunoglobulin for category III exposure.

Azerbaijan healthcare law: Law on Protection of Population Health (1997, amended) defines rights to free emergency care and informed consent.

Compulsory health insurance introduced by Law on Medical Insurance (2016); phased rollout from 2020; mandatory for all residents.

State medical facilities report to the Ministry of Health; the State Agency for Compulsory Health Insurance (CHIA) purchases services.

Medical secrecy: disclosure permitted only with patient consent, for public health threat, or by court order; violation carries disciplinary and criminal liability.

Informed consent must include diagnosis, proposed intervention, risks, alternatives, and right to refuse; emergency exception applies when patient cannot consent.

Sanitary-epidemiological service: State Sanitary-Epidemiological Surveillance Agency conducts inspections under the Law on Sanitary-Epidemiological Well-being (1992).

Patient rights include access to medical records, second opinion, confidentiality, and complaint to the Ministry of Health or ombudsman.

Medical error reporting: adverse events must be documented in the medical record and reported to facility quality committee within 24 hours.

Four principles: autonomy, beneficence, non-maleficence, justice; autonomy governs informed consent and refusal of treatment by competent adults.

Confidentiality exceptions: patient consent, statutory reporting (infectious disease, gunshot wound), serious harm to third parties, court subpoena.

Competence assessment: patient understands information, appreciates consequences, reasons about options, and communicates a consistent choice.

Minors: consent for routine care from parent/guardian; emancipated minors and adolescent reproductive health exceptions apply per Azerbaijani law.

End-of-life: withholding futile treatment is permitted; euthanasia and physician-assisted suicide are prohibited under Azerbaijani criminal law.

Research ethics: institutional review board approval, informed consent, risk-benefit assessment, and right to withdraw without penalty.

Professional deontology: physician must not abandon a patient, must maintain professional boundaries, and must report impaired colleagues.

Medical records access: patient may receive copies; third parties require written authorization except as required by law.

Prescription elements: prescriber name, license, patient name/age, drug name (INN), dose, route, frequency, duration, signature, date, and facility stamp.

Narrow therapeutic index drugs (digoxin, warfarin, lithium, phenytoin, aminoglycosides) require therapeutic drug monitoring.

CYP450 interactions: CYP3A4 inhibitors (macrolides, azoles, grapefruit) raise levels of statins, calcium channel blockers; inducers (rifampicin, carbamazepine) lower them.

Antibiotic stewardship: prescribe only for bacterial infection, use narrowest effective agent, complete course, avoid unnecessary prophylaxis.

Renal dose adjustment: use Cockcroft-Gault creatinine clearance; reduce dose or extend interval when CrCl <60 mL/min for renally cleared drugs.

Adverse drug reaction reporting: submit to national pharmacovigilance center; serious reactions reported within 15 days.

Prescription validity: narcotic and psychotropic prescriptions valid 5 days; other prescription-only medicines typically 30 days in Azerbaijan.

Rational prescribing: match drug to diagnosis, consider contraindications, interactions, pregnancy category, and patient preference.

Hand hygiene: WHO 5 moments - before patient contact, before aseptic task, after body fluid exposure, after patient contact, after touching surroundings.

Alcohol-based hand rub 20-30 s for non-soiled hands; soap and water 40-60 s when visibly soiled or after C. difficile exposure.

Sterilization: autoclave 121 °C at 15 psi for 15-20 min or 134 °C for 3-4 min; monitor with biological indicator (Geobacillus stearothermophilus) weekly.

Isolation precautions: standard for all patients; contact for MRSA, C. difficile; droplet for influenza, pertussis; airborne for TB, measles, varicella.

Sharps: do not recap needles; dispose immediately in puncture-resistant container filled to ≤3/4; report needlestick within 1 hour.

Healthcare waste classification: class A general, class B infectious, class C pathological, class D pharmaceutical, class E sharps; separate at point of generation.

Operating room ventilation: ≥15 air changes per hour, HEPA-filtered, positive pressure relative to corridors; temperature 20-24 °C, humidity 30-60%.

Food safety: refrigerator ≤+4 °C, freezer ≤−18 °C, hot holding ≥+63 °C; cooling from +63 to +5 °C within 2 hours.

Medical record entries: date, time, patient identification, subjective/objective findings, assessment, plan, signature, and legible corrections with single line and initials.

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

Number needed to treat = 1/absolute risk reduction; ARR = control event rate − treatment event rate.

Mean, median, mode: mean sensitive to outliers; median preferred for skewed data; standard deviation describes spread of normally distributed data.

Chi-square test compares proportions in independent groups; t-test compares means of two groups; p<0.05 conventionally significant.

Quality indicators: structure, process, outcome; clinical audit cycle - define standards, measure, compare, implement change, re-audit.

Incident reporting: voluntary, non-punitive; root cause analysis for sentinel events within 45 days.

Confidence interval 95% = estimate ± 1.96 × standard error; wider interval indicates less precision.

SBAR handover: Situation, Background, Assessment, Recommendation - concise structured communication for clinical transfers.

Open-ended questions first (e.g., 'What brings you in today?'), then closed questions to clarify; avoid leading questions.

Breaking bad news: SPIKES - Setting, Perception, Invitation, Knowledge, Empathy, Strategy and summary.

Diagnostic reasoning: generate hypotheses, weigh pretest probability, order tests with likelihood ratios >10 or <0.1 to meaningfully change probability.

Anchoring bias: premature fixation on initial diagnosis; mitigate by deliberately considering alternatives and using diagnostic time-outs.

Teach-back method: ask patient to explain plan in own words to confirm understanding; use interpreter for limited-language proficiency.

Shared decision-making: present options, risks, benefits, and patient values; document the discussion and decision in the record.

Conflict resolution: separate person from problem, identify interests, generate options, agree on objective criteria, document outcome.