BMDC RQE cheat sheet

Acute myocardial infarction: ST-elevation in two contiguous leads; troponin rises 3-6 h after onset and peaks at 12-24 h; aspirin 300 mg chewed plus reperfusion within 12 h of symptom onset.

Diabetic ketoacidosis: glucose >250 mg/dL, pH <7.3, bicarbonate <18 mEq/L, ketonemia; total body potassium is depleted even when serum potassium is normal or high, so potassium is replaced once K <5.5 mEq/L and urine output is adequate.

Nephrotic syndrome: proteinuria >3.5 g/24 h, albumin <3.0 g/dL, edema, hyperlipidemia; minimal change disease is the commonest cause in children and responds to corticosteroids.

Hyperkalemia ECG sequence: peaked T waves, prolonged PR, widened QRS, sine wave; give calcium gluconate first for membrane stabilization, then insulin-dextrose and salbutamol to shift potassium intracellularly.

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) score >=2 suggests inpatient care.

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

Thyroid function interpretation: primary hypothyroidism shows high TSH with low free T4; subclinical hypothyroidism shows high TSH with normal free T4; a low TSH with high free T4 indicates primary hyperthyroidism.

Anemia classification by mean corpuscular volume: microcytic (<80 fL) suggests iron deficiency, thalassemia, or chronic disease; macrocytic (>100 fL) suggests B12 or folate deficiency, alcohol, or hypothyroidism.

Acute appendicitis: migration of pain to the right iliac fossa with rebound tenderness at McBurney's point; Alvarado score >=7 supports operative management.

Bowel obstruction: colicky pain, vomiting, distension, absolute constipation; erect abdominal radiograph shows multiple air-fluid levels; strangulation is suggested by fever, tachycardia, and constant pain.

Shock classification: class I loss <15% blood volume, class II 15-30% (tachycardia), class III 30-40% (hypotension), class IV >40% (marked hypotension, altered consciousness).

Burn surface area by Wallace 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/% burn of crystalloid in 24 h, half in the first 8 h.

Thyroidectomy risks: recurrent laryngeal nerve injury causes hoarseness, external branch of superior laryngeal nerve injury causes voice fatigue, and hypocalcemia from parathyroid injury appears 24-72 h postoperatively.

Hernia: indirect inguinal hernia passes lateral to inferior epigastric vessels through the deep ring and is the commonest type in both sexes; direct hernia passes medial to the vessels through Hesselbach's triangle.

Acute pancreatitis: diagnosis needs two of epigastric pain radiating to the back, serum lipase or amylase >3 times upper limit, and characteristic imaging; Ranson and modified Glasgow scores predict severity at 48 h.

Wound healing: primary intention heals clean approximated wounds; secondary intention heals by granulation from the base; hypertrophic scars stay within wound margins while keloids extend beyond them.

Estimated date of delivery by Naegele's rule: first day of last menstrual period plus 7 days minus 3 months, adjusted for cycle length; ultrasound crown-rump length is more accurate in the first trimester.

Preeclampsia: blood pressure >=140/90 mmHg after 20 weeks with proteinuria >=300 mg/24 h or other organ dysfunction; severe features include BP >=160/110, platelets <100,000/mm3, and transaminases twice normal.

Postpartum hemorrhage: primary PPH is blood loss >=500 mL after vaginal delivery or >=1000 mL after cesarean within 24 h; causes follow the four Ts (tone, trauma, tissue, thrombin), with uterine atony the commonest.

Fetal heart rate interpretation: baseline 110-160 beats/min; late decelerations indicate uteroplacental insufficiency; variable decelerations indicate cord compression; prolonged deceleration >10 min is an emergency.

Ectopic pregnancy: classic triad of amenorrhea, abdominal pain, and vaginal bleeding; a discriminatory beta-hCG of 1500-3500 mIU/mL with an empty uterus on transvaginal scan is suspicious; treatment is methotrexate or surgery.

Contraception effectiveness: combined oral contraceptive failure rate <1% with perfect use; copper intrauterine device is effective as emergency contraception up to 5 days after unprotected intercourse.

Menstrual cycle: ovulation occurs about 14 days before the next menses; the luteal phase is constant at 14 days while the follicular phase varies; progesterone peaks in the mid-luteal phase.

Gestational diabetes screening: 75 g oral glucose tolerance test at 24-28 weeks; diagnostic thresholds are fasting >=92, 1 h >=180, and 2 h >=153 mg/dL, with one abnormal value sufficient.

Neonatal resuscitation: dry and stimulate, then assess; if apnoeic or heart rate <100/min give positive pressure ventilation; chest compressions at 3:1 ratio if heart rate <60/min after effective ventilation.

Neonatal jaundice: physiological jaundice appears after 24 h and peaks at day 3-5; jaundice within 24 h, a rise >5 mg/dL per day, or direct hyperbilirubinemia is pathological.

Growth monitoring: weight doubles by 5 months and triples by 1 year; birth length increases by 50% at 1 year; head circumference increases about 12 cm in the first year.

Acute gastroenteritis with dehydration: use WHO oral rehydration salts; give 50-100 mL/kg over 4 h for some dehydration and 100 mL/kg over 4 h for severe dehydration, with zinc for 10-14 days.

Kussmaul breathing with acetone breath in a dehydrated child suggests diabetic ketoacidosis; in a child with vomiting and altered consciousness, check bedside glucose before lumbar puncture.

Immunization: BCG and hepatitis B at birth; pentavalent vaccine at 6, 10, and 14 weeks; measles-rubella at 9 and 15 months; vitamin A at 6 months with deworming from 1 year.

Respiratory distress in children: intercostal and subcostal recession, nasal flaring, grunting, and tachypnea; in croup a barking cough and inspiratory stridor respond to dexamethasone and nebulized adrenaline.

Febrile seizures: simple febrile seizure lasts <15 min, is generalized, and occurs once in 24 h in a child aged 6 months to 5 years without prior neurological disease.

Anatomy: the femoral triangle is bounded by the inguinal ligament superiorly, sartorius laterally, and adductor longus medially; its floor is iliopsoas and pectineus, and it contains the femoral nerve, artery, vein, and lymphatics from lateral to medial.

Physiology: cardiac output equals heart rate times stroke volume; the Frank-Starling relationship states that stroke volume rises with preload up to an optimal sarcomere length.

Biochemistry: glycolysis yields 2 ATP and 2 NADH per glucose; the citric acid cycle yields 3 NADH, 1 FADH2, and 1 GTP; oxidative phosphorylation yields about 2.5 ATP per NADH and 1.5 ATP per FADH2.

Pharmacology: first-order kinetics eliminate a constant fraction per unit time with a half-life independent of dose; zero-order kinetics eliminate a constant amount per unit time, as with ethanol and phenytoin at high doses.

Pathology: acute inflammation features vasodilation, increased vascular permeability, and neutrophil emigration within hours; chronic inflammation features lymphocytes and macrophages with fibrosis.

Microbiology: Gram-positive organisms retain crystal violet and appear purple; Gram-negative organisms decolorize and counterstain pink; catalase-positive, coagulase-positive cocci in clusters indicate Staphylococcus aureus.

Enzyme kinetics: Michaelis-Menten constant Km equals substrate concentration at half maximal velocity; competitive inhibitors raise Km without changing Vmax; noncompetitive inhibitors lower Vmax.

Acid-base: Henderson-Hasselbalch equation pH = 6.1 + log([HCO3-]/0.03 x PaCO2); respiratory compensation for metabolic acidosis lowers PaCO2 by 1.2 mmHg per 1 mEq/L fall in bicarbonate.

Incidence measures new cases per population at risk per unit time; prevalence measures all existing cases and equals incidence times mean disease duration when disease is stable.

Sensitivity is true positives divided by all diseased; specificity is true negatives divided by all non-diseased; positive predictive value depends on prevalence and equals true positives divided by all test positives.

Relative risk is used in cohort studies and equals incidence in exposed divided by incidence in unexposed; odds ratio approximates relative risk in case-control studies when disease is rare.

Screening criteria: the condition must be important, have a detectable latent stage, have an acceptable test, and have effective early treatment; Wilson-Jungner criteria summarize these requirements.

Herd immunity threshold equals 1 minus 1/R0; measles with R0 of 12-18 requires about 92-95% coverage, while influenza with R0 near 2 requires about 50%.

Levels of prevention: primordial prevention removes risk factors, primary prevention acts before disease onset, secondary prevention detects early disease, and tertiary prevention limits disability.

Maternal mortality ratio is maternal deaths per 100,000 live births; infant mortality rate is infant deaths under 1 year per 1000 live births in the same year.

Outbreak investigation steps: confirm the diagnosis, define cases, describe by person, place, and time, generate hypotheses, test them, and implement control measures.

Rigor mortis begins in the eyelids and jaw 2-4 h after death, becomes complete in 12 h, and passes off in 24-36 h; livor mortis fixation occurs in 6-8 h and its distribution changes with position.

Postmortem changes: algor mortis falls about 1-1.5 degrees Celsius per hour in the first 12 h; putrefaction begins in the right iliac fossa; adipocere forms in moist conditions and mummification in dry conditions.

Injury interpretation: abrasions indicate friction, contusions indicate blunt force, and lacerations show tissue bridging; incised wounds are longer than deep, while stab wounds are deeper than long.

Organophosphate poisoning: muscarinic features (salivation, lacrimation, urination, diarrhea, bradycardia, bronchorrhea, miosis) plus nicotinic features (fasciculation, weakness); treat with atropine and pralidoxime.

Carbon monoxide poisoning: cherry-red skin, headache, confusion; carboxyhemoglobin >20% is toxic; treat with high-flow oxygen and hyperbaric oxygen for neurological or cardiac involvement.

Methanol and ethylene glycol poisoning: high anion gap metabolic acidosis with an osmolal gap; treat with fomepizole or ethanol, sodium bicarbonate, and hemodialysis for severe cases.

Lead poisoning: anemia with basophilic stippling, abdominal colic, wrist drop, and a blue line on the gums; blood lead >5 micrograms/dL in children is a public health concern.

Medicolegal documentation: record the date, time, place, and consent, describe wounds in centimeters with anatomical landmarks, and note whether injuries are fresh, healing, or healed.

Acute otitis media: bulging, erythematous, opaque tympanic membrane with reduced mobility; first-line treatment is amoxicillin, with amoxicillin-clavulanate for treatment failure or recent antibiotic use.

Rinne and Weber tests: in conductive hearing loss, Rinne is negative (bone conduction better than air) and Weber lateralizes to the affected ear; in sensorineural loss, Rinne is positive and Weber lateralizes to the better ear.

Epistaxis: most anterior bleeds arise at Kiesselbach's plexus on the anteroinferior septum; management is pressure, topical vasoconstrictor, and anterior packing; posterior bleeds need posterior packing or arterial ligation.

Acute angle-closure glaucoma: painful red eye, halos around lights, fixed mid-dilated pupil, shallow anterior chamber, and intraocular pressure >21 mmHg; treat with topical and systemic pressure-lowering agents plus laser iridotomy.

Cataract: painless progressive loss of vision with a yellow-brown lens on retroillumination; surgery is indicated when vision limits daily activity; posterior capsule opacification is managed by Nd:YAG laser capsulotomy.

Diabetic retinopathy: non-proliferative shows microaneurysms, dot hemorrhages, and hard exudates; proliferative shows neovascularization; screening intervals are determined by retinopathy grade and pregnancy status.

Papilledema indicates raised intracranial pressure and is bilateral; unilateral disc swelling with normal intracranial pressure suggests anterior ischemic optic neuropathy or optic neuritis.

Sudden painless monocular vision loss suggests retinal artery occlusion with a cherry-red spot; sudden painful vision loss with a red eye suggests acute glaucoma or uveitis.

Psoriasis: well-demarcated salmon plaques with silvery scale on extensor surfaces; Auspitz sign is pinpoint bleeding on scale removal; Koebner phenomenon describes lesions at trauma sites.

Leprosy spectrum: tuberculoid disease is paucibacillary with few well-defined hypopigmented anesthetic lesions and a strong cell-mediated response; lepromatous disease is multibacillary with widespread lesions and a weak response.

Pemphigus vulgaris shows intraepidermal suprabasal acantholysis with flaccid bullae and a positive Nikolsky sign; bullous pemphigoid shows subepidermal split with tense bullae and a negative Nikolsky sign.

Scabies: nocturnal itch with burrows in web spaces, wrists, and genitalia; treat with topical permethrin 5% or oral ivermectin, and treat all close contacts simultaneously.

Depression diagnostic criteria: five or more symptoms for at least 2 weeks, including depressed mood or anhedonia, plus sleep, appetite, energy, concentration, psychomotor, and suicidal symptoms.

Psychosis: first-rank symptoms include auditory hallucinations commenting on the patient, thought insertion or withdrawal, and delusions of control; antipsychotics act mainly by blocking dopamine D2 receptors.

Alcohol withdrawal: tremor, sweating, and anxiety begin 6-24 h after cessation; withdrawal seizures occur at 12-48 h; delirium tremens appears at 48-96 h and is treated with benzodiazepines and thiamine.

Lithium: therapeutic range 0.6-1.2 mmol/L; toxicity features tremor, ataxia, vomiting, and confusion; monitor levels, renal function, and thyroid function every 3-6 months.

Informed consent requires capacity, adequate disclosure of risks, benefits, and alternatives, and voluntariness; consent may be verbal, written, or implied by conduct, and written form is not a legal substitute for the discussion.

Four principles of biomedical ethics: autonomy respects informed choice, beneficence promotes welfare, non-maleficence avoids harm, and justice distributes benefits and burdens fairly.

Confidentiality may be breached only with patient consent, a legal requirement such as notifiable disease reporting, or a clear public safety threat; disclose the minimum necessary information.

Capacity assessment: the patient must understand the information, retain it, weigh it, and communicate a choice; a patient with capacity may refuse beneficial treatment.

Negligence requires a duty of care, a breach of the standard expected of a reasonably competent practitioner, causation, and resulting harm; the Bolam standard compares practice with a responsible body of peers.

Notifiable diseases in many jurisdictions include cholera, plague, yellow fever, tuberculosis, and measles; notification is a legal duty that overrides ordinary confidentiality.

Professional boundaries: sexual relationships with current patients are prohibited; conflicts of interest must be declared; gifts or referrals that could influence care must be disclosed.

Good medical practice includes keeping records contemporaneously, working within competence, referring when necessary, and reporting impaired or unsafe colleagues to the appropriate authority.