Belarus Medical Specialist Attestation cheat sheet

Core statute: Law of the Republic of Belarus "On Healthcare" (18 June 1993, as amended) governs state guarantees of medical care, patient rights and medical secrecy.

Article 16 of the Constitution guarantees citizens the right to health protection, free qualified care in state institutions, and free treatment in state facilities.

Healthcare is financed through the state budget (budget-funded institutions) plus voluntary medical insurance and paid services regulated by the Council of Ministers.

Medical secrecy (врачебная тайна) may be disclosed only with patient consent or by legal requirement (e.g., notifiable infectious disease, court order, threat to public health).

Informed voluntary consent is required before any medical intervention; for minors under 14 and legally incapacitated patients, consent is given by legal representatives.

The Ministry of Health (Министерство здравоохранения) issues clinical protocols (клинические протоколы) that are binding standards for diagnosis and treatment.

Medical activity is licensed; the licensing authority is the Ministry of Health, and practice without a licence or by an unqualified person carries administrative or criminal liability.

Informed consent, refusal of treatment, and the right to choose a physician and institution are statutory patient rights; refusal must be documented in the medical record.

Primary care is organised on the territorial-district principle: a district physician (терапевт) serves a defined population; the polyclinic is the first-contact unit.

Medical record form 025/у is the outpatient card; form 003/у is the inpatient (case) history - both are the primary legal documents of care.

Records must be entered contemporaneously, dated, signed and legible; corrections are made by striking through (not erasing) with the correction signed and dated.

A single record entry should contain: date/time, complaints, anamnesis, objective status, diagnosis (with ICD-10 code), investigations, treatment and follow-up plan.

Informed consent for procedures and refusals are filed in the record; the record is retained per Ministry of Health retention schedules (typically decades for inpatient histories).

Emergency care must be available 24/7; the feldsher-obstetric point (ФАП) and rural outpatient clinic provide first-level care in rural areas.

Referral to a specialist requires a documented indication from the attending physician; self-referral is permitted for emergencies and certain specialists.

Quality control uses internal audit (ведомственный контроль) and external expert review of records; the record is the primary evidence in complaints and litigation.

Hypertension diagnosis requires office BP ≥140/90 mmHg on repeated measurements; ≥135/85 mmHg for home/ambulatory monitoring.

Type 2 diabetes diagnostic thresholds: fasting plasma glucose ≥7.0 mmol/L, or 2-h OGTT ≥11.1 mmol/L, or HbA1c ≥6.5%, or random ≥11.1 with symptoms.

Acute coronary syndrome: ST-elevation MI requires immediate reperfusion (primary PCI preferred, door-to-balloon ≤90 min); give aspirin 150–300 mg chewed plus P2Y12 inhibitor.

Community-acquired pneumonia: CURB-65 (confusion, urea >7 mmol/L, RR ≥30, low BP, age ≥65) guides site of care; severity scoring drives admission.

Anemia: WHO defines anemia in adult men as Hb <130 g/L and in non-pregnant women as Hb <120 g/L; iron deficiency shows low ferritin.

Asthma control is assessed by symptom frequency, night waking, reliever use and activity limitation; step-up/down follows GINA-style protocol.

Chronic kidney disease is staged by eGFR (G1 ≥90 to G5 <15 mL/min/1.73 m²) plus albuminuria category A1–A3.

Peptic ulcer with H. pylori requires eradication therapy (proton-pump inhibitor plus two antibiotics) with post-treatment testing.

Acute abdomen red flags: rigidity, rebound tenderness, absent bowel sounds, free air on imaging - indicate surgical emergency.

Appendicitis: migration of pain to right lower quadrant, McBurney point tenderness, leukocytosis; Alvarado score ≥7 suggests high probability.

Acute cholecystitis: Murphy sign, RUQ pain, fever; ultrasound shows wall thickening >3 mm, pericholecystic fluid, stones.

Bowel obstruction: colicky pain, vomiting, distension, absent flatus/stool; imaging shows dilated loops and air-fluid levels; strangulation signs mandate urgent surgery.

Perforated viscus: sudden severe pain, board-like abdomen, pneumoperitoneum on upright film or CT - requires emergency laparotomy/laparoscopy.

Postoperative care: early mobilisation, thromboprophylaxis (LMWH) in moderate/high-risk patients, and wound care with aseptic technique.

Surgical site infection prevention: preoperative antibiotic prophylaxis within 60 minutes of incision, skin antisepsis, normothermia and glucose control.

Acute pancreatitis diagnosis requires 2 of 3: characteristic pain, serum lipase/amylase >3× upper limit, and imaging findings; initial management is fluids and analgesia.

Normal pregnancy lasts 280 days (40 weeks) from the first day of the last menstrual period; estimated due date by Naegele's rule (LMP + 7 days − 3 months).

Antenatal care schedule: first visit early, then visits every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, weekly thereafter.

Preeclampsia: BP ≥140/90 after 20 weeks plus proteinuria ≥0.3 g/24 h or organ dysfunction; severe features include BP ≥160/110, platelets <100, liver enzymes elevated, pulmonary oedema.

Eclampsia management: magnesium sulfate (loading then maintenance), control of BP, and delivery; monitor for magnesium toxicity (loss of reflexes, respiratory depression).

Postpartum hemorrhage: >500 mL after vaginal or >1000 mL after cesarean delivery; first-line uterotonic is oxytocin, plus uterine massage and bimanual compression.

Gestational diabetes screening: 75-g OGTT at 24–28 weeks; thresholds fasting ≥5.1, 1-h ≥10.0, 2-h ≥8.5 mmol/L (any one abnormal).

Fetal heart rate monitoring: baseline 110–160 bpm; late decelerations suggest uteroplacental insufficiency; variable decelerations suggest cord compression.

Ectopic pregnancy: amenorrhea, abdominal pain, vaginal bleeding; ultrasound without intrauterine gestational sac plus elevated hCG - treat medically (methotrexate) or surgically.

Normal newborn weight 2500–4000 g; physiologic weight loss up to 8–10% in the first days, regained by 10–14 days.

Breastfeeding is recommended exclusively for the first 6 months, with complementary feeding introduced at 6 months and continued breastfeeding to 2 years.

Vaccination schedule (Belarus national calendar) includes BCG at birth, hepatitis B at birth, DTP series, polio, MMR at 12 months and 6 years, and others per the calendar.

Fever in infants under 3 months is a red flag: full sepsis work-up and admission are required; antipyretics are paracetamol or ibuprofen (not aspirin).

Dehydration in children is graded by percent weight loss and clinical signs; oral rehydration solution is first-line for mild-moderate dehydration.

Growth assessment uses WHO/percentile charts; failure to thrive is weight or height below the 3rd percentile or crossing two major percentile lines.

Acute laryngotracheitis (croup): barking cough, inspiratory stridor, hoarseness; treat with a single dose of dexamethasone and nebulised epinephrine if severe.

Kawasaki disease: fever ≥5 days plus ≥4 of conjunctivitis, mucosal changes, rash, extremity changes, cervical lymphadenopathy; treat with IVIG and aspirin to prevent coronary aneurysms.

Adult CPR: compressions at 100–120/min, depth 5–6 cm, full recoil, compression:ventilation 30:2, minimise interruptions; defibrillate VF/pVT immediately.

Advanced airway: after intubation, give 1 breath every 6 seconds (10/min) with continuous compressions; capnography confirms tube placement.

Reversible causes of cardiac arrest (4 Hs and 4 Ts): hypoxia, hypovolemia, hypo/hyperkalemia, hypothermia; tension pneumothorax, tamponade, toxins, thrombosis.

Anaphylaxis: intramuscular adrenaline 0.5 mg (1:1000) into the anterolateral thigh, repeat every 5 minutes; fluids and oxygen; antihistamines and steroids are adjuncts.

Adult adrenaline dose in cardiac arrest is 1 mg IV/IO every 3–5 minutes; amiodarone 300 mg after the third shock in refractory VF/pVT.

Glasgow Coma Scale: eye 1–4, verbal 1–5, motor 1–6; total 3–15; score ≤8 indicates need for airway protection.

Sepsis bundle: measure lactate, obtain blood cultures before antibiotics, give broad-spectrum antibiotics within 1 hour, and fluids 30 mL/kg for hypotension.

Pre-anesthesia assessment includes airway evaluation (Mallampati), ASA physical status, allergy and medication review, and informed consent.

Notifiable infectious diseases must be reported to the sanitary-epidemiological service immediately by telephone with a written notification (form 058/у) within 12 hours.

Vaccine cold chain: +2 to +8 °C for most vaccines; freeze-sensitive vaccines (DTP, hepatitis B) must never be frozen.

Herd immunity thresholds: measles ~95%, diphtheria ~95%, polio ~90%, influenza variable (often 40–60%).

Live vaccines are contraindicated in severe immunodeficiency, pregnancy and with recent immunoglobulin; inactivated vaccines are safe in immunocompromised patients.

Post-exposure prophylaxis for rabies: wound washing, rabies vaccine on days 0, 3, 7, 14, 28; rabies immunoglobulin for category III exposures.

Tuberculosis diagnosis: sputum microscopy, culture, and molecular testing (GeneXpert); latent TB is treated with isoniazid-based regimens.

Acute viral hepatitis B: HBsAg, anti-HBc IgM, HBeAg; chronic hepatitis B defined by HBsAg >6 months with HBV DNA and liver enzymes.

Epidemiological investigation of a case includes identifying contacts, incubation period, transmission route and disinfection measures.

Chest X-ray: PA view is standard; silhouette sign localises opacity to adjacent structure; air bronchograms suggest alveolar consolidation.

CT is first-line for acute stroke (exclude hemorrhage), pulmonary embolism (CTPA), renal colic (non-contrast CT) and major trauma.

MRI is preferred for soft-tissue and brain/spinal cord pathology; gadolinium contrast is avoided in severe renal impairment (eGFR <30).

ECG: normal PR 120–200 ms, QRS <120 ms, QT corrected by Bazett; ST elevation in contiguous leads localises infarction.

Echocardiography assesses ejection fraction, valve function, chamber size and pericardial effusion; EF <40% indicates reduced systolic function.

Complete blood count reference values (adults): Hb 130–160 g/L (men), WBC 4–9 ×10⁹/L, platelets 150–400 ×10⁹/L, ESR <15 mm/h (men).

Liver panel: ALT/AST, bilirubin, alkaline phosphatase, GGT, albumin and INR; elevated INR and low albumin indicate impaired synthetic function.

Spirometry: FEV1/FVC <0.70 after bronchodilator defines obstructive defect; reduced FVC with normal ratio suggests restriction.

Rehabilitation is staged: early (in acute setting), inpatient, outpatient and sanatorium-resort; goals are set by a multidisciplinary team with functional assessment.

Cardiac rehabilitation after MI includes early mobilisation, exercise training, risk-factor modification and psychological support; typically 3 phases.

Stroke rehabilitation should begin within 24–48 hours once medically stable; task-specific training and constraint-induced movement therapy improve outcomes.

Physical therapy modalities: therapeutic exercise, massage, electrotherapy, ultrasound, laser, magnetotherapy and hydrotherapy; each has specific indications and contraindications.

Balneology uses mineral waters, therapeutic muds (peloids) and climatic factors; contraindications include acute infection, decompensated heart failure and active malignancy.

Mineral water classification by mineralisation: low (<2 g/L), medium (2–15 g/L), high (15–35 g/L), brine (>35 g/L); temperature: cold <20 °C, warm 20–37 °C, hot >37 °C.

Rehabilitation outcome measures include Barthel index, modified Rankin scale, 6-minute walk test and goniometry for range of motion.

Contraindications to sanatorium-resort treatment: acute inflammatory disease, febrile states, uncontrolled hypertension, severe arrhythmia and psychiatric decompensation.

Four core principles: beneficence, non-maleficence, respect for autonomy and justice - guide clinical decisions and conflict resolution.

Informed consent requires disclosure of diagnosis, proposed intervention, risks, benefits and alternatives, plus voluntary decision without coercion.

Medical secrecy protects all information obtained in the course of care; disclosure requires patient consent or statutory exception.

Patient safety: identify patients by two identifiers, use surgical safety checklist (sign-in, time-out, sign-out), and apply hand-hygiene "five moments".

Medical errors should be reported through incident reporting systems; root-cause analysis identifies system failures rather than blaming individuals.

Communication ethics: truth-telling, empathy, confidentiality and avoidance of conflicts of interest; gifts and industry ties must be disclosed.

End-of-life care respects autonomy, advance directives and palliative principles; withholding futile treatment requires documented discussion.

Ethical review boards approve research involving human subjects; informed consent and risk-benefit assessment are mandatory.

Incidence rate = new cases in a period / population at risk × 1000; prevalence = all existing cases / total population × 1000.

Relative risk = incidence in exposed / incidence in unexposed; attributable risk = incidence in exposed − incidence in unexposed.

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

Outbreak investigation steps: verify diagnosis, define cases, describe by time/place/person, generate hypothesis, implement control, communicate.

Hand hygiene: alcohol-based rub for routine decontamination; soap and water when hands are visibly soiled or after C. difficile exposure.

Air disinfection and ventilation standards: operating theatres and clean rooms require controlled air exchange and positive pressure relative to corridors.

Drinking water quality parameters include microbiological (E. coli absent per 100 mL) and chemical (nitrates, heavy metals) standards.

Screening programme criteria: important disease, detectable preclinical phase, acceptable test, effective treatment, and cost-effective programme.