MCCQE Part I cheat sheet

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); a highly sensitive test is best for ruling out disease (negative result is informative).

Positive predictive value depends on prevalence: PPV = TP/(TP+FP); the same test has higher PPV in a high-prevalence population.

Likelihood ratio positive = sensitivity/(1 − specificity); LR > 10 markedly increases post-test probability, LR < 0.1 markedly decreases it.

Number needed to treat = 1/absolute risk reduction; NNT is calculated from the difference in event rates between control and treatment groups.

For a diagnosis, pretest probability determines the next step: very low probability may need no test; intermediate probability needs a discriminatory test; very high probability may justify empiric treatment.

Anion gap = Na − (Cl + HCO3); normal is roughly 8–12 mmol/L; elevated gap with metabolic acidosis suggests ketones, lactate, uremia, or toxins.

Corrected sodium for hyperglycemia: add 1.6 mmol/L to measured Na for every 5.5 mmol/L glucose above 5.5 mmol/L.

Winters formula for expected respiratory compensation of metabolic acidosis: expected PaCO2 = 1.5 × HCO3 + 8 ± 2.

Informed consent requires capacity, disclosure of material risks/benefits/alternatives, and voluntariness; a capable patient may refuse even life-saving treatment.

Patient-centred interviewing sequence: open-ended question, active listening, facilitation, then focused closed questions for precision.

The SPIKES framework for breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions/empathy, Strategy/summary.

Teach-back confirms comprehension: the clinician asks the patient to explain the plan in their own words; a correct restatement is the verification criterion.

Ask-tell-ask: elicit the patient's current understanding, provide information in small chunks, then check understanding before continuing.

Shared decision-making requires presenting options with their risks and benefits, exploring patient values, and agreeing on a plan; clinician alone deciding is not shared.

Use of a qualified medical interpreter (not a family member) is indicated when language barriers could affect clinical accuracy or consent.

Acknowledging emotion before giving information (naming the emotion) reduces anxiety and improves retention of the subsequent message.

Health literacy red flags include missed appointments, medication errors, and asking few questions; plain-language materials at roughly grade 6 reading level are recommended.

Closed-loop communication: sender gives order, receiver repeats it back, sender confirms; this reduces handover and medication errors.

SBAR handover structure: Situation, Background, Assessment, Recommendation.

Conflict resolution on a team follows a graded approach: address directly and privately first, then involve a team lead, then formal channels.

Role clarity reduces duplication: each team member's scope of practice (e.g., pharmacist medication review, nurse monitoring) should be explicitly stated.

Psychological safety - team members can raise concerns without fear - is associated with fewer adverse events and better error reporting.

Interprofessional rounds improve outcomes when each discipline contributes a structured assessment; the physician remains accountable for the overall medical plan.

When a colleague appears impaired or incompetent, the obligation is to protect patients first: intervene, escalate to the appropriate authority, and document.

Quality improvement uses the Plan-Do-Study-Act (PDSA) cycle; small tests of change are preferred over large untested redesigns.

A run chart or statistical process control chart distinguishes true improvement (special-cause variation) from random variation.

Choosing Wisely principles: avoid tests and treatments whose harm or cost exceeds benefit; deprescribing is an active stewardship step.

Resource allocation in a publicly funded system prioritizes need and expected benefit; individual advocacy must be balanced against population-level equity.

Root cause analysis examines system factors (not individual blame) after a critical incident; the goal is redesign to prevent recurrence.

Adverse events should be disclosed to patients; disclosure improves trust and is an ethical and often legal obligation.

Wait-time and access targets are managed by triage based on urgency; a first-come-first-served model is inappropriate for medically urgent cases.

A just culture distinguishes human error (console), at-risk behaviour (coach), and reckless behaviour (sanction).