COMLEX Level 1 cheat sheet

Somatic dysfunction is diagnosed by TART: Tissue texture change, Asymmetry of landmarks, Restriction of motion, and Tenderness; at least one element must be documented.

Fryette law I describes neutral, group curves of the thoracic and lumbar spine: sidebending precedes rotation, and the two are coupled to opposite sides.

Fryette law II describes a non-neutral single vertebral unit in which sidebending and rotation occur to the same side, most often in the lumbar spine.

HVLA is relatively contraindicated in severe osteoporosis, metastatic bone disease, acute fracture, joint instability, myelopathy, and vertebrobasilar insufficiency for cervical techniques.

Muscle energy technique uses a patient-generated isometric contraction against operator counterforce, exploiting post-isometric relaxation to lengthen a restricted muscle.

Counterstrain places the patient in the position of comfort that reduces the tender point for roughly 90 seconds, then returns slowly to neutral.

The five osteopathic models of patient care are biomechanical, respiratory-circulatory, neurological, behavioral, and metabolic-nutritional.

The primary respiratory mechanism comprises CNS motility, CSF fluctuation, dural tension, cranial bone mobility, and involuntary sacral motion; the cranial rhythmic impulse normally runs 10-14 cycles per minute.

Lymphatic technique mobilizes edema and improves immune flow; the thoracic duct empties at the junction of the left internal jugular and left subclavian veins.

The SOAP note organizes documentation into Subjective, Objective, Assessment, and Plan.

Order of draw: blood culture bottles first, then light blue (citrate), serum red/gold, green heparin, lavender EDTA, and gray fluoride-oxalate.

Lumbar puncture is performed at L3-L4 or L4-L5, at or below Tuffier's line through the iliac crests, which lies below the conus medullaris in adults.

Thoracentesis is entered one to two rib spaces below the upper fluid level, typically the 7th-8th intercostal space in the posterior midscapular line, passing just above the rib to avoid the neurovascular bundle.

Paracentesis is performed in the left lower quadrant, about 2 cm below the umbilicus and lateral to the rectus sheath, avoiding the inferior epigastric vessels.

Valid informed consent requires decisional capacity, disclosure of risks, benefits, and alternatives, voluntariness, and documentation.

Nonabsorbable sutures are removed at about 4-5 days on the face, 7-10 days on the scalp and trunk, and 10-14 days on the extremities.

Standard precautions treat all blood and body fluids as potentially infectious: gloves for contact, gown and mask for splash risk, and hand hygiene before and after every patient encounter.

Sensitivity = TP/(TP+FN); a highly sensitive test that is negative rules out disease (SnNout).

Specificity = TN/(TN+FP); a highly specific test that is positive rules in disease (SpPin).

PPV = TP/(TP+FP) and NPV = TN/(TN+FN); both change with disease prevalence, whereas sensitivity and specificity do not.

Positive likelihood ratio = sensitivity/(1 - specificity); an LR greater than 10 substantially increases post-test probability.

Absolute risk reduction = control event rate minus treatment event rate, and number needed to treat = 1/ARR.

Type I error (alpha) is rejecting a true null hypothesis; type II error (beta) is failing to reject a false null; power = 1 - beta.

Phase I trials establish safety and dosing, phase II assess efficacy and dose ranging, phase III compare with standard therapy in large randomized samples, and phase IV is post-marketing surveillance.

Relative risk is calculated in cohort studies and odds ratio in case-control studies; the odds ratio approximates relative risk only when the outcome is rare, under about 10%.

Incidence counts new cases per population at risk over time, while prevalence counts all existing cases at a point in time; prevalence approximates incidence multiplied by disease duration.

The PDSA (Plan-Do-Study-Act) cycle tests small changes iteratively and measures results before system-wide spread.

Evidence hierarchy from strongest: systematic reviews or meta-analyses of randomized trials, individual randomized trials, cohort studies, case-control studies, case series or reports, then expert opinion.

The five evidence-based medicine steps are assess the patient, ask a focused question, acquire the evidence, appraise it, and apply it with self-evaluation.

The PICO format frames a clinical question as Population, Intervention, Comparison, and Outcome.

Root cause analysis is a systems-based review after an adverse event that identifies process failures rather than assigning individual blame.

The six ACGME core competencies are patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.

SMART learning objectives are Specific, Measurable, Achievable, Relevant, and Time-bound.

Deliberate practice requires specific goals, immediate feedback, and repeated performance just beyond the learner's current ability level.

SPIKES structures delivery of bad news: Setting, Perception, Invitation, Knowledge, Empathy, and Strategy or Summary.

OARS micro-skills are Open-ended questions, Affirmations, Reflections, and Summaries.

Motivational interviewing rolls with resistance rather than confronting it, supporting patient autonomy and self-efficacy for behavior change.

NURSE statements respond to emotion: Naming, Understanding, Respecting, Supporting, and Exploring.

Teach-back asks the patient to restate the plan in their own words and detects limited health literacy better than asking whether they understand.

Use a trained medical interpreter rather than a family member for patients with limited English proficiency, and document the interpreter's identity.

Plain-language written materials should target roughly a 5th-6th grade reading level to match average US adult health literacy.

SBAR structures handoffs as Situation, Background, Assessment, and Recommendation.

Fiduciary duty requires the physician to place the patient's interests above self-interest, encompassing competence, confidentiality, and loyalty.

Financial and research conflicts of interest must be disclosed to patients, institutions, and journals, and managed or recused when material.

HIPAA permits disclosure without patient authorization for public health reporting, suspected abuse or neglect, imminent serious threat to an identifiable person, and court orders or subpoenas.

Informed refusal by a patient with decisional capacity must follow disclosure of risks and alternatives and should be documented in the record.

A physician impaired by substance use or illness should be referred to a physician health program; abrupt termination of care that abandons patients is never acceptable.

Sexual contact with a current patient is a boundary violation and is prohibited regardless of patient consent.

Medical errors that reach and harm patients should be disclosed promptly and fully, with apology, explanation, and a plan to prevent recurrence.

Core professional attributes include altruism, accountability, excellence, duty, honor and integrity, and respect for others.

The Institute of Medicine six aims describe care that is safe, effective, patient-centered, timely, efficient, and equitable.

Diagnosis-related group prospective payment pays hospitals a fixed amount per discharge by diagnosis, incentivizing shorter stays and lower cost per case.

Medicare Part A covers inpatient hospital care, Part B outpatient and physician services, Part C Medicare Advantage plans, and Part D outpatient prescription drugs.

HMOs use in-network primary care gatekeeping, PPOs allow out-of-network care at higher cost sharing, and POS plans blend the two models.

Medicare physician payment equals the sum of work, practice expense, and malpractice RVUs multiplied by the geographic practice cost index and a conversion factor.

A patient-centered medical home delivers coordinated, accessible, comprehensive primary care with emphasis on prevention and quality measurement.

Accountable care organizations share savings or losses with payers when they meet quality and total-cost benchmarks for an assigned population.

Never events such as wrong-site surgery or a retained foreign body are serious, largely preventable errors that payers do not reimburse.

A quality-adjusted life year weights survival by utility from 0 (death) to 1 (perfect health), and cost per QALY compares interventions across diseases.