HKMLE Part II cheat sheet

Medical Knowledge and Clinical Practice (HKMLE Part II)

• Acute coronary syndrome: STEMI requires immediate reperfusion (primary PCI within 90 min of first medical contact, or fibrinolysis within 30 min if PCI unavailable). Troponin is the preferred biomarker; ECG should be performed within 10 min of arrival.

• Stroke thrombolysis: IV alteplase is licensed for ischaemic stroke within 4.5 h of symptom onset after excluding haemorrhage by CT; door-to-needle time target ≤60 min. Blood pressure must be <185/110 mmHg before thrombolysis.

• Diabetic ketoacidosis: diagnostic triad of hyperglycaemia (>13.9 mmol/L), ketonaemia/ketonuria, and metabolic acidosis (pH <7.3 or bicarbonate <18 mmol/L). Initial management is IV 0.9% saline, potassium replacement, and fixed-rate IV insulin (0.1 units/kg/h); bicarbonate is rarely indicated.

• Community-acquired pneumonia severity: CURB-65 score (Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min, Blood pressure systolic <90 or diastolic ≤60 mmHg, age ≥65) guides admission; score 0–1 = outpatient, 2 = consider admission, ≥3 = severe, consider ICU.

• Hyponatraemia: assess volume status and urine osmolality. In SIADH, urine osmolality >100 mOsm/kg with euvolemia; treat with fluid restriction. Correct chronic hyponatraemia slowly (≤8–10 mmol/L in 24 h) to avoid osmotic demyelination.

• Paediatric dehydration: use WHO ORS for mild-moderate dehydration; give 50–100 mL/kg over 3–4 h with ongoing replacement. Signs of severe dehydration (lethargy, sunken eyes, skin pinch ≥2 s) require IV Ringer's lactate or normal saline boluses.

• Sepsis and septic shock: administer broad-spectrum antibiotics within 1 h of recognition; 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L; start vasopressors (noradrenaline first-line) if MAP <65 mmHg despite fluids.

• Asthma acute severe: inability to complete sentences, respiratory rate >25/min, heart rate >110/min, PEF 33–50% predicted. Life-threatening features include silent chest, cyanosis, poor respiratory effort, bradycardia, and exhaustion. Treat with oxygen, repeated salbutamol, ipratropium, and systemic corticosteroids.

• Chronic kidney disease staging by eGFR (mL/min/1.73 m²): G1 ≥90, G2 60–89, G3a 45–59, G3b 30–44, G4 15–29, G5 <15. Albuminuria category A1 <3 mg/mmol, A2 3–30, A3 >30.