HKMLE Part II flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

STEMI reperfusion window

Primary PCI is preferred if achievable within 90 minutes of first medical contact; otherwise fibrinolysis should be given within 30 minutes of arrival, provided no contraindications.

Door-to-needle time

Target time from hospital arrival to intravenous thrombolysis in ischaemic stroke is 60 minutes or less; CT must exclude intracranial haemorrhage before alteplase is given.

DKA diagnostic triad

Hyperglycaemia above 13.9 mmol/L, presence of ketones in blood or urine, and metabolic acidosis with pH below 7.3 or bicarbonate below 18 mmol/L define diabetic ketoacidosis.

CURB-65 components

Confusion, urea above 7 mmol/L, respiratory rate 30/min or more, systolic BP below 90 or diastolic 60 mmHg or less, and age 65 or older; score 3 or more suggests severe pneumonia.

SIADH urine osmolality

In syndrome of inappropriate antidiuretic hormone, urine osmolality exceeds 100 mOsm/kg and urine sodium is typically above 30 mmol/L despite low serum sodium and euvolemia.

Hyponatraemia correction limit

Chronic hyponatraemia should be corrected by no more than 8–10 mmol/L in the first 24 hours to reduce the risk of osmotic demyelination syndrome; rapid correction is reserved for symptomatic patients.

WHO ORS dehydration plan

For mild to moderate dehydration, give 50–100 mL/kg of oral rehydration solution over 3–4 hours, replacing ongoing losses; severe dehydration requires intravenous Ringer's lactate or normal saline.

Sepsis antibiotic timing

Broad-spectrum antibiotics should be administered within one hour of recognising sepsis or septic shock; each hour of delay is associated with increased mortality.

Septic shock fluid bolus

Give 30 mL/kg of intravenous crystalloid for hypotension or lactate 4 mmol/L or higher, then start noradrenaline if mean arterial pressure remains below 65 mmHg.

Acute severe asthma signs

Inability to complete sentences, respiratory rate above 25/min, heart rate above 110/min, and peak expiratory flow 33–50% of predicted indicate acute severe asthma needing oxygen and systemic steroids.

Life-threatening asthma features

Silent chest, cyanosis, poor respiratory effort, bradycardia, hypotension, exhaustion, and altered consciousness are life-threatening features requiring immediate resuscitation and intensive care referral.

CKD eGFR stages

G1 is eGFR 90 or above; G2 60–89; G3a 45–59; G3b 30–44; G4 15–29; G5 below 15 mL/min/1.73 m². Albuminuria category A3 is above 30 mg/mmol.

Hyperkalaemia ECG changes

Peaked T waves appear first, followed by flattened P waves, prolonged PR interval, and widened QRS. Severe hyperkalaemia can progress to sine wave pattern and ventricular fibrillation.

Hypoglycaemia treatment

Conscious patient: 15–20 g oral glucose, repeated after 15 minutes if needed. Unconscious: IV 10% glucose 150–200 mL or IM glucagon 1 mg, then a long-acting carbohydrate snack.

Anaphylaxis first-line drug

Intramuscular adrenaline 0.5 mg (0.5 mL of 1:1000) into the anterolateral thigh is first-line; repeat after 5 minutes if no improvement, along with oxygen, fluids, and antihistamines.

Meningococcal meningitis prophylaxis

Close contacts should receive ciprofloxacin 500 mg as a single oral dose or rifampicin for 2 days; healthcare workers without direct exposure to respiratory secretions do not require prophylaxis.

Tuberculosis isolation

Patients with suspected pulmonary TB should be placed in a negative-pressure room with airborne precautions until three sputum smears are negative or treatment is established.

Acute upper GI bleed

Resuscitate with crystalloid and blood products, start a proton pump inhibitor infusion, and perform endoscopy within 24 hours; variceal bleeding requires terlipressin and prophylactic antibiotics.

Paracetamol overdose antidote

N-acetylcysteine is given if the paracetamol level is above the treatment line on the Rumack-Matthew nomogram at 4 hours post-ingestion, or if ingestion time is unknown with abnormal liver enzymes.

Opioid overdose antidote

Naloxone 0.4–2 mg IV, repeated every 2–3 minutes as needed, reverses respiratory depression; its duration is shorter than most opioids, so observation for re-sedation is required.

Acute pancreatitis diagnosis

Diagnosis requires two of three: characteristic epigastric pain, serum lipase or amylase more than three times the upper limit of normal, and imaging findings on CT or MRI.

Glasgow Coma Scale

Eye opening (1–4), verbal response (1–5), and motor response (1–6) sum to 3–15; a score of 8 or less indicates severe coma and consideration of airway protection.

Paediatric febrile seizure

A seizure associated with fever in a child aged 6 months to 5 years without CNS infection; simple febrile seizures are generalised, last under 15 minutes, and do not recur within 24 hours.

Kawasaki disease criteria

Fever for 5 days or more plus four of: conjunctivitis, oral changes, cervical lymphadenopathy, rash, and extremity changes. Treat with IV immunoglobulin and aspirin to prevent coronary aneurysms.

Preeclampsia diagnosis

New hypertension after 20 weeks' gestation (≥140/90 mmHg) with proteinuria (≥300 mg/24 h) or maternal organ dysfunction; delivery is the definitive treatment, with magnesium sulphate for seizures.

Postpartum haemorrhage

Blood loss of 500 mL or more after vaginal delivery or 1000 mL or more after caesarean section; initial management includes uterine massage, oxytocin, and tranexamic acid within 3 hours.

Neonatal jaundice phototherapy

Phototherapy is indicated when bilirubin exceeds the treatment threshold for age in hours and risk factors; exchange transfusion is considered if levels approach the exchange line or signs of acute bilirubin encephalopathy appear.

Fracture immobilisation

Immobilise the joint above and below the fracture, assess neurovascular status distally before and after splinting, and provide analgesia; open fractures need antibiotics and surgical debridement.

Compartment syndrome signs

Pain out of proportion, pain on passive stretch, paraesthesia, pallor, and pulselessness (late) indicate compartment syndrome; immediate fasciotomy is required, and pulses are usually present initially.

Burn fluid resuscitation

Use the Parkland formula: 4 mL/kg/% total body surface area of Ringer's lactate in 24 hours, half in the first 8 hours from burn time; urine output target 0.5–1 mL/kg/h in adults.

Tension pneumothorax

Tracheal deviation away from the affected side, absent breath sounds, and hypotension require immediate needle decompression in the second intercostal space mid-clavicular line, followed by chest drain.

Hyperthyroidism treatment

Carbimazole or methimazole is first-line, with beta-blockers for symptom control; radioiodine is preferred for recurrent disease, and surgery is reserved for large goitres or compression.