HKMLE Part II key terms

The process of sorting patients by urgency of need so that limited resources go first to those who will benefit most and deteriorate soonest. In Hong Kong hospitals it is usually nurse-led using a five-category scale.

A structured sequence for assessing and treating a deteriorating patient: Airway, Breathing, Circulation, Disability, Exposure. Each step is treated before moving on, and the patient is reassessed after every intervention.

A numeric score derived from routine observations such as respiratory rate, oxygen saturation, blood pressure, pulse, temperature and consciousness. Rising scores trigger escalating clinical review and are used to track deterioration over time.

Life-threatening organ dysfunction caused by a dysregulated host response to infection. It is recognised by suspected infection plus a rise in a validated organ dysfunction score, and requires prompt cultures, antibiotics and fluid resuscitation.

Sepsis with persisting hypotension requiring vasopressors to maintain mean arterial pressure and a raised serum lactate despite adequate fluid resuscitation. Mortality is high, so source control and early critical care referral matter.

The average arterial pressure across the cardiac cycle, approximated as diastolic pressure plus one third of the pulse pressure. It is the perfusion target used when titrating vasopressors in shock.

Rapid administration of intravenous crystalloid to restore circulating volume in shock or severe dehydration, given as measured boluses with reassessment of pulse, blood pressure, perfusion and lung sounds after each bolus.

The spectrum of myocardial ischaemia from unstable angina through non-ST-elevation to ST-elevation myocardial infarction. Diagnosis combines history, serial troponin and ECG, and management is time-critical.

A cardiac muscle protein released into blood when myocytes are injured. High-sensitivity assays are used with serial sampling and the clinical picture, because raised values also occur in renal failure and other conditions.

Catheter-based reopening of a narrowed or blocked coronary artery, usually with balloon inflation and stent placement. In ST-elevation infarction it is the preferred reperfusion strategy when it can be delivered promptly.

Sudden focal neurological deficit due to vascular causes, either infarction or haemorrhage. Urgent brain imaging distinguishes the two, since thrombolysis is beneficial in ischaemia but harmful in haemorrhage.

Administration of a clot-dissolving drug to restore perfusion, used in ischaemic stroke within a defined time window and in selected myocardial infarction or pulmonary embolism cases. Bleeding risk must be assessed first.

A brief episode of focal neurological dysfunction caused by temporary cerebral ischaemia without infarction on imaging. It signals high short-term stroke risk and warrants urgent assessment and secondary prevention.

Abnormally low blood glucose, typically below 4 mmol/L, causing sweating, tremor, confusion, seizures or coma. It is corrected with oral glucose if the patient can swallow, otherwise intravenous glucose or glucagon.

A metabolic emergency of insulin deficiency with hyperglycaemia, ketonaemia and metabolic acidosis. Treatment is intravenous fluid, insulin infusion, potassium replacement and treatment of the precipitating cause.

The difference between measured serum cations and anions, calculated as sodium minus chloride and bicarbonate. A raised gap indicates accumulation of unmeasured acids such as ketones or lactate.

A 3-to-15 score summing eye opening, verbal response and motor response to assess level of consciousness. It is used for head injury and neurological monitoring and guides airway decisions.

A patient's voluntary agreement to examination or treatment after receiving adequate information about benefits, risks and alternatives. Valid consent requires capacity, sufficient disclosure and freedom from coercion.

The ability to make a particular decision at a particular time, judged by whether the person can understand, retain, weigh and communicate the relevant information. It is decision-specific, not global.

The standard used when an adult lacks capacity to decide, requiring a decision that considers the person's wishes, values and least restrictive option. In Hong Kong this is often supported by the Guardianship Board.

An infectious disease that doctors must report to the public health authority so that surveillance, contact tracing and control measures can be started. The statutory list and reporting timelines are set locally.

Identifying and following up people who may have been exposed to an infectious case, so they can be tested, quarantined or treated early. It is a core public health tool for containing outbreaks.

The interval between exposure to an infectious agent and the appearance of the first symptoms. It determines how long contacts are monitored and when isolation can safely end.

Coordinated efforts to use antibiotics and other antimicrobials appropriately: right indication, agent, dose and duration. It aims to improve outcomes while limiting resistance and healthcare-associated infection.

The concurrent use of multiple medicines, often defined as five or more regular drugs. It raises the risk of interactions and adverse events, so regular medication review and deprescribing are important.

A harmful or unintended response to a medicine given at normal doses. Suspected serious reactions should be documented and reported to the local pharmacovigilance scheme.

Measuring blood concentrations of drugs with a narrow therapeutic range, such as digoxin, lithium, phenytoin and aminoglycosides, to individualise dosing and avoid toxicity.

The proportion of people with a disease who test positive. A highly sensitive test is useful for ruling a condition out when the result is negative.

The proportion of people without a disease who test negative. A highly specific test is useful for confirming a diagnosis when the result is positive.

The probability that a person with a positive test result truly has the disease. It depends on disease prevalence as well as test sensitivity and specificity.

The number of patients who must receive an intervention for one additional patient to benefit, calculated as the reciprocal of the absolute risk reduction. Smaller values indicate greater clinical benefit.

A range of values within which the true effect is likely to lie, usually stated at 95 percent. Its width reflects precision, and inclusion of the null value indicates a non-significant result.

A study in which participants are randomly allocated to intervention or control groups. Randomisation balances known and unknown confounders, making it the strongest design for establishing causality.

A structured conversation, often using a stepwise framework, in which a clinician discloses a serious diagnosis. It requires preparation, clear language, checking understanding and responding to emotion.

The contemporaneous written account of a patient's history, findings, investigations, treatment and consent. It is a legal document that may be used in complaints, audits and medico-legal proceedings.