HKMLE Part III cheat sheet

Hong Kong medical registration: full registration requires an acceptable primary qualification plus internship and licensure; limited registration is time- and scope-bound, and the Licensing Examination (Part I professional knowledge, Part II English, Part III clinical) is the route for non-exempt candidates.

Resuscitation standard: high-quality CPR at 100–120 compressions/min, depth 5–6 cm in adults, full recoil, minimal interruptions (<10 s), compression:ventilation 30:2 without an advanced airway, and early defibrillation for shockable rhythms (VF/pulseless VT).

Sepsis: suspect when infection plus organ dysfunction (qSOFA ≥2 or NEWS escalation); give broad-spectrum antibiotics within 1 hour of recognition in septic shock and measure lactate; fluid resuscitation 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Acute coronary syndrome: ST-elevation on ECG mandates reperfusion - primary PCI within 90 minutes of first medical contact where achievable, otherwise fibrinolysis within 30 minutes of arrival if no contraindication; give aspirin and a P2Y12 inhibitor unless contraindicated.

Stroke: non-contrast CT excludes haemorrhage before thrombolysis; intravenous alteplase is licensed within 4.5 hours of symptom onset, with door-to-needle target ≤60 minutes; thrombectomy consideration extends to selected large-vessel occlusions up to 24 hours.

Hypoglycaemia in a conscious patient: 15–20 g fast-acting oral carbohydrate, recheck glucose after 15 minutes, repeat if still <4 mmol/L, then a longer-acting carbohydrate; in an unconscious patient give IV glucose or IM glucagon.

Paediatric fluid and drug dosing is weight-based (mL/kg, mg/kg); use a length-based tape or estimated weight formula only when weighing is impossible, since dosing errors are a leading source of harm.

Antimicrobial stewardship: take cultures before antibiotics when this does not delay therapy, review at 48–72 hours with culture results, and narrow or stop agents based on clinical response and local resistance patterns.

Consent: valid consent requires capacity, adequate information on material risks and alternatives, and voluntariness; a competent adult's refusal must be respected, and treatment of a patient lacking capacity follows the best-interests framework under Hong Kong's Mental Health Ordinance and common law.

High-alert medications requiring independent double-check: insulin, heparin and other anticoagulants, concentrated potassium chloride, chemotherapy, and opioids; never give undiluted potassium chloride by IV push.

Warfarin is monitored by INR; target is usually 2.0–3.0 for most indications and 2.5–3.5 for mechanical mitral valves; major bleeding risk rises steeply above INR 5, and reversal uses vitamin K with prothrombin complex concentrate in serious bleeding.

Paracetamol overdose: the Rumack–Matthew nomogram guides N-acetylcysteine treatment, which is most effective within 8 hours of ingestion; assess with timed serum level, and treat empirically if timing is uncertain or the level is above the treatment line.

Digoxin toxicity features nausea, visual disturbance (yellow-green halation), bradyarrhythmias and hyperkalaemia; risk is increased by hypokalaemia, renal impairment and interacting drugs such as amiodarone and verapamil.

Opioid safety: co-prescribe naloxone where overdose risk is high, avoid combining with benzodiazepines, and reassess sedation and respiratory rate after dose changes rather than relying on pain scores alone.

Breaking bad news: use a structured framework (setting, perception, invitation, knowledge, empathy, strategy), give information in small chunks, check understanding, and avoid false reassurance; document what was discussed and with whom.

Medical records: contemporaneous, dated, signed entries; record decisions and the reasoning behind them, including capacity assessments and discussions of risk; late entries must be clearly marked as such.

Error disclosure: an adverse event should be explained to the patient openly and promptly, with an apology and an explanation of what happens next; this is a professional duty distinct from any liability question.

Infection control: perform hand hygiene per the WHO five moments, use standard precautions for all patients, and add transmission-based precautions (contact, droplet, airborne) according to the suspected organism.

Interpreting a test: sensitivity = TP/(TP+FN), specificity = TN/(TN+FP); a highly sensitive test is useful to rule out disease (negative result reassuring), a highly specific test to rule it in.

Positive predictive value depends on prevalence, so a positive result in a low-prevalence population may still be a false positive; likelihood ratios are prevalence-independent and summarise test performance.

Arterial blood gas stepwise: assess pH (acidaemia vs alkalaemia), then PaCO2 (respiratory component), then bicarbonate/base excess (metabolic component), then check compensation and calculate the anion gap (Na − [Cl + HCO3], normal 8–12 mmol/L).

Hyponatraemia: check serum osmolality and urine osmolality/sodium first; correct chronic hyponatraemia slowly (generally ≤8–10 mmol/L in 24 hours) to avoid osmotic demyelination, and treat symptomatic severe cases with hypertonic saline.

Hyperkalaemia with ECG changes (peaked T waves, widened QRS, sine wave) is an emergency: give IV calcium for cardiac protection, shift potassium intracellularly with insulin-dextrose and salbutamol, then remove potassium from the body.

Acute kidney injury is staged by creatinine rise and urine output (KDIGO); distinguish pre-renal, renal and post-renal causes, review nephrotoxins, and look for obstruction with bladder scan or ultrasound.

Chest pain risk stratification uses history, ECG and troponin; a single early troponin does not exclude acute coronary syndrome, and serial sampling with a validated pathway is required.

Antibiotic choice is empirical first and targeted later: consider likely organisms by site, local resistance data, allergy history, renal/hepatic dose adjustment, and source control (drainage, debridement, catheter removal).

Clinical handover uses a structured format (SBAR or ISBAR) covering situation, background, assessment, recommendation, with explicit read-back of critical results and escalation criteria.