HKMLE Part III flashcards

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

Sensitivity

The proportion of people with disease who test positive: true positives divided by true positives plus false negatives. A highly sensitive test is used to rule out disease when negative.

Specificity

The proportion of people without disease who test negative: true negatives divided by true negatives plus false positives. A highly specific test is used to rule in disease when positive.

Positive predictive value

The probability that a patient with a positive test truly has the disease. It depends on disease prevalence, so the same test performs better in high-prevalence populations.

Anion gap

Calculated as sodium minus the sum of chloride and bicarbonate, normally about 8 to 12 mmol/L. A raised gap suggests accumulation of unmeasured acids such as ketones, lactate or toxins.

High-quality CPR

Chest compressions at 100 to 120 per minute, 5 to 6 cm deep in adults, with full recoil, minimal pauses, and a compression-to-ventilation ratio of 30 to 2 before an advanced airway is placed.

Defibrillation in VF

For ventricular fibrillation or pulseless ventricular tachycardia, deliver an unsynchronised shock as early as possible and resume compressions immediately afterwards without pausing to check the rhythm.

Sepsis hour-one bundle

Measure lactate, take blood cultures, give broad-spectrum antibiotics and 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or more, all within one hour of recognition.

Primary PCI window

For ST-elevation myocardial infarction, reperfusion by primary percutaneous coronary intervention is targeted within 90 minutes of first medical contact, or within 120 minutes if transfer is required.

Door-to-needle time

The interval from hospital arrival to intravenous thrombolysis in ischaemic stroke, targeted at 60 minutes or less, with treatment licensed up to 4.5 hours after symptom onset.

Hypoglycaemia treatment

In a conscious patient give 15 to 20 g fast-acting oral carbohydrate and recheck glucose in 15 minutes. If unconscious, give intravenous glucose or intramuscular glucagon.

Hyperkalaemia emergency sequence

Give intravenous calcium first for cardiac membrane protection, then shift potassium intracellularly with insulin-dextrose and nebulised salbutamol, then remove potassium using binders or dialysis.

Hyponatraemia correction rate

Correct chronic hyponatraemia by no more than about 8 to 10 mmol/L in 24 hours, because faster correction risks osmotic demyelination; symptomatic severe cases need hypertonic saline.

AKI staging

KDIGO stages acute kidney injury by serum creatinine rise and urine output; stage 1 is a rise of 26 micromol/L or more, or urine output below 0.5 mL/kg/h for six hours.

Warfarin INR targets

Most indications target an INR of 2.0 to 3.0; a mechanical mitral valve targets 2.5 to 3.5. Serious bleeding with a raised INR is reversed with vitamin K and prothrombin complex concentrate.

Paracetamol overdose antidote

N-acetylcysteine is the antidote, most effective when started within eight hours of ingestion. The Rumack-Matthew nomogram guides treatment using a timed serum paracetamol level.

Digoxin toxicity features

Nausea, anorexia, visual disturbance such as yellow-green halation, bradyarrhythmias and hyperkalaemia. Hypokalaemia, renal impairment and interacting drugs such as amiodarone increase risk.

Potassium chloride safety

Concentrated potassium chloride is a high-alert medication: it must be diluted and given by controlled infusion, never by rapid intravenous push, because it can cause fatal arrhythmia.

Valid consent elements

Consent requires the patient to have capacity, to be given adequate information about material risks and alternatives, and to decide voluntarily. A competent adult's refusal must be respected.

Best interests framework

When an adult lacks capacity, treatment decisions are made in the patient's best interests, weighing benefits and burdens, previously expressed wishes, and the views of those close to them.

Breaking bad news framework

Use a structured approach: prepare the setting, explore what the patient knows, invite questions, give information in small chunks, respond with empathy, and agree a plan.

SBAR handover

A structured communication tool covering Situation, Background, Assessment and Recommendation, used for clinical handover and escalation, with read-back to confirm critical information.

Duty of candour

The professional obligation to tell a patient promptly and openly when they have suffered harm in their care, explaining what happened, apologising, and describing what will be done next.

WHO five moments

Hand hygiene is performed before touching a patient, before a clean procedure, after body fluid exposure risk, after touching a patient, and after touching the patient's surroundings.

Standard precautions

Measures applied to every patient regardless of diagnosis: hand hygiene, gloves, gowns, eye protection, safe sharps handling, and safe waste disposal, based on anticipated exposure to body fluids.

Airborne precautions

Used for suspected tuberculosis, measles and varicella: a negative-pressure room, fitted respirator mask for staff, and a surgical mask on the patient during transport.

Antimicrobial stewardship

Take cultures before antibiotics when this does not delay treatment, start empirical therapy, then review at 48 to 72 hours to narrow, change or stop agents based on results.

Limited registration

A form of Hong Kong medical registration limited in time and scope, typically tied to a specific institution or service, distinct from full registration and from the Licensing Examination route.

Licensing Examination structure

The Hong Kong Licensing Examination has three parts: Part I professional knowledge, Part II English language, and Part III clinical examination with practical and communication components.

Opioid co-prescribing risk

Combining opioids with benzodiazepines increases respiratory depression and overdose risk; co-prescribe naloxone where risk is high and reassess sedation and respiratory rate after dose changes.

Serial troponin testing

A single early troponin cannot exclude acute coronary syndrome; serial sampling with a validated pathway, interpreted alongside history and ECG, is required for safe risk stratification.

Paediatric weight-based dosing

Children's drug doses and fluid volumes are calculated per kilogram of measured weight; length-based tapes are a fallback only, because estimation errors can cause serious dosing harm.

Contemporaneous records

Clinical entries should be made at the time of the event or as soon as possible, dated, timed and signed, with any later addition clearly marked as a late entry.