Israel Medical Licensing Exam cheat sheet

Acute coronary syndrome: ST-elevation MI mandates immediate reperfusion (primary PCI if available within 120 minutes of first medical contact, otherwise fibrinolysis); high-sensitivity troponin rises/falls with at least one value above the 99th percentile upper reference limit.

Heart failure with reduced ejection fraction (≤40%): quadruple therapy improves mortality - ARNI/ACE inhibitor/ARB, evidence-based beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.

Diabetic ketoacidosis: total body potassium is depleted despite normal or high serum potassium; hold insulin until K ≥3.3 mEq/L and add potassium to fluids once K <5.2 mEq/L.

Community-acquired pneumonia severity: CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30, blood pressure low, age ≥65) - 0-1 outpatient, 2 ward admission, ≥3 consider intensive care.

Hyponatremia: correct chronic hyponatremia by ≤8-10 mmol/L in 24 hours to avoid osmotic demyelination; hypertonic saline plus desmopressin for overcorrection.

Hyperkalemia with ECG changes: intravenous calcium gluconate stabilizes myocardium first, then insulin-glucose and beta-2 agonist shift potassium intracellularly; dialysis for refractory cases.

Nephrotic syndrome: proteinuria >3.5 g/day, albumin <3.0 g/dL, edema, hyperlipidemia; in adults the most common primary cause is membranous nephropathy, in children minimal change disease.

Pulmonary embolism: use age-adjusted D-dimer (age × 10 µg/L in patients >50) in low/intermediate pretest probability; hemodynamically unstable patients warrant systemic thrombolysis or embolectomy.

Acute appendicitis: Alvarado score components are migratory pain, anorexia, nausea/vomiting, right lower quadrant tenderness, rebound pain, fever, leukocytosis, and left shift; score ≤4 makes appendicitis unlikely.

Bowel obstruction: supine and upright abdominal films plus CT; nasogastric decompression, intravenous fluids, and correction of electrolytes are initial management; surgery for strangulation signs (fever, tachycardia, peritoneal signs, lactate rise).

Trauma primary survey follows ABCDE; in hemorrhagic shock, permissive hypotension (systolic ~80-90 mmHg) until hemorrhage control, and tranexamic acid within 3 hours of injury.

Acute cholecystitis: right upper quadrant ultrasound shows wall thickening >3 mm, pericholecystic fluid, and sonographic Murphy sign; early laparoscopic cholecystectomy within 72 hours is preferred.

Thyroidectomy complications: recurrent laryngeal nerve injury causes hoarseness, external branch of superior laryngeal nerve injury causes voice fatigue, and bilateral nerve injury causes stridor requiring immediate airway control.

Anastomotic leak after colorectal surgery typically presents on days 5-7 with tachycardia, fever, ileus, and rising CRP; CT with contrast and surgical re-exploration if peritonitis.

Breast cancer staging uses TNM; sentinel lymph node biopsy is standard for clinically node-negative invasive disease, and axillary dissection is reserved for clinically positive nodes or failed mapping.

Postoperative fever workup follows the timing rule: day 1-2 atelectasis, day 3-5 urinary tract infection or pneumonia, day 5-7 wound infection or anastomotic leak, day 7+ deep vein thrombosis or drug fever.

Neonatal resuscitation: initial steps are warmth, drying, stimulation, and clearing the airway; positive pressure ventilation starts at 21% oxygen for term infants and 21-30% for preterm <35 weeks, titrated by preductal SpO2.

Pediatric maintenance fluids use the Holliday-Segar method: 100 mL/kg/day for first 10 kg, 50 mL/kg/day for next 10 kg, 20 mL/kg/day thereafter.

Kawasaki disease: fever ≥5 days plus 4 of 5 criteria (conjunctivitis, oral changes, rash, extremity changes, cervical lymphadenopathy); treat with intravenous immunoglobulin 2 g/kg plus aspirin to prevent coronary aneurysms.

Intussusception: colicky pain, currant-jelly stool, sausage-shaped mass; air or contrast enema is both diagnostic and therapeutic if no peritonitis or perforation.

Croup (laryngotracheobronchitis): barking cough, inspiratory stridor, hoarseness; dexamethasone is first-line, nebulized epinephrine for moderate-severe stridor, and intubation is rarely needed.

Bronchiolitis: most common cause is respiratory syncytial virus; management is supportive with oxygen and hydration; bronchodilators, corticosteroids, and antibiotics are not routinely recommended.

Febrile seizures: simple febrile seizure lasts <15 minutes, is generalized, and occurs once in 24 hours; lumbar puncture is indicated if meningeal signs, age <6 months, or incomplete immunization.

Pediatric dehydration: use the Clinical Dehydration Scale; severe dehydration needs 20 mL/kg isotonic fluid boluses, and oral rehydration solution is preferred for mild-moderate dehydration.

Preeclampsia: new hypertension after 20 weeks plus proteinuria or end-organ dysfunction; severe features include blood pressure ≥160/110, platelets <100,000, transaminases >2× normal, creatinine >1.1 mg/dL, pulmonary edema, or visual/cerebral symptoms.

Magnesium sulfate is first-line for eclampsia prophylaxis and treatment; monitor deep tendon reflexes, respiratory rate, and urine output; calcium gluconate is the antidote for toxicity.

Postpartum hemorrhage: uterine atony is the most common cause; manage with uterine massage, oxytocin, then carboprost, misoprostol, or methylergonovine, and tranexamic acid within 3 hours.

Gestational diabetes screening: 50 g glucose challenge at 24-28 weeks; diagnosis with 100 g 3-hour test requires two or more elevated values; first-line therapy is medical nutrition and exercise.

Ectopic pregnancy: discriminatory human chorionic gonadotropin zone is 3,500 mIU/mL for transvaginal ultrasound; methotrexate is used if unruptured, hemodynamically stable, and hCG <5,000 mIU/mL.

Group B Streptococcus prophylaxis: intrapartum penicillin is indicated for prior infant with invasive disease, GBS bacteriuria, or positive culture at 36-37 weeks; clindamycin for penicillin allergy if susceptible.

Ovarian torsion: sudden unilateral pelvic pain with nausea and vomiting; ultrasound may show enlarged edematous ovary with decreased Doppler flow; detorsion and ovarian preservation are preferred.

Cervical cancer screening: start at age 21 with cytology every 3 years, or at age 30 with co-testing every 5 years; high-risk HPV types 16 and 18 account for most cases.

Major depressive disorder: diagnosis requires ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia; first-line treatment is psychotherapy, SSRI, or both.

Serotonin syndrome: triad of altered mental status, autonomic instability, and neuromuscular hyperactivity (clonus, hyperreflexia); stop serotonergic agents, give benzodiazepines, and cyproheptadine in severe cases.

Neuroleptic malignant syndrome: fever, rigidity, autonomic instability, and elevated creatine kinase after dopamine antagonists; stop the drug, provide supportive care, and use dantrolene or bromocriptine.

Bipolar disorder: manic episode requires elevated/irritable mood plus increased energy for ≥1 week with ≥3 symptoms; avoid antidepressant monotherapy because of switch risk; lithium remains first-line mood stabilizer.

Schizophrenia: diagnosis requires ≥2 of delusions, hallucinations, disorganized speech, grossly disorganized behavior, or negative symptoms for ≥6 months; first-line antipsychotics are second-generation agents.

Alcohol withdrawal: use the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar); benzodiazepines are first-line, and thiamine is given before glucose to prevent Wernicke encephalopathy.

Opioid use disorder: first-line pharmacotherapy is buprenorphine or methadone; naltrexone is an alternative after detoxification; naloxone reverses acute overdose.

Delirium: acute onset, fluctuating course, and inattention; the Confusion Assessment Method is a validated screening tool; treat the underlying cause and avoid physical restraints.

Hypertension: diagnose with ≥2 readings ≥140/90 mmHg on separate occasions; first-line agents are thiazide diuretics, ACE inhibitors/ARBs, and calcium channel blockers; target <130/80 in most adults.

Type 2 diabetes: metformin is first-line unless contraindicated; add SGLT2 inhibitor or GLP-1 receptor agonist when atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease is present.

Hyperlipidemia: statin intensity is guided by 10-year atherosclerotic cardiovascular disease risk; high-intensity statin (atorvastatin 40-80 mg) for risk ≥20%, moderate intensity for 7.5-20%.

Screening: colorectal cancer from age 45-50, mammography every 2 years from age 50 (or 40 by some guidelines), cervical cancer from 21, and osteoporosis with bone density at age 65.

Asthma: classify by symptom frequency and forced expiratory volume; stepwise therapy uses inhaled corticosteroid-formoterol as preferred reliever and controller; short-acting beta-agonist alone is no longer preferred.

Acute otitis media: observation is appropriate for children ≥2 years with mild symptoms; antibiotics (amoxicillin) for severe symptoms, age <2 years, or bilateral infection.

Smoking cessation: varenicline, bupropion, and nicotine replacement are first-line; combine behavioral counseling with pharmacotherapy for the highest quit rates.

Low back pain: red flags include fever, weight loss, night pain, neurological deficits, and history of cancer; imaging is not indicated in the absence of red flags within the first 6 weeks.

Acute ischemic stroke: intravenous alteplase is indicated within 4.5 hours of symptom onset; mechanical thrombectomy for large vessel occlusion up to 24 hours in selected patients; noncontrast CT excludes hemorrhage.

Stroke localization: middle cerebral artery infarction causes contralateral hemiparesis and aphasia (dominant) or neglect (nondominant); posterior circulation causes vertigo, diplopia, ataxia, and crossed findings.

Multiple sclerosis: diagnosis uses McDonald criteria requiring dissemination in space and time; typical findings are periventricular, juxtacortical, infratentorial, and spinal cord lesions; oligoclonal bands in cerebrospinal fluid support diagnosis.

Status epilepticus: defined as seizure >5 minutes or repeated seizures without recovery; first-line is benzodiazepines (lorazepam or midazolam), then second-line phenytoin, valproate, or levetiracetam.

Myasthenia gravis: fatigable weakness, ptosis, and diplopia; anti-acetylcholine receptor antibodies are diagnostic; edrophonium test is historical; treat with pyridostigmine and immunotherapy.

Guillain-Barré syndrome: ascending symmetric weakness with areflexia and albuminocytologic dissociation in cerebrospinal fluid; monitor vital capacity and treat with intravenous immunoglobulin or plasma exchange.

Parkinson disease: resting tremor, bradykinesia, rigidity, and postural instability; levodopa-carbidopa is most effective; dopamine agonists are used in younger patients to delay motor complications.

Migraine: unilateral throbbing headache with nausea, photophobia, and phonophobia; triptans are acute treatment, and preventive options include beta-blockers, topiramate, and CGRP monoclonal antibodies.

Rapid sequence intubation: pretreatment, induction with an induction agent, and paralysis with succinylcholine or rocuronium; cricoid pressure is no longer routinely recommended.

Sepsis: use the Sepsis-3 definition of suspected infection plus Sequential Organ Failure Assessment increase ≥2; give broad-spectrum antibiotics within 1 hour and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Acute respiratory distress syndrome: Berlin criteria require acute onset within 1 week, bilateral opacities not fully explained by heart failure, and PaO2/FiO2 ≤300 mmHg on positive end-expiratory pressure ≥5 cmH2O; use low tidal volume 6 mL/kg predicted body weight.

Anesthesia machine check: verify oxygen supply, vaporizers, breathing circuit, suction, and airway equipment; the mnemonic is MS MAID (machine, suction, monitors, airway, intravenous access, drugs).

Malignant hyperthermia: triggered by volatile anesthetics and succinylcholine; signs are rising end-tidal CO2, rigidity, hyperthermia, and acidosis; treat with dantrolene and stop triggering agents.

Local anesthetic systemic toxicity: stop injection, secure airway, give 20% lipid emulsion, and avoid vasopressin, calcium channel blockers, beta-blockers, and local anesthetics.

Ventilator weaning: perform a spontaneous breathing trial with pressure support or T-piece for 30-120 minutes; extubate if the rapid shallow breathing index is <105 breaths/min/L and the patient is awake and cooperative.

Central line-associated bloodstream infection prevention: use a checklist with hand hygiene, maximal sterile barrier, chlorhexidine skin antisepsis, optimal site selection, and daily review of line necessity.

Incidence measures new cases per population at risk per unit time; prevalence measures all existing cases at a point in time; prevalence ≈ incidence × duration for stable diseases.

Relative risk = incidence in exposed / incidence in unexposed; attributable risk = incidence in exposed − incidence in unexposed; odds ratio approximates relative risk when the disease is rare.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); positive predictive value depends on prevalence.

Screening test criteria: important disease, accepted treatment, detectable preclinical phase, suitable test with acceptable sensitivity and specificity, and cost-effective program.

Randomized controlled trial: randomization reduces confounding; intention-to-treat analysis preserves the prognostic balance; blinding reduces observer and reporting bias.

Outbreak investigation steps: verify diagnosis, define cases, describe by time/place/person, generate hypotheses, conduct analytic studies, implement control, and communicate findings.

Herd immunity threshold = 1 − 1/R0; for measles R0 is 12-18, requiring roughly 92-95% coverage; for influenza R0 ~1.3, threshold is around 25%.

Levels of prevention: primary (prevent disease), secondary (early detection and treatment), tertiary (reduce disability and complications), and quaternary (avoid overmedicalization).

Informed consent requires capacity, disclosure of material risks and alternatives, understanding, and voluntariness; documentation should reflect the discussion, not only a signature.

Capacity assessment evaluates understanding, appreciation, reasoning, and expression of choice; capacity is decision-specific, and a patient with capacity may refuse treatment even if the decision seems unwise.

Confidentiality may be breached only when required by law or when there is a serious and imminent risk to the patient or others; disclose the minimum necessary information.

Minors: in Israel, the Age of Legal Capacity Law generally sets full civil capacity at 18; adolescents may consent to certain medical treatments at 16 under specific provisions, and parental consent applies otherwise.

End-of-life care: the Dying Patient Law in Israel governs terminal patients and allows withholding or withdrawing certain treatments while prohibiting active euthanasia and physician-assisted suicide.

Organ donation in Israel follows the brain-death determination under the Brain-Respiratory Death Law; consent is obtained from the family, and a national transplant law regulates allocation.

Medical error disclosure: patients should receive an honest explanation of what happened, an apology, and information about consequences and prevention; disclosure is both an ethical and legal expectation.

Research ethics: the Declaration of Helsinki and local Helsinki committees require independent review, informed consent, proportionality of risk, and protection of vulnerable populations.