Iran Medical Residency Entrance Exam cheat sheet

Acute MI: ST elevation in ≥2 contiguous leads (or new LBBB with symptoms) = STEMI; door-to-balloon target ≤90 min at PCI center.

Community-acquired pneumonia severity: CURB-65 (Confusion, Urea >7 mmol/L, RR ≥30, SBP <90 or DBP ≤60, age ≥65); ≥2 points suggests inpatient care.

Diabetic ketoacidosis: anion gap = Na − (Cl + HCO3); target resolution is gap ≤12 with pH >7.3, not merely glucose normalization.

Hyponatremia: correct ≤8–10 mmol/L in 24 h to avoid osmotic demyelination; symptomatic seizures warrant 3% saline bolus.

Nephrotic syndrome: proteinuria >3.5 g/day, albumin <3.0 g/dL, edema, hyperlipidemia; biopsy indicated in adults.

Hyperkalemia with ECG changes: IV calcium gluconate first (membrane stabilization), then insulin/glucose, then elimination.

Anemia workup: MCV <80 = microcytic (iron, thalassemia, chronic disease); MCV >100 = macrocytic (B12, folate, alcohol, hypothyroid).

Cirrhosis ascites first-line: spironolactone + furosemide; diagnostic paracentesis if new ascites, and SAAG ≥1.1 g/dL indicates portal hypertension.

Acute appendicitis: migration of pain to right lower quadrant with McBurney point tenderness; Alvarado score ≥7 supports operative management.

Acute cholecystitis: RUQ pain, Murphy sign, ultrasound wall thickening >3 mm; early laparoscopic cholecystectomy within 72 h is preferred.

Bowel obstruction: air-fluid levels on upright film; if strangulation suspected (fever, tachycardia, peritoneal signs, lactate rise) → urgent laparotomy.

Trauma: ATLS sequence is primary survey ABCDE; FAST examines pericardial, perihepatic, perisplenic, and pelvic windows.

Burn resuscitation: Parkland formula 4 mL × kg × %TBSA lactated Ringer over 24 h, half in first 8 h from burn time.

Hernia: indirect inguinal passes lateral to inferior epigastric vessels through deep ring; direct passes medial through Hesselbach triangle.

Thyroidectomy complication timing: hematoma hours (airway emergency), recurrent laryngeal nerve injury immediate hoarseness, hypocalcemia 24–72 h.

Postoperative fever timeline: day 1–2 atelectasis, day 3–5 urinary/line infection, day 5–7 wound infection, day 7+ abscess or drug fever.

Neonatal jaundice: phototherapy threshold depends on age in hours, gestational age, and risk factors; exchange transfusion if signs of bilirubin encephalopathy.

Pediatric dehydration: WHO ORS for some/mild dehydration; severe dehydration → IV Ringer 100 mL/kg (infants: 30 mL/kg in 1 h then 70 mL/kg over 5 h).

Kawasaki disease: fever ≥5 days plus 4 of 5 (conjunctivitis, mucosal changes, rash, extremity changes, cervical adenopathy); treat with IVIG 2 g/kg + aspirin.

Febrile seizure: simple = generalized, <15 min, once in 24 h, age 6 months–5 years; no routine EEG or neuroimaging.

Growth: expected height at age 2 doubles birth length; weight quadruples birth weight by age 2.

Croup: barking cough with inspiratory stridor; dexamethasone 0.15–0.6 mg/kg single dose; nebulized epinephrine for moderate-severe.

Intussusception: colicky pain, currant-jelly stool, sausage-shaped mass; air or contrast enema is diagnostic and therapeutic.

Pediatric dosing: maintenance fluids by Holliday-Segar 4-2-1 rule (4 mL/kg/h first 10 kg, 2 next 10 kg, 1 mL/kg/h thereafter).

Preeclampsia: BP ≥140/90 after 20 weeks plus proteinuria or end-organ dysfunction; delivery is the only cure, timing by gestational age and severity.

Eclampsia: magnesium sulfate 4–6 g IV loading then 1–2 g/h; monitor reflexes, respiratory rate, urine output for toxicity.

Postpartum hemorrhage: uterine atony is most common cause; stepwise uterotonics (oxytocin, methylergonovine, carboprost, misoprostol) then balloon/surgery.

Gestational diabetes screening: 50 g glucose challenge at 24–28 weeks; diagnostic 100 g 3-hour OGTT using Carpenter-Coustan or NDDG criteria.

Ectopic pregnancy: discriminatory hCG zone ~3,500 mIU/mL for transvaginal ultrasound; unstable patient → surgery, not methotrexate.

Fetal heart rate: category III = absent variability with recurrent late/variable decelerations or bradycardia; requires immediate intervention.

Rh prophylaxis: anti-D 300 µg at 28 weeks and within 72 h postpartum if infant Rh-positive and mother unsensitized.

Cervical cancer screening: start at 21; cytology every 3 years or co-testing every 5 years from 30; stop at 65 with adequate prior negative screening.

Major depressive episode: ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia; psychosis or suicidality changes management.

Serotonin syndrome: clonus, hyperreflexia, agitation, hyperthermia after serotonergic agents; stop offending drug, supportive care, cyproheptadine in severe cases.

Neuroleptic malignant syndrome: rigidity, fever, autonomic instability, elevated CK after dopamine antagonists; stop drug, dantrolene or bromocriptine.

Bipolar I mania: elevated mood plus ≥3 of grandiosity, decreased sleep, pressured speech, flight of ideas, distractibility, increased activity, risky behavior for ≥1 week.

Alcohol withdrawal: CIWA-Ar guides treatment; benzodiazepines are first line; thiamine before glucose to prevent Wernicke encephalopathy.

First-line OCD: SSRIs at higher doses plus CBT with exposure and response prevention.

Schizophrenia: positive symptoms respond to dopamine D2 blockade; clozapine for treatment-resistant cases with mandatory ANC monitoring.

Lithium toxicity: tremor, ataxia, confusion, vomiting; levels >1.5 mmol/L concerning; hemodialysis for severe toxicity.

Anatomy: femoral triangle borders are inguinal ligament (superior), sartorius (lateral), adductor longus (medial); contents NAVEL from lateral to medial.

Physiology: Frank-Starling states stroke volume rises with end-diastolic volume; oxygen delivery = cardiac output × arterial O2 content.

Pathology: Virchow triad for thrombosis = endothelial injury, stasis/turbulence, hypercoagulability.

Pharmacology: zero-order kinetics (phenytoin, ethanol, aspirin high dose) = constant amount eliminated per time regardless of concentration.

Biochemistry: rate-limiting enzyme of glycolysis is phosphofructokinase-1, activated by AMP and fructose-2,6-bisphosphate, inhibited by ATP and citrate.

Microbiology: Gram-positive cocci in clusters with coagulase positivity = Staphylococcus aureus; in chains = Streptococcus.

Immunology: type I hypersensitivity is IgE-mediated mast cell degranulation; type IV is T-cell mediated and delayed (e.g., contact dermatitis).

Pharmacology: aminoglycosides are bactericidal via 30S inhibition but nephro/ototoxic; monitor levels in renal impairment.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); positive predictive value depends on prevalence.

Incidence measures new cases per population at risk per time; prevalence = incidence × average duration.

Relative risk is used in cohort studies; odds ratio approximates RR in case-control studies and for rare diseases.

Herd immunity threshold ≈ 1 − 1/R0; measles R0 high (12–18), requiring ~92–95% coverage.

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

Randomized controlled trial reduces confounding by randomization and selection bias by concealment; blinding reduces observer bias.

Levels of prevention: primordial (risk factor reduction), primary (pre-disease), secondary (early detection), tertiary (disability limitation).

Confidence interval: 95% CI excluding the null value (1 for ratios, 0 for differences) corresponds to p < 0.05.

Four principles: autonomy, beneficence, non-maleficence, justice; autonomy governs informed consent in competent adults.

Informed consent elements: capacity, disclosure of material risks/benefits/alternatives, comprehension, voluntariness, and documentation.

Confidentiality may be breached only when legally mandated (reportable diseases, imminent harm to identifiable person, court order).

Decision-making capacity requires understanding, appreciation, reasoning, and ability to express a choice; it is decision-specific.

Minors: assent from the child plus consent from parent/guardian; emancipated minors and specific conditions (e.g., STI care) vary by law.

Conflict of interest: disclose financial or personal interests; recusal from decisions where impartiality is compromised.

Research ethics: IRB approval, informed consent, risk minimization, equitable subject selection, and post-trial access considerations.

End-of-life: advance directives and durable power of attorney for healthcare take precedence over family preference when valid.

Medical malpractice requires four elements: duty, breach of standard of care, causation, and damages.

Standard of care is what a reasonably competent practitioner in the same specialty would do under similar circumstances.

Documentation is the legal record; alterations must be dated and signed, never obliterated, as records may be subpoenaed.

Reportable conditions typically include communicable diseases, child/elder abuse, gunshot wounds, and certain occupational diseases per national law.

Prescription regulations: controlled substances require valid license, patient identification, and quantity/dose limits per national schedule.

Good Samaritan protections generally apply to emergency aid rendered without expectation of compensation, subject to jurisdictional limits.

Medical records retention and patient access rights are set by national regulation; patients generally may obtain copies of their records.

Professional licensing: practicing outside licensed scope or with expired registration is an offense independent of patient harm.

Adult cardiac arrest: high-quality CPR 100–120/min, depth 5–6 cm, full recoil, minimize interruptions; defibrillate VF/pVT immediately.

Anaphylaxis: IM epinephrine 0.3–0.5 mg (1:1000) into anterolateral thigh, repeat every 5–15 min; adjuncts (antihistamine, steroid) are secondary.

Tension pneumothorax: clinical diagnosis (hypotension, distended neck veins, absent breath sounds, tracheal deviation) → immediate needle decompression.

Stroke: thrombolysis window up to 4.5 h from last known well; thrombectomy up to 24 h in selected large-vessel occlusion.

Sepsis bundle: measure lactate, blood cultures before antibiotics, broad-spectrum antibiotics within 1 h of recognition, 30 mL/kg crystalloid for hypotension or lactate ≥4.

Opioid overdose: naloxone titrated to respiratory effort; observe for re-narcotization due to shorter half-life.

Status epilepticus: benzodiazepine first (lorazepam 0.1 mg/kg or midazolam IM), then second-line (levetiracetam, phenytoin, valproate).

Anion gap metabolic acidosis with high osmolal gap: consider toxic alcohol (methanol, ethylene glycol); treat with fomepizole and dialysis.

Medical reading: identify the study design, population, intervention, comparator, outcome, and limitation before answering inference items.

Signal words: 'however', 'although', 'unless', and 'except' invert or restrict the expected meaning; mark them before choosing.

Hedging vocabulary: 'may', 'suggests', 'is associated with' do not assert causation; 'proves' and 'causes' are stronger claims.

Common confusions: 'incidence' (new cases) vs 'prevalence' (existing cases); 'efficacy' (trial conditions) vs 'effectiveness' (real world).

Prefixes/suffixes: brady- slow, tachy- fast, -itis inflammation, -ectomy removal, -ostomy creation of opening, -penia deficiency.

Passive voice items: locate the agent by 'by' phrase; the grammatical subject may not be the actor performing the action.

Cloze and paraphrase items: choose the option preserving both meaning and register, not merely a synonym with different connotation.

Time management: answer direct vocabulary/grammar items first, reserve longer inference passages for later in the section.