Clinical Officers Council Pre-Internship cheat sheet

Anaphylaxis: adrenaline 0.5 mg of 1:1000 solution IM into the mid-outer thigh, repeated every 5 minutes if needed, plus oxygen, IV fluids and corticosteroid.

DKA: 0.9% sodium chloride IV, insulin infusion 0.1 units/kg/hour, add 10% dextrose when glucose falls below 14 mmol/L, and replace potassium once K+ is below 5.5 mmol/L with adequate urine output.

Acute severe asthma: oxygen to keep SpO2 94-98%, repeated nebulised salbutamol with ipratropium, early systemic corticosteroid, and IV magnesium sulphate 2 g over 20 minutes for life-threatening features.

Hyperkalaemia with ECG changes: IV calcium gluconate 10 mL of 10% first for myocardial protection, then soluble insulin 10 units with 25 g glucose and nebulised salbutamol, then potassium removal.

Correct chronic hyponatraemia by no more than 8-10 mmol/L in the first 24 hours to avoid osmotic demyelination; hypertonic saline is reserved for seizures or coma.

New smear-positive pulmonary TB: 2 months of rifampicin, isoniazid, pyrazinamide and ethambutol, followed by 4 months of rifampicin and isoniazid.

Uncomplicated falciparum malaria: artemether-lumefantrine, six doses over 3 days taken with a fatty meal; severe malaria requires IV artesunate.

Heart failure with reduced ejection fraction: ACE inhibitor or ARB, beta-blocker, mineralocorticoid receptor antagonist and SGLT2 inhibitor each reduce mortality.

Ascites in cirrhosis: salt restriction with spironolactone 100 mg and furosemide 40 mg daily titrated together; large-volume paracentesis requires albumin replacement.

ATLS sequence: control catastrophic haemorrhage, then airway with cervical spine protection, breathing, circulation, disability and exposure.

Burns: Parkland formula 4 mL/kg per %TBSA of Ringer's lactate over 24 hours, half given in the first 8 hours from the time of injury; adult urine output target 0.5-1 mL/kg/hour.

Shock index = heart rate divided by systolic blood pressure; a value above 0.9 suggests significant occult blood loss.

Acute appendicitis is a clinical diagnosis; migration of pain to the right iliac fossa with rebound tenderness and leucocytosis supports operative management.

Small bowel obstruction: nil by mouth, nasogastric decompression, IV crystalloid and urine output monitoring; operate for strangulation, closed loop or failure to resolve.

After thyroidectomy, stridor suggests recurrent laryngeal nerve injury or haematoma, while perioral tingling and carpopedal spasm suggest hypocalcaemia.

Triple assessment of a breast lump: clinical examination, imaging (ultrasound under 40 years, mammography above 40) and tissue sampling.

Acute pancreatitis: aggressive IV fluid resuscitation, analgesia, antiemetics and early enteral nutrition; severity scored with modified Glasgow or APACHE II.

Testicular torsion is a surgical emergency; detorsion with bilateral orchidopexy within 6 hours offers the best chance of testicular salvage.

Eclampsia: magnesium sulphate 4 g IV plus 10 g IM loading dose, then 5 g IM every 4 hours; monitor respiratory rate, reflexes and urine output, with calcium gluconate as antidote.

Antepartum haemorrhage: resuscitate first; digital vaginal examination is contraindicated until placenta praevia has been excluded by ultrasound.

Postpartum haemorrhage: uterine atony is the commonest cause; uterine massage, oxytocin 10 IU IM, tranexamic acid 1 g IV within 3 hours, then misoprostol or balloon tamponade.

Pre-eclampsia is blood pressure of 140/90 mmHg or more with proteinuria or end-organ dysfunction after 20 weeks; delivery is the only definitive treatment.

Partograph: the active phase begins at 4 cm cervical dilatation, and the alert line corresponds to dilatation of 1 cm per hour.

Shoulder dystocia: call for help and perform the McRoberts manoeuvre first, then suprapubic pressure and internal rotation, considering the all-fours position.

Gestational diabetes screening uses a 75 g oral glucose tolerance test at 24-28 weeks; fasting 5.1, 1-hour 10.0 or 2-hour 8.5 mmol/L or above is diagnostic.

Prolonged second stage: more than 2 hours in a nullipara or 1 hour in a multipara without epidural, extended to 3 and 2 hours respectively with epidural analgesia.

Paediatric maintenance fluid (4-2-1 rule): 4 mL/kg/hour for the first 10 kg, plus 2 mL/kg/hour for the next 10 kg, plus 1 mL/kg/hour for each kilogram above 20.

Diarrhoea: oral rehydration salts plus zinc 20 mg daily (10 mg if under 6 months) for 10-14 days; antibiotics are reserved for cholera, dysentery or proven infection.

Severe acute malnutrition: stabilise with F-75, treat hypoglycaemia and hypothermia, give broad-spectrum antibiotics, and add iron only during rehabilitation.

Apgar score at 1 and 5 minutes grades colour, heart rate, reflex irritability, muscle tone and respiration 0-2 each; 7-10 is normal.

A febrile infant under 28 days requires a full septic screen and empirical IV antibiotics; fever in this age group is never assumed benign.

Neonatal resuscitation: provide initial steps for 60 seconds, then start positive pressure ventilation with air if the heart rate is below 100 beats per minute.

Kangaroo mother care for low birth weight infants combines continuous skin-to-skin contact, exclusive breastfeeding and early discharge to reduce mortality.

Croup: a single dose of dexamethasone 0.15-0.6 mg/kg, with nebulised adrenaline added when stridor is present at rest.

In Kenya, BCG and oral polio vaccine are given at birth, with the pentavalent series starting at 6 weeks.

Sensitivity = TP/(TP+FN) and specificity = TN/(TN+FP); positive predictive value varies with disease prevalence while sensitivity and specificity do not.

Herd immunity threshold is approximately 1 - 1/R0, for example about 95% for measles and 80-85% for poliomyelitis.

Maternal mortality ratio = maternal deaths per 100,000 live births; infant mortality rate = deaths under 1 year per 1,000 live births.

Primary prevention reduces exposure before disease occurs, secondary prevention detects disease early, and tertiary prevention limits disability and complications.

Most vaccines are kept in the cold chain at +2 to +8 degrees Celsius; freeze-sensitive products such as DPT and hepatitis B must never be frozen.

Attack rate = new cases among those exposed divided by total exposed, multiplied by 100, used during outbreak investigation.

Case fatality rate = deaths from a disease divided by diagnosed cases of that disease, multiplied by 100.

Screening is worthwhile when the disease is important, has a detectable preclinical phase, the test is acceptable, and early treatment improves outcome.

Open fracture: IV antibiotics within 1 hour, tetanus prophylaxis, wound cover, splinting and urgent surgical debridement with stabilisation.

Femoral shaft fracture can lose 1-2 litres of blood; treat as major trauma with IV fluids, blood transfusion and traction splinting.

Compartment syndrome: pain on passive stretch is the earliest sign while pulselessness is late; urgent fasciotomy is required and the limb should not be elevated above heart level.

Fat embolism syndrome occurs 24-72 hours after long bone fracture with hypoxia, confusion and petechiae; management is supportive oxygen therapy.

Colles fracture is a distal radius fracture with dorsal displacement, typically from a fall onto an outstretched hand.

Supracondylar humeral fracture in children risks brachial artery injury and median nerve palsy; pulses and nerve function must be documented.

Hip fracture in the elderly requires analgesia, immobilisation, thromboprophylaxis and surgery ideally within 48 hours.

The five Ps of limb vascular assessment are pain, pallor, pulselessness, paraesthesia and paralysis.

Moderate to severe depression: an SSRI combined with structured psychotherapy, with antidepressants continued for at least 6-12 months after remission.

Neuroleptic malignant syndrome: rigidity, hyperthermia, autonomic instability and raised creatine kinase; stop the antipsychotic, cool, hydrate and consider dantrolene or bromocriptine.

Serotonin syndrome: clonus, hyperreflexia, agitation and hyperthermia after serotonergic drugs; stop the agent and give benzodiazepines with supportive care.

Alcohol withdrawal: benzodiazepines are first line, and parenteral thiamine is given before or with glucose to prevent Wernicke encephalopathy.

Lithium therapeutic range is 0.6-1.0 mmol/L; monitor renal function, thyroid and calcium, and check levels after dose changes or dehydration.

Delirium is an acute fluctuating disturbance of attention and awareness, common in the elderly, treated by correcting the cause with non-pharmacological measures first.

Acute psychosis with agitation: attempt verbal de-escalation first, then use a short-acting IM antipsychotic or benzodiazepine rather than physical restraint alone.

Suicide risk is highest in the weeks after discharge and in those with previous attempts, hopelessness, social isolation or access to means.

Acute otitis media: amoxicillin is first line; recurrent disease with persistent effusion warrants ENT referral for tympanostomy.

Epistaxis: sit the patient upright and leaning forward, pinch the cartilaginous part of the nose for 10-15 minutes; if it persists, cauterise or pack the anterior nasal cavity.

Acute angle-closure glaucoma: painful red eye with fixed mid-dilated pupil and hazy cornea; give IV acetazolamide, topical timolol and pilocarpine with urgent ophthalmology referral.

Rinne test: air conduction exceeds bone conduction normally and in sensorineural loss; bone conduction exceeds air conduction in conductive loss. Weber lateralises to the affected ear in conductive loss.

Trachoma control uses the WHO SAFE strategy: Surgery for trichiasis, Antibiotics, Facial cleanliness and Environmental improvement.

Orbital cellulitis presents with proptosis, ophthalmoplegia, pain on eye movement and fever, and requires IV antibiotics with urgent imaging.

Cataract is the leading cause of reversible blindness worldwide, and surgery is the only effective treatment.

Benign paroxysmal positional vertigo gives brief positional vertigo with a positive Dix-Hallpike test and responds to the Epley repositioning manoeuvre.

Tonsillectomy is indicated for recurrent tonsillitis such as 7 documented episodes in 1 year, or for obstructive sleep apnoea.

Scabies: permethrin 5% cream from the neck down, repeated after 7 days, with simultaneous treatment of all household contacts and hot washing of bedding and clothing.

Leprosy: rifampicin, dapsone and clofazimine for multibacillary disease; rifampicin, ofloxacin and minocycline are used for paucibacillary disease.

Stevens-Johnson syndrome involves less than 10% body surface area of epidermal detachment, while toxic epidermal necrolysis involves more than 30%.

Tinea capitis requires oral griseofulvin or terbinafine because topical agents do not penetrate the infected hair follicle.

Psoriasis: well-demarcated plaques with silvery scale on extensor surfaces; first-line treatment is a topical corticosteroid combined with a vitamin D analogue.

Erythema nodosum presents as tender red nodules on the shins and is associated with streptococcal infection, tuberculosis, sarcoidosis and inflammatory bowel disease.

Melanoma assessment uses ABCDE: Asymmetry, Border irregularity, Colour variation, Diameter over 6 mm and Evolution.

Atopic eczema: emollients are the mainstay, topical corticosteroids control flares, and secondary bacterial infection needs an antibiotic.

Adult CPR: compressions at 100-120 per minute to a depth of 5-6 cm with a ratio of 30:2 and minimal interruptions; defibrillate ventricular fibrillation and pulseless VT as early as possible.

Glasgow Coma Scale: eye 4, verbal 5, motor 6, total 3-15; a score of 8 or less indicates an unprotected airway.

Spinal anaesthesia causes sympathetic blockade and hypotension; prevent with fluid preload and treat with vasopressors.

Lidocaine maximum dose is 3 mg/kg without adrenaline and 7 mg/kg with adrenaline; IV lipid emulsion is the antidote for local anaesthetic systemic toxicity.

Succinylcholine is contraindicated in hyperkalaemia, burns beyond 24-48 hours, spinal cord injury and known susceptibility to malignant hyperthermia.

ASA physical status 1 is a healthy patient, 3 is severe systemic disease, and 5 is a moribund patient not expected to survive without the operation.

Mallampati class 3 or 4 predicts a difficult airway; also assess mouth opening, thyromental distance and neck mobility before induction.

Mass casualty triage uses red for immediate, yellow for delayed, green for minor and blue for expectant, with haemorrhage and airway control prioritised.

The four principles of biomedical ethics are respect for autonomy, beneficence, non-maleficence and justice.

Valid consent requires capacity, adequate information, voluntariness and documentation; minors require a parent or guardian to consent on their behalf.

Medical negligence requires a duty of care, breach of the standard of a reasonable practitioner, causation and resulting damage; all four must be proved.

Confidentiality may be breached where the law mandates notification, where there is a serious risk to others, or with the patient's consent.

Immediately notifiable diseases include cholera, plague, yellow fever, measles and poliomyelitis; notification triggers public health action.

Emergency treatment may proceed without consent when the patient lacks capacity and delay would risk death or serious harm.

A clinician must practise within competence and refer when the required skill or facilities are unavailable; abandoning a patient constitutes professional misconduct.

Research involving human participants requires ethical approval, informed consent and a favourable risk-benefit ratio.

First-line antiretroviral therapy for adults is tenofovir plus lamivudine plus dolutegravir (TLD) as one daily tablet, started regardless of CD4 count.

Infants under 18 months are tested with HIV DNA PCR because maternal antibodies persist; antibody tests are reliable after 18 months.

Prevention of mother-to-child transmission: lifelong maternal ART, infant nevirapine prophylaxis for 6 weeks (12 weeks if high risk), and early infant diagnosis at 6 weeks.

Post-exposure prophylaxis: three antiretrovirals started within 72 hours and continued for 28 days, with HIV testing at baseline, 6 weeks, 3 months and 6 months.

Emergency contraception: levonorgestrel 1.5 mg orally within 72 hours, or a copper IUCD inserted within 5 days of unprotected intercourse.

Viral load is checked 6 months after ART initiation and then annually; two consecutive results above 1000 copies/mL define treatment failure.

Syphilis in pregnancy is treated with a single IM dose of benzathine penicillin 2.4 million units, with partner treatment and repeat screening.

Pre-exposure prophylaxis with daily tenofovir/emtricitabine is offered to HIV-negative people at substantial ongoing risk of infection.