Cambodia Medicine Exit Exam flashcards

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

STEMI reperfusion window

Primary PCI is preferred if it can be delivered within 120 minutes of first medical contact. Otherwise give fibrinolysis within 12 hours of symptom onset, provided there are no contraindications.

DKA insulin and potassium

Start an insulin infusion at 0.1 U/kg/h, but if potassium is below 3.3 mmol/L, hold insulin and replace potassium first to avoid fatal arrhythmia.

Nephrotic syndrome definition

Proteinuria above 3.5 g per day, serum albumin below 30 g/L, oedema, and hyperlipidaemia. Renal vein thrombosis is a recognised complication.

Tension pneumothorax treatment

A clinical diagnosis requiring immediate needle decompression, followed by chest tube insertion. Never delay treatment to obtain a chest radiograph.

Parkland burn formula

Give 4 mL/kg per percent total body surface area of crystalloid in 24 hours, with half in the first 8 hours measured from the time of injury.

Shock index meaning

Heart rate divided by systolic blood pressure. A value above 0.9 suggests occult haemorrhage in trauma even when blood pressure appears normal.

Postpartum haemorrhage first steps

Uterine massage and oxytocin, then ergometrine, carboprost, or misoprostol. Give tranexamic acid 1 g IV within 3 hours, and use balloon tamponade or surgery if refractory.

Eclampsia magnesium regimen

Loading dose 4 g IV over 20 minutes plus 10 g IM, then 1 g/h IV infusion. Monitor respiratory rate, reflexes, and urine output; antidote is calcium gluconate.

Gestational diabetes OGTT thresholds

With a 75 g oral glucose tolerance test at 24-28 weeks, thresholds are fasting 5.1, one-hour 10.0, and two-hour 8.5 mmol/L. Any single abnormal value is diagnostic.

WHO dehydration plans

Plan A for no dehydration, Plan B with oral rehydration solution 75 mL/kg over 4 hours for some dehydration, and Plan C with IV Ringer's lactate 100 mL/kg for severe dehydration.

Kawasaki disease treatment

Fever for at least 5 days plus 4 of 5 clinical features. Give IV immunoglobulin 2 g/kg and high-dose aspirin; watch for coronary artery aneurysm.

Severe acute malnutrition criteria

Weight-for-height z-score below −3, mid-upper arm circumference below 115 mm, or bilateral pitting oedema. Treat hypoglycaemia and hypothermia before starting F-75 feeding.

Severe malaria treatment

Intravenous artesunate is first-line, with intramuscular artemether as an alternative. Treat for at least 24 hours, then complete a full oral artemisinin-based combination course.

Dengue warning signs

Abdominal pain, persistent vomiting, mucosal bleeding, lethargy, liver enlargement over 2 cm, and rising haematocrit with falling platelets. Give isotonic crystalloid and avoid NSAIDs.

New pulmonary TB regimen

Two months of rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by four months of rifampicin and isoniazid. Use fixed-dose combinations and check drug interactions.

Rabies post-exposure prophylaxis

Wash the wound with soap and water for 15 minutes, then give vaccine on days 0, 3, 7, and 14. Add rabies immunoglobulin for category III exposures.

Sensitivity and specificity

Sensitivity is true positives divided by true positives plus false negatives. Specificity is true negatives divided by true negatives plus false positives. Both are test properties, not prevalence-dependent.

Herd immunity threshold

Calculated as 1 − 1/R0. For measles with R0 around 12-18, coverage above roughly 95% is needed to interrupt transmission.

Maternal mortality ratio

Maternal deaths per 100,000 live births. It differs from under-5 mortality, which counts deaths before age 5 per 1,000 live births.

Odds ratio versus relative risk

The odds ratio approximates relative risk only when the outcome is rare, roughly under 10%. It is the standard measure in case-control studies.

Confounding definition

A variable associated with both exposure and outcome but not on the causal pathway. Control it by randomisation, restriction, matching, or statistical adjustment.

Sample size for a proportion

n = Z² × p(1−p) / d², where p is the expected proportion and d is the desired margin of error. Increasing sample size reduces random error.

Loading dose formula

Loading dose = volume of distribution × target concentration / bioavailability. Maintenance dose rate = clearance × target concentration / bioavailability.

Zero-order kinetics

Elimination of a constant amount per unit time because enzymes are saturated. Examples include phenytoin and ethanol, where small dose increases can cause toxicity.

Paracetamol overdose antidote

N-acetylcysteine. Use the Rumack-Matthew nomogram from 4 hours after ingestion; the toxic dose is roughly 150 mg/kg or 10 g in adults.

Adult CPR compression targets

Compressions at 100-120 per minute, depth 5-6 cm, full chest recoil, ratio 30:2 with two breaths, and interruptions kept under 10 seconds.

Anaphylaxis adrenaline dose

Adrenaline 0.5 mg intramuscularly into the anterolateral thigh, or 0.01 mg/kg in children, maximum 0.5 mg. Repeat every 5 minutes if needed.

Sepsis bundle essentials

Measure lactate, take cultures, give broad-spectrum antibiotics within 1 hour of recognition, and give 30 mL/kg crystalloid for hypotension or lactate of 4 mmol/L or more.

Informed consent elements

Capacity, adequate disclosure of risks and alternatives, understanding, and voluntariness. Document the discussion and use an interpreter when language differs.

Four ethical principles

Autonomy respects patient choices, beneficence acts in the patient's interest, non-maleficence avoids harm, and justice requires fair allocation of resources.

Negligence four elements

A duty of care, a breach of the standard of care, causation, and resulting harm. Clear documentation of clinical reasoning is the best defence.

Hepatitis B serology markers

HBsAg indicates infection, anti-HBs indicates immunity, HBeAg indicates high infectivity, and anti-HBc IgM indicates acute or recent infection.