Kuwait MOH Doctor Exam cheat sheet

Acute STEMI: door-to-balloon time <90 min at PCI-capable centers; fibrinolysis within 30 min if PCI unavailable and symptom onset <12 h without contraindications.

Diabetic ketoacidosis: IV 0.9% saline bolus, insulin infusion 0.1 U/kg/h after potassium >3.3 mmol/L; add 5% dextrose when glucose <11.1 mmol/L (200 mg/dL).

Community-acquired pneumonia: CURB-65 score (Confusion, Urea >7 mmol/L, Respiratory rate ≥30, Blood pressure systolic <90 or diastolic ≤60, Age ≥65); score 0–1 outpatient, 2 ward, ≥3 consider ICU.

Heart failure with reduced ejection fraction: four pillars - ARNI/ACEi/ARB, evidence-based beta-blocker, MRA, and SGLT2 inhibitor - each reduces mortality and is titrated to target or maximum tolerated dose.

Hyponatremia correction: limit rise to 8–10 mmol/L in 24 h to avoid osmotic demyelination; hypertonic 3% saline for severe symptoms with 100 mL boluses repeated as needed.

Acute upper GI bleed: pre-endoscopy IV proton-pump inhibitor; transfuse to hemoglobin 7–8 g/dL unless massive bleeding or cardiovascular disease; variceal bleed adds octreotide and prophylactic antibiotics.

Thyroid storm: PTU or methimazole, beta-blocker (propranolol), iodine load at least 1 h after thionamide, hydrocortisone, and supportive care; Burch-Wartofsky score aids diagnosis.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia <30 g/L, edema, hyperlipidemia; biopsy adults, especially if age >40 or atypical features.

Acute appendicitis: Alvarado score (migration, anorexia, nausea/vomiting, tenderness RIF, rebound, fever, leukocytosis, shift to left) - score ≥7 supports operative management.

Trauma primary survey: Airway with cervical spine protection, Breathing, Circulation with hemorrhage control, Disability (GCS), Exposure/environment; adjuncts include FAST and chest/pelvis X-ray.

Bowel obstruction: IV fluids, nasogastric decompression, serial abdominal exams; urgent surgery for strangulation signs (fever, tachycardia, peritoneal signs, rising lactate, closed-loop).

Postoperative fever timing: within 48 h consider atelectasis; days 3–5 urinary tract infection or pneumonia; days 5–7 surgical site infection; after day 7 deep abscess or thrombophlebitis.

Hernia: femoral hernias carry highest strangulation risk and warrant early elective repair; inguinal hernia in infants and irreducible or tender hernias need urgent surgical assessment.

Acute limb ischemia: 6 Ps (pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia); immediate IV heparin and vascular surgery referral; Rutherford class determines revascularization urgency.

Pancreatitis (acute): diagnosis needs 2 of 3 - characteristic pain, lipase/amylase >3× upper limit, imaging findings; early aggressive lactated Ringer's and enteral nutrition when tolerated.

Surgical site infection prevention: prophylactic antibiotic within 60 min before incision (120 min for vancomycin/fluoroquinolones), redosing for long operations, normothermia, and glucose control.

Pediatric weight estimate: (age in years + 4) × 2 kg for children 1–10 years; use length-based tape or actual weight when available for drug dosing.

Dehydration in children: WHO plan A (no dehydration, oral rehydration at home), plan B (some dehydration, ORS 75 mL/kg over 4 h), plan C (severe, IV Ringer's lactate 100 mL/kg with 30 mL/kg bolus first).

Neonatal jaundice: phototherapy thresholds depend on gestational age, postnatal hours, and risk factors; exchange transfusion for severe hyperbilirubinemia or signs of acute bilirubin encephalopathy.

Kawasaki disease: fever ≥5 days plus 4 of 5 (conjunctivitis, oral changes, rash, extremity changes, cervical lymphadenopathy); treat with IVIG 2 g/kg and aspirin; echocardiography for coronary aneurysms.

Febrile seizure: simple if generalized, <15 min, once in 24 h, age 6 months–5 years; no routine lumbar puncture if meningeal signs absent and immunization current; antipyretics do not prevent recurrence.

Pediatric basic life support: compression-to-ventilation ratio 30:2 for single rescuer, 15:2 for two rescuers; compression depth one-third of chest diameter at 100–120/min.

Croup: barking cough, inspiratory stridor; dexamethasone 0.15–0.6 mg/kg single dose; nebulized epinephrine for moderate-severe stridor; intubation for impending airway failure.

Failure to thrive: weight below 3rd–5th percentile or crossing two major percentile lines; evaluate feeding history, caloric intake, organic causes (celiac, cystic fibrosis, renal, cardiac), and psychosocial factors.

Preeclampsia: hypertension ≥140/90 after 20 weeks plus proteinuria ≥300 mg/24 h or end-organ dysfunction; severe features include BP ≥160/110, platelets <100,000, liver enzymes elevated, pulmonary edema, visual/cerebral symptoms.

Eclampsia: magnesium sulfate 4–6 g IV loading over 15–20 min, then 1–2 g/h infusion; monitor reflexes, respiratory rate, urine output; calcium gluconate for toxicity.

Postpartum hemorrhage: uterine atony most common cause; uterotonics (oxytocin, carboprost, misoprostol, methylergonovine), bimanual massage, tranexamic acid within 3 h, and balloon tamponade or surgery if refractory.

Gestational diabetes screening: 75 g OGTT at 24–28 weeks with fasting ≥5.1 mmol/L, 1 h ≥10.0, or 2 h ≥8.5 mmol/L; lifestyle first, insulin or metformin if targets not met.

Ectopic pregnancy: risk factors include prior ectopic, tubal surgery, PID, smoking, IVF; diagnostic algorithm uses serial hCG and transvaginal ultrasound; methotrexate for stable, unruptured cases meeting criteria.

Labor stages: first stage to full dilatation, second stage to delivery, third stage to placental delivery; active management of third stage with oxytocin reduces postpartum hemorrhage.

Contraception: combined oral contraceptives contraindicated in migraine with aura, smoking age ≥35, hypertension, VTE history, and breastfeeding <6 weeks; progestin-only and LARC options remain.

Cervical cancer screening: cytology every 3 years from age 21 or co-testing every 5 years from age 30; HPV testing preferred; stop screening after hysterectomy for benign disease or age 65 with adequate prior negative screening.

Hypertension: confirm with home or ambulatory monitoring; start pharmacotherapy for BP ≥140/90 (or ≥130/80 in high-risk patients); first-line classes are thiazide-type diuretics, ACEi/ARB, and calcium channel blockers.

Type 2 diabetes: metformin first-line unless contraindicated; add SGLT2 inhibitor or GLP-1 receptor agonist for atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease; HbA1c target individualized, commonly <7%.

Lipid management: use ASCVD risk estimator; statin intensity based on risk; high-intensity statin for established ASCVD; check baseline liver enzymes and lipid panel 4–12 weeks after initiation.

Asthma stepwise care: reliever inhaler as needed; step 1 low-dose ICS-formoterol or ICS with SABA; step up if uncontrolled; assess adherence, inhaler technique, and triggers before escalating.

Antibiotic stewardship: do not prescribe antibiotics for viral upper respiratory infection, acute bronchitis, or uncomplicated rhinosinusitis without criteria; use delayed prescriptions when appropriate.

Screening adults: colorectal cancer from age 45–50, breast cancer mammography from age 40–50 depending on guideline, cervical cancer as per gynecology, and osteoporosis in women ≥65.

Immunization: annual influenza for all ≥6 months; pneumococcal for adults ≥65 or with risk conditions; tetanus-diphtheria booster every 10 years; shingles vaccine for adults ≥50.

Anaphylaxis: IM epinephrine 0.3–0.5 mg (1:1000) into anterolateral thigh, repeat every 5–15 min; adjuncts include IV fluids, oxygen, bronchodilators, and H1/H2 antihistamines; observe for biphasic reaction.

Cardiac arrest: high-quality CPR at 100–120/min, depth 5–6 cm, full recoil, minimize interruptions; defibrillate shockable rhythms immediately; epinephrine 1 mg every 3–5 min; amiodarone after third shock.

Acute stroke: activate stroke pathway; noncontrast CT to exclude hemorrhage; IV alteplase within 4.5 h of onset for eligible patients; thrombectomy up to 24 h in selected large-vessel occlusion.

Sepsis: recognize with qSOFA (respiratory rate ≥22, altered mentation, systolic BP ≤100); measure lactate, obtain cultures, give broad-spectrum antibiotics within 1 h, and 30 mL/kg crystalloid for hypotension or lactate ≥4.

Opioid overdose: naloxone 0.4–2 mg IV/IM or 4 mg intranasal, repeat every 2–3 min; support ventilation; observe for re-sedation because naloxone half-life is shorter than most opioids.

Status epilepticus: benzodiazepine first-line (lorazepam 0.1 mg/kg IV, diazepam, or midazolam IM); if persistent, second-line antiepileptic (levetiracetam, valproate, fosphenytoin); then anesthetic doses.

Ankle injury: Ottawa ankle rules - X-ray if pain in malleolar zone plus bone tenderness at posterior edge/tip of lateral or medial malleolus or inability to bear weight both immediately and in ED.

Toxicology: activated charcoal within 1 h for selected ingestions with protected airway; urinary alkalinization for salicylate; fomepizole for methanol/ethylene glycol; N-acetylcysteine for acetaminophen.

Major depressive disorder: ≥5 symptoms for ≥2 weeks including depressed mood or anhedonia; assess suicide risk; first-line psychotherapy or SSRI; continue antidepressant ≥6–12 months after remission.

Bipolar disorder: mania requires elevated/irritable mood plus increased energy for ≥1 week with ≥3 symptoms (grandiosity, decreased sleep, pressured speech, flight of ideas, distractibility, increased activity, risky behavior); treat acute mania with mood stabilizer and antipsychotic.

Schizophrenia: ≥2 of delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms for ≥6 months with functional decline; antipsychotic therapy with metabolic monitoring.

Serotonin syndrome: clonus, hyperreflexia, agitation, hyperthermia after serotonergic agents; stop offending drugs, supportive care, benzodiazepines, cyproheptadine for moderate-severe cases.

Neuroleptic malignant syndrome: rigidity, fever, autonomic instability, altered mental status, elevated CK after dopamine antagonists; stop agent, supportive care, dantrolene or bromocriptine.

Alcohol withdrawal: CIWA-Ar guided therapy; benzodiazepines first-line; thiamine before glucose to prevent Wernicke encephalopathy; monitor for delirium tremens.

Suicide risk assessment: ask directly about ideation, plan, intent, means, and prior attempts; high-risk features include plan, access to lethal means, recent loss, and hopelessness; safety planning and close follow-up.

Opioid use disorder: buprenorphine or methadone maintenance reduces mortality; naloxone co-prescribing for overdose prevention; avoid abrupt discontinuation.

Cardiac output = heart rate × stroke volume; stroke volume determined by preload, afterload, and contractility; Fick principle estimates CO from oxygen consumption and arteriovenous oxygen difference.

Renal physiology: glomerular filtration rate ≈ 125 mL/min; filtration fraction = GFR/renal plasma flow ≈ 20%; clearance C = (U × V)/P; inulin measures GFR, PAH measures renal plasma flow.

Acid-base: Henderson-Hasselbalch pH = 6.1 + log([HCO3−]/(0.03 × PaCO2)); Winter's formula expected PaCO2 = 1.5 × HCO3− + 8 ± 2 for metabolic acidosis.

Autonomic pharmacology: muscarinic antagonists (atropine) cause tachycardia, dry mouth, mydriasis; beta-1 agonists increase heart rate and contractility; alpha-1 agonists cause vasoconstriction.

Pathology: apoptosis is energy-dependent, caspase-mediated, no inflammation; necrosis is passive, causes inflammation; metaplasia is reversible change of one mature cell type to another.

Pharmacokinetics: first-order elimination half-life t½ = 0.693 × Vd/CL; steady state reached in ~4–5 half-lives; loading dose = Vd × target concentration / bioavailability.

Anatomy: brachial plexus roots C5–T1; median nerve carpal tunnel syndrome; femoral triangle contents NAVEL (nerve, artery, vein, empty space, lymphatics) from lateral to medial.

Microbiology: gram-positive cocci in clusters = Staphylococcus; in chains = Streptococcus; gram-negative diplococci = Neisseria; acid-fast bacilli = Mycobacterium.

Four principles: autonomy (respect patient choices), beneficence (act in patient's interest), non-maleficence (avoid harm), justice (fair distribution of resources).

Informed consent requires capacity, adequate information (diagnosis, risks, benefits, alternatives), and voluntariness; document discussion; emergency exception when patient lacks capacity and no surrogate.

Confidentiality: disclose only with patient consent or legal requirement; exceptions include reportable communicable diseases, imminent harm to self or others, and child/elder abuse.

Capacity assessment: patient can understand information, appreciate consequences, reason, and communicate a choice; capacity is decision-specific and presumed unless clinical evidence suggests otherwise.

End-of-life: advance directives and do-not-resuscitate orders require discussion; surrogate decision-makers use substituted judgment or best interests; palliative sedation is ethically permissible for refractory symptoms.

Research ethics: institutional review board approval, informed consent, risk minimization, and equipoise; Declaration of Helsinki and Belmont Report principles guide human-subject research.

Professional boundaries: avoid conflicts of interest, dual relationships, and accepting gifts that could influence care; disclose errors honestly and apologize.

Mandatory reporting: suspected child abuse, elder abuse, and certain communicable diseases must be reported to authorities per local law; document findings objectively.

Incidence = new cases / population at risk per time; prevalence = all cases / total population; prevalence ≈ incidence × duration for stable diseases.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); positive predictive value depends on prevalence; screening programs require high sensitivity and acceptable PPV.

Relative risk = incidence exposed / incidence unexposed; odds ratio approximates RR for rare diseases; attributable risk = incidence exposed − incidence unexposed.

Herd immunity threshold = 1 − 1/R0; for measles R0 12–18, threshold ~92–95%; for influenza R0 ~1.3, threshold ~25%.

Levels of prevention: primary (prevent onset, e.g., vaccination), secondary (early detection, e.g., screening), tertiary (limit disability, e.g., rehabilitation).

Outbreak investigation steps: verify diagnosis, establish case definition, find cases, describe time/place/person, generate hypothesis, test hypothesis, implement control, communicate.

Screening criteria: important disease, accepted treatment, detectable early stage, suitable test, cost-effective, and continuous process; lead-time bias and length bias affect survival estimates.

Kuwait vaccination schedule includes BCG at birth, hepatitis B birth dose, and routine childhood immunizations; adult influenza and pneumococcal vaccination for high-risk groups.