Lebanon Medical Colloquium cheat sheet

Acute coronary syndrome: serial high-sensitivity troponin with a 0/1-hour or 0/3-hour algorithm; a rise-and-fall pattern plus ischemic symptoms or ECG change establishes myocardial infarction.

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

Diabetic ketoacidosis: total body potassium is depleted despite normal or high serum values; hold insulin until K ≥3.3 mmol/L and replace potassium concurrently with fluids.

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

Hyperkalemia with ECG changes: IV calcium gluconate stabilizes myocardium first, then insulin-dextrose and beta-2 agonists shift potassium intracellularly; dialysis or binders remove it.

Hyponatremia: assess serum osmolality and volume status; SIADH shows euvolemia, low serum osmolality, urine osmolality >100 mOsm/kg, and urine sodium >30 mmol/L.

Chronic obstructive pulmonary disease: post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow limitation; GOLD ABE group guides inhaled therapy.

Cirrhosis: Child-Pugh and MELD scores stratify prognosis; ascites is managed with sodium restriction, spironolactone plus furosemide, and large-volume paracentesis with albumin for >5 L.

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

Bowel obstruction: supine and upright abdominal films plus CT show dilated loops, air-fluid levels, and transition point; free air or strangulation signs mandate urgent laparotomy.

Trauma: in hemodynamically unstable patients, FAST identifies pericardial or intraperitoneal fluid; the lethal triad is hypothermia, acidosis, and coagulopathy.

Hernia: strangulation signs include irreducible tender mass, absent bowel sounds, fever, and leukocytosis; femoral hernias carry the highest strangulation risk.

Postoperative fever timing: within 48 hours consider atelectasis or drug reaction; days 3–5 consider urinary or line infection; days 5–10 consider anastomotic leak or abscess.

Thyroidectomy: recurrent laryngeal nerve injury causes hoarseness; bilateral injury causes stridor; hypocalcemia from parathyroid injury appears 24–72 hours postoperatively.

Breast cancer staging uses TNM; sentinel lymph node biopsy is standard for clinically node-negative axilla, and hormone receptor and HER2 status drive adjuvant therapy.

Cholecystitis: Murphy sign and ultrasound findings of wall thickening >3 mm, pericholecystic fluid, and stones support diagnosis; early laparoscopic cholecystectomy is preferred.

Neonatal jaundice: phototherapy thresholds depend on age in hours, gestational age, and risk factors; conjugated hyperbilirubinemia beyond 2 weeks requires urgent evaluation.

Pediatric dehydration: use the Clinical Dehydration Scale or WHO criteria; oral rehydration solution 50–100 mL/kg over 3–4 hours treats mild-moderate dehydration.

Bronchiolitis: supportive care with oxygen, hydration, and suctioning; routine bronchodilators, corticosteroids, and antibiotics are not recommended.

Kawasaki disease: fever ≥5 days plus 4 of 5 criteria (rash, conjunctivitis, mucosal changes, extremity changes, cervical lymphadenopathy); IVIG plus aspirin prevents coronary aneurysms.

Febrile seizures: simple if generalized, <15 minutes, once in 24 hours; complex features warrant lumbar puncture and EEG consideration.

Growth: use WHO charts for children under 2 years and CDC charts for 2 years and older; crossing two major percentile lines signals faltering growth.

Pediatric dosing: weight-based mg/kg with maximum adult dose; check renal and hepatic adjustment in neonates due to immature clearance.

Intussusception: colicky pain, vomiting, and red currant jelly stool; air or contrast enema is both diagnostic and therapeutic in stable patients.

Preeclampsia: hypertension after 20 weeks plus proteinuria or end-organ dysfunction; delivery is the definitive treatment, and magnesium sulfate prevents eclampsia.

Postpartum hemorrhage: uterine atony is the leading cause; manage with uterine massage, oxytocin, then tranexamic acid, carboprost, or misoprostol.

Gestational diabetes screening: 75 g oral glucose tolerance test at 24–28 weeks; fasting ≥5.1, 1-hour ≥10.0, or 2-hour ≥8.5 mmol/L confirms diagnosis.

Ectopic pregnancy: transvaginal ultrasound plus serial beta-hCG; a discriminatory zone of 1,500–3,500 mIU/mL without intrauterine sac raises concern.

Contraception: combined oral contraceptives are contraindicated in migraine with aura, prior venous thromboembolism, and uncontrolled hypertension.

Cervical cancer screening: cytology every 3 years from age 21 or co-testing every 5 years from age 30; high-risk HPV 16/18 positivity warrants colposcopy.

Labor stages: first stage to full dilation, second stage to delivery, third stage to placental expulsion; active third-stage management reduces hemorrhage.

Rh isoimmunization: anti-D immunoglobulin at 28 weeks and within 72 hours postpartum for Rh-negative unsensitized mothers with Rh-positive infants.

Hypertension: confirm with home or ambulatory monitoring; initiate therapy for ≥140/90 mmHg, and target <130/80 in most adults with cardiovascular risk.

Statins: use the pooled cohort equation; moderate-intensity statin for 10-year atherosclerotic risk ≥7.5%, high-intensity for ≥20%.

Depression screening: PHQ-2 followed by PHQ-9; scores of 10 or more indicate moderate depression warranting treatment.

Vaccination: annual influenza for all adults; shingles vaccine from age 50; pneumococcal vaccine based on age and risk conditions.

Obesity: BMI ≥30 kg/m²; lifestyle plus pharmacotherapy or bariatric surgery for BMI ≥40 or ≥35 with comorbidities.

Smoking cessation: combination of behavioral counseling and pharmacotherapy (varenicline, bupropion, or nicotine replacement) doubles quit rates.

Antibiotic stewardship: avoid antibiotics for viral upper respiratory infections; sore throat without Centor criteria does not warrant testing or treatment.

Contraceptive counseling and preconception care: folic acid 400 mcg daily before conception reduces neural tube defects.

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

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

Serotonin syndrome: triad of mental status change, autonomic instability, and neuromuscular hyperactivity; stop serotonergic agents and give cyproheptadine if severe.

Neuroleptic malignant syndrome: rigidity, hyperthermia, altered mental status, and elevated creatine kinase after dopamine antagonists; treat with dantrolene or bromocriptine.

Schizophrenia: positive and negative symptoms; antipsychotics are first-line, and clozapine is indicated for treatment-resistant cases with monitoring for agranulocytosis.

Alcohol withdrawal: CIWA-Ar guides treatment; benzodiazepines are first-line, and thiamine before glucose prevents Wernicke encephalopathy.

Suicide risk assessment: inquire directly about ideation, plan, intent, and access to means; safety planning and means restriction reduce risk.

Delirium versus dementia: delirium has acute onset, fluctuating course, and inattention; dementia is chronic and progressive with preserved consciousness.

Advanced cardiac life support: high-quality CPR at 100–120 compressions/min, depth 5–6 cm, full recoil; defibrillate shockable rhythms immediately.

Anaphylaxis: intramuscular epinephrine 0.3–0.5 mg of 1:1,000 into the anterolateral thigh; repeat every 5–15 minutes as needed, then adjuncts.

Sepsis: within 1 hour obtain cultures, measure lactate, give broad-spectrum antibiotics, and start 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Acute stroke: noncontrast CT excludes hemorrhage; IV thrombolysis within 4.5 hours and thrombectomy within 24 hours for large vessel occlusion in selected patients.

Acute asthma: peak flow <40% predicted or silent chest indicates severe exacerbation; give oxygen, inhaled beta-2 agonist, ipratropium, and systemic steroids.

Diabetic ketoacidosis and hyperosmolar hyperglycemic state: fluids first, then insulin infusion; monitor potassium and anion gap until closure.

Trauma resuscitation: permissive hypotension in penetrating trauma until hemorrhage control; massive transfusion protocol with balanced ratios.

Acute respiratory distress syndrome: Berlin criteria of acute onset, bilateral infiltrates, and PaO2/FiO2 ≤300 on PEEP ≥5; lung-protective ventilation with tidal volume 6 mL/kg.

ASA physical status: I healthy, II mild systemic disease, III severe systemic disease, IV constant threat to life, V moribund, VI organ donor.

Mallampati classification grades I–IV predict difficult visualization; grade III–IV with short thyromental distance raises difficult airway risk.

Succinylcholine: depolarizing blocker causing hyperkalemia in burns, crush injury, and denervation; avoid after 24–48 hours in these states.

Malignant hyperthermia: triggered by volatile anesthetics and succinylcholine; treat with dantrolene 2.5 mg/kg IV, stop triggers, and cool the patient.

Local anesthetic systemic toxicity: stop injection, secure airway, give 20% lipid emulsion 1.5 mL/kg bolus, and monitor for arrhythmias.

Spinal anesthesia: hypotension from sympathetic blockade; preload or co-load with crystalloid and use vasopressors as needed.

Postoperative nausea and vomiting: Apfel score uses female sex, nonsmoker, history of PONV, and postoperative opioids; prophylaxis for ≥2 risk factors.

Preoperative fasting: 2 hours for clear liquids, 6 hours for light meal, 8 hours for fatty meal; prolonged fasting is discouraged.

Chest radiograph: silhouette sign localizes opacity to adjacent structure; air bronchograms suggest alveolar disease, and Kerley B lines indicate interstitial edema.

CT pulmonary angiography is the test of choice for pulmonary embolism in stable patients; D-dimer is useful only to exclude in low pretest probability.

Acute abdomen: CT with IV contrast is preferred in adults; ultrasound is first-line for right upper quadrant pain and pelvic pain in women.

Radiation dose: CT abdomen approximately 10 mSv; use ALARA principles and avoid unnecessary imaging in pregnancy and children.

MRI is preferred for brain, spinal cord, and musculoskeletal soft tissue; gadolinium is avoided in severe renal failure due to nephrogenic systemic fibrosis.

Pneumothorax: upright chest radiograph shows pleural line and absent lung markings; ultrasound is more sensitive in supine trauma patients.

Bone fractures: plain radiographs first; CT for complex or occult fractures; MRI for stress fractures and ligamentous injury.

Contrast reactions: mild urticaria treated with antihistamine; anaphylactoid reactions need epinephrine; premedicate prior reactors with steroids and antihistamines.

Anemia classification: microcytic (MCV <80) from iron deficiency, thalassemia, or chronic disease; macrocytic (MCV >100) from B12/folate deficiency, alcohol, or hypothyroidism.

Iron studies: iron deficiency shows low ferritin, low serum iron, high TIBC, and low transferrin saturation; anemia of chronic disease shows high ferritin and low TIBC.

Coagulation: prolonged PT suggests factor VII or warfarin effect; prolonged aPTT suggests heparin, hemophilia, or lupus anticoagulant; both prolonged suggests disseminated intravascular coagulation.

Tumor markers: CA-125 for ovarian cancer, CEA for colorectal, AFP for hepatocellular carcinoma, PSA for prostate; none are diagnostic alone.

Gram stain and culture: identify organism and guide antibiotics; blood cultures before antibiotics in sepsis improve yield.

Liver enzymes: ALT/AST elevation suggests hepatocellular injury; alkaline phosphatase and bilirubin elevation suggest cholestasis.

Cardiac troponin is the preferred biomarker for myocardial injury; CK-MB is less specific and used for reinfarction detection.

Frozen section: intraoperative consultation for margin status or diagnosis; limitations include artifact and sampling error.

Pharmacokinetics: half-life determines dosing interval; steady state is reached after 4–5 half-lives; loading dose = volume of distribution × target concentration / bioavailability.

Cytochrome P450: CYP3A4 metabolizes many drugs; inhibitors (macrolides, azoles, grapefruit) raise levels, inducers (rifampin, carbamazepine, St John's wort) lower them.

Warfarin: monitor INR; vitamin K reverses effect; major bleeding requires prothrombin complex concentrate or fresh frozen plasma.

Aminoglycosides: nephrotoxic and ototoxic; dose by weight and renal function; monitor trough levels.

Vancomycin: monitor AUC or trough; infusion reaction (red man syndrome) from rapid infusion is treated by slowing the rate.

Beta-blockers: contraindicated in severe asthma and decompensated heart failure; abrupt withdrawal can cause rebound angina.

NSAIDs: risk of gastrointestinal bleeding and renal injury; avoid in chronic kidney disease and with anticoagulants.

Antibiotic resistance: complete the prescribed course; culture-guided therapy and stewardship reduce resistance.

Informed consent requires capacity, disclosure of risks, benefits, and alternatives, comprehension, and voluntariness; documented discussion supports the process.

Capacity assessment: patient can understand, appreciate, reason, and express a choice; capacity is decision-specific and presumed unless impaired.

Confidentiality: may be breached with patient consent, legal requirement, or serious public health risk; disclose only the minimum necessary.

End-of-life care: advance directives and durable power of attorney for healthcare guide decisions when capacity is lost; do-not-resuscitate orders require discussion.

Medical errors: disclose to the patient, document, and report per institutional policy; apology laws vary by jurisdiction.

Professional boundaries: avoid dual relationships and conflicts of interest; declare gifts and financial ties.

Research ethics: institutional review board approval, informed consent, and the Belmont principles of respect for persons, beneficence, and justice.

Mandatory reporting: suspected child abuse, certain communicable diseases, and gunshot wounds per local law; know jurisdiction-specific requirements.

Thyroid: TSH is the first-line test; low TSH with high free T4 indicates hyperthyroidism; high TSH with low free T4 indicates primary hypothyroidism.

Diabetes: HbA1c ≥6.5%, fasting glucose ≥7.0 mmol/L, or 2-hour glucose ≥11.1 mmol/L diagnose diabetes; metformin is first-line unless contraindicated.

Chronic kidney disease: classify by eGFR and albuminuria; stage G3a–G5 requires monitoring for anemia and metabolic bone disease.

Atrial fibrillation: CHA2DS2-VASc guides anticoagulation; DOACs are preferred over warfarin in nonvalvular AF.

Peptic ulcer disease: Helicobacter pylori testing and eradication; proton pump inhibitor for 4–8 weeks.

Gout: acute flare treated with NSAIDs, colchicine, or steroids; urate-lowering therapy with allopurinol for recurrent attacks.

Surgical site infection prevention: preoperative antibiotics within 60 minutes of incision, chlorhexidine skin prep, and normothermia.

Appendicitis in pregnancy: ultrasound first, then MRI; laparoscopy is safe in all trimesters.

Biliary colic versus cholecystitis: colic resolves within hours; cholecystitis has persistent pain, fever, and leukocytosis.

Bowel anastomosis: tension-free, adequate blood supply, and no distal obstruction are essential for healing.

Postoperative ileus versus obstruction: ileus is diffuse and self-limited; obstruction shows transition point on CT.

Wound dehiscence: risk factors include obesity, diabetes, malnutrition, and infection; evisceration requires emergency reoperation.

Immunization schedule: DTaP, IPV, Hib, PCV, and MMR at recommended ages; catch-up schedules exist for delayed children.

Neonatal sepsis: group B streptococcus and E. coli common; ampicillin plus gentamicin empiric therapy.

Failure to thrive: weight below 3rd percentile or crossing two major lines; evaluate organic and psychosocial causes.

Croup: barking cough and inspiratory stridor; treat with dexamethasone and nebulized epinephrine for severe cases.

Nephrotic syndrome: edema, proteinuria >3.5 g/day, hypoalbuminemia, and hyperlipidemia; corticosteroids first-line for minimal change disease.

Pediatric trauma: primary survey ABCDE; head injury is the leading cause of death.

Antepartum hemorrhage: placenta previa painless bleeding; placental abruption painful bleeding with uterine tenderness.

Fetal monitoring: category I normal, category II indeterminate, category III abnormal with absent variability and late decelerations requiring urgent delivery.

Preterm labor: tocolysis with nifedipine or indomethacin; antenatal corticosteroids for fetal lung maturity between 24 and 34 weeks.

Ovarian torsion: sudden severe unilateral pain with nausea; ultrasound shows enlarged ovary with decreased flow; surgical detorsion.

Endometriosis: dysmenorrhea, dyspareunia, infertility; laparoscopy is diagnostic and therapeutic.

Menopause: diagnosis clinical; hormone therapy for vasomotor symptoms within 10 years of menopause if no contraindications.

Diabetes screening: adults ≥35 years or with risk factors; repeat every 3 years if normal.

Lipid screening: adults ≥20 years every 4–6 years; more frequent with risk factors.

Colorectal cancer screening: start at 45–50 years; colonoscopy every 10 years or stool-based tests annually.

Breast cancer screening: mammography every 1–2 years from age 40–50 based on guidelines.

Cervical cancer screening: start at 21 years; cytology every 3 years or co-testing every 5 years.

Osteoporosis screening: DXA for women ≥65 years and men ≥70 years; earlier with risk factors.

Anxiety disorders: SSRIs and cognitive behavioral therapy are first-line; benzodiazepines short-term only.

Panic attack: sudden intense fear with palpitations, sweating, trembling, and derealization; rule out medical causes.

Obsessive-compulsive disorder: obsessions and compulsions causing distress; SSRIs and exposure response prevention.

Post-traumatic stress disorder: re-experiencing, avoidance, negative cognition, and hyperarousal after trauma; trauma-focused psychotherapy first-line.

Bipolar depression: avoid antidepressant monotherapy; use mood stabilizer or atypical antipsychotic.

Eating disorders: anorexia nervosa has low BMI and fear of weight gain; bulimia has binge-purge cycles; medical stabilization first.

Acute myocardial infarction: aspirin, nitroglycerin, and reperfusion within 90 minutes for STEMI.

Status epilepticus: benzodiazepine first-line; second-line phenytoin, valproate, or levetiracetam.

Acute poisoning: activated charcoal within 1 hour for select toxins; naloxone for opioids; flumazenil for benzodiazepines.

Hypoglycemia: glucose 15–20 g orally or IV dextrose; recheck in 15 minutes.

Trauma: primary survey ABCDE; secondary survey head-to-toe after stabilization.

Burn management: Parkland formula 4 mL/kg/%TBSA over 24 hours; half in first 8 hours.

Airway assessment: Mallampati, thyromental distance, mouth opening, neck mobility.

Preoxygenation: 100% oxygen for 3–5 minutes before induction.

Anesthesia depth: monitor with clinical signs, MAC, and BIS where available.

Postoperative pain: multimodal analgesia with opioids as needed.

Regional anesthesia: contraindicated with coagulopathy or infection at site.

Perioperative antibiotics: within 60 minutes before incision.

Chest X-ray: PA and lateral views; evaluate for consolidation, effusion, and pneumothorax.

Abdominal X-ray: limited value; CT preferred for acute abdomen.

Ultrasound: first-line for gallbladder, obstetric, and soft tissue evaluation.

CT: contrast-enhanced for tumor staging and vascular evaluation.

MRI: preferred for brain and spinal cord; avoid in patients with certain implants.

Radiation safety: ALARA; shield gonads and use lowest dose.

Complete blood count: anemia, infection, and platelet disorders.

Basic metabolic panel: electrolytes, renal function, and glucose.

Liver function tests: ALT, AST, alkaline phosphatase, bilirubin.

Coagulation: PT/INR and aPTT for bleeding disorders.

Urinalysis: infection, hematuria, and proteinuria.

Microbiology: Gram stain and culture for organism identification.

Antibiotics: beta-lactams, macrolides, fluoroquinolones; choose based on culture.

Anticoagulants: heparin, warfarin, DOACs; monitor INR for warfarin.

Antihypertensives: ACE inhibitors, ARBs, calcium channel blockers, diuretics.

Analgesics: acetaminophen, NSAIDs, opioids; multimodal approach.

Adverse drug reactions: recognize and report; adjust doses in renal/hepatic impairment.

Drug interactions: check CYP450 interactions before prescribing.

Informed consent: capacity, disclosure, comprehension, voluntariness.

Confidentiality: protect patient information; exceptions for legal or public health.

End-of-life: advance directives and palliative care.

Medical errors: disclose and report.

Professional boundaries: avoid conflicts of interest.

Research ethics: IRB approval and informed consent.

Pneumonia: CURB-65 guides admission; antibiotics according to severity.

Urinary tract infection: dysuria, frequency, urgency; nitrite and leukocyte esterase on dipstick.

Cellulitis: erythema, warmth, tenderness; antibiotics covering streptococci and staphylococci.

Sepsis: early recognition and treatment with antibiotics and fluids.

Venous thromboembolism: D-dimer and imaging; anticoagulation.

Stroke: thrombolysis within 4.5 hours; thrombectomy for large vessel occlusion.

Acute abdomen: history, examination, and imaging; surgical consultation.

Hernia: reducible versus incarcerated; urgent repair for strangulation.

Appendicitis: Alvarado score and imaging; appendectomy.

Cholecystitis: ultrasound and antibiotics; cholecystectomy.

Bowel obstruction: CT and nasogastric decompression; surgery for strangulation.

Trauma: ABCDE approach and FAST.

Growth and development: monitor milestones and growth charts.

Immunizations: follow schedule and catch-up.

Common infections: otitis media, pharyngitis, bronchiolitis.

Dehydration: oral rehydration solution.

Fever: antipyretics and evaluation for serious bacterial infection.

Child abuse: recognize and report.

Prenatal care: regular visits and screening.

Labor: monitor fetal heart rate and progress.

Postpartum care: hemorrhage and infection prevention.

Contraception: counseling and choice.

Gynecologic cancers: screening and early detection.

Menopause: symptom management.

Preventive care: screening and vaccinations.

Chronic disease management: hypertension, diabetes, and asthma.

Health promotion: diet, exercise, and smoking cessation.

Mental health: screening and referral.

Geriatric care: falls and polypharmacy.

Palliative care: symptom management and goals of care.

Mood disorders: depression and bipolar disorder.

Anxiety disorders: generalized anxiety, panic, and phobias.

Psychotic disorders: schizophrenia and antipsychotics.

Substance use disorders: screening and treatment.

Suicide risk: assessment and safety planning.

Therapy: cognitive behavioral therapy and supportive therapy.

Cardiac arrest: CPR and defibrillation.

Airway management: bag-mask ventilation and intubation.

Shock: fluid resuscitation and vasopressors.

Trauma: primary and secondary survey.

Toxicology: antidotes and decontamination.

Sepsis: early antibiotics and fluids.

Preoperative assessment: airway and comorbidities.

Anesthesia types: general, regional, and local.

Monitoring: vital signs and capnography.

Postoperative care: pain and nausea management.

Complications: malignant hyperthermia and anaphylaxis.

Patient safety: checklist and teamwork.