North Macedonia Physician Licensing Exam flashcards

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

CURB-65

A pneumonia severity score using confusion, urea over 7 mmol/L, respiratory rate 30 or more, low blood pressure, and age 65 or older. A score of 2 or more usually indicates hospital admission.

DKA potassium rule

In diabetic ketoacidosis, insulin infusion starts only when potassium exceeds 3.3 mmol/L; potassium is added to fluids when the level is below 5.5 mmol/L and urine output is present.

Four pillars of heart failure

For heart failure with reduced ejection fraction, an ARNI or ACE inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and an SGLT2 inhibitor each reduce mortality and are started early.

Spontaneous bacterial peritonitis

A complication of cirrhotic ascites diagnosed when the ascitic fluid neutrophil count reaches 250 cells per cubic millimetre. It requires prompt antibiotic treatment even when cultures are negative.

Alvarado score

A clinical score for acute appendicitis combining migratory pain, anorexia, nausea, right lower quadrant tenderness, rebound tenderness, fever and leukocytosis. Higher scores support operative management.

Postoperative fever timeline

Fever within 48 hours suggests atelectasis; days 3 to 5 suggest urinary or line infection; days 5 to 7 suggest anastomotic leak or wound infection; later fever suggests abscess or thrombosis.

Murphy sign

Inspiratory arrest during deep palpation below the right costal margin. It supports acute cholecystitis, commonly confirmed by ultrasound showing gallbladder wall thickening and pericholecystic fluid.

Hernia strangulation

An irreducible, tender hernia with systemic toxicity and absent bowel sounds, indicating compromised blood supply. It requires emergency surgery rather than attempted manual reduction.

Neonatal jaundice timing

Jaundice appearing within the first 24 hours of life is always pathological and needs urgent bilirubin measurement. Phototherapy treats unconjugated hyperbilirubinemia; exchange transfusion is reserved for severe levels.

WHO dehydration grading

Severe dehydration with two or more signs needs intravenous Ringer lactate at 100 mL/kg; some dehydration is treated with oral rehydration solution at 75 mL/kg over four hours.

Kawasaki disease criteria

Fever lasting at least five days plus four of five features: conjunctivitis, oral mucosal changes, rash, extremity changes and cervical lymphadenopathy. IVIG plus aspirin prevents coronary aneurysms.

Simple febrile seizure

A generalised seizure lasting under 15 minutes occurring once in 24 hours in a child aged 6 months to 5 years with fever. Routine EEG and long-term anticonvulsants are not indicated.

Intussusception target sign

An ultrasound appearance of concentric bowel loops typical of intussusception, which presents with colicky pain and red currant jelly stool. An air or contrast enema is both diagnostic and therapeutic.

Preeclampsia definition

Blood pressure of 140/90 or higher after 20 weeks of gestation with proteinuria or end-organ dysfunction. Magnesium sulfate prevents seizures and delivery is the definitive treatment.

Postpartum hemorrhage sequence

Uterine atony is the commonest cause. Treat with uterine massage, oxytocin, then ergometrine, carboprost or misoprostol, and give tranexamic acid within three hours of onset.

Gestational diabetes targets

Screening occurs at 24 to 28 weeks with an oral glucose tolerance test. Treatment targets are fasting glucose below 5.1 mmol/L and one-hour postprandial glucose below 7.8 mmol/L.

Herd immunity threshold

The proportion of a population needing immunity to stop transmission, calculated as 1 minus 1 divided by the basic reproduction number. Measles requires roughly 92 to 95 percent coverage.

Positive predictive value

The probability that a positive test result is a true positive. Unlike sensitivity and specificity, it depends strongly on disease prevalence and falls when screening low-prevalence populations.

Relative risk versus odds ratio

Relative risk compares incidence between exposed and unexposed groups in cohort studies. The odds ratio approximates it in case-control studies, where incidence cannot be measured directly.

Attributable risk

The difference in disease incidence between exposed and unexposed groups. It estimates the excess burden of disease caused by the exposure and is expressed as a risk difference.

Zero-order kinetics

Elimination of a constant drug amount per unit time regardless of plasma concentration, seen with ethanol, high-dose phenytoin and high-dose aspirin. Small dose increases can cause disproportionate toxicity.

Warfarin mechanism and reversal

Warfarin inhibits vitamin K epoxide reductase, reducing clotting factor synthesis, and is monitored by INR. Major bleeding is reversed with vitamin K and prothrombin complex concentrate.

CYP3A4 inhibitors

Drugs such as macrolides, azole antifungals and grapefruit that raise levels of CYP3A4 substrates including statins, calcium channel blockers and tacrolimus, increasing toxicity risk.

ACE inhibitor cough

A dry persistent cough caused by bradykinin accumulation during ACE inhibition. Switching to an angiotensin receptor blocker usually resolves it while preserving blood pressure control.

Coagulative necrosis

Necrosis with preserved tissue architecture, typical of ischaemic injury in most organs except the brain. The brain instead undergoes liquefactive necrosis after infarction.

Tumour suppressor genes

Genes such as TP53, RB and APC that normally restrain cell growth. Loss of function requires both alleles to be affected, in contrast to oncogenes where one mutation suffices.

Amyloid staining

Misfolded beta-pleated protein deposits that show apple-green birefringence under polarised light when stained with Congo red. Deposition causes organ dysfunction in amyloidosis.

Informed consent elements

Valid consent requires patient capacity, adequate disclosure of risks and alternatives, comprehension, and voluntariness. A capacitated patient's documented refusal must be respected.

Confidentiality exceptions

Confidentiality may be breached when legally mandated, such as reportable infectious diseases or suspected child abuse, or when a specific serious threat exists to an identifiable person.

Anaphylaxis first drug

Intramuscular adrenaline 0.5 mg of a 1:1000 solution into the anterolateral thigh, repeated after five minutes if needed. Antihistamines and corticosteroids are adjuncts, not first-line treatment.

Sepsis hour-one bundle

Measure lactate, obtain blood cultures, give broad-spectrum antibiotics within one hour, and start 30 mL/kg of crystalloid for hypotension or lactate of 4 mmol/L or higher.

Status epilepticus sequence

Give a benzodiazepine first, then a second-line anticonvulsant such as levetiracetam, valproate or phenytoin. Refractory cases require anaesthesia and intubation in intensive care.

Depression screening

Primary care uses the two-question screen followed by PHQ-9. Moderate depression is treated with brief psychological therapy or an SSRI, with clinical review after two to four weeks.

Stroke thrombolysis window

Intravenous thrombolysis may be given within 4.5 hours of symptom onset after CT excludes haemorrhage. Selected large-vessel occlusions may undergo thrombectomy up to 24 hours.

Serotonin syndrome features

Hyperreflexia, clonus, agitation and dilated pupils caused by serotonergic excess. It contrasts with neuroleptic malignant syndrome, which shows lead-pipe rigidity, bradyreflexia and raised creatine kinase.