Mongolia Feldsher Licensing Exam cheat sheet

Cardiac output = heart rate × stroke volume; normal adult 4–8 L/min. Mean arterial pressure ≈ diastolic pressure + 1/3 (systolic − diastolic).

Normal adult blood pH 7.35–7.45; PaCO2 35–45 mmHg; HCO3− 22–26 mmol/L. Respiratory acidosis = low pH with raised PaCO2; metabolic acidosis = low pH with low HCO3−.

Serum potassium 3.5–5.0 mmol/L; sodium 135–145 mmol/L; fasting glucose 3.9–6.1 mmol/L. Insulin lowers potassium by driving it intracellularly.

Hepatotoxic first-line antituberculosis drugs are isoniazid, rifampicin and pyrazinamide; stop all three if ALT exceeds 3× upper limit of normal with symptoms or 5× without symptoms.

Paracetamol adult maximum 4 g/day (lower in liver disease or low body weight); acetylcysteine is the antidote and is most effective within 8 hours of ingestion.

First-generation (typical) antipsychotics act mainly by blocking dopamine D2 receptors; extrapyramidal effects are dose-related and treatable with an anticholinergic such as trihexyphenidyl.

Inflammation cardinal signs: redness, heat, swelling, pain and loss of function - produced by vasodilation, increased vascular permeability and leukocyte migration.

Cell injury becomes irreversible when the cell can no longer restore mitochondrial ATP production and membrane integrity; necrosis triggers surrounding inflammation, apoptosis does not.

Hypertension in adults: diagnose when clinic blood pressure is ≥140/90 mmHg on repeated measurements; start drug treatment plus lifestyle change and reassess within 1 month.

Type 2 diabetes diagnostic thresholds: fasting plasma glucose ≥7.0 mmol/L, random ≥11.1 mmol/L with symptoms, or HbA1c ≥6.5%; metformin is first-line unless contraindicated.

Asthma control is assessed by daytime symptoms, night waking, reliever use and activity limitation; a step-up is indicated when reliever use exceeds twice weekly.

Community-acquired pneumonia: assess severity (respiratory rate, blood pressure, confusion, oxygen saturation) before deciding on outpatient or inpatient treatment.

In heart failure with reduced ejection fraction, ACE inhibitor or ARB, beta-blocker and mineralocorticoid antagonist each reduce mortality and are titrated to tolerated dose.

Peptic ulcer disease with Helicobacter pylori requires eradication therapy plus a confirmatory test of cure at least 4 weeks after treatment ends.

Anemia in adults: WHO defines hemoglobin <130 g/L in men and <120 g/L in non-pregnant women; low MCV suggests iron deficiency or thalassemia, high MCV suggests B12/folate deficiency.

Gout acute attack: NSAID, colchicine or corticosteroid; do not start or stop urate-lowering therapy during the attack because shifts in urate can prolong it.

Adult CPR: compressions at 100–120 per minute, depth 5–6 cm, full chest recoil, compression-to-ventilation ratio 30:2; minimize interruptions to under 10 seconds.

Defibrillation is indicated for ventricular fibrillation and pulseless ventricular tachycardia; each shock should be followed immediately by 2 minutes of CPR before rechecking rhythm.

Triage colour codes: red = immediate life threat, yellow = delayed but urgent, green = walking wounded, black = deceased or expectant; reassess after every intervention.

Primary survey sequence is airway, breathing, circulation, disability, exposure; life-threatening problems are treated as they are found, before moving on.

Anaphylaxis: intramuscular adrenaline 0.01 mg/kg (maximum 0.5 mg) into the anterolateral thigh, repeated every 5–15 minutes; oxygen and fluids are adjuncts, not substitutes.

Hypoglycemia in a conscious patient: 15–20 g oral fast-acting carbohydrate, recheck glucose after 15 minutes; if unconscious, give IV glucose or intramuscular glucagon.

Burn fluid resuscitation (Parkland formula): 4 mL × body weight in kg × % total body surface area burned of crystalloid in the first 24 hours, half in the first 8 hours from injury time.

Tension pneumothorax is a clinical diagnosis - severe dyspnea, unilateral absent breath sounds, hypotension and tracheal deviation - and requires immediate needle decompression.

Normal infant weight gain: about 25–30 g/day in the first 3 months, 15–20 g/day at 3–6 months; birth weight usually doubles by 4–5 months and triples by 12 months.

Integrated Management of Childhood Illness danger signs: inability to drink or breastfeed, persistent vomiting, convulsions, lethargy or unconsciousness, and chest indrawing or stridor.

Acute diarrhea in children is treated with oral rehydration salts and zinc; antibiotics are reserved for dysentery, cholera-like illness or confirmed invasive infection.

BCG is given at birth in tuberculosis-endemic settings; it protects against severe disseminated disease such as miliary tuberculosis and meningitis, not against infection itself.

Measles-containing vaccine is given in two doses; a first dose at 9 months is used in high-incidence settings, with a second dose later to catch primary vaccine failures.

Fever in a child under 3 months is a red flag for serious bacterial infection; such infants need urgent assessment and usually admission and parenteral antibiotics.

Dehydration assessment in children: sunken eyes, slow skin pinch, lethargy and inability to drink indicate severe dehydration requiring intravenous or nasogastric fluid.

Dosing in children is calculated per kilogram of body weight; always confirm the weight, the concentration of the preparation and the maximum adult dose before administering.

Estimated date of delivery: Nägele's rule - first day of last menstrual period minus 3 months plus 7 days; ultrasound dating is more accurate in the first trimester.

Preeclampsia is defined as blood pressure ≥140/90 mmHg after 20 weeks with proteinuria or other organ dysfunction; the only definitive treatment is delivery.

Eclampsia: give magnesium sulfate for seizure control and prophylaxis; monitor respiratory rate, urine output and deep tendon reflexes for magnesium toxicity.

Postpartum hemorrhage is blood loss ≥500 mL after vaginal birth or ≥1000 mL after cesarean; uterine atony is the commonest cause - massage the uterus and give a uterotonic.

Normal labor progress: cervix dilates about 1 cm per hour in active first stage; second stage is up to 3 hours in a first birth with epidural, shorter in later births.

Active management of the third stage - prophylactic oxytocin, controlled cord traction and uterine massage - reduces postpartum hemorrhage.

Gestational diabetes screening is done at 24–28 weeks; a fasting glucose ≥5.1 mmol/L on a 75 g oral glucose tolerance test is diagnostic.

Emergency contraception with a copper intrauterine device is effective up to 5 days after unprotected intercourse and is more effective than oral hormonal methods.

Pulmonary tuberculosis is confirmed by sputum smear microscopy and Xpert MTB/RIF testing; two sputum specimens are collected, and drug-susceptibility testing is required before retreatment.

Standard drug-susceptible tuberculosis regimen: 2 months of isoniazid, rifampicin, pyrazinamide and ethambutol, followed by 4 months of isoniazid and rifampicin (2HRZE/4HR).

Latent tuberculosis infection treatment options include 6–9 months of isoniazid or shorter rifamycin-based regimens; exclude active disease before starting.

Notifiable disease reporting: the clinician who makes the diagnosis must report to the designated public health authority within the legally defined time frame, and case-based data are kept confidential.

Incidence measures new cases per population at risk per time period; prevalence measures all existing cases at a point in time.

An outbreak is investigated by confirming the diagnosis, defining and counting cases, describing time-place-person, generating a hypothesis and applying control measures.

Hand hygiene according to WHO's five moments is the single most effective measure for preventing healthcare-associated infection transmission.

Herd immunity threshold ≈ 1 − 1/R0; measles with R0 of 12–18 requires roughly 92–95% coverage to interrupt transmission.

Wound cleansing is done with sterile normal saline under pressure; antiseptics such as hydrogen peroxide or alcohol damage tissue and are avoided in open wounds.

Tetanus prophylaxis depends on wound type and immunization history: clean minor wounds need a booster if the last dose was over 10 years ago; dirty wounds over 5 years.

Sutures are removed at 5–7 days on the face and neck, 7–10 days on the trunk and limbs, and 10–14 days over joints.

Signs of wound infection: spreading erythema, warmth, purulent discharge, increasing pain and fever; open and drain an abscess rather than treating with antibiotics alone.

Local anesthetic maximum doses: lidocaine 3 mg/kg without adrenaline and 7 mg/kg with adrenaline; calculate the dose before infiltration to avoid systemic toxicity.

Acute abdomen red flags: rigidity, rebound tenderness, absent bowel sounds, hemodynamic instability and free air on imaging - surgical consultation is urgent.

Appendicitis classically migrates from periumbilical pain to the right lower quadrant with anorexia, low-grade fever and tenderness at McBurney's point.

Sterile technique for minor procedures: hand hygiene, sterile gloves, skin antisepsis in concentric circles, sterile drape, and no re-entry of a contaminated instrument.

Primary health care principles: first contact, continuity, comprehensiveness, coordination and community orientation - the soum feldsher is usually the first and only contact.

Screening detects disease before symptoms appear; it is worthwhile only when the condition is common or serious, has a detectable early stage, and effective early treatment exists.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); a highly sensitive test is useful to rule out disease.

Positive predictive value rises with disease prevalence, so a test's meaning depends on the population screened, not only on its sensitivity and specificity.

Risk factor modification for noncommunicable disease: stop smoking, limit alcohol, reduce salt, increase physical activity to at least 150 minutes per week, and control weight.

Cold-chain management: vaccines are kept at 2–8 °C, monitored with a thermometer twice daily, and freeze-sensitive vaccines such as hepatitis B must never be frozen.

Referral decision rule: refer when the condition exceeds the soum's diagnostic or treatment capacity, when red flags are present, or when the patient is not improving as expected.

Informed consent requires capacity, adequate information about benefits and risks, and a voluntary decision; a competent adult may refuse treatment even if the refusal risks death.

Confidentiality may be broken only when required by law (for example notifiable disease reporting), when the patient consents, or to prevent serious imminent harm to others.

Medical records must be accurate, legible, dated and signed; entries are made contemporaneously and corrections are made by a single line-through with initials, never by erasure.

A complete progress note documents subjective findings, objective findings, assessment, plan, and the name and signature of the author.

Emergency treatment may proceed without consent when the patient lacks capacity and delay would endanger life or health; document the reason and the steps taken.

Prescribing is documented with drug name, dose, route, frequency, duration and indication; verbal orders are written down, read back and countersigned.

Professional duty includes reporting suspected child abuse, unsafe practice or impaired colleagues through the appropriate channel, and maintaining competence through continuing education.

Patient records are stored securely and released only to authorized persons; patients have a right to access their own records under the applicable health law.

Vital signs: measure blood pressure with the patient seated and the arm supported at heart level; use a cuff whose bladder covers about 80% of arm circumference.

Hand hygiene with alcohol-based rub: apply to dry hands, rub palms, backs, between fingers, thumbs and fingertips until dry; wash with soap and water when hands are visibly soiled.

Standard precautions apply to every patient: treat all blood and body fluids as potentially infectious and use gloves, gown, mask and eye protection according to exposure risk.

Needlestick injury: wash the site with soap and water, do not squeeze or suck, report immediately, and start post-exposure prophylaxis as soon as possible after risk assessment.

Sterile field rules: sterile items touch only sterile items; anything below waist level or out of direct view is considered contaminated.

Blood pressure measurement errors: cuff too small raises the reading, arm unsupported or below heart level raises it, and talking or a full bladder raises it.

Sharps are disposed of immediately in puncture-resistant containers filled to no more than three-quarters; never recap a needle by hand.

Urine dipstick interpretation: nitrite and leukocyte esterase suggest urinary tract infection; blood and protein require further assessment and culture.