Mongolia Physician Licensing Exam cheat sheet

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

Heart failure with reduced EF: start ACE inhibitor/ARB or ARNI plus beta-blocker plus MRA plus SGLT2 inhibitor; loop diuretics for congestion only, not mortality benefit.

Diabetic ketoacidosis: IV isotonic saline first, then insulin infusion 0.1 U/kg/h; add dextrose when glucose <14 mmol/L; monitor potassium and replace when K <5.2 mmol/L.

Community-acquired pneumonia severity: CURB-65 (confusion, urea >7 mmol/L, respiratory rate >=30, BP systolic <90 or diastolic <=60, age >=65); score >=2 suggests admission.

Hypertension diagnosis requires repeated elevated readings; stage 2 or high-risk patients start two agents, preferably a thiazide-like diuretic plus ACE inhibitor/ARB or calcium channel blocker.

Anemia workup begins with MCV: microcytic suggests iron deficiency, thalassemia, or chronic disease; macrocytic suggests B12/folate deficiency, alcohol, hypothyroidism, or myelodysplasia.

Acute pancreatitis diagnosis needs 2 of 3: characteristic epigastric pain radiating to back, lipase/amylase >3x upper limit, or imaging findings; early fluid resuscitation is the mainstay.

Acute appendicitis: migration of periumbilical pain to right lower quadrant, McBurney point tenderness, leukocytosis; ultrasound or CT confirms; appendectomy or antibiotics in selected uncomplicated cases.

Bowel obstruction: colicky pain, vomiting, distension, absolute constipation; erect abdominal X-ray shows air-fluid levels; CT identifies transition point and strangulation risk.

Postoperative fever timing: within 48 h consider atelectasis; days 3-5 consider urinary or wound infection; days 5-7 consider anastomotic leak or abscess; after day 7 consider deep vein thrombosis or prosthetic infection.

Shock in trauma follows ATLS: airway with cervical spine protection, breathing and ventilation, circulation with hemorrhage control, disability, exposure; hypotensive trauma patient receives blood products early rather than large crystalloid volumes.

Hernia strangulation signs: irreducible, tender, overlying skin changes, absent bowel sounds, systemic toxicity; requires emergent surgical exploration.

Thyroidectomy complications: recurrent laryngeal nerve injury causes hoarseness, external branch superior laryngeal nerve injury causes voice fatigue, hypocalcemia from parathyroid injury appears 24-72 h postoperatively.

Burn resuscitation: Parkland formula 4 mL/kg/% total body surface area lactated Ringer over 24 h, half in first 8 h from burn time; urine output target 0.5-1 mL/kg/h in adults.

Preeclampsia: blood pressure >=140/90 after 20 weeks plus proteinuria or end-organ dysfunction; severe features include BP >=160/110, platelets <100,000, elevated liver enzymes, pulmonary edema, or cerebral symptoms; delivery is definitive treatment.

Eclampsia management: magnesium sulfate loading 4-6 g IV over 15-20 min then 1-2 g/h; monitor reflexes, respiratory rate, and urine output; calcium gluconate is the antidote for toxicity.

Postpartum hemorrhage causes follow the four Ts: tone (uterine atony), trauma, tissue (retained placenta), thrombin (coagulopathy); atony is most common, treated with uterine massage and oxytocin.

Gestational diabetes screening at 24-28 weeks with 75 g oral glucose tolerance test; fasting >=5.1, 1 h >=10.0, or 2 h >=8.5 mmol/L diagnoses gestational diabetes.

Ectopic pregnancy: amenorrhea, unilateral pelvic pain, vaginal bleeding; quantitative beta-hCG and transvaginal ultrasound; discriminatory zone about 3,500 mIU/mL; methotrexate for stable unruptured cases.

Cervical cancer screening: cytology every 3 years from age 21 or co-testing every 5 years from age 30; high-risk HPV types 16 and 18 cause most cases; vaccination before exposure is most effective.

Fetal heart rate monitoring: category I is baseline 110-160 with moderate variability and no decelerations; late decelerations suggest uteroplacental insufficiency; variable decelerations suggest cord compression.

Neonatal resuscitation: warm, dry, stimulate, position airway; positive pressure ventilation if apneic or heart rate <100/min; chest compressions if heart rate <60/min after effective ventilation.

Pediatric dehydration: mild <5% weight loss, moderate 5-10%, severe >10%; oral rehydration solution is first-line for mild-moderate; IV isotonic saline bolus 20 mL/kg for shock.

Kawasaki disease: fever >=5 days plus 4 of 5 (conjunctivitis, mucosal changes, rash, extremity changes, cervical lymphadenopathy); treat with IV immunoglobulin 2 g/kg and aspirin to prevent coronary aneurysms.

Bronchiolitis: most common cause is respiratory syncytial virus; treat with supportive oxygen and hydration; bronchodilators and corticosteroids are not routinely recommended.

Growth assessment uses WHO charts for children under 2 and national or CDC charts after age 2; crossing two major percentile lines warrants evaluation for failure to thrive.

Febrile seizures: simple if generalized, lasting <15 min, once in 24 h, age 6 months to 5 years; no routine EEG or anticonvulsant prophylaxis needed.

Vaccination schedule principles: live vaccines are contraindicated in severe immunodeficiency; inactivated vaccines may be given; catch-up schedules follow minimum intervals rather than restarting series.

Sepsis-3 definition: suspected infection plus SOFA score increase >=2; septic shock requires vasopressor need to maintain MAP >=65 mmHg and lactate >2 mmol/L despite fluid resuscitation.

Tuberculosis: sputum smear and culture, GeneXpert for rapid detection and rifampicin resistance; standard regimen 2 months isoniazid, rifampicin, pyrazinamide, ethambutol followed by 4 months isoniazid and rifampicin.

Antibiotic de-escalation: obtain cultures before starting empiric therapy, review at 48-72 h, narrow based on susceptibilities, and set a defined duration.

Hepatitis B serology: HBsAg indicates infection; anti-HBs indicates immunity; anti-HBc IgM indicates acute infection; HBeAg indicates high infectivity.

Epidemic curve interpretation: point source shows a single peak within one incubation period; propagated outbreak shows successive peaks one incubation period apart.

Sensitivity and specificity: sensitivity = true positives/(true positives + false negatives); specificity = true negatives/(true negatives + false positives); predictive values depend on prevalence.

Notifiable disease reporting and contact tracing aim to interrupt transmission; isolation separates infected persons, quarantine restricts exposed persons during the incubation period.

Adult cardiac arrest: high-quality chest compressions at 100-120/min, depth 5-6 cm, full recoil, minimal interruptions; defibrillate shockable rhythms (ventricular fibrillation, pulseless ventricular tachycardia) as early as possible.

Anaphylaxis: intramuscular epinephrine 0.3-0.5 mg of 1:1,000 solution into the anterolateral thigh, repeated every 5-15 min as needed; adjuncts include fluids, oxygen, and antihistamines but do not replace epinephrine.

Acute asthma exacerbation: oxygen to target saturation 93-95%, repeated inhaled short-acting beta-2 agonist, systemic corticosteroids within 1 h, ipratropium for severe cases, magnesium sulfate IV for refractory cases.

Opioid overdose: support airway and ventilation, give naloxone titrated to restore breathing, and observe for re-sedation because naloxone half-life is shorter than most opioids.

Acute coronary syndrome: obtain 12-lead ECG within 10 min of arrival; aspirin 150-300 mg chewed; avoid nitrates in right ventricular infarction or recent phosphodiesterase inhibitor use.

Diabetic emergencies: hypoglycemia treated with oral glucose if conscious or IV dextrose/glucagon if not; hyperosmolar hyperglycemic state requires aggressive isotonic fluid replacement and insulin after volume correction.

Stroke: activate stroke pathway, obtain CT within 20-25 min of arrival; thrombolysis within 4.5 h of onset for eligible patients; thrombectomy up to 24 h in selected large-vessel occlusion.

Screening for hypertension begins at age 18 with blood pressure at every visit; screening for type 2 diabetes in adults aged 35-70 with overweight or obesity.

Depression screening uses PHQ-2 followed by PHQ-9; treatment includes psychotherapy, SSRIs, or both; assess suicide risk at every encounter.

Low back pain without red flags: reassure, encourage activity, avoid routine imaging in the first 6 weeks; red flags include age >50 with new pain, fever, weight loss, neurological deficit, or cancer history.

Smoking cessation: brief advice plus pharmacotherapy (nicotine replacement, varenicline, or bupropion) plus behavioral support; combine counseling with medication for best results.

Contraception counseling: combined hormonal contraceptives are contraindicated in migraine with aura, uncontrolled hypertension, smoking over age 35, and history of venous thromboembolism.

Childhood immunization and growth monitoring are core primary care tasks; missed opportunities should be addressed at every visit.

Antibiotic stewardship in primary care: avoid antibiotics for viral upper respiratory infections, acute bronchitis, and uncomplicated otitis media with mild symptoms in older children.

Pharmacokinetics: bioavailability is the fraction of dose reaching systemic circulation; volume of distribution relates dose to plasma concentration; clearance determines maintenance dose; half-life determines time to steady state (about 4-5 half-lives).

First-order kinetics: elimination rate proportional to concentration; zero-order kinetics (phenytoin, ethanol, high-dose aspirin) eliminates a constant amount per time and risks toxicity with small dose increases.

Cytochrome P450 interactions: inhibitors (ketoconazole, erythromycin, grapefruit) raise substrate levels; inducers (rifampicin, carbamazepine, phenytoin) lower them; warfarin is a sensitive substrate.

Aminoglycosides and vancomycin require therapeutic drug monitoring due to narrow therapeutic index; monitor renal function and trough or AUC levels.

Rational prescribing: confirm diagnosis, select first-line agent per guidelines, use the correct dose and duration, check allergies and interactions, and document the plan.

Adverse drug reaction reporting: distinguish type A (dose-dependent, predictable) from type B (idiosyncratic, unpredictable); report serious reactions to the national pharmacovigilance system.

Antimicrobial resistance is driven by unnecessary and incomplete courses; complete prescribed courses for confirmed bacterial infection and avoid antibiotics for viral illness.

Complete blood count interpretation: anemia by MCV; neutrophilia suggests bacterial infection; lymphocytosis suggests viral infection; thrombocytopenia requires review of the peripheral smear.

Liver enzymes: ALT and AST reflect hepatocellular injury; alkaline phosphatase and bilirubin reflect cholestasis; an AST/ALT ratio >2 suggests alcoholic liver disease.

Renal function: creatinine and eGFR estimate filtration; urea/creatinine ratio >20 suggests prerenal state; urinalysis with casts and protein suggests intrinsic renal disease.

Chest X-ray: silhouetting of the right heart border suggests right middle lobe disease; left heart border suggests lingula; air bronchograms suggest alveolar consolidation.

Abdominal ultrasound is first-line for gallstones and biliary colic; CT is preferred for suspected appendicitis, diverticulitis, and renal colic in adults.

Arterial blood gas: stepwise interpretation begins with pH, then PaCO2, then bicarbonate to classify respiratory or metabolic acidosis/alkalosis and check compensation.

Point-of-care testing must be confirmed by laboratory testing when results are unexpected or critical; document quality control and reference ranges.

Incidence measures new cases per population at risk per time; prevalence measures all existing cases at a point in time; prevalence approximately equals incidence times duration for stable disease.

Relative risk is used in cohort studies; odds ratio approximates relative risk in case-control studies; attributable risk is the difference in incidence between exposed and unexposed.

Screening test criteria: important disease, accepted treatment, detectable preclinical phase, acceptable test, and evidence that early treatment improves outcomes.

Herd immunity threshold depends on basic reproduction number: for measles (R0 about 12-18) very high coverage is required; for influenza it is lower.

Levels of prevention: primary prevents exposure (vaccination), secondary detects early disease (screening), tertiary limits disability (rehabilitation).

Outbreak investigation steps: verify diagnosis, confirm outbreak, define cases, describe by person, place, and time, generate hypotheses, test hypotheses, implement control, and communicate.

Health determinants include income, education, environment, and access to care; health equity requires addressing avoidable differences in health status.

Informed consent requires capacity, adequate information about risks, benefits, and alternatives, and voluntary agreement; emergency treatment may proceed without consent when life-threatening and no surrogate is available.

Confidentiality may be breached only when required by law or when necessary to prevent serious harm; disclose the minimum necessary information.

Medical records are legal documents; document contemporaneously, accurately, and legibly; corrections should be made with a dated addendum, not erasure.

Four principles of biomedical ethics: autonomy (respect patient choice), beneficence (act for benefit), non-maleficence (avoid harm), and justice (fair distribution).

Mandatory reporting obligations include certain communicable diseases, suspected child abuse, and gunshot wounds, according to national law.

Professional boundaries: avoid conflicts of interest, dual relationships, and accepting gifts that could influence clinical judgment.

End-of-life care: advance directives and surrogate decision-makers guide care; withholding or withdrawing futile treatment is ethically permissible with appropriate process.

Action potential: resting membrane potential about -70 mV; threshold about -55 mV; depolarization from sodium influx; repolarization from potassium efflux; refractory period limits re-excitation.

Cardiac output = heart rate x stroke volume; stroke volume depends on preload, afterload, and contractility; mean arterial pressure approximately equals diastolic pressure plus one-third of pulse pressure.

Acid-base: Henderson-Hasselbalch equation pH = 6.1 + log([HCO3-]/0.03 x PaCO2); respiratory compensation changes PaCO2 by 1.2 mmHg per 1 mmol/L acute bicarbonate change.

Renal physiology: glomerular filtration rate depends on net filtration pressure; proximal tubule reabsorbs most filtered sodium and water; loop of Henle creates the medullary gradient.

Autonomic pharmacology: alpha-1 receptors cause vasoconstriction, beta-1 increases heart rate and contractility, beta-2 causes bronchodilation and vasodilation, muscarinic receptors mediate parasympathetic effects.

Genetics: autosomal recessive disease requires two carrier parents; autosomal dominant shows vertical transmission; X-linked recessive affects males predominantly; mitochondrial inheritance is maternal.

Microbiology: gram-positive bacteria have thick peptidoglycan and retain crystal violet; gram-negative have thin peptidoglycan and an outer membrane with lipopolysaccharide; acid-fast organisms resist decolorization.

History-taking structure: open-ended question, active listening, structured exploration of symptoms (onset, location, duration, character, aggravating/relieving factors, timing, severity), then review of systems.

Breaking bad news uses a structured protocol such as SPIKES: setting, perception, invitation, knowledge, empathy, strategy and summary.

Shared decision-making requires presenting options, discussing benefits and harms, exploring patient values, and reaching a mutually agreed plan.

Motivational interviewing uses open questions, affirmation, reflective listening, and summarization to strengthen the patient's own motivation for change.

Medical error disclosure: explain what happened, take responsibility, apologize, describe corrective action, and document the conversation.

Interpreters should be used for patients with limited language proficiency; family members, especially children, should not be relied on for interpretation.

Clinical examination: wash hands, introduce yourself, obtain consent, maintain privacy, compare sides, and explain findings to the patient.