Medical Council Malta Statutory Exam cheat sheet

Acute coronary syndrome: ST-elevation myocardial infarction requires emergency reperfusion (primary PCI if available within 120 minutes of first medical contact, otherwise fibrinolysis); dual antiplatelet therapy plus anticoagulation is standard.

Sepsis: defined as life-threatening organ dysfunction from dysregulated host response to infection; septic shock = persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg with lactate >2 mmol/L despite adequate fluid resuscitation.

Stroke: ischaemic stroke within 4.5 hours of symptom onset may receive intravenous thrombolysis after excluding haemorrhage on imaging; thrombectomy is considered for large-vessel occlusion up to 6 hours (selected cases longer).

Diabetic ketoacidosis: managed with isotonic fluid replacement, intravenous insulin infusion, and potassium replacement; insulin is withheld until serum potassium is ≥3.3 mmol/L to avoid precipitating arrhythmia.

Anaphylaxis: intramuscular adrenaline 0.5 mg (0.5 mL of 1:1000) into the anterolateral thigh for adults, repeated after 5 minutes if needed; antihistamines and corticosteroids are adjuncts, not first-line.

Acute asthma: severity assessed on ability to speak, respiratory rate, heart rate, peak flow and oxygen saturation; life-threatening features include silent chest, cyanosis, exhaustion, bradycardia and normal or rising PaCO2.

Hyponatraemia: correct chronic hyponatraemia slowly (typically ≤8-10 mmol/L in 24 hours) to avoid osmotic demyelination; acute symptomatic hyponatraemia with seizures warrants hypertonic saline.

Acute upper GI bleeding: resuscitate before endoscopy; pre-endoscopic proton pump inhibitor therapy is given, and variceal bleeding is treated with terlipressin plus prophylactic antibiotics and urgent endoscopic band ligation.

Drug dosing in renal impairment: calculate estimated glomerular filtration rate (e.g. CKD-EPI) and adjust renally cleared drugs; the Cockcroft-Gault creatinine clearance is commonly used for drug labelling thresholds.

Consent: valid consent requires capacity, adequate information and voluntariness; a competent adult may refuse treatment even where refusal risks death, and treatment without consent may constitute assault.

Capacity assessment: a person lacks capacity if unable to understand, retain, weigh and communicate information relevant to the decision; capacity is decision-specific and time-specific, not global.

Confidentiality: disclosure of patient information without consent is permitted only where required by law, ordered by a court, or justified by a public-interest risk of serious harm that cannot otherwise be averted.

Medical Council Malta: the statutory regulator established under the Health Care Professions Act; it maintains the specialist and general registers and handles complaints and fitness-to-practice proceedings against registered practitioners.

Registration: practising as a doctor in Malta requires registration with the Medical Council Malta; registration may be granted on the basis of recognised qualifications and is subject to conditions, suspension or erasure following disciplinary findings.

Mandatory reporting and notification: practitioners must notify the Council of specified events (e.g. certain convictions, adverse findings elsewhere); failure to do so is itself a disciplinary matter.

Professional indemnity: registered practitioners are expected to hold adequate professional indemnity cover; patients harmed by negligent care may pursue civil damages separately from any Council disciplinary process.

Duty of candour: after a patient safety incident the clinician should explain what happened, apologise and describe remedial steps; an apology is not, in itself, an admission of legal liability.

Prescribing controlled drugs: prescriptions must be legible, dated, signed and include the drug, dose, form and quantity; repeat prescribing and record-keeping are subject to statutory controls and audit.