MMDC Medical Licensing Exam cheat sheet

Acute coronary syndrome: ST-elevation MI prompts immediate reperfusion (PCI within 90 min of first medical contact); NSTEMI/unstable angina managed with antiplatelet plus anticoagulant and risk-stratified invasive strategy.

Heart failure with reduced ejection fraction (LVEF ≤40%): guideline-directed therapy combines ARNI/ACE inhibitor/ARB, beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.

Diabetic ketoacidosis: anion gap metabolic acidosis with ketonemia; treatment is isotonic saline, intravenous insulin, and potassium replacement once K+ is below the upper reference limit.

Community-acquired pneumonia severity is scored with CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30, blood pressure low, age ≥65); score ≥2 suggests inpatient care.

Hyperkalemia with ECG changes: intravenous calcium gluconate stabilizes myocardium, then insulin with glucose and beta-2 agonist shift potassium intracellularly; dialysis for refractory cases.

Thyroid storm is diagnosed clinically (Burch-Wartofsky score) and treated with thionamide, iodine load given at least 1 hour after thionamide, beta-blockade, and glucocorticoid.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipidemia; minimal change disease is the commonest cause in children and responds to corticosteroids.

Acute appendicitis: migration of periumbilical pain to right lower quadrant with McBurney point tenderness; Alvarado score ≥7 supports operative management.

Bowel obstruction: air-fluid levels and dilated loops on plain film; initial management is nil per os, intravenous fluids, nasogastric decompression, and serial abdominal examination.

Damage-control surgery prioritizes hemorrhage and contamination control with temporary abdominal closure, followed by staged definitive repair after physiologic restoration.

Postoperative fever timing: within 48 hours consider atelectasis; days 3-5 consider urinary or line infection; days 5-7 consider surgical site infection; after day 7 consider abscess or deep vein thrombosis.

Trauma primary survey follows ABCDE (airway, breathing, circulation, disability, exposure); hypotension with distended abdomen and absent breath sounds suggests hemorrhagic shock plus pneumothorax.

Breast cancer staging uses tumor size, nodal involvement, and distant metastasis (TNM); sentinel lymph node biopsy is standard for clinically node-negative axillary assessment.

Anastomotic leak after colorectal surgery typically presents days 5-7 with tachycardia, fever, and peritonitis; CT with contrast and prompt reoperation are indicated.

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

Postpartum hemorrhage is most often due to uterine atony; management sequence is uterine massage, oxytocin, then ergometrine, carboprost, or misoprostol, plus tranexamic acid.

Ectopic pregnancy: positive beta-hCG with empty uterus and adnexal mass; hemodynamically unstable patients require immediate surgery, while stable cases may receive methotrexate if criteria are met.

Gestational diabetes screening is typically performed at 24-28 weeks with an oral glucose tolerance test; treatment targets fasting glucose <95 mg/dL.

Fetal heart rate tracing: late decelerations indicate uteroplacental insufficiency, variable decelerations indicate cord compression, and early decelerations reflect head compression.

Ovarian torsion presents with sudden severe unilateral pelvic pain and nausea; Doppler may be normal, and laparoscopic detorsion is the treatment of choice.

RhD-negative mothers receive anti-D immunoglobulin at 28 weeks and within 72 hours postpartum if the newborn is RhD-positive.

Pediatric weight estimation: 1-12 months weight (kg) = (age in months + 9)/2; 1-5 years weight = 2 × (age in years + 5).

Neonatal jaundice appearing within 24 hours is always pathologic; causes include hemolysis, sepsis, and biliary obstruction, and requires urgent bilirubin measurement.

Acute otitis media in children older than 6 months may be observed for 48-72 hours if symptoms are mild; amoxicillin is first-line when antibiotics are indicated.

Kawasaki disease: fever ≥5 days plus conjunctivitis, mucositis, rash, extremity changes, and cervical lymphadenopathy; treat with intravenous immunoglobulin and aspirin to prevent coronary aneurysms.

Pediatric dehydration is assessed by capillary refill, skin turgor, mucous membranes, and mental status; isotonic crystalloid boluses of 10-20 mL/kg are used for shock.

Febrile seizures are common between 6 months and 5 years; simple febrile seizures last under 15 minutes and do not require long-term anticonvulsant therapy.

Bronchiolitis in infants under 2 years is usually caused by respiratory syncytial virus; management is supportive with oxygen and hydration, not routine bronchodilators or steroids.

Major depressive disorder requires ≥5 symptoms for ≥2 weeks, including depressed mood or anhedonia; first-line treatment is psychotherapy and/or a selective serotonin reuptake inhibitor.

Serotonin syndrome presents with clonus, hyperreflexia, agitation, and hyperthermia after serotonergic agents; treatment is discontinuation, supportive care, and cyproheptadine in severe cases.

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

Delirium is acute, fluctuating inattention with altered awareness; it is a medical emergency requiring identification of the underlying cause, unlike dementia which is chronic and progressive.

Alcohol withdrawal: symptoms peak at 24-72 hours; benzodiazepines are first-line, and thiamine is given before glucose to prevent Wernicke encephalopathy.

Schizophrenia requires ≥6 months of symptoms including ≥1 month of active symptoms; treatment is antipsychotic medication plus psychosocial intervention.

Bipolar I disorder is defined by at least one manic episode lasting ≥1 week or requiring hospitalization; mood stabilizers such as lithium or valproate are first-line.

Aminoglycosides are bactericidal through 30S ribosomal binding; they are nephrotoxic and ototoxic, and require therapeutic drug monitoring of trough levels.

Warfarin inhibits vitamin K epoxide reductase; monitor with INR (target 2-3 for most indications) and reverse with vitamin K plus prothrombin complex concentrate for major bleeding.

Heparin potentiates antithrombin III; monitor with aPTT or anti-Xa, and reverse with protamine sulfate.

Beta-blockers reduce heart rate and blood pressure; they are avoided in decompensated heart failure and in cocaine-induced coronary vasospasm.

Metformin is first-line for type 2 diabetes; it is contraindicated in severe renal impairment (eGFR <30) and in acute decompensated states due to lactic acidosis risk.

ACE inhibitors cause cough and hyperkalemia and are contraindicated in pregnancy and bilateral renal artery stenosis; ARBs share most contraindications.

Digoxin inhibits the sodium-potassium ATPase; toxicity presents with visual changes, nausea, and arrhythmias, and is worsened by hypokalemia and renal impairment.

Cell injury: reversible changes include swelling and fatty change; irreversible injury is marked by membrane rupture, mitochondrial permeability transition, and nuclear dissolution.

Inflammation: acute response is neutrophil-predominant; chronic response is macrophage and lymphocyte-predominant with fibrosis and angiogenesis.

Neoplasia: benign tumors are well circumscribed and non-invasive; malignant tumors invade and metastasize, and grade reflects differentiation while stage reflects spread.

Atherosclerosis begins with endothelial injury, lipid accumulation, and foam cell formation, progressing to a fibrous cap and plaque rupture.

Nephrotic versus nephritic: nephrotic shows heavy proteinuria and edema; nephritic shows hematuria, hypertension, and oliguria with red cell casts.

Cirrhosis is characterized by bridging fibrosis and regenerative nodules, leading to portal hypertension, varices, ascites, and hepatic encephalopathy.

Anemia classification uses mean corpuscular volume: microcytic (iron deficiency, thalassemia), normocytic (chronic disease, hemolysis), and macrocytic (B12/folate deficiency).

Informed consent requires capacity, disclosure of material risks and alternatives, comprehension, and voluntariness; it is documented before non-emergency procedures.

Decision-making capacity is assessed by the patient's ability to understand, appreciate, reason, and express a choice; capacity is task-specific and clinical, while competence is legal.

Confidentiality may be breached when required by law (reportable diseases, suspected abuse) or when necessary to prevent serious imminent harm.

When a patient lacks capacity and has no advance directive, treatment decisions follow substituted judgment or the best interests standard, usually with surrogate involvement.

Physician-assisted dying and euthanasia are legally restricted in most jurisdictions; requests should be explored for underlying depression, pain, or unmet needs.

Mandatory reporting includes suspected child abuse, elder abuse, and certain communicable diseases; reporting duties override patient confidentiality.

Conflict of interest: physicians must disclose financial or personal interests that could bias clinical judgment and avoid accepting gifts that could influence prescribing.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Positive predictive value depends on disease prevalence, while sensitivity and specificity are intrinsic test characteristics.

Incidence measures new cases over time; prevalence measures all existing cases at a point or period and rises with longer disease duration.

Relative risk is used in cohort studies; odds ratio approximates relative risk in case-control studies and for rare outcomes.

Screening programs require a detectable preclinical phase, an effective treatment for early disease, acceptable test performance, and adequate follow-up.

Herd immunity threshold depends on basic reproduction number; for measles (R0 ~12-18) it exceeds 90-95% vaccination coverage.

Levels of prevention: primary (prevent disease), secondary (early detection), tertiary (limit disability and rehabilitation).

Hand hygiene is the single most effective measure to prevent healthcare-associated infection; perform it before and after every patient contact.

SBAR (situation, background, assessment, recommendation) is a structured handover tool that reduces communication errors during transitions of care.

Medication reconciliation should be performed at admission, transfer, and discharge to prevent adverse drug events.

Surgical safety checklist includes correct patient, site, and procedure, anesthesia safety, and prophylactic antibiotic timing before incision.

Time-out before procedures confirms patient identity, procedure, site, consent, allergies, and equipment availability.

Root cause analysis examines system failures after a serious adverse event, while morbidity and mortality conferences review individual cases for learning.

Speak-up culture: any team member can halt a procedure when patient safety is threatened, and near-miss reporting is encouraged without blame.

Vital sign interpretation: hypotension with tachycardia suggests shock; bradycardia with hypertension suggests raised intracranial pressure (Cushing reflex).

Electrocardiogram basics: P wave (atrial depolarization), PR interval 0.12-0.20 s, QRS <0.12 s, QT corrected for heart rate.

Arterial blood gas interpretation: pH determines acidemia or alkalemia; then assess PaCO2 (respiratory) and bicarbonate (metabolic) to identify the primary disorder.

Glasgow Coma Scale: eye (1-4), verbal (1-5), motor (1-6); total ≤8 indicates severe impairment and consideration of airway protection.

Abdominal examination sequence: inspection, auscultation, percussion, palpation; auscultation precedes palpation to avoid altering bowel sounds.

Sepsis screening: suspected infection plus two or more systemic inflammatory response criteria warrant immediate cultures, antibiotics, and fluid resuscitation.

Documentation must be contemporaneous, legible, and include date, time, findings, and plan; alterations should be clearly attributed.

Outbreak investigation steps: verify the diagnosis, define cases, describe by person/place/time, generate hypotheses, test hypotheses, and implement control measures.

Screening test validity: a highly sensitive test is useful to rule out disease (SnNout); a highly specific test is useful to rule in disease (SpPin).

Lead-time bias inflates apparent survival in screened populations because diagnosis occurs earlier without changing the time of death.

Case fatality rate = deaths from disease / diagnosed cases; it reflects severity rather than incidence.

Vaccine types: live attenuated vaccines are contraindicated in immunocompromised patients and in pregnancy.

Attributable risk is the difference in incidence between exposed and unexposed groups and estimates the excess risk due to exposure.

Randomized controlled trials minimize confounding through randomization and allocation concealment; intention-to-treat analysis preserves randomization benefits.