Palestinian Board Part II flashcards

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

Seddon nerve injury classes

Neurapraxia is reversible conduction block without Wallerian degeneration; axonotmesis is axonal loss with intact endoneurium allowing spontaneous regeneration; neurotmesis is complete transection requiring surgical repair.

Anion gap formula

Anion gap equals sodium minus the sum of chloride and bicarbonate, normally 8-12 mEq/L. Elevated values suggest methanol, uremia, ketoacidosis, paraldehyde, isoniazid, lactic acidosis, ethylene glycol, or salicylate poisoning.

Drug half-life relation

Half-life equals 0.693 times volume of distribution divided by clearance. Roughly four to five half-lives are needed to reach steady-state plasma concentration during continuous dosing.

Cardiac output and MAP

Cardiac output is heart rate multiplied by stroke volume. Mean arterial pressure equals diastolic pressure plus one third of the pulse pressure, reflecting perfusion of vital organs.

Sensitivity versus specificity

Sensitivity is true positives divided by all diseased patients; specificity is true negatives divided by all healthy patients. Highly sensitive tests exclude disease, highly specific tests confirm it.

Positive likelihood ratio meaning

Positive likelihood ratio equals sensitivity divided by one minus specificity. Values above ten substantially raise post-test probability of disease; values below 0.1 substantially lower it.

Glasgow Coma Scale scoring

Eye response scores 1-4, verbal 1-5, motor 1-6, giving a total of 3-15. A score of 8 or less indicates coma and the need to secure the airway.

Shock index in trauma

Shock index is heart rate divided by systolic blood pressure. A value above 0.9 suggests significant occult hemorrhage even when blood pressure still appears normal.

DKA insulin and potassium rules

Start insulin infusion at 0.1 units/kg/h only after confirming potassium is at least 3.3 mEq/L. Add dextrose when glucose falls below 200-250 mg/dL while continuing insulin until ketosis resolves.

Warfarin INR targets

Target INR is 2.0-3.0 for atrial fibrillation and venous thromboembolism, and 2.5-3.5 for a mechanical mitral valve. Higher targets apply to some mechanical prostheses.

Hypertensive emergency pressure reduction

Lower mean arterial pressure by no more than 25% within the first hour, then toward 160/100 mmHg over two to six hours. Faster reduction risks cerebral, coronary, and renal ischemia.

Sepsis one-hour bundle

Measure lactate, draw blood cultures before antibiotics, give broad-spectrum antibiotics within one hour of septic shock recognition, and give 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Maximum lidocaine dose

Lidocaine maximum is 4.5 mg/kg without epinephrine and 7 mg/kg with epinephrine. Bupivacaine maximum is 2.5 mg/kg; calculate the dose before infiltrating any patient.

Lumbar puncture opening pressure

Opening pressure is measured with the patient in lateral decubitus position, normally 10-20 cm H2O. Lumbar puncture is contraindicated with raised intracranial pressure signs or coagulopathy.

Central line insertion bundle

Use hand hygiene, maximal sterile barrier, chlorhexidine skin antisepsis, and ultrasound guidance. Confirm the tip at the cavoatrial junction before infusing vasopressors or hypertonic solutions.

Suture material selection

Absorbable sutures such as vicryl close deep and mucosal layers; nonabsorbable nylon or prolene close skin. Use 5-0 to 6-0 on the face and 3-0 to 4-0 on the trunk.

Anaphylaxis epinephrine dosing

Give intramuscular epinephrine 0.3-0.5 mg of 1:1000 concentration into the anterolateral thigh, repeating every 5-15 minutes. Antihistamines and steroids are adjuncts, never first-line treatment.

Tension pneumothorax decompression

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression at the second intercostal space midclavicular line or fourth/fifth space anterior axillary line, followed by tube thoracostomy.

Stroke thrombolysis window

Intravenous alteplase is given within 4.5 hours of symptom onset when no contraindication exists. Noncontrast CT must exclude hemorrhage, ideally within 20 minutes of arrival.

Status epilepticus drug sequence

Give a benzodiazepine such as lorazepam 0.1 mg/kg intravenously and repeat once. If seizures persist, use levetiracetam, fosphenytoin, or valproate, and intubate if refractory.

Massive transfusion ratio

Give packed red cells, plasma, and platelets in a balanced 1:1:1 ratio with permissive hypotension. Tranexamic acid improves survival when given within three hours of traumatic hemorrhage.

Five hand hygiene moments

Perform hand hygiene before patient contact, before an aseptic task, after body fluid exposure risk, after patient contact, and after touching patient surroundings.

Surgical site infection prevention

Give antibiotic prophylaxis within 60 minutes before incision, maintain normothermia and glycemic control, and remove hair by clipping rather than shaving to reduce infection risk.

Isolation precaution categories

Use contact precautions for MRSA, VRE, and Clostridioides difficile; droplet for influenza, pertussis, and meningococcus; airborne for tuberculosis, measles, and varicella.

Plan-Do-Study-Act cycle

A quality improvement method that tests a small change, studies the measured result, and acts on findings before the next cycle. Run charts reveal special-cause variation over time.

Four principles of ethics

Autonomy respects patient choice, beneficence acts in the patient's interest, nonmaleficence avoids harm, and justice ensures fair distribution of benefits and burdens.

SPIKES bad news protocol

SPIKES stands for Setting, Perception, Invitation, Knowledge, Empathy, and Strategy or summary. It structures disclosure of serious diagnoses while preserving patient autonomy and emotional support.

Capacity assessment elements

The patient must understand the information, appreciate its consequences, reason through options, and communicate a choice. Capacity is decision-specific and may fluctuate over time.

Type I versus type II error

Type I error (alpha) is a false-positive conclusion rejecting a true null hypothesis. Type II error (beta) is a false negative; power equals 1 minus beta, conventionally 0.80.

Number needed to treat

Number needed to treat equals one divided by the absolute risk reduction. It expresses how many patients must be treated for one additional favorable outcome.

Herd immunity threshold formula

The threshold equals 1 minus 1 divided by the basic reproduction number R0. Measles with R0 around 12-18 requires roughly 92-95% population immunity.

Incremental cost-effectiveness ratio

ICER equals the difference in cost between intervention and comparator divided by the difference in health effect, usually expressed per quality-adjusted life-year gained.