Russia Primary Medical Accreditation - General Medicine cheat sheet

Community-acquired pneumonia: stratify with CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30, low blood pressure, age ≥65); score 0–1 supports outpatient therapy.

Acute coronary syndrome: obtain 12-lead ECG within 10 minutes of first medical contact; serial high-sensitivity troponin at 0 and 1–3 hours.

Hypertensive emergency = BP elevation with acute target-organ damage; reduce mean arterial pressure by no more than 20–25% in the first hour.

Sepsis: qSOFA (respiratory rate ≥22, altered mentation, systolic BP ≤100 mmHg); each criterion carries 1 point, score ≥2 signals high risk.

Anemia workup starts with MCV: microcytic <80 fL, normocytic 80–100 fL, macrocytic >100 fL; then iron studies, B12/folate, reticulocyte count.

Venous thromboembolism: pretest probability by Wells score; D-dimer is useful mainly to exclude disease in low/intermediate probability patients.

Diabetic ketoacidosis: isotonic saline resuscitation, insulin infusion 0.1 U/kg/h, and potassium replacement once K+ <5.5 mmol/L with adequate urine output.

Ascites: serum-ascites albumin gradient ≥11 g/L indicates portal hypertension; diagnostic paracentesis is indicated in new-onset or hospitalized ascites.

STEMI: ST elevation ≥1 mm in two contiguous limb leads or ≥2 mm in precordial leads (or new LBBB with ischemic symptoms) mandates urgent reperfusion; door-to-balloon ≤90 minutes.

Heart failure with reduced ejection fraction (≤40%): four pillars - ACE inhibitor/ARB or ARNI, beta-blocker, mineralocorticoid receptor antagonist, SGLT2 inhibitor.

Atrial fibrillation stroke risk: CHA2DS2-VASc score ≥2 in men or ≥3 in women supports oral anticoagulation; bleeding risk assessed by HAS-BLED.

Acute decompensated heart failure: IV loop diuretic for congestion; nitrates if systolic BP adequate; noninvasive ventilation for pulmonary edema with respiratory distress.

Aortic stenosis severity: aortic valve area <1.0 cm², mean gradient ≥40 mmHg, or peak velocity ≥4 m/s indicates severe disease.

Pericarditis: diffuse ST elevation with PR depression; treat with NSAIDs plus colchicine; avoid anticoagulation when effusion is large.

Infective endocarditis: obtain three sets of blood cultures from separate sites before antibiotics; echocardiography (TTE then TEE) defines vegetations and complications.

Hypertrophic cardiomyopathy: asymmetric septal hypertrophy, systolic murmur increasing with Valsalva; avoid vasodilators and dehydration; sudden-death risk drives ICD decisions.

Asthma control is assessed by daytime symptoms, night waking, reliever use, and activity limitation; step-up or step-down therapy accordingly.

COPD: post-bronchodilator FEV1/FVC <0.70 confirms persistent airflow limitation; GOLD grades A–E combine symptom burden (mMRC, CAT) and exacerbation history.

Acute severe asthma: oxygen to target saturation 93–95%, repeated inhaled short-acting beta-agonist, systemic corticosteroid, and ipratropium for severe attacks.

Pleural effusion: Light's criteria classify exudate when pleural protein/serum protein >0.5, pleural LDH/serum LDH >0.6, or pleural LDH >2/3 upper normal serum LDH.

Pulmonary embolism: ECG may show sinus tachycardia, S1Q3T3, or right heart strain; CT pulmonary angiography is the diagnostic standard.

Tuberculosis screening: interferon-gamma release assay or Mantoux tuberculin skin test detects infection; sputum smear, culture, and PCR confirm active disease.

Obstructive sleep apnea: apnea-hypopnea index ≥5 with symptoms, or ≥15 regardless of symptoms, defines clinically significant disease.

Community-acquired pneumonia severity: CURB-65 ≥2 generally warrants hospital admission; ≥3 suggests consideration of intensive care.

Upper GI bleeding: resuscitate first, then endoscopy within 24 hours; high-risk stigmata (active bleeding, visible vessel) require endoscopic hemostasis plus PPI.

Helicobacter pylori eradication uses proton-pump inhibitor-based triple or quadruple therapy; confirm cure at least 4 weeks after therapy with urea breath test or stool antigen.

Acute pancreatitis diagnosis requires 2 of 3: characteristic epigastric pain, serum lipase/amylase >3× upper limit, and imaging findings.

Liver cirrhosis: Child-Pugh and MELD scores stratify prognosis; ascites, varices, encephalopathy, and jaundice define decompensation.

Spontaneous bacterial peritonitis: ascitic polymorphonuclear count ≥250 cells/mm³ is diagnostic; start third-generation cephalosporin and give albumin.

Inflammatory bowel disease: ulcerative colitis is continuous and distal; Crohn disease is transmural, skip-lesion, and may affect any GI segment.

Celiac disease: positive tissue transglutaminase IgA with elevated total IgA; duodenal biopsy shows villous atrophy and crypt hyperplasia.

Acute liver injury: ALT/AST elevation with INR ≥1.5 and encephalopathy defines acute liver failure; transfer to a transplant center is indicated.

Diabetes diagnosis: fasting glucose ≥7.0 mmol/L, 2-hour OGTT ≥11.1 mmol/L, HbA1c ≥6.5%, or random glucose ≥11.1 mmol/L with classic symptoms.

Hypothyroidism: elevated TSH with low free T4 confirms primary hypothyroidism; levothyroxine is titrated to TSH, starting low in elderly or cardiac patients.

Thyroid storm: Burch-Wartofsky score ≥45 is highly suggestive; treat with beta-blocker, thionamide, iodine after thionamide, and glucocorticoid.

Adrenal crisis: hypotension with hyponatremia, hyperkalemia, and hypoglycemia; draw cortisol/ACTH then give IV hydrocortisone 100 mg immediately.

Primary hyperaldosteronism: elevated aldosterone with suppressed renin; screen with aldosterone-to-renin ratio in resistant hypertension or hypokalemia.

Pheochromocytoma: plasma free metanephrines are the initial test; alpha-blockade precedes beta-blockade to avoid unopposed vasoconstriction.

Hypercalcemia: correct calcium for albumin (add 0.02 mmol/L per g/L albumin below 40); primary hyperparathyroidism and malignancy are the commonest causes.

Diabetic foot: annual monofilament and vibration testing for neuropathy; offloading and debridement are central to ulcer management.

Acute kidney injury staging (KDIGO): creatinine rise ≥26.5 µmol/L in 48 h, ≥1.5× baseline in 7 days, or urine output <0.5 mL/kg/h for 6 h.

Estimated GFR by CKD-EPI; chronic kidney disease requires GFR <60 mL/min/1.73 m² or markers of kidney damage for ≥3 months.

Hyperkalemia with ECG changes (peaked T waves, widened QRS): IV calcium gluconate first, then insulin-glucose, beta-agonist, and potassium removal.

Hyponatremia: assess volume status and urine osmolality; correct chronic hyponatremia by ≤8–10 mmol/L per 24 h to prevent osmotic demyelination.

Nephrotic syndrome: proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipidemia; nephritic syndrome features hematuria, hypertension, and oliguria.

Metabolic acidosis: anion gap = Na − (Cl + HCO3); normal 8–12 mmol/L; elevated gap suggests ketoacidosis, lactic acidosis, renal failure, or toxins.

Hyperkalemia ECG progression: peaked T waves, PR prolongation, widened QRS, sine wave pattern, ventricular fibrillation or asystole.

Nephrotoxic avoidance: withhold NSAIDs, ACE inhibitors, and aminoglycosides in acute kidney injury; adjust renally cleared drug doses by GFR.

Iron deficiency anemia: low ferritin, low serum iron, high total iron-binding capacity, low transferrin saturation; ferritin is an acute-phase reactant and may be normal in inflammation.

Vitamin B12 deficiency: macrocytic anemia with hypersegmented neutrophils and elevated methylmalonic acid; treat before or with folate to avoid neurologic progression.

Heparin-induced thrombocytopenia: platelet drop >50% at 5–10 days, thrombosis rather than bleeding; stop heparin and start a non-heparin anticoagulant.

Immune thrombocytopenia: isolated thrombocytopenia without other cytopenias; treat if platelets <30×10⁹/L or bleeding; glucocorticoids and IVIG are first-line.

Acute leukemia: blasts ≥20% in marrow or blood defines acute leukemia; urgent hematology referral for cytogenetics and molecular testing.

Multiple myeloma: CRAB features (hypercalcemia, renal insufficiency, anemia, bone lesions); serum protein electrophoresis and free light chains support diagnosis.

Transfusion: crossmatch-compatible red cells for symptomatic anemia; restrictive threshold (Hb 70–80 g/L) is appropriate for most stable adults.

Disseminated intravascular coagulation: prolonged PT/APTT, low fibrinogen, elevated D-dimer, thrombocytopenia; treat the underlying cause.

Acute monoarthritis: arthrocentesis is mandatory to exclude septic arthritis; synovial fluid leukocytes >50,000/mm³ with crystals or organisms are concerning.

Gout: negatively birefringent needle-shaped monosodium urate crystals; treat acute flare with NSAIDs, colchicine, or glucocorticoids, not urate-lowering therapy initiation alone.

Rheumatoid arthritis: symmetric small-joint synovitis with morning stiffness >1 hour; anti-CCP is more specific than rheumatoid factor; early DMARD therapy is standard.

Systemic lupus erythematosus: ANA is sensitive but not specific; anti-dsDNA and anti-Smith are specific; complement C3/C4 fall during active disease.

Giant cell arteritis: age >50, headache, jaw claudication, elevated ESR; start high-dose glucocorticoids immediately and confirm with temporal artery biopsy.

Ankylosing spondylitis: inflammatory back pain, sacroiliitis on imaging, HLA-B27 association; first-line therapy is NSAIDs plus physiotherapy.

Osteoporosis: T-score ≤−2.5 defines osteoporosis; ≤−2.5 with fragility fracture is severe; bisphosphonates and calcium/vitamin D are standard.

Polymyalgia rheumatica: proximal shoulder and hip girdle pain with elevated ESR/CRP in older adults; rapid response to low-dose glucocorticoids is characteristic.

Pulmonary tuberculosis: sputum microscopy, culture, and nucleic acid amplification; drug susceptibility testing guides regimen selection.

Standard drug-susceptible TB regimen: 2 months isoniazid, rifampicin, pyrazinamide, ethambutol, then 4 months isoniazid plus rifampicin.

Latent TB treatment options include isoniazid for 6–9 months or rifampicin-based short regimens; exclude active disease before starting.

HIV: screen with fourth-generation antigen/antibody test; confirm with Western blot or HIV RNA; CD4 count guides opportunistic infection prophylaxis.

Meningococcal meningitis: droplet precautions, immediate ceftriaxone, and chemoprophylaxis (rifampicin or ciprofloxacin) for close contacts.

Sepsis and septic shock: obtain blood cultures before antibiotics, give broad-spectrum antibiotics within 1 hour, and start 30 mL/kg crystalloid for hypotension or lactate ≥4.

Infective endocarditis prophylaxis is reserved for high-risk cardiac conditions undergoing dental procedures.

Tick-borne infections: erythema migrans is clinical and treated with doxycycline; avoid unnecessary serology in early localized disease.

Adult cardiac arrest: high-quality chest compressions at 100–120/min, depth 5–6 cm, full recoil, minimal interruptions, and early defibrillation for shockable rhythms.

Ventricular fibrillation or pulseless VT: immediate defibrillation, then CPR for 2 minutes before rhythm recheck; adrenaline 1 mg every 3–5 minutes after the second shock.

Asystole or pulseless electrical activity: CPR plus adrenaline 1 mg every 3–5 minutes; search for reversible causes (4 H's and 4 T's).

Post-resuscitation care: target oxygen saturation 94–98%, avoid hyperoxia, maintain normocapnia, and consider targeted temperature management.

Anaphylaxis: intramuscular adrenaline 0.5 mg (1 mg/mL) into the anterolateral thigh, repeat every 5 minutes as needed; fluids for hypotension.

Acute upper airway obstruction: assess for stridor and use bag-mask or surgical airway if intubation fails; do not attempt blind airway maneuvers.

Shock classification: hypovolemic, cardiogenic, distributive, and obstructive; lactate and capillary refill guide resuscitation adequacy.

Poisoning: activated charcoal within 1 hour for selected ingestions; specific antidotes include naloxone, N-acetylcysteine, and flumazenil (with caution).

Primary prevention targets risk factors before disease; secondary prevention detects disease early; tertiary prevention limits disability and complications.

Vaccination schedules are age- and risk-based; live vaccines are contraindicated in significant immunosuppression and pregnancy.

Screening: colorectal cancer from age 50 (earlier with family history), cervical cancer by cytology/HPV testing, and breast cancer by mammography in eligible age groups.

Cardiovascular risk: calculate 10-year risk with SCORE or equivalent; statin therapy is indicated for high risk and for established atherosclerotic disease.

Smoking cessation: brief advice plus pharmacotherapy (nicotine replacement, varenicline, or bupropion) substantially improves quit rates.

Hypertension screening: measure BP on at least two occasions; confirm with home or ambulatory monitoring before diagnosing hypertension.

Obesity: body mass index ≥30 kg/m²; waist circumference adds cardiometabolic risk information; lifestyle intervention is first-line.

Occupational and environmental health: identify exposure history (asbestos, silica, solvents) and use appropriate surveillance and protective measures.

Primary care functions as first contact, continuous, comprehensive, and coordinated care; gatekeeping directs referrals to specialist levels.

Patient flow: appointment scheduling, triage, and home visits should match population needs and available workforce.

Preventive services are delivered through organized screening programs and vaccination campaigns with recall systems.

Quality indicators include accessibility, continuity, chronic disease control, and patient satisfaction; audit and feedback improve performance.

Electronic health records support prescribing safety, decision support, and continuity; data protection rules govern handling of personal health data.

Chronic disease management uses structured registers, planned reviews, and multidisciplinary teams to reduce avoidable hospital admissions.

Referral criteria should be explicit; unnecessary referrals increase waiting times, while delayed referrals worsen outcomes.

Home care and palliative care coordination in primary care reduce emergency visits and support patients with advanced disease.

Rehabilitation begins early after stroke, trauma, or surgery; mobilization within 24–48 hours reduces complications where safe.

Stroke rehabilitation: multidisciplinary team, task-specific training, and intensity matched to tolerance; assess swallowing before oral intake.

Cardiac rehabilitation includes exercise training, risk-factor modification, and psychosocial support; it reduces mortality after myocardial infarction.

Pulmonary rehabilitation improves dyspnea and exercise capacity in COPD; it includes exercise training, education, and self-management.

Musculoskeletal rehabilitation: progressive resistance training and functional exercise for osteoarthritis and after fracture; avoid bed rest.

Assessment tools include Barthel index for activities of daily living, 6-minute walk test for exercise capacity, and visual analogue scale for pain.

Spasticity management: physiotherapy, positioning, oral antispastics (baclofen, tizanidine), and botulinum toxin for focal spasticity.

Aphasia and cognitive rehabilitation require speech therapy and cognitive training; early intervention improves functional outcomes.

Pharmacokinetics: absorption, distribution, metabolism, and elimination; bioavailability and volume of distribution determine loading dose.

Half-life determines time to steady state (about 4–5 half-lives) and dosing interval; renal or hepatic impairment prolongs it.

Cytochrome P450 interactions: inhibitors (macrolides, azoles, grapefruit) raise concentrations; inducers (rifampicin, carbamazepine) lower them.

Narrow therapeutic index drugs (digoxin, warfarin, lithium, phenytoin, aminoglycosides) require therapeutic drug monitoring.

Adverse drug reactions: dose-related (type A) are predictable; idiosyncratic (type B) are unpredictable and often immune-mediated.

Warfarin: monitor INR; target 2–3 for most indications; bleeding is reversed with vitamin K and prothrombin complex concentrate.

Renal dose adjustment: use estimated GFR or creatinine clearance; avoid nephrotoxins in impaired kidney function.

Antibiotic stewardship: choose agent by culture and susceptibility, use the shortest effective course, and avoid unnecessary broad-spectrum therapy.

ECG interpretation sequence: rate, rhythm, axis, intervals (PR, QRS, QT), hypertrophy, ischemia/infarction, and comparison with prior tracings.

Chest radiograph: assess position, inspiration, rotation, and penetration; then review lungs, pleura, mediastinum, heart, and bones.

Arterial blood gas: pH, PaCO2, PaO2, HCO3; respiratory acidosis has high PaCO2, metabolic acidosis low HCO3; calculate anion gap.

Laboratory reference intervals are population-based; interpret results in clinical context and compare with previous values.

Ultrasound is first-line for suspected gallstones, renal obstruction, and abdominal aortic aneurysm; it is operator-dependent.

CT pulmonary angiography is the standard test for pulmonary embolism; ventilation-perfusion scanning is an alternative when contrast is contraindicated.

Spirometry: FEV1/FVC <0.70 after bronchodilator indicates obstruction; restriction requires reduced total lung capacity.

Troponin and natriuretic peptide are biomarkers for myocardial injury and heart failure; serial measurement improves diagnostic accuracy.

Informed consent requires capacity, adequate information about risks and alternatives, and voluntary decision-making; document the discussion.

Medical confidentiality may be breached only where law requires notification (certain infectious diseases, gunshot wounds) or with patient consent.

Emergency care may proceed without consent under the doctrine of necessity when the patient lacks capacity and delay would cause harm.

Advance directives and refusal of treatment must be respected when made with capacity; surrogate decision-makers act in the patient's best interests.

Medical error disclosure: patients should be informed of harmful errors; reporting systems support system-level learning rather than blame.

Prescribing controlled substances requires adherence to legal documentation, indication, and quantity limits; diversion is a criminal offense.

Minors: consent rules vary; emancipated minors and specific conditions (e.g., certain infections) may permit confidential care.

Professional boundaries: dual relationships and conflicts of interest must be avoided or disclosed; gifts and industry payments are regulated.