- First-line reperfusion for STEMI
- Primary PCI, door-to-balloon under 90 minutes; fibrinolytics only if timely PCI is unavailable.
- Initial workup of acute chest pain
- ECG within 10 minutes + troponin; aspirin, monitor, treat ischemia.
- STEMI on ECG
- ST-segment elevation in a coronary territory (or new LBBB); complete coronary occlusion.
- NSTEMI vs unstable angina
- Both lack ST-elevation; NSTEMI has a rising troponin, unstable angina has a normal troponin.
- Aspirin in suspected ACS
- Give chewed aspirin immediately to all patients with suspected acute coronary syndrome.
- Heart failure with reduced EF — survival drugs
- ACE inhibitor (or ARB/ARNI), beta-blocker, and aldosterone antagonist improve survival.
- Acute decompensated heart failure first step
- Diuresis for congestion (IV loop diuretic), oxygen, and address the precipitant.
- Atrial fibrillation management pillars
- Rate (or rhythm) control plus anticoagulation guided by CHA2DS2-VASc score.
- Aortic stenosis murmur
- Crescendo-decrescendo systolic ejection murmur at the right upper sternal border, radiating to the carotids.
- Mitral regurgitation murmur
- Holosystolic murmur at the apex radiating to the axilla.
- Most common cause of secondary hypertension (young woman)
- Fibromuscular dysplasia (renal artery); in older patients, atherosclerotic renal artery stenosis.
- First-line antihypertensives
- Thiazide diuretic, ACE inhibitor/ARB, or calcium channel blocker (per patient factors).
- Hypertensive emergency
- Severe hypertension with acute end-organ damage; lower BP with IV agents in a controlled fashion.
- Suspected pulmonary embolism — confirmatory test
- CT pulmonary angiography (V/Q scan if contrast contraindicated).
- Pulmonary embolism treatment
- Anticoagulation (heparin or a DOAC); thrombolysis if massive/hemodynamically unstable.
- Wells score use
- Estimates pretest probability of pulmonary embolism (or DVT) to guide D-dimer vs imaging.
- Obstructive vs restrictive lung disease
- Obstructive: low FEV1/FVC ratio (asthma, COPD). Restrictive: low volumes, preserved ratio.
- Asthma reliever vs controller
- Short-acting beta-agonist relieves; inhaled corticosteroid is the cornerstone controller.
- COPD exacerbation treatment
- Bronchodilators, systemic steroids, and antibiotics if increased/purulent sputum; oxygen as needed.
- Community-acquired pneumonia first test
- Chest X-ray; treat with empiric antibiotics by severity and setting.
- Sepsis early bundle
- Lactate, blood cultures before antibiotics, broad-spectrum antibiotics, and crystalloid fluids.
- Septic shock first-line vasopressor
- Norepinephrine.
- Definition of septic shock
- Sepsis with persistent hypotension needing vasopressors plus an elevated lactate despite fluids.
- Anion gap metabolic acidosis causes
- MUDPILES: methanol, uremia, DKA, propylene glycol, isoniazid/iron, lactic acidosis, ethylene glycol, salicylates.
- Normal-gap metabolic acidosis causes
- Bicarbonate loss: diarrhea and renal tubular acidosis.
- Diabetic ketoacidosis treatment order
- IV fluids first, then insulin infusion, with potassium replacement; treat the precipitant.
- Why replace potassium in DKA
- Insulin drives potassium into cells, so total-body potassium falls; hold insulin if K+ is dangerously low.
- When to switch DKA to subcutaneous insulin
- After the anion gap closes and the patient can eat.
- Acute kidney injury categories
- Prerenal (low perfusion), intrinsic (e.g., ATN), and postrenal (obstruction).
- FeNa interpretation in AKI
- Low FeNa (under 1%) suggests prerenal; higher FeNa suggests intrinsic (ATN).
- Hyperkalemia ECG changes
- Peaked T waves progressing to a widened QRS and a sine-wave pattern.
- Hyperkalemia emergency treatment
- IV calcium to stabilize the myocardium; insulin with glucose and albuterol to shift potassium intracellularly.
- Hyponatremia first step
- Assess volume status and serum osmolality; correct slowly to avoid osmotic demyelination.
- Microcytic anemia causes
- Iron deficiency, thalassemia, anemia of chronic disease, sideroblastic, lead poisoning.
- Macrocytic anemia causes
- Vitamin B12 or folate deficiency (megaloblastic) and other causes.
- Iron-deficiency anemia confirming test
- Low ferritin; microcytic, hypochromic red cells. Find the source of blood loss.
- Hyperthyroidism labs
- Low TSH with high free T4 (and/or T3); Graves disease is the most common cause.
- Hypothyroidism labs and first symptom set
- High TSH with low free T4; fatigue, weight gain, cold intolerance, constipation.
- Cushing syndrome screening tests
- Late-night salivary cortisol, 24-hour urinary free cortisol, or low-dose dexamethasone suppression test.
- Adrenal insufficiency labs
- Low cortisol; primary (Addison) shows high ACTH with hyperkalemia and hyponatremia.
- Type 2 diabetes first-line drug
- Metformin, alongside lifestyle change.
- Upper vs lower GI bleed
- Upper: hematemesis, melena (above the ligament of Treitz). Lower: hematochezia.
- Acute pancreatitis diagnosis
- Two of: typical pain, lipase (or amylase) 3x upper limit of normal, or imaging findings.
- Most common causes of acute pancreatitis
- Gallstones and alcohol.
- Cirrhosis decompensation signs
- Ascites, variceal bleeding, hepatic encephalopathy, and jaundice.
- Hepatic encephalopathy treatment
- Lactulose (and rifaximin); identify and treat the precipitant.
- Spontaneous bacterial peritonitis diagnosis
- Ascitic fluid neutrophil count of 250 cells per microliter or more.
- Inflammatory bowel disease — UC vs Crohn
- UC: continuous colonic involvement, mucosa only. Crohn: skip lesions, transmural, anywhere mouth to anus.
- C. difficile colitis treatment
- Oral vancomycin or fidaxomicin; stop the offending antibiotic.
- Stroke — ischemic acute treatment window
- IV thrombolysis within the eligible time window if no hemorrhage on CT; mechanical thrombectomy for large-vessel occlusion.
- First imaging in suspected stroke
- Non-contrast head CT to exclude hemorrhage before thrombolysis.
- Bacterial meningitis empiric treatment
- Empiric antibiotics promptly (do not delay for imaging or LP) plus dexamethasone where indicated.
- Community-acquired UTI vs pyelonephritis
- Cystitis: dysuria, frequency. Pyelonephritis: fever, flank pain, costovertebral angle tenderness.
- Gout acute attack treatment
- NSAIDs, colchicine, or corticosteroids; start urate-lowering therapy later, not during the acute attack.
- Rheumatoid arthritis hallmark
- Symmetric small-joint inflammatory arthritis with morning stiffness; treat with DMARDs (e.g., methotrexate).
- Systemic lupus screening antibody
- ANA is sensitive (screening); anti-dsDNA and anti-Smith are specific.
- Most common cause of hyperthyroidism
- Graves disease (autoimmune TSH-receptor stimulation).
- DVT confirmatory test
- Compression ultrasound of the legs; treat with anticoagulation.
- Anticoagulation reversal — warfarin
- Vitamin K plus prothrombin complex concentrate (or FFP) for major bleeding.
- Anticoagulation reversal — dabigatran
- Idarucizumab.
- Anticoagulation reversal — factor Xa inhibitors
- Andexanet alfa (or PCC).
- Statin indication
- Established atherosclerotic disease, LDL very high, diabetes (age-based), or elevated 10-year risk.
- Diabetic nephropathy protective drug
- ACE inhibitor or ARB (reduces proteinuria and slows progression).
- SIADH lab pattern
- Euvolemic hyponatremia with concentrated urine and low serum osmolality.
- Most common cause of community-acquired pneumonia
- Streptococcus pneumoniae.
- Aortic dissection — best initial imaging (stable)
- CT angiography of the chest; control heart rate and blood pressure (beta-blocker first).
- Most common cause of infective endocarditis (native valve)
- Staphylococcus aureus; obtain blood cultures and an echocardiogram.
- Tuberculosis treatment (initial phase)
- Rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE).
- Latent TB treatment
- Isoniazid (with B6) or a rifampin-based regimen; treat to prevent reactivation.
- Hyperthyroid storm treatment
- Beta-blocker, thionamide, iodine (after thionamide), and steroids; supportive care.
- Diabetic foot infection principles
- Assess perfusion and bone (osteomyelitis), debride, and give targeted antibiotics.
- Most common electrolyte cause of long QT
- Hypokalemia, hypomagnesemia, or hypocalcemia; correct to prevent torsades.
- Torsades de pointes treatment
- IV magnesium sulfate; correct electrolytes and remove offending drugs.
- Acute asthma exacerbation severity sign
- Inability to speak in full sentences, a silent chest, and a rising CO2 are ominous.
- COPD long-term oxygen therapy indication
- Resting hypoxemia (low PaO2 or SaO2); improves survival.
- Hyponatremia correction rate caution
- Correct slowly to avoid osmotic demyelination syndrome.
- Most common cause of hypercalcemia (outpatient)
- Primary hyperparathyroidism; in inpatients, malignancy.
- Acute gout vs septic arthritis
- Aspirate the joint: gout shows negatively birefringent crystals; septic shows organisms/high WBC.
- Pulmonary embolism in pregnancy imaging
- Compression ultrasound first; V/Q scan or CT-PA as needed with shielding.
- Anaphylaxis biphasic reaction
- Symptoms can recur hours later; observe after the initial event.
- Most common cause of acute pericarditis presentation
- Pleuritic chest pain relieved by sitting forward, diffuse ST elevation; often viral.
- Heparin-induced thrombocytopenia
- Platelet drop ~5-10 days after heparin with thrombosis; stop heparin, use a non-heparin anticoagulant.
- Acute upper GI bleed initial step
- Resuscitate, IV PPI, and urgent endoscopy; octreotide if variceal.
- Hypoglycemia treatment (conscious)
- Oral fast-acting glucose; IV dextrose or glucagon if unable to take oral.
- Most common cause of secondary headache to exclude
- Subarachnoid hemorrhage — 'worst headache of life'; non-contrast CT then LP if negative.
- Multiple sclerosis acute flare treatment
- High-dose corticosteroids.
- Diabetic retinopathy prevention
- Tight glycemic and blood-pressure control plus regular eye screening.
- Asthma vs COPD reversibility
- Asthma airflow obstruction is largely reversible with bronchodilators; COPD is largely fixed.
- Trauma primary survey order
- ABCDE: Airway with C-spine, Breathing, Circulation, Disability, Exposure/Environment.
- Tension pneumothorax treatment
- Immediate needle decompression, then a chest tube — a clinical diagnosis, treat before imaging.
- Cardiac tamponade — Beck triad
- Hypotension, distended neck veins, and muffled heart sounds; treat with pericardiocentesis.
- Anaphylaxis first treatment
- Intramuscular epinephrine first, before antihistamines or steroids.
- Appendicitis classic presentation
- Periumbilical pain migrating to the right lower quadrant (McBurney point) with anorexia and rebound.
- Appendicitis confirming imaging
- CT in adults; ultrasound first in children and pregnancy.
- Appendicitis treatment
- Appendectomy with perioperative antibiotics.
- Cholecystitis first imaging
- Right-upper-quadrant ultrasound; positive Murphy sign.
- Perforated viscus signs
- Sudden severe diffuse abdominal pain with free air under the diaphragm; emergency laparotomy.
- Small-bowel obstruction findings
- Distension, vomiting, obstipation, and air-fluid levels on imaging.
- Most common cause of small-bowel obstruction
- Adhesions from prior surgery.
- Mesenteric ischemia clue
- Pain out of proportion to the exam in a patient with vascular risk factors.
- Abdominal aortic aneurysm rupture triad
- Hypotension, back/flank pain, and a pulsatile abdominal mass; emergency surgery.
- Postoperative fever — the five Ws
- Wind (atelectasis), Water (UTI), Wound, Walking (DVT), Wonder-drugs.
- Postoperative fever days 1-2
- Atelectasis (Wind) — encourage incentive spirometry and ambulation.
- VTE prophylaxis in surgical patients
- Early ambulation, mechanical prophylaxis, and pharmacologic prophylaxis when bleeding risk allows.
- Compartment syndrome signs
- Pain out of proportion, pain on passive stretch; emergency fasciotomy.
- Burn fluid resuscitation
- Calculate by body-surface area burned (e.g., Parkland-type formula); titrate to urine output.
- GCS intubation threshold
- Intubate to protect the airway when the Glasgow Coma Scale is 8 or below.
- Massive hemorrhage in trauma — resuscitation
- Control bleeding, give blood products (balanced transfusion), and find the source.
- FAST exam purpose
- Bedside ultrasound to detect free intra-abdominal or pericardial fluid in trauma.
- Bowel ischemia from a hernia
- An incarcerated, then strangulated hernia; tenderness and systemic signs require urgent surgery.
- Diverticulitis treatment
- Antibiotics and bowel rest for uncomplicated cases; surgery for complications (abscess, perforation).
- Acute limb ischemia — six Ps
- Pain, pallor, pulselessness, paresthesia, poikilothermia, paralysis; emergency revascularization.
- Necrotizing fasciitis clue
- Pain out of proportion, rapid spread, crepitus, systemic toxicity; emergency surgical debridement.
- Pneumothorax (simple) initial step in stable patient
- Chest X-ray; observe small ones, drain larger or symptomatic ones.
- Bowel perforation antibiotics
- Broad-spectrum coverage including anaerobes plus source control (surgery).
- Acute cholangitis — Charcot triad
- Fever, right-upper-quadrant pain, and jaundice; needs biliary drainage.
- Testicular torsion management
- Surgical emergency; immediate exploration/detorsion — do not delay for imaging if classic.
- Indication for emergent surgery in GI bleed
- Hemodynamic instability not controlled by resuscitation and endoscopy.
- Blunt abdominal trauma unstable patient
- Positive FAST with instability goes straight to the operating room.
- Surgical site infection prevention
- Timely prophylactic antibiotics, normothermia, glucose control, and sterile technique.
- Bowel obstruction — large vs small
- Large-bowel obstruction often from cancer/volvulus; small-bowel from adhesions/hernias.
- Sigmoid volvulus initial treatment
- Endoscopic detorsion if no peritonitis; surgery if ischemia/perforation.
- Acute appendicitis in pregnancy
- Still the most common non-obstetric surgical emergency; ultrasound/MRI, appendectomy.
- Epidural hematoma
- Lucid interval then deterioration; lens-shaped (biconvex) bleed; neurosurgical emergency.
- Subdural hematoma
- Crescent-shaped bleed, common in elderly/alcoholics after minor trauma.
- Increased intracranial pressure — Cushing triad
- Hypertension, bradycardia, and irregular respirations.
- Open fracture management
- Urgent antibiotics, tetanus prophylaxis, irrigation/debridement, and stabilization.
- Hip fracture in elderly
- Surgical fixation/replacement; early mobilization and VTE prophylaxis.
- Acute urinary retention treatment
- Bladder catheterization for decompression; treat the cause (e.g., BPH).
- Bowel perforation imaging clue
- Free air under the diaphragm on upright chest X-ray.
- Pancreatic pseudocyst
- A late complication of pancreatitis; drain if symptomatic or complicated.
- APGAR score components
- Appearance, Pulse, Grimace, Activity, Respiration; scored 0-2 each at 1 and 5 minutes.
- Physiologic vs pathologic neonatal jaundice
- Physiologic appears after 24 hours and resolves in ~2 weeks; jaundice in the first 24 hours or conjugated is pathologic.
- Unconjugated hyperbilirubinemia treatment
- Phototherapy; exchange transfusion at very high levels to prevent kernicterus.
- Conjugated (direct) hyperbilirubinemia in a newborn
- Never physiologic; suspect biliary atresia or hepatic disease and evaluate promptly.
- Social smile milestone
- About 2 months — the earliest social milestone.
- Sits unsupported milestone
- About 6 months.
- First words milestone
- About 12 months; two-word phrases by about 24 months.
- Walks independently milestone
- About 12-15 months.
- MMR and varicella vaccine timing
- About 12-15 months; both are live attenuated vaccines.
- Hepatitis B vaccine timing
- First dose at birth.
- Rotavirus vaccine route
- Oral, live vaccine given in infancy.
- Live vaccine contraindications
- Avoid in pregnancy and significant immunocompromise.
- Pyloric stenosis presentation
- Non-bilious projectile vomiting at 3-6 weeks with a palpable 'olive' mass.
- Pyloric stenosis lab abnormality
- Hypochloremic, hypokalemic metabolic alkalosis.
- Intussusception classic findings
- Currant-jelly stool and a target/'bull's-eye' sign on ultrasound; ages 6-36 months.
- Croup features
- Barking 'seal' cough, stridor, 'steeple sign'; usually parainfluenza virus.
- Epiglottitis features
- Drooling, tripod posture, toxic appearance; an airway emergency (now rare with Hib vaccine).
- Bronchiolitis cause
- Respiratory syncytial virus (RSV) in infants; supportive care.
- Febrile seizures age range
- 6 months to 5 years; simple febrile seizures are usually benign.
- Most common pediatric malignancy
- Acute lymphoblastic leukemia (ALL).
- Kawasaki disease criteria clue
- Fever 5+ days plus conjunctivitis, rash, adenopathy, mucosal changes, and extremity changes; treat with IVIG and aspirin.
- Cystic fibrosis screening test
- Sweat chloride test (elevated).
- Developmental dysplasia of the hip screening
- Barlow and Ortolani maneuvers; ultrasound if positive.
- Vaccine schedule authority
- The CDC's Advisory Committee on Immunization Practices (ACIP).
- Non-accidental trauma red flag
- Injury pattern inconsistent with the stated mechanism or the child's developmental stage.
- Neonatal sepsis approach
- Low threshold for full sepsis workup and empiric antibiotics in an ill-appearing neonate.
- Failure to thrive definition
- Weight (or growth) falling across percentiles; evaluate intake, organic causes, and psychosocial factors.
- Most common cause of bronchiolitis hospitalization
- RSV.
- Meningitis in neonates — common organisms
- Group B Streptococcus, E. coli, and Listeria.
- Sickle cell — fever management
- Treat fever urgently with empiric antibiotics; high risk of encapsulated-organism sepsis.
- Tetralogy of Fallot — 'tet spell' maneuver
- Knee-to-chest positioning increases systemic vascular resistance and improves shunting.
- Childhood lead poisoning screening
- Blood lead level; common in older housing with lead paint.
- Reye syndrome association
- Aspirin use during a viral illness in children — avoid aspirin in kids.
- Roseola pattern
- High fever for days, then a rash appears as the fever breaks; HHV-6.
- Measles features
- Fever, cough, coryza, conjunctivitis, Koplik spots, then a descending rash.
- Whooping cough (pertussis)
- Paroxysmal cough with inspiratory whoop; treat with a macrolide.
- Slipped capital femoral epiphysis
- Obese adolescent with hip/knee pain and a limp; non-weight-bearing, surgery.
- Henoch-Schonlein purpura tetrad
- Palpable purpura, arthralgia, abdominal pain, and renal involvement.
- Neonatal respiratory distress syndrome
- Surfactant deficiency in preterm infants; antenatal steroids and surfactant.
- Jaundice in breastfed newborn timing
- Breastfeeding jaundice (early, suboptimal intake) vs breast-milk jaundice (later).
- Most common congenital heart defect
- Ventricular septal defect.
- Cyanotic congenital heart disease — the 5 Ts
- Truncus, Transposition, Tricuspid atresia, Tetralogy, TAPVR.
- Childhood immunization catch-up
- Use the ACIP catch-up schedule for late or missed vaccines.
- Preeclampsia definition
- New-onset hypertension after 20 weeks of pregnancy with proteinuria or end-organ dysfunction.
- Preeclampsia seizure prophylaxis
- Magnesium sulfate; the definitive cure is delivery.
- Eclampsia treatment
- Magnesium sulfate plus control of blood pressure and delivery.
- Magnesium toxicity signs
- Loss of deep tendon reflexes, respiratory depression; treat with IV calcium gluconate.
- Gestational diabetes screening timing
- 24-28 weeks with a glucose challenge/tolerance test.
- RhoGAM (anti-D) indication
- Rh-negative mother — give around 28 weeks and after delivery of an Rh-positive infant.
- Placenta previa presentation
- Painless third-trimester vaginal bleeding; no digital exam — confirm with ultrasound.
- Placental abruption presentation
- Painful vaginal bleeding with a rigid, tender uterus.
- Postpartum hemorrhage — four Ts
- Tone (atony, most common), Trauma, Tissue (retained placenta), Thrombin (coagulopathy).
- Uterine atony treatment
- Uterine massage and uterotonics (oxytocin first-line), escalating as needed.
- Ectopic pregnancy clue
- Positive pregnancy test with an empty uterus on ultrasound and pelvic pain.
- Ectopic pregnancy treatment
- Methotrexate for stable, eligible patients; surgery if unstable or ruptured.
- Prenatal first-visit screening
- Confirm and date the pregnancy; blood type/Rh, CBC, infections, and Pap as indicated.
- Group B Streptococcus screening
- Rectovaginal culture at 36-37 weeks; intrapartum penicillin if positive.
- Naegele rule for due date
- First day of last menstrual period minus 3 months plus 7 days.
- Preterm labor definition
- Regular contractions with cervical change before 37 weeks.
- Magnesium for fetal neuroprotection
- Given for anticipated very preterm delivery to reduce cerebral palsy risk.
- Gestational hypertension vs preeclampsia
- Gestational hypertension lacks proteinuria/end-organ dysfunction; preeclampsia has them.
- HELLP syndrome
- Hemolysis, Elevated Liver enzymes, Low Platelets — a severe preeclampsia variant; deliver.
- Most common cause of abnormal uterine bleeding by reproductive age
- Anovulation (and structural causes); always exclude pregnancy first.
- First test in reproductive-age woman with abnormal bleeding
- Urine or serum pregnancy test.
- Cervical cancer screening
- Pap smear with HPV co-testing on the recommended interval.
- Combined hormonal contraception contraindications
- History of VTE, migraine with aura, or smoking over age 35.
- Emergency contraception options
- Levonorgestrel, ulipristal acetate, or a copper IUD (most effective).
- PCOS features
- Oligo-ovulation, hyperandrogenism, and polycystic ovaries; associated with insulin resistance.
- Ovarian torsion presentation
- Sudden unilateral pelvic pain with an adnexal mass; surgical emergency.
- Pelvic inflammatory disease treatment
- Empiric antibiotics covering gonorrhea and chlamydia; treat partners.
- Menopause definition
- Twelve months of amenorrhea; rising FSH.
- Most common gynecologic cancer (US)
- Endometrial (uterine) cancer; postmenopausal bleeding warrants endometrial biopsy.
- Postmenopausal bleeding workup
- Endometrial biopsy to exclude endometrial cancer.
- Down syndrome screening in pregnancy
- Combined first-trimester screen or cell-free fetal DNA; confirm with diagnostic testing.
- Hyperemesis gravidarum
- Severe nausea/vomiting with dehydration and ketonuria; treat with fluids and antiemetics.
- Shoulder dystocia first maneuver
- McRoberts maneuver with suprapubic pressure.
- Fetal heart rate late decelerations
- Suggest uteroplacental insufficiency; reposition, oxygen, fluids, and evaluate for delivery.
- Fetal heart rate variable decelerations
- Suggest cord compression; reposition and consider amnioinfusion.
- Gestational trophoblastic disease clue
- Markedly elevated beta-hCG, 'snowstorm' uterus, hyperemesis; evacuate and follow hCG.
- Endometriosis presentation
- Cyclic pelvic pain, dysmenorrhea, dyspareunia, and infertility.
- Threatened vs inevitable abortion
- Threatened: bleeding, closed cervix. Inevitable: bleeding, open cervix.
- Preterm premature rupture of membranes
- Manage by gestational age with antibiotics and steroids; watch for infection.
- Breast mass workup by age
- Ultrasound first in young women; mammography and biopsy as indicated; triple assessment.
- Cervical insufficiency treatment
- Cerclage in selected patients with painless cervical dilation.
- Mastitis (lactational) treatment
- Continue breastfeeding and give antibiotics; drain an abscess if present.
- Anti-D in miscarriage/trauma
- Give RhoGAM to Rh-negative women after bleeding events in pregnancy.
- Major depressive disorder criteria
- 5 or more of 9 symptoms (SIG-E-CAPS) for at least 2 weeks, including depressed mood or anhedonia.
- First-line treatment for major depression
- An SSRI plus psychotherapy (e.g., CBT).
- Antidepressant onset of effect
- Several weeks; reassess for suicidality at start and dose changes.
- Manic episode duration (bipolar I)
- At least 1 week of elevated/irritable mood with increased activity.
- Bipolar I maintenance
- Mood stabilizer (e.g., lithium) or an antipsychotic; avoid antidepressant monotherapy.
- Schizophrenia duration
- Symptoms for at least 6 months (with active-phase symptoms).
- Schizophreniform disorder duration
- 1 to 6 months.
- Brief psychotic disorder duration
- Less than 1 month, often after a stressor.
- Generalized anxiety disorder
- Excessive worry most days for at least 6 months; SSRI/SNRI plus CBT.
- Panic disorder
- Recurrent unexpected panic attacks with anticipatory anxiety; SSRI and CBT.
- OCD treatment
- SSRI (often higher doses) plus exposure and response prevention therapy.
- PTSD features
- Re-experiencing, avoidance, negative cognitions, and hyperarousal after trauma; SSRI and trauma-focused therapy.
- Serotonin syndrome features
- Within hours of a serotonergic drug: agitation, autonomic instability, clonus, hyperreflexia.
- Serotonin syndrome treatment
- Stop the drug, supportive care, and cyproheptadine in severe cases.
- Neuroleptic malignant syndrome features
- Over days after a dopamine antagonist: 'lead-pipe' rigidity, high fever, autonomic instability, very high CK.
- Neuroleptic malignant syndrome treatment
- Stop the antipsychotic, supportive care; dantrolene or bromocriptine if severe.
- Serotonin syndrome vs NMS quick clue
- Serotonin syndrome = hyperreflexia/clonus; NMS = rigidity/hyporeflexia.
- Lithium monitoring
- Narrow therapeutic window; monitor levels, renal function, and thyroid function.
- Lithium toxicity signs
- Tremor, ataxia, confusion, and seizures at high levels.
- Tardive dyskinesia
- Involuntary movements from long-term dopamine antagonists; consider a VMAT2 inhibitor.
- Alcohol withdrawal treatment
- Benzodiazepines; watch for progression to delirium tremens.
- Delirium tremens
- Severe alcohol withdrawal with autonomic instability and confusion 48-96 hours after the last drink.
- Opioid overdose antidote
- Naloxone; supportive ventilation.
- Opioid intoxication signs
- Pinpoint pupils, respiratory depression, and decreased consciousness.
- Benzodiazepine overdose antidote
- Flumazenil (use cautiously — can precipitate seizures).
- Wernicke encephalopathy triad
- Confusion, ophthalmoplegia, and ataxia from thiamine deficiency; give thiamine before glucose.
- Delirium vs dementia
- Delirium: acute, fluctuating, altered attention (find the cause). Dementia: chronic, progressive.
- Anorexia nervosa danger
- Low body weight with refeeding syndrome risk; monitor electrolytes (phosphate).
- ADHD first-line treatment
- Stimulants (methylphenidate or amphetamines) with behavioral therapy.
- Autism spectrum disorder
- Early social-communication deficits and restricted/repetitive behaviors; early intervention.
- Antidepressant for a patient with neuropathic pain or insomnia
- Consider an SNRI or a TCA (off-label) based on the comorbidity.
- Suicide risk assessment priority
- Directly assess plan, intent, means, and prior attempts; ensure safety first.
- Borderline personality disorder
- Unstable relationships, affect, and self-image with impulsivity; dialectical behavior therapy.
- Antisocial personality disorder
- Pervasive disregard for others' rights; must be 18+ with prior conduct disorder.
- Adjustment disorder
- Emotional/behavioral symptoms within 3 months of an identifiable stressor; resolves within 6 months.
- Acute stress disorder vs PTSD
- Same symptom clusters; acute stress disorder lasts 3 days to 1 month, PTSD over 1 month.
- Bulimia nervosa
- Binge eating with compensatory behaviors; often normal weight; SSRI and CBT.
- Conversion (functional neurological) disorder
- Neurologic symptoms inconsistent with disease, often after stress.
- Somatic symptom disorder
- Excessive thoughts/anxiety about physical symptoms causing distress.
- Major depression with psychotic features
- Add an antipsychotic to the antidepressant (or consider ECT).
- ECT indication
- Severe/refractory depression, psychotic depression, or when rapid response is needed (e.g., catatonia).
- First-generation vs second-generation antipsychotics
- First-gen: more extrapyramidal effects. Second-gen: more metabolic effects.
- Clozapine monitoring
- Monitor absolute neutrophil count for agranulocytosis; reserved for refractory schizophrenia.
- Sensitivity (SnNout)
- True-positive rate, TP/(TP+FN); a negative on a sensitive test rules a disease OUT.
- Specificity (SpPin)
- True-negative rate, TN/(TN+FP); a positive on a specific test rules a disease IN.
- Positive predictive value
- TP/(TP+FP); the chance a positive test is a true case — rises with prevalence.
- Negative predictive value
- TN/(TN+FN); the chance a negative test is truly disease-free — falls with prevalence.
- Sensitivity/specificity vs prevalence
- Sensitivity and specificity are fixed properties of the test; predictive values depend on prevalence.
- Number needed to treat
- 1 divided by the absolute risk reduction; lower NNT means a more effective treatment.
- Relative risk source
- Calculated from cohort studies (risk in exposed / risk in unexposed).
- Odds ratio source
- Calculated from case-control studies; approximates relative risk for rare diseases.
- Gold standard for causation
- The randomized controlled trial.
- Type I error
- Rejecting a true null hypothesis — a false positive; its probability is alpha (often 0.05).
- Type II error and power
- Type II (beta) is failing to reject a false null; power equals 1 minus beta.
- Incidence vs prevalence
- Incidence is new cases over time; prevalence is existing cases at a point in time.
- Lead-time bias
- Earlier detection makes survival appear longer without changing the true outcome.
- Selection bias
- Systematic differences in who is included, distorting results.
- Recall bias
- Differential accuracy of memory between groups, common in case-control studies.
- Confounding
- A third variable associated with both exposure and outcome; control by randomization or adjustment.
- Informed consent elements
- Decision-making capacity, disclosure, understanding, and voluntariness.
- Capacity vs competency
- Capacity is a clinical, decision-specific judgment; competency is a legal determination.
- A patient with capacity refusing treatment
- May refuse — respect autonomy, even against medical advice.
- Minor consent exceptions
- Emergencies, STIs, contraception, pregnancy, substance use, and emancipated minors.
- Confidentiality exceptions
- Duty to warn/protect, reportable diseases, and certain abuse situations.
- Disclosure of medical errors
- Disclose errors to patients honestly; it is an ethical and professional duty.
- Root-cause analysis
- A reactive, after-the-event analysis of why an error occurred.
- Failure mode and effects analysis
- A proactive analysis to anticipate and prevent errors before they happen.
- Swiss cheese model
- Errors result when gaps in multiple defenses line up; build redundant safeguards.
- Primary prevention
- Prevents disease before it occurs (vaccination, smoking-cessation counseling).
- Secondary prevention
- Detects disease early (screening such as mammography and colonoscopy).
- Tertiary prevention
- Limits the impact of established disease (rehabilitation, complication prevention).
- Colorectal cancer screening start age
- Age 45 for average-risk adults (per current US guidance).
- Likelihood ratio property
- Independent of disease prevalence; combines sensitivity and specificity.
- Intention-to-treat analysis
- Analyze participants in their assigned groups regardless of adherence; preserves randomization.
- Beneficence vs non-maleficence
- Beneficence is acting for the patient's good; non-maleficence is 'do no harm.'
- Justice (medical ethics)
- Fair distribution of benefits, risks, and resources among patients.
- Surrogate decision-making order
- Follow the patient's advance directive, then the legal surrogate/next of kin, using substituted judgment.
- Advance directive vs living will
- An advance directive names a healthcare proxy; a living will states treatment wishes.
- Reportable conditions
- Certain infectious diseases and suspected abuse must be reported to public health/authorities.
- Number needed to harm
- 1 divided by the absolute risk increase of an adverse event.
- Absolute vs relative risk reduction
- Absolute is the raw difference; relative is the proportional difference (can exaggerate small effects).
- p-value meaning
- The probability of results this extreme if the null hypothesis were true; below alpha is 'significant.'
- Confidence interval crossing the null
- A 95% CI that crosses 1 (ratios) or 0 (differences) is not statistically significant.
- Screening test choice
- Use a sensitive test to screen (rule out), then a specific test to confirm (rule in).
- Validity vs reliability
- Validity is measuring the right thing; reliability is consistency on repeat measurement.
- Sentinel event
- An unexpected event causing death or serious harm; triggers root-cause analysis.
- Never event
- A serious, largely preventable error (e.g., wrong-site surgery) that should never occur.
- Quality improvement PDSA cycle
- Plan, Do, Study, Act — iterative testing of a change to improve a process.
