Timing, Thresholds & "Magic Numbers"

Diagnostic threshold

What is the level below which a physician rules out a condition and stops further testing?

Treatment threshold

What is the level above which a physician decides to initiate treatment without needing further diagnostic tests?

Pretest probability

What is the quantitative estimate of the likelihood of a diagnosis before a diagnostic test is performed?

Posttest probability

What is the revised estimate of disease likelihood after the result of a diagnostic test is known?

LR positive greater than 10

What Likelihood Ratio value indicates a significant or conclusive change to posttest probability?

LR negative less than 0.1

What Likelihood Ratio value indicates a strong, often conclusive negative test result?

LR equals 1

What Likelihood Ratio value indicates that a test has no diagnostic value?

Bayes Rule

Which statistical rule is used to calculate the likelihood of disease following a positive test by incorporating pretest probability?

80 percent

In the procalcitonin application exercise, at what illustratively set percentage was the therapeutic threshold established?

40 percent

In the procalcitonin application exercise, what was the pretest probability based on history and physical exam?

67 percent

In the procalcitonin application exercise, what was the calculated posttest probability after a positive test result?

7 to 10 days

How many days before elective surgery should Aspirin typically be discontinued to reduce bleeding risk?

5 days

How many days before elective surgery should Warfarin (Vitamin K antagonists) be stopped?

1.5 or less

Stopping Warfarin 5 days before surgery ideally allows the INR to fall to what range?

4 to 8 weeks

How many weeks before elective surgery should a patient cease smoking to effectively reduce pulmonary risks?

36 to 48 hours

How many hours after Warfarin interruption should therapeutic LMWH or UFH be started for high-risk patients?

At least 24 hours

How many hours before surgery should the last dose of LMWH be administered?

4 to 6 hours

How many hours before surgery should IV UFH be stopped?

24 to 72 hours

How many hours after surgery should LMWH or UFH be resumed at the preprocedural dose, depending on bleeding risk?

12 to 24 hours

How many hours after surgery should VKA (Warfarin) therapy be resumed according to hemostatic status?

1 full day

For a patient on Rivaroxaban with a CrCl > 30 undergoing standard bleeding risk surgery, when should the drug be stopped?

2 full days

For a patient on Rivaroxaban with a CrCl > 30 undergoing high bleeding risk surgery, when should the drug be stopped?

2 days

For a patient on Dabigatran with a CrCl of 31-50 undergoing standard bleeding risk surgery, when should the drug be stopped?

4 days

For a patient on Dabigatran with a CrCl < 30 undergoing high bleeding risk surgery, when should the drug be stopped?

0 to 1 month

Which pediatric patient population is defined as the neonatal period?

9 to 18 months

Between what ages does the anterior fontanelle normally close?

12 months

By what age does independent walking typically develop in a healthy child?

18 months

Inability to walk independently by what age represents a gross motor delay warranting evaluation?

30 to 60 seconds

What is the typical time frame for completing a rapid visual assessment using the Pediatric Assessment Triangle?

Tanner Stage 2

During which Tanner stage do the first clinical signs of puberty emerge?

Testicular enlargement

What is the first clinical sign of puberty in boys (Tanner Stage 2)?

Breast budding

What is the first clinical sign of puberty in girls (Tanner Stage 2)?

Tanner Stage 3

At approximately what Tanner stage do girls reach peak height velocity?

Between Tanner Stage 4 and 5

When does menarche typically occur in girls relative to Tanner staging?

Between Tanner Stage 4 to 5

When do boys typically reach their apex strength or height spurt relative to Tanner staging?

18 to 24 months after menarche

When do adolescent girls usually complete their spinal growth?

Dependence on 2 tasks

What number of KATZ BADL or Lawton IADL dependencies signals a need for 12-hour caregiver support?

Dependence on 4 tasks

What number of KATZ BADL or Lawton IADL dependencies signals a need for 24-hour caregiver support?

Once per year

How often should community-dwelling elderly patients be rescreened for nutritional status using the MNA?

Every 3 months

How often should institutionalized geriatric patients be rescreened for nutritional status?

Every 3 months

How often should geriatric patients at risk of malnutrition be rescreened?

5 to 7 minutes

In what time frame can the 15-item Geriatric Depression Scale (GDS) typically be completed?

5 to 10 minutes

In what time frame can the Folstein MMSE typically be administered?

3 points per year

By how many points do MMSE scores typically decline per year in individuals with Alzheimer's disease?

3 minutes

The Mini-Cog is designed to detect cognitive impairment in what approximate time frame?

16 seconds

A Timed Get Up and Go test should ideally be completed in less than how many seconds?

20 seconds

A score higher than how many seconds on the Get Up and Go test prompts a more in-depth evaluation?

One-third

Approximately what proportion of community-living older persons fall at least once per year?

1st week of October

When is "Elderly Filipino Week" celebrated in the Philippines every year?

Less than 1 percent

A surgical procedure with a cardiac risk of what percentage is considered Low Risk?

1 to 5 percent

A surgical procedure with a cardiac risk of what range is considered Intermediate Risk?

Greater than 5 percent

A surgical procedure with a cardiac risk of what percentage is considered High Risk?

0.4 percent

In the RCRI, what is the estimated risk of cardiac arrest for a patient with 0 predictors?

0.9 percent

In the RCRI, what is the estimated risk for a patient with 1 predictor?

6.6 percent

In the RCRI, what is the estimated risk for a patient with 2 predictors?

Greater than 11 percent

In the RCRI, what is the estimated risk for a patient with 3 or more predictors?

4 METs

In preoperative evaluation, climbing two flights of stairs represents a functional capacity of at least how many METs?

Creatinine greater than or equal to 2.0 mg/dL

What serum creatinine level is considered an independent predictor of perioperative cardiac risk in the RCRI?

45 points

A patient is classified as high risk for pulmonary complications if their ARISCAT score is greater than or equal to what?

Child Class A

In the staging of cirrhosis, which class is associated with a 10 percent mortality rate during abdominal operations?

Child Class B

Which cirrhosis class is associated with a 31 percent mortality rate?

Child Class C

Which cirrhosis class is associated with a 76 percent mortality rate?

MELD score greater than 15

What MELD score threshold indicates that elective surgery is usually contraindicated?

140 to 180 mg/dL

What is the target preoperative glucose range to maintain in patients with Diabetes Mellitus?

Greater than or equal to 18 to 20 micrograms/dL

In an ACTH stimulation test, what peak cortisol level indicates a normal HPA axis response?

Hemoglobin greater than 10 g/dL

What is the hemoglobin cut-off above which transfusion is generally not indicated in a stable surgical patient?

50,000

What is the minimum platelet count required for most major surgeries?

INR less than 1.5

In preoperative coagulation studies, the PT should be within 3 seconds of control, which corresponds to what INR?

150 to 300 minutes

How many minutes of moderate physical activity per week are required to be categorized as Sufficiently Active?

18.5 to 22.9 kg/m2

According to the WHO-APP cut-offs for adult Filipinos, what is the BMI range for a Normal weight classification?

23 to 24.9 kg/m2

What is the BMI classification for Overweight in adult Filipinos?

Greater than or equal to 25 kg/m2

What is the BMI threshold for Obesity in adult Filipinos?

Less than 18.5 kg/m2

What is the BMI cut-off for Underweight?

Greater than or equal to 90 cm

What is the waist circumference cut-off for obesity in adult Filipino males?

Greater than or equal to 80 cm

What is the waist circumference cut-off for obesity in adult Filipino females?

Greater than or equal to 1.0

What is the waist-to-hip ratio cut-off for obesity in adult Filipino males?

Greater than or equal to 0.85

What is the waist-to-hip ratio cut-off for obesity in adult Filipino females?

150 or more minutes

How many minutes of exercise per week categorize a patient as "Sufficiently active" in PAVS?

1 to 149 minutes

What range of minutes per week categorizes a patient as "Moderately active" in PAVS?

0 minutes

What median number of minutes per week categorizes a patient as "Inactive" in PAVS?

75 minutes

According to WHO, how many minutes of vigorous physical activity are recommended per week?

150 minutes

According to WHO, how many minutes of moderate physical activity are recommended per week?

Less than 6 hours

What sleep duration is considered high risk in a Mini Sleep Assessment?

7 to 9 hours

How many hours of sleep are recommended for adults in the sleep vital sign assessment?

One instance

In a single-question alcohol screen, how many instances of heavy drinking in the past year constitute a positive screen?

5 and above

What AUDIT-C score is considered a positive screen for hazardous alcohol consumption?

12 hours

How long after quitting smoking does the carbon monoxide level in the blood drop to normal?

1 year

After how long of quitting smoking is the risk of coronary heart disease half that of a smoker?

15 years

After how long of quitting smoking is the risk of coronary heart disease the same as that of a non-smoker?

85 Hz (decibels)

What is the Threshold Limit Value (TLV) for noise in the Philippines for an 8-hour working day?

115 decibels

According to OSHS, there should be no exposure allowed for continuous intermittent noise exceeding how many decibels?

21 years old

At what age should cervical cancer screening (Pap smear) ideally begin for non-sexually active women?

Within 3 years

How soon after the onset of sexual activity should a woman begin receiving Pap smears?

Every 3 years

How often should cytologic testing (Pap smear) be performed for women aged 21 to 29?

Every 5 years

How often should an HPV/Pap cotest be performed for women aged 30 to 65?

66 years old

At what age can cervical cancer screening be discontinued if there is a history of adequate negative prior screening?

50 to 69 years old

What is the target age range for mammography screening every 1 to 2 years in the Philippine guidelines?

Every 2 years

How often should women receive a Clinical Breast Exam according to the CBE frequency guideline for those over 50?

40 years old

At what age is a baseline comprehensive eye evaluation recommended for women with no risk factors?

3 doses

How many doses are required for the HPV vaccine series?