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NBME Questions Flashcards

1
Q

What are the SIRS criteria?

A

2+ of the following:

  • T >38 or <35
  • HR >90
  • RR >20 or CO2 <32
  • WBC >12,000 or >10% immature forms
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2
Q

What is sepsis?

A

SIRS positive plus documented infex

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3
Q

What are the 7 main causes of JVD?

A
  1. RHF
  2. Pulmonary HTN
  3. Tricuspid valve stenosis
  4. SVC obstrux
  5. Constrictive pericarditis
  6. Cardiac tamponade
  7. Tension pneumothorax
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4
Q

Which type of fracture causes one leg to be shorter?

A

Femoral neck

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5
Q

What’s the best combo of drugs (2) for aortic dissection?

A

Esmolol + nitroprusside

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6
Q

What’s the triad of cardiac tamponade?

A
  1. Hypotension
  2. Muffled heart sounds
  3. JVD
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7
Q

What are the 3 types of pneumothorax?

A
  1. Closed
  2. Open
  3. Tension
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8
Q

What’s the tx for tension pneumothorax?

A

Needle decompression at 2nd intercostal space at midclavicular line

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9
Q

What’s the tx for hemothorax?

A

Tube thoracostomy

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10
Q

What’s the tx for open pneumothorax?

A

3-sided dressing and then tube thoracostomy

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11
Q

What’s the tx for closed pneumothorax?

A

Needle decompression then chest tube, unless small

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12
Q

What gauge needle is a large bore?

A

16 gauge

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13
Q

What’s the treatment for cardiac tamponade?

A

Pericardiocentesis

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14
Q

When do you do a FAST scan?

A

Unstable with abdominal pain, suspected hemoperitoneum, or cardiac tamponade

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15
Q

All wounds that penetrate the _______ are considered penetrating neck trauma?

A

Platysmus

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16
Q

If a stable chest trauma patient dies, suspect what?

A

Air embolism

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17
Q

What’s the immediate step for penetrating stab wounds in a hemodynamically stable patient?

A

CT

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18
Q

What are the 5 main signs of elevated ICP?

A
  1. Bradycardia
  2. HTN
  3. Respiratory depression
  4. Fixed, dilated pupils
  5. IV mannitol
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19
Q

Which type of brain bleed is a lens shape and is caused by the MMA, does not cross suture lines, and presents with a lucid interval?

A

Epidural hematoma

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20
Q

Which type of brain bleed crosses suture lines and is caused by damage to the bridging veins?

A

Subdural hematoma

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21
Q

What type of injury is caused by high speed motor vehicle, falls from heights?

A

Rapid-deceleration

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22
Q

What large vessel can rapid-decelerations and also scapular fractures cause damage to?

A

Aorta

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23
Q

What is it called when 3+ adjacent ribs are fractured at 2 points, causing paradoxical inward movement of the flail segment with inspiration?

A

Flail chest

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24
Q

What is Kehr’s sign (referred shoulder pain due to diaphragmatic irritation) often due to?

A

Splenic rupture

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25
Q

Should you do a FAST exam for hemodynamically unstable patients with blunt abdominal trauma?

A

No, go straight to laparotomy

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26
Q

What’s the very initial step for pelvic fracture?

A

External binder

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27
Q

What can present with blood at the urethral meatus or a high riding “ballotable,” or nonpalpable prostate?

A

Pelvic injury

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28
Q

What step should be performed before cath if a pelvic injury is suspected?

A

Retrograde urethrogram

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29
Q

Do you defibrillate with pulseless electrical activity?

A

No

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30
Q

Do you defibrillate with Vfib or pulseless Vtach?

A

Yes

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31
Q

What do you do to treat SVT if it’s unstable?

A

Synchronized electrical cardioversion

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32
Q

What do you do to treat SVT if it’s stable?

A

Valsalva, carotid massage, cold stimulus, or adenosinefollowed by B-blockers or Ca channel blockers

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33
Q

What’s the tx for Afib or Aflutter if it’s unstable?

A

Synchronized electrical cardioversion

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34
Q

What drug do you use for Afib from WPW?

A

Procainamide (no nodal blockers)

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35
Q

What’s the tx for symptomatic bradycardia?

A

Atropine

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36
Q

Which type of acute abdomen leads to diffuse, severe pain with rigidity?

A

Perforation

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37
Q

Which type of acute abdomen leads to acute onset of severe, radiating colicky pain?

A

Obstruction

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38
Q

Which type of acute abdomen presents with gradual onset of constant, ill-defined pain?

A

Inflammation

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39
Q

What should you start for all patients with suspected perforation or signs of sepsis?

A

Broad-spectrum abx

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40
Q

What is the Parkland formula for burns?

A

Fluids for the first 24 hours = 4x the patient’s weight in kg x % BSA

“4 sides to a park”

Note: give 50% of the fluid over the first 8 hours, then remainder

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41
Q

What % SA is the head for burns?

A

9%

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42
Q

What % SA is each side of the torso for burns?

A

18%

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43
Q

What % SA is each leg for burns?

A

18%

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44
Q

Is there a proven benefit for using abx or corticosteroids for 2nd & 3rd degree burns?

A

No, but you can use silver sulfadiazine

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45
Q

What is the criteria for transfer to a burn center?

A
  • Partial or full thickness >10% BSA in patients <10 or >50
  • Partial or full thickness burns >20% for other ages
  • Any partial or full over face, hands, feet, genitals, perineum, major joints
  • Chemical, circumferential, electrical, lightning, inhalation
  • Psychosocial or rehab needs
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46
Q

What % SA is head?

A

9%

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47
Q

What % SA is each arm?

A

9%

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48
Q

What’s the first vital sign to change in hemorrhagic shock?

A

HR

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49
Q

Fevers before postop day 3 are unlikely to be infectious unless they are caused by which 2 bugs?

A
  1. Clostridium

2. B-hemolytic strep

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50
Q

Which 2 conditions are treated with dantrolene?

A
  1. NMS

2. Malignant hyperthermia

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51
Q

In which type of inhalation is O2 sat normal?

A

CO (due to the carboxyhemoglobin)

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52
Q

What type of shock presents with the following:

CO: decr
PCWP: decr
PVR: incr

A

Hypovolemic

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53
Q

What are the 4 main causes of hypovolemic shock?

A
  1. Blood loss
  2. Third spacing
  3. Dehydration
  4. Burns
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54
Q

What’s the tx for hypovolemic shock?

A

NS and blood in a 3:1 ratio

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55
Q

What 2 types of shock present with the following:

CO: decr
PCWP: incr
PVR: incr

A
  1. Cardiogenic

2. Obstructive

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56
Q

What are the 4 main causes of cardiogenic shock?

A
  1. CHF
  2. Arrhythmia
  3. Structural dz
  4. MI
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57
Q

What are the 3 main causes of obstructive shock?

A
  1. Cardiac tamponade
  2. Tension pneumothorax
  3. PE
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58
Q

What 2 types of shock present with the following:

CO: incr
PCWP: decr
PVR: decr

A
  1. Septic

2. Anaphylactic

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59
Q

How much fluid do you give in septic shock patients?

A

Until CVP=8

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60
Q

How do you treat anaphylactic shock?

A

1:1000 epinephrine

61
Q

Which toxicity exposure leads to cherry red skin, confusion, headaches?

A

CO

62
Q

What bite presents with necrosis and hypocalcemia?

A

Spider

63
Q

What bite presents with cranial nerve dysfunction, hypersalivation, and respiratory compromise?

A

Scorpion

64
Q

How do you treat scorpion bites?

A

Benzos, atropine

65
Q

What abx should be given for dog and cat bites?

A

Amoxicillin-clav

66
Q

What abx should be given for human bites?

A

Amoxicillin-clav

67
Q

Do rodents carry rabies?

A

No

68
Q

If a patient gets a bite from a rabid seeming animal and they have never had the rabies vax, what treatment is indicated?

A

1 dose of human rabies immune globulin and 4 doses of rabies vaccine

69
Q

If a patient gets a bite from a rabid seeming animal and they have had the rabies vax, what treatment do they need?

A

Just 2 doses of vaccine

70
Q

If a patient had 3 or fewer lifetime toxoids or the last was 10+ years ago for a clean wound, or 5+ years ago for other wounds, what treatment do you need?

A

Tetanus toxoid

71
Q

If a patient has a major/dirty wound and 3 or fewer lifetime toxoids, what treatment do you need?

A

Tetanus immune globulin

72
Q

What’s the tx for CO poisoning?

A

100% O2

73
Q

How many hours after ingestion is orogastric lavage recommended?

A

1 or less

74
Q

How many hours after ingestion is activated charcoal recommended?

A

2 or less

75
Q

Which 4 drugs increase the risk of digoxin toxicity?

A
  1. Quinidine
  2. Cimetidine
  3. Amiodarone
  4. CCBs
76
Q 
What can the following all cause?: 
Sulfonamides
INH
ASA
Ibuprofen
Primaquine
Pyrimethamine
Chloramphenicol
A

Hemolysis in G6PD patients

77
Q

What weird effect can cimetidine cause?

A

Gynecomastia

78
Q

What 3 types of drugs can cause SJS?

A
  1. Anticonvulsants
  2. Sulfonamides
  3. Penicillins
79
Q

What 3 types of drugs can cause photosensitivity?

A
  1. Tetracycline
  2. Amiodarone
  3. Sulfonamides
80
Q

What’s the antidote for acetaminophen OD?

A

N-acetylcysteine

81
Q

What’s the antidote for acid/alkali ingestion?

A

Upper endoscopy

82
Q

What’s the antidote for anticholinesterases and organophosphates?

A

Atropine, pralidoxime (anticholinergics)

83
Q

How does anticholinesterase toxicity present?

A

Wet and willy

84
Q

How does anticholinergic toxicity present?

A 
Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat
Mad as a hatter
85
Q

What’s the antidote for anticholinergics and antimuscarinics?

A

Physostigmine

86
Q

What’s the antidote for arsenic, mercury, or gold toxicity?

A

Succimer, dimercaprol

87
Q

What’s the antidote for B-blocker toxicity?

A

Glucagon

88
Q

What’s the antidote for barbiturate toxicity?

A

Urine alkalinization, dialysis, activated charcoal, supportive care

89
Q

What’s the antidote for benzo toxicity?

A

Flumazenil

90
Q

What’s the antidote for black widow bite?

A

Calcium gluconate, methocarbamol

91
Q

What’s the antidote for copper, arsenic, lead, and gold toxicity?

A

Penicillamine

92
Q

What’s the antidote for cyanide toxicity?

A

Hydroxycobalamin, amyl nitrate, sodium nitrate, sodium thiosulfate

93
Q

What’s the antidote for digitalis toxicity?

A

Normalize K and anti-digitalis Fab

Note: avoid giving Ca, Mg, or lidocaine

94
Q

What’s the antidote for heparin toxicity?

A

Protamine sulfate

95
Q

What’s the antidote for INH toxicity?

A

Pyridoxine

96
Q

What’s the antidote for iron salt toxicity?

A

Deferoxamine

97
Q

What’s the antidote for lead toxicity?

A

Succimer, EDTA, or dimercaprol

98
Q

What’s the antidote for methanol or ethylene glycol poisoning?

A

Fomepizole, EtOH, calcium gluconate for ethylene glycol

99
Q

What’s the antidote for methemoglobin poisoning?

A

Methylene blue

100
Q

How does methemoglobin poisoning present?

A

Brown blood, blue skin

101
Q

What’s the antidote for opioid toxicity?

A

Naloxone

102
Q

What’s the antidote for salicylate poisoning?

A

Urine alkalinization, dialysis, activated charcoal

103
Q

What’s the antidote for TCA toxicity?

A

Sodium bicarbonate for QRS prolongation, benzo for seizures

104
Q

What’s the antidote for theophylline toxicity?

A

Activated charcoal

105
Q

What’s the antidote for tPA, streptokinase toxicity?

A

Aminocaprioic acid

106
Q

What’s the antidote for warfarin toxicity?

A

Vitamin K, FFP

107
Q

Which drug causes livedo reticularis?

A

Amantadine

108
Q

Which drug causes gray baby syndrome?

A

Chloramphenicol

109
Q

Which drug can cause severe rebound HA?

A

Clonidine

110
Q

Which drug can cause hemorrhagic cystitis?

A

Cyclophosphamide

111
Q

Which drug can cause junctional tachycardia or SVT and yellow visual changes?

A

Digoxin

112
Q

Which drug can cause cardiotoxicity?

A

Doxorubicin

113
Q

Which 2 drugs can cause malignant hyperthermia?

A

Halothane

Succinylcholine

114
Q

Which drug can cause hypertensive tyramine rxn and serotonin syndrome?

A

MAOIs

115
Q

Which drug can cause metallic taste?

A

Metronidazole

116
Q

Which drug can cause cutaneous flushing?

A

Niacin

117
Q

Which drug can cause gingival hyperplasia?

A

Phenytoin

118
Q

Which drug can cause torsades de pointes?

A

Quinidine

119
Q

Which drug can cause orange-red body secretions?

A

Rifampin

120
Q

Which drug can cause respiratory alkalosis and metabolic acidosis?

A

Salicylates

121
Q

Which antidepressant can cause QRS prolongation?

A

TCAs

122
Q

Which drug can cause red man syndrome?

A

Vancomycin

123
Q

What should you avoid in treating cocaine withdrawal?

A

Pure B-blockers (can cause unopposed a activity)

124
Q

Which toxidrome presents with pupillary constriction, respiratory depression?

A

Opioid

125
Q

Which withdrawal presents with insomnia, myalgias, lacrimation, diaphoresis, dilated pupils, nausea, vomiting, yawning?

A

Opioid

126
Q

Which toxidrome presents with agitation, HTN, pupillary dilation, seizures, euphoria, possible hallucinations?

A

Amphetamine

127
Q

Which toxidrome presents with euphoria, tachycardia, pupillary dilation, HTN, feeling of bugs under skin, ischemic chest pain?

A

Cocaine

128
Q

Which toxidrome presents with assaultiveness, psychosis, violence, vertical/horizontal nystagmus, HTN, ataxia, seizures?

A

PCP

129
Q

Which toxidrome presents with anxiety or depression, flashbacks, pupillary dilation, tachycardia, diaphoresis?

A

LSD

130
Q

Is barbiturate withdrawal life-threatening?

A

Yes

131
Q

Which toxidrome presents with amnesia, somnolence, mild respiratory depression?

A

Benzos

132
Q

Which toxidrome presents with restlessness, insomnia, diuresis, muscle twitching, flushed face?

A

Caffeine

133
Q

Which toxidrome presents with restlessness, insomnia, anxiety, and arrhythmias?

A

Nicotine

134
Q

How do you calculate the anion gap?

A

Na-(Cl+HCO3)

135
Q

What’s the normal range for the anion gap?

A

8-16

136
Q

What is new-onset HTN >140 after 20th week of gestation, with proteinuria or end organ dysfunction?

A

Preeclampsia

137
Q

What is preeclampsia plus maternal seizures?

A

Eclampsia

138
Q

What’s the tx for eclampsia?

A

MgSO4, delivery

139
Q

What’s hemolysis, elevated liver enzymes, and low platelets in pregnancy?

A

HELLP Syndrome

140
Q

How do you treat HELLP Syndrome?

A

Delivery

141
Q

What pregnancy issue presents with abrupt, painful bleeding and is life threatening?

A

Placental abruption

142
Q

What pregnancy issue presents with abnormal placental attachment after delivery, resulting in postpartum bleeding?

A

Placenta accreta/increta/percreta

143
Q

What pregnancy issue presents with painless third trimester bleeding?

A

Placenta previa

144
Q

What pregnancy issue presents with membrane rupture, painless bleeding, and fetal bradycardia?

A

Vasa previa

145
Q

Which type of kidney stone is associated with ethylene glycol ingestion?

A

Calcium oxalate

146
Q

Which type of kidney stone is caused by infex with urease positive bugs?

A

Struvite (ammonium)

147
Q

Which type of kidney stone is seen in leukemia or gout?

A

Uric acid

148
Q

Which type of kidney stone is hereditary?

A

Cystine

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