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
2
Q
What is sepsis?
A
SIRS positive plus documented infex
3
Q
What are the 7 main causes of JVD?
A
- RHF
- Pulmonary HTN
- Tricuspid valve stenosis
- SVC obstrux
- Constrictive pericarditis
- Cardiac tamponade
- Tension pneumothorax
4
Q
Which type of fracture causes one leg to be shorter?
A
Femoral neck
5
Q
What’s the best combo of drugs (2) for aortic dissection?
A
Esmolol + nitroprusside
6
Q
What’s the triad of cardiac tamponade?
A
- Hypotension
- Muffled heart sounds
- JVD
7
Q
What are the 3 types of pneumothorax?
A
- Closed
- Open
- Tension
8
Q
What’s the tx for tension pneumothorax?
A
Needle decompression at 2nd intercostal space at midclavicular line
9
Q
What’s the tx for hemothorax?
A
Tube thoracostomy
10
Q
What’s the tx for open pneumothorax?
A
3-sided dressing and then tube thoracostomy
11
Q
What’s the tx for closed pneumothorax?
A
Needle decompression then chest tube, unless small
12
Q
What gauge needle is a large bore?
A
16 gauge
13
Q
What’s the treatment for cardiac tamponade?
A
Pericardiocentesis
14
Q
When do you do a FAST scan?
A
Unstable with abdominal pain, suspected hemoperitoneum, or cardiac tamponade
15
Q
All wounds that penetrate the _______ are considered penetrating neck trauma?
A
Platysmus
16
Q
If a stable chest trauma patient dies, suspect what?
A
Air embolism
17
Q
What’s the immediate step for penetrating stab wounds in a hemodynamically stable patient?
A
CT
18
Q
What are the 5 main signs of elevated ICP?
A
- Bradycardia
- HTN
- Respiratory depression
- Fixed, dilated pupils
- IV mannitol
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
20
Q
Which type of brain bleed crosses suture lines and is caused by damage to the bridging veins?
A
Subdural hematoma
21
Q
What type of injury is caused by high speed motor vehicle, falls from heights?
A
Rapid-deceleration
22
Q
What large vessel can rapid-decelerations and also scapular fractures cause damage to?
A
Aorta
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
24
Q
What is Kehr’s sign (referred shoulder pain due to diaphragmatic irritation) often due to?
A
Splenic rupture
25
Should you do a FAST exam for hemodynamically unstable patients with blunt abdominal trauma?
No, go straight to laparotomy
26
What's the very initial step for pelvic fracture?
External binder
27
What can present with blood at the urethral meatus or a high riding "ballotable," or nonpalpable prostate?
Pelvic injury
28
What step should be performed before cath if a pelvic injury is suspected?
Retrograde urethrogram
29
Do you defibrillate with pulseless electrical activity?
No
30
Do you defibrillate with Vfib or pulseless Vtach?
Yes
31
What do you do to treat SVT if it's unstable?
Synchronized electrical cardioversion
32
What do you do to treat SVT if it's stable?
Valsalva, carotid massage, cold stimulus, or adenosinefollowed by B-blockers or Ca channel blockers
33
What's the tx for Afib or Aflutter if it's unstable?
Synchronized electrical cardioversion
34
What drug do you use for Afib from WPW?
Procainamide (no nodal blockers)
35
What's the tx for symptomatic bradycardia?
Atropine
36
Which type of acute abdomen leads to diffuse, severe pain with rigidity?
Perforation
37
Which type of acute abdomen leads to acute onset of severe, radiating colicky pain?
Obstruction
38
Which type of acute abdomen presents with gradual onset of constant, ill-defined pain?
Inflammation
39
What should you start for all patients with suspected perforation or signs of sepsis?
Broad-spectrum abx
40
What is the Parkland formula for burns?
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
41
What % SA is the head for burns?
9%
42
What % SA is each side of the torso for burns?
18%
43
What % SA is each leg for burns?
18%
44
Is there a proven benefit for using abx or corticosteroids for 2nd & 3rd degree burns?
No, but you can use silver sulfadiazine
45
What is the criteria for transfer to a burn center?
- 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
46
What % SA is head?
9%
47
What % SA is each arm?
9%
48
What's the first vital sign to change in hemorrhagic shock?
HR
49
Fevers before postop day 3 are unlikely to be infectious unless they are caused by which 2 bugs?
1. Clostridium
| 2. B-hemolytic strep
50
Which 2 conditions are treated with dantrolene?
1. NMS
| 2. Malignant hyperthermia
51
In which type of inhalation is O2 sat normal?
CO (due to the carboxyhemoglobin)
52
What type of shock presents with the following:
CO: decr
PCWP: decr
PVR: incr
Hypovolemic
53
What are the 4 main causes of hypovolemic shock?
1. Blood loss
2. Third spacing
3. Dehydration
4. Burns
54
What's the tx for hypovolemic shock?
NS and blood in a 3:1 ratio
55
What 2 types of shock present with the following:
CO: decr
PCWP: incr
PVR: incr
1. Cardiogenic
| 2. Obstructive
56
What are the 4 main causes of cardiogenic shock?
1. CHF
2. Arrhythmia
3. Structural dz
4. MI
57
What are the 3 main causes of obstructive shock?
1. Cardiac tamponade
2. Tension pneumothorax
3. PE
58
What 2 types of shock present with the following:
CO: incr
PCWP: decr
PVR: decr
1. Septic
| 2. Anaphylactic
59
How much fluid do you give in septic shock patients?
Until CVP=8
60
How do you treat anaphylactic shock?
1:1000 epinephrine
61
Which toxicity exposure leads to cherry red skin, confusion, headaches?
CO
62
What bite presents with necrosis and hypocalcemia?
Spider
63
What bite presents with cranial nerve dysfunction, hypersalivation, and respiratory compromise?
Scorpion
64
How do you treat scorpion bites?
Benzos, atropine
65
What abx should be given for dog and cat bites?
Amoxicillin-clav
66
What abx should be given for human bites?
Amoxicillin-clav
67
Do rodents carry rabies?
No
68
If a patient gets a bite from a rabid seeming animal and they have never had the rabies vax, what treatment is indicated?
1 dose of human rabies immune globulin and 4 doses of rabies vaccine
69
If a patient gets a bite from a rabid seeming animal and they have had the rabies vax, what treatment do they need?
Just 2 doses of vaccine
70
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?
Tetanus toxoid
71
If a patient has a major/dirty wound and 3 or fewer lifetime toxoids, what treatment do you need?
Tetanus immune globulin
72
What's the tx for CO poisoning?
100% O2
73
How many hours after ingestion is orogastric lavage recommended?
1 or less
74
How many hours after ingestion is activated charcoal recommended?
2 or less
75
Which 4 drugs increase the risk of digoxin toxicity?
1. Quinidine
2. Cimetidine
3. Amiodarone
4. CCBs
76
```
What can the following all cause?:
Sulfonamides
INH
ASA
Ibuprofen
Primaquine
Pyrimethamine
Chloramphenicol
```
Hemolysis in G6PD patients
77
What weird effect can cimetidine cause?
Gynecomastia
78
What 3 types of drugs can cause SJS?
1. Anticonvulsants
2. Sulfonamides
3. Penicillins
79
What 3 types of drugs can cause photosensitivity?
1. Tetracycline
2. Amiodarone
3. Sulfonamides
80
What's the antidote for acetaminophen OD?
N-acetylcysteine
81
What's the antidote for acid/alkali ingestion?
Upper endoscopy
82
What's the antidote for anticholinesterases and organophosphates?
Atropine, pralidoxime (anticholinergics)
83
How does anticholinesterase toxicity present?
Wet and willy
84
How does anticholinergic toxicity present?
```
Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat
Mad as a hatter
```
85
What's the antidote for anticholinergics and antimuscarinics?
Physostigmine
86
What's the antidote for arsenic, mercury, or gold toxicity?
Succimer, dimercaprol
87
What's the antidote for B-blocker toxicity?
Glucagon
88
What's the antidote for barbiturate toxicity?
Urine alkalinization, dialysis, activated charcoal, supportive care
89
What's the antidote for benzo toxicity?
Flumazenil
90
What's the antidote for black widow bite?
Calcium gluconate, methocarbamol
91
What's the antidote for copper, arsenic, lead, and gold toxicity?
Penicillamine
92
What's the antidote for cyanide toxicity?
Hydroxycobalamin, amyl nitrate, sodium nitrate, sodium thiosulfate
93
What's the antidote for digitalis toxicity?
Normalize K and anti-digitalis Fab
Note: avoid giving Ca, Mg, or lidocaine
94
What's the antidote for heparin toxicity?
Protamine sulfate
95
What's the antidote for INH toxicity?
Pyridoxine
96
What's the antidote for iron salt toxicity?
Deferoxamine
97
What's the antidote for lead toxicity?
Succimer, EDTA, or dimercaprol
98
What's the antidote for methanol or ethylene glycol poisoning?
Fomepizole, EtOH, calcium gluconate for ethylene glycol
99
What's the antidote for methemoglobin poisoning?
Methylene blue
100
How does methemoglobin poisoning present?
Brown blood, blue skin
101
What's the antidote for opioid toxicity?
Naloxone
102
What's the antidote for salicylate poisoning?
Urine alkalinization, dialysis, activated charcoal
103
What's the antidote for TCA toxicity?
Sodium bicarbonate for QRS prolongation, benzo for seizures
104
What's the antidote for theophylline toxicity?
Activated charcoal
105
What's the antidote for tPA, streptokinase toxicity?
Aminocaprioic acid
106
What's the antidote for warfarin toxicity?
Vitamin K, FFP
107
Which drug causes livedo reticularis?
Amantadine
108
Which drug causes gray baby syndrome?
Chloramphenicol
109
Which drug can cause severe rebound HA?
Clonidine
110
Which drug can cause hemorrhagic cystitis?
Cyclophosphamide
111
Which drug can cause junctional tachycardia or SVT and yellow visual changes?
Digoxin
112
Which drug can cause cardiotoxicity?
Doxorubicin
113
Which 2 drugs can cause malignant hyperthermia?
Halothane
| Succinylcholine
114
Which drug can cause hypertensive tyramine rxn and serotonin syndrome?
MAOIs
115
Which drug can cause metallic taste?
Metronidazole
116
Which drug can cause cutaneous flushing?
Niacin
117
Which drug can cause gingival hyperplasia?
Phenytoin
118
Which drug can cause torsades de pointes?
Quinidine
119
Which drug can cause orange-red body secretions?
Rifampin
120
Which drug can cause respiratory alkalosis and metabolic acidosis?
Salicylates
121
Which antidepressant can cause QRS prolongation?
TCAs
122
Which drug can cause red man syndrome?
Vancomycin
123
What should you avoid in treating cocaine withdrawal?
Pure B-blockers (can cause unopposed a activity)
124
Which toxidrome presents with pupillary constriction, respiratory depression?
Opioid
125
Which withdrawal presents with insomnia, myalgias, lacrimation, diaphoresis, dilated pupils, nausea, vomiting, yawning?
Opioid
126
Which toxidrome presents with agitation, HTN, pupillary dilation, seizures, euphoria, possible hallucinations?
Amphetamine
127
Which toxidrome presents with euphoria, tachycardia, pupillary dilation, HTN, feeling of bugs under skin, ischemic chest pain?
Cocaine
128
Which toxidrome presents with assaultiveness, psychosis, violence, vertical/horizontal nystagmus, HTN, ataxia, seizures?
PCP
129
Which toxidrome presents with anxiety or depression, flashbacks, pupillary dilation, tachycardia, diaphoresis?
LSD
130
Is barbiturate withdrawal life-threatening?
Yes
131
Which toxidrome presents with amnesia, somnolence, mild respiratory depression?
Benzos
132
Which toxidrome presents with restlessness, insomnia, diuresis, muscle twitching, flushed face?
Caffeine
133
Which toxidrome presents with restlessness, insomnia, anxiety, and arrhythmias?
Nicotine
134
How do you calculate the anion gap?
Na-(Cl+HCO3)
135
What's the normal range for the anion gap?
8-16
136
What is new-onset HTN >140 after 20th week of gestation, with proteinuria or end organ dysfunction?
Preeclampsia
137
What is preeclampsia plus maternal seizures?
Eclampsia
138
What's the tx for eclampsia?
MgSO4, delivery
139
What's hemolysis, elevated liver enzymes, and low platelets in pregnancy?
HELLP Syndrome
140
How do you treat HELLP Syndrome?
Delivery
141
What pregnancy issue presents with abrupt, painful bleeding and is life threatening?
Placental abruption
142
What pregnancy issue presents with abnormal placental attachment after delivery, resulting in postpartum bleeding?
Placenta accreta/increta/percreta
143
What pregnancy issue presents with painless third trimester bleeding?
Placenta previa
144
What pregnancy issue presents with membrane rupture, painless bleeding, and fetal bradycardia?
Vasa previa
145
Which type of kidney stone is associated with ethylene glycol ingestion?
Calcium oxalate
146
Which type of kidney stone is caused by infex with urease positive bugs?
Struvite (ammonium)
147
Which type of kidney stone is seen in leukemia or gout?
Uric acid
148
Which type of kidney stone is hereditary?
Cystine
