NBME Shelf Review (Part 1) – General Concepts

General Approach to a Test Question



* Read the last sentence of the question* Read the answer choices* THEN read the vignette



Common Scenarios with Quick Answers



* Hypotensive patients* Give a fluid bolus* Altered mental status* Check a blood glucose* Hypoglycemia* Orange juice if can swallow safely* D50 if patient cannot swallow and mildly altered* IM glucagon if unresponsive* Patient with altered mental status and possible drug overdose* Give empiric naloxone * Female patients of childbearing age* Get a pregnancy test* If you need to give contrast for a CT scan (example CTA for pulmonary embolism)* Need renal function



Hyperkalemia



* Common scenarios* Crush injury* Severe burns* End stage renal disease* Especially if missed dialysis* Leukemia on chemotherapy* Remember: Don’t give succinylcholine to a patient with hyperkalemia* Common EKG findings on test* Hyperacute T waves* Sinusoidal waves* Treatment* Stabilizes cardiac cell membranes* Calcium* Shifts potassium into the cells* Insulin/Glucose* Albuterol* Sodium Bicarbonate* Removes potassium* Furosemide* Dialysis* Kayexalate



Hypokalemia



* EKG findings* Flattened T waves* QTC prolongation* U waves* At risk for ventricular arrhythmias* Treatment* Oral potassium replacement* IV potassium replacement* Consider magnesium replacement



Hyponatremia



* Hypertonic saline IF* Comatose* Actively seizing* Otherwise treat with normal saline* Pseuohyponatremia * Correct the sodium if patient has severe hyperglycemia* Add 1.6 to sodium for every 100 glucose above normal limit



Hypercalcemia



* Symptoms* “Stones, bones, groans, psychiatric overtones”* Treatment* IV fluids (promotes excretion) FIRST* Then calcitonin/bisphosphates



Torsade de Pointes



* Common in patients with prolonged QTc* Hypokalemia* Hypocalcemia* Treat with magnesium



Additional Reading



* Hyperkalemia (EM Clerkship)