NMLE Integrated flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Anion gap formula

Anion gap equals sodium minus the sum of chloride and bicarbonate, normally 8 to 12 mEq/L. A raised gap suggests unmeasured anions such as ketoacids, lactate, or toxins.

Expected PaCO₂ in metabolic acidosis

Winter formula: expected PaCO₂ equals 1.5 times bicarbonate plus 8, plus or minus 2. A measured value outside this range indicates an additional respiratory disorder.

Michaelis-Menten constant Km

Km is the substrate concentration at which reaction velocity is half of Vmax. Competitive inhibitors increase apparent Km with unchanged Vmax; noncompetitive inhibitors lower Vmax.

Hardy-Weinberg carrier frequency

For a recessive disease with incidence q², the carrier frequency is 2pq, approximately 2 times the square root of the incidence when q is small.

STEMI reperfusion target

Primary percutaneous coronary intervention should be performed within 90 minutes of first medical contact for ST-elevation myocardial infarction, with aspirin and a P2Y12 inhibitor given promptly.

Heart failure quadruple therapy

Reduced-ejection-fraction heart failure is treated with an ARNI or ACE inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor, each shown to reduce mortality.

CURB-65 components

Confusion, urea above 7 mmol/L, respiratory rate 30 or more, blood pressure below 90/60, and age 65 or older. A score of 2 or more suggests hospital admission.

Spontaneous bacterial peritonitis threshold

In cirrhotic ascites, a polymorphonuclear cell count of 250 per cubic millimeter or more in ascitic fluid establishes spontaneous bacterial peritonitis and warrants prompt antibiotics.

Parkland burn formula

Give 4 mL of lactated Ringer per kilogram of body weight per percent total body surface area burned in the first 24 hours, with half infused in the first 8 hours.

McBurney point tenderness

Tenderness one-third of the distance from the anterior superior iliac spine to the umbilicus supports acute appendicitis, especially with migratory pain and leukocytosis.

ATLS primary survey order

Airway with cervical spine protection, breathing, circulation with hemorrhage control, disability and neurologic assessment, then exposure with environmental control. Life threats are treated as found.

Postoperative fever timing

Atelectasis within 48 hours, urinary or wound infection around days 3 to 5, anastomotic leak or abscess days 5 to 7, and deep vein thrombosis after day 7.

Naegele rule

Estimated delivery date equals the first day of the last menstrual period minus 3 months plus 7 days. First-trimester ultrasound is more accurate for dating.

Severe preeclampsia features

Blood pressure of 160/110 or higher, platelets below 100,000, doubled transaminases, pulmonary edema, visual or cerebral symptoms, or renal insufficiency occurring after 20 weeks of gestation.

Magnesium sulfate toxicity signs

Loss of deep tendon reflexes, respiratory depression, and oliguria signal magnesium toxicity. Stop the infusion and give intravenous calcium gluconate as the antidote.

Most common postpartum hemorrhage cause

Uterine atony accounts for most postpartum hemorrhage. Treat with uterine massage, oxytocin, then tranexamic acid within 3 hours and escalating uterotonics.

APGAR components

Appearance, pulse, grimace, activity, and respiration, each scored 0 to 2 at 1 and 5 minutes. A score of 0 to 3 indicates need for immediate resuscitation.

Kawasaki disease criteria

Fever for 5 days or more plus 4 of conjunctivitis, oral changes, rash, extremity changes, and cervical lymphadenopathy. Treat with intravenous immunoglobulin and aspirin.

Bronchiolitis first-line management

Supportive care with oxygen and hydration. Respiratory syncytial virus is the usual cause, and routine bronchodilators or corticosteroids are not recommended.

Infant weight doubling time

Birth weight typically doubles by about 5 months and triples by 12 months, with birth weight regained by 2 weeks of age.

Positive predictive value

The proportion of positive test results that are true positives. Unlike sensitivity and specificity, predictive value depends on disease prevalence in the tested population.

Number needed to treat

The reciprocal of the absolute risk reduction. It estimates how many patients must be treated for one additional favorable outcome compared with control.

Lead-time bias

Screening detects disease earlier without delaying death, so measured survival appears longer. This artifact can falsely suggest screening benefit unless mortality is compared.

Herd immunity threshold

Approximately 1 minus 1 divided by the basic reproduction number. For measles with R₀ of 12 to 18, roughly 92 to 95 percent coverage is required.

Informed consent elements

Capacity, disclosure of diagnosis, risks, benefits, and alternatives, comprehension of that information, and voluntary decision. A capacitated adult's refusal must be respected.

Emergency treatment exception

Treatment without consent is permitted when delay would cause serious harm, the patient lacks capacity, and no surrogate decision maker can be reached in time.

Mandatory reporting examples

Suspected child abuse, elder abuse, gunshot wounds, and specified communicable diseases must be reported under law, overriding ordinary confidentiality obligations.

Brain death criteria

Irreversible coma with absent brainstem reflexes and a positive apnea test, after establishing an adequate cause and excluding confounders such as sedatives, hypothermia, and metabolic derangement.

Adult cardiac arrest epinephrine dose

Give 1 mg of epinephrine intravenously every 3 to 5 minutes during cardiac arrest, with high-quality compressions at 100 to 120 per minute and minimal interruptions.

Anaphylaxis first-line drug

Intramuscular epinephrine 0.3 to 0.5 mg of the 1 mg/mL concentration into the anterolateral thigh, repeated every 5 to 15 minutes. Antihistamines and steroids are adjuncts only.

Tension pneumothorax treatment

Immediate needle decompression followed by tube thoracostomy, based on clinical signs such as hypotension, absent breath sounds, and tracheal deviation. Do not wait for imaging.

Sepsis antibiotic timing

In septic shock, give broad-spectrum antibiotics within 1 hour of recognition and 30 mL/kg of crystalloid for hypotension or lactate of 4 mmol/L or higher.