Basic and Preclinical Sciences Applied to Clinical Practice
Basic and Preclinical Sciences Applied to Clinical Practice tests physiology, pathophysiology, anatomy, biochemistry, microbiology, and genetics at the bedside. The exam asks why a sign occurs and what to do first.
Core rules
- Acid-base: use pH, PaCO2, and bicarbonate to identify primary disorder; calculate compensation and anion gap.
- Potassium: hyperkalemia causes peaked T waves, widened QRS, and sine wave; treat ECG changes with calcium first.
- Anatomy: correlate pain and neurologic findings with dermatomes and structures.
- Microbiology: Gram stain, culture, and virulence factors guide empiric therapy.
Worked example
A patient with renal failure has peaked T waves, widened QRS, and potassium 7.2 mmol/L. Give intravenous calcium gluconate first to stabilize the myocardium, then insulin with glucose and salbutamol to shift potassium intracellularly, and arrange dialysis. Reasoning: calcium protects the heart but does not lower potassium; definitive removal is needed.
Traps
- Giving insulin without glucose in a normoglycemic patient.
- Treating hyperkalemia without ECG assessment.
- Using bicarbonate routinely for every acidosis.
- Ignoring anion gap in metabolic acidosis.