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SMLE Clinical Guidelines and High-Yield Facts

25 flashcards to revise the key facts for the SMLE. Study material written for practice, not the official exam.

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First-Line Treatment for Anaphylaxis

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First-Line Treatment for Anaphylaxis

Intramuscular Epinephrine (1:1,000 concentration, 0.3-0.5 mg in adults; 0.01 mg/kg in children) injected into the anterolateral mid-thigh immediately.

CURB-65 Criteria for Community-Acquired Pneumonia

Confusion, Urea > 7 mmol/L, Respiratory rate >= 30/min, Blood pressure (SBP < 90 or DBP <= 60 mmHg), Age >= 65. Score >= 2 warrants inpatient admission; score >= 3 warrants ICU assessment.

Initial Step in Acute Coronary Syndrome (STEMI)

Immediate chewable Aspirin (162-325 mg), oxygen if SaO2 < 90%, sublingual nitroglycerin (if not contraindicated by right ventricular infarct or PDE-5 inhibitors), and urgent primary PCI within 90 minutes of FMC.

CHA2DS2-VASc Score Components and Anticoagulation Threshold

CHF (1), Hypertension (1), Age >= 75 (2), Diabetes (1), Stroke/TIA (2), Vascular disease (1), Age 65-74 (1), Sex category female (1). Score >= 2 in men or >= 3 in women warrants oral anticoagulation (DOAC).

Emergency Triad of Cardiac Tamponade (Beck's Triad)

Hypotension, Jugular venous distension, and Muffled heart sounds, accompanied by pulsus paradoxus (> 10 mmHg drop in SBP during inspiration).

Diagnostic Triad of Normal Pressure Hydrocephalus (Adams-Hakim)

Gait disturbance (magnetic/shuffling gait, earliest sign), Urinary incontinence, and Cognitive dementia ('wet, wacky, and wobbly').

First-Line Antihypertensive Regimen in Pregnancy

Oral Labetalol, Nifedipine (extended-release), or Methyldopa. ACE inhibitors, ARBs, and direct renin inhibitors are strictly contraindicated due to fetopathy and renal dysgenesis.

First-Line Treatment for Eclampsia and Severe Preeclampsia

Intravenous Magnesium Sulfate (4-6 g loading dose over 15-20 min, followed by 1-2 g/hour continuous maintenance infusion) for seizure prophylaxis and control.

Parkland Formula for Burn Fluid Resuscitation

Total 24-hour Lactated Ringer's volume = 4 mL x body weight (kg) x % TBSA of 2nd/3rd degree burns. Administer half in the first 8 hours post-burn, and the remaining half over the next 16 hours.

Rule of Nines for Adult Burn Assessment

Head: 9%; Each Arm: 9% (anterior 4.5%, posterior 4.5%); Anterior Trunk: 18%; Posterior Trunk: 18%; Each Leg: 18% (anterior 9%, posterior 9%); Perineum: 1%.

Glasgow Coma Scale (GCS) Minimum and Maximum Scores

Score ranges from 3 to 15: Eye opening (1-4), Verbal response (1-5), Motor response (1-6). GCS <= 8 defines severe brain injury and warrants endotracheal intubation.

Centor Criteria for Streptococcal Pharyngitis

History of fever (+1), Absence of cough (+1), Tender anterior cervical lymphadenopathy (+1), Tonsillar exudates (+1). Age 3-14 (+1), Age 15-44 (0), Age >= 45 (-1). Score >= 3-4 warrants rapid antigen testing and antibiotic treatment.

First-Line Oral Pharmacotherapy for Type 2 Diabetes Mellitus

Metformin (biguanide), which suppresses hepatic gluconeogenesis and improves peripheral insulin sensitivity without causing hypoglycemia or weight gain (monitor eGFR; avoid if eGFR < 30 mL/min).

Diagnostic Criteria for Diabetic Ketoacidosis (DKA)

Blood glucose > 250 mg/dL, arterial pH < 7.30, serum bicarbonate < 18 mEq/L, elevated serum/urine ketones, and high anion gap (> 12 mEq/L).

Management Priority in Diabetic Ketoacidosis (DKA)

Aggressive IV fluid resuscitation with 0.9% Normal Saline (1-1.5 L in 1st hour) and potassium repletion before or alongside low-dose IV regular insulin (hold insulin if K+ < 3.3 mEq/L).

Initial Empirical Therapy for Bacterial Meningitis in Adults (Age 18-50)

Intravenous Ceftriaxone (2 g q12h) + Vancomycin (15-20 mg/kg q8-12h) + Dexamethasone (10 mg IV administered prior to or with the first antibiotic dose to attenuate S. pneumoniae neurological sequelae).

Empirical Therapy for Meningitis in Neonates (< 1 Month)

Intravenous Ampicillin (covering Listeria monocytogenes) + Cefotaxime or Gentamicin (covering E. coli and Group B Streptococcus). Avoid Ceftriaxone in neonates due to biliary sludging and bilirubin displacement.

First-Line Treatment for Status Epilepticus (> 5 min seizure)

IV Lorazepam (0.1 mg/kg, up to 4 mg) or IM Midazolam (10 mg if no IV access), followed by IV Levetiracetam, Fosphenytoin, or Valproate if seizures persist beyond 5-10 minutes.

Clinical Presentation of Acute Appendicitis

Dull periumbilical pain migrating to the right lower quadrant (McBurney's point), accompanied by anorexia, nausea, low-grade fever, Rovsing's sign, Psoas sign, and Obturator sign.

Diagnostic Imaging of Choice for Acute Cholecystitis

Right upper quadrant abdominal ultrasound (reveals gallstones, gallbladder wall thickening > 3 mm, pericholecystic fluid, and sonographic Murphy's sign). HIDA cholescintigraphy is the gold standard if ultrasound is equivocal.

First-Line Prophylaxis for Migraine Headaches

Beta-blockers (Propranolol, Metoprolol), anticonvulsants (Topiramate, Divalproex sodium), or tricyclic antidepressants (Amitriptyline); CGRP antagonists for refractory cases.

Classic Triad of Wernicke Encephalopathy

Encephalopathy (acute confusion), Oculomotor dysfunction (nystagmus, bilateral lateral rectus palsy), and Gait ataxia, caused by thiamine (vitamin B1) deficiency; administer thiamine before IV glucose.

Management of Hyperkalemia with ECG Changes (Peaked T Waves / QRS Widening)

Immediate IV Calcium Gluconate (10%) to stabilize cardiac membrane potential, followed by IV regular insulin with 50% dextrose, nebulized albuterol, and potassium-binding agents or dialysis.

Criteria for Kawasaki Disease Diagnosis

Fever persisting >= 5 days plus at least 4 of: bilateral non-exudative conjunctivitis, oral mucosal changes (strawberry tongue/lip erythema), polymorphous rash, extremity changes (erythema/edema/desquamation), and unilateral cervical lymphadenopathy (> 1.5 cm).

Treatment of Kawasaki Disease to Prevent Coronary Aneurysms

Single high-dose Intravenous Immunoglobulin (IVIG, 2 g/kg infused over 10-12 hours) plus high-dose oral Aspirin (80-100 mg/kg/day during acute febrile phase, tapered to 3-5 mg/kg/day antiplatelet dose).

SMLE (Saudi Medical Licensing Exam) in Saudi Arabia

In Saudi Arabia, SMLE (Saudi Medical Licensing Exam) is part of: Health professions.

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