TrueLearn has Enhanced its Family Medicine SmartBanks

Over the course of TrueLearn’s recent beta program, hundreds of Family Medicine residents used our SmartBanks to prepare for the Family Medicine Boards and In-Training exams. We’ve gathered feedback from these users and have made some major upgrades to our Family Medicine SmartBanks.

Hundreds of New Family Medicine Questions Added To Our SmartBank

The most effective tool for Family Medicine Board review just got even better! TrueLearn’s added 700 high-yield questions to our ABFM Board Exam and In-Training exam question banks, bringing both Q-banks up to 1,000 questions.

Question Updates are Live

In addition to adding new questions to TrueLearn’s SmartBanks, we’ve also made hundreds of updates to our existing Family Medicine board review questions based on psychometric data, resident-submitted feedback and survey results. We are committed to making updates to our questions that ensure that they are challenging, reflective of the exam, include helpful explanations and are as high-quality as possible.

Sample Family Medicine Question

Q: A 3-year-old male with a history of leukemia presents via EMS with lethargy. He is tachycardiac and tachypneic on presentation. Minutes into your exam, his pulse drops to 42 and he becomes unresponsive but he still has a palpable pulse. Oxygen is applied and bag-valve mask ventilation is begun without difficulty. His SpO2 drops to 82 percent and his EtCO2 is 48 mmHg. After two minutes of interventions, his exam is unchanged. What is the next step in this resuscitation?

A) Atropine

B) Cardiopulmonary resuscitation (CPR)

C) Defibrillation

D) Epinephrine

E) Intubation

Answer and Analysis

Correct Answer: B

Following the bradycardia with a pulse Pediatric Advanced Life Support algorithm, beginning CPR would be the next step in management of this patient. If the perfusion is poor and heart rate is less than 60, oxygen should be applied and BVM ventilation begun. If no response is seen, CPR is the next step in management. This would be followed by 0.1 mL/kg of epinephrine (repeated every three to five minutes) and 0.02 mg/kg atropine (may repeat with a minimum of 0.1 mg, maximum 1 mg). If the above fails, consider cardiac pacing. At any point if the patient loses a palpable pulse, move to the pulseless arrest algorithm.

Answer A: Atropine would not be the next step but should be considered if symptomatic bradycardia continues despite CPR. This medication is generally indicated if there is suspicion of increased vagal tone or a primary atrioventricular block on EKG. Remember the atropine needs to be pushed quickly, therefore, should immediately be followed by a saline flush. Vagal maneuvers also may be attempted, only if the patient is hemodynamically stable and they are readily available.

Answer C: Defibrillation is only indicated for ventricular fibrillation and pulseless ventricular tachycardia.

Answer D: Epinephrine would be the next step in management if CPR fails to improve the patient’s symptomatic bradycardia.

Answer E: Intubation is indicated for respiratory failure, inability to ventilation/oxygenate, airway protection, and for surgical procedures. Since the patient is being ventilated without difficulty with a BVM, intubation is not the next step in management of this patient. Moreover, the time taken to intubate this patient would not be supplemented with CPR.

Bottom Line: The bradycardia algorithm in pediatric patients requires the knowledge that even with a pulse, CPR should be started if the patient is still symptomatic despite oxygenation and ventilation.

For more information, see: American Heart Association PALS Algorithm: Pediatric Bradycardia with a pulse and poor perfusion