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NBME 22 Answers

nbme22/Block 3/Question#41 (32.5 difficulty score)
A 56-year-old man develops brief episodes of ...
CL x Css🔍

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submitted by joha961(41),
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inaennMeatc sedo = C(ss * CL * )t / F

... ewerh t si despale miet weteneb edsso t(no alvtnere eher nceis t’is onsoitucun ufisni)no adn F is aiylaibbiaovtli (wihch is 0%10 ro 01. erhe scebuea ’sti viegn )VI.

ttors​anC iwht nlaigod de:so

s(sC * dV) / F

... rwehe Vd is vomlue of stiouit.bridn

yotsubato  So do we just have to memorize this... +9  
gh889  yep +12  
drschmoctor  @yotsubato Not necessarily. I can't remember a formula to save my life. The Css is the amount you want in the blood. The clearance is the fraction removed per unit time. Since we want to maintain a steady state, we only need to replace what is removed. Thus, maintenance dose = amount present * fraction removed. +8  
mambaforstep good & short explanation +1  
castlblack  I remember CLoCk Time as in check the clock time to give the next dose Cl = clearance, C = concentration and T = half life. I have never had to use F. +20  
baja_blast  This is on p. 233 in FA 2019. +  

submitted by drzed(203),

You do not need to memorize a formula to know this, as long as you know the units (which are SO much easier to remember as they are intuitive). The answers are mostly clearance and steady state, which means you can cancel units to see if the answer choice makes sense.

For example, since CL has units of L/min and Css has units of mg/L, then (A) works out because L/min x mg/L = mg/min which is the correct units for infusion rate.

Whereas (B) CL/Css would not work because those units would be L/min / mg/L = L^2/min*mg, which does not make sense.

So if you just cancel some units, you can answer many of the questions.

Huge disclaimer: this won't work with things like half-life, because there is a factor of Ln(2) that has no units, so you have to memorize formulas that have factors before them.

submitted by corndog(2),

FWIW, I committed this shortcut equation to memory: Steady State (Css) = Infusion Rate / Clearance (CL)

To me, this makes sense. Steady State equals the volume in divided by the volume out. Flip this bad boy around and it leaves you with Infusion Rate = CL * Css