Common questions asked during rotations

[PistonsMD]

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I thought this could become a useful tool for all of us here. We could post common questions asked by residents, attendings, etc, during rounds or teaching sessions. We could use the following format:

Rotation: ex. Gastroenterology

Question: What is the differential of abdominal distention?

Answer: (6Fs) Fat, Feces, Fetus, Flatus, Fluid, Fatal Growth


Hopefully we can get a lot of the common questions so that us med students atleast don't look completely incompetent...lol

 

[ssg]

I was just asked this today:

What is the normal urine output for an adult?

1/2 cc/hr

children:

1 cc/hr

 

[lord_jeebus]

I was just asked this today:

What is the normal urine output for an adult?

1/2 cc/hr

children:

1 cc/hr

well, cc/kg/hr but I'm sure that's what you meant

 

[Blade28]

Oh man there are tons...we could do some teaching here!

How about I throw out some questions and you guys answer them? 🙂

*What are the 4 Fs seen in a typical cholecystitis patient?
*What are the reasons a fistula may not close?
*What's the blood supply to the stomach?
*What are the 5 Salter-Harris fracture types in children?
*How do you calculate maintenance IV fluids?
*What's the Parkland formula?
*What's the differential diagnosis for RUQ/RLQ/LUQ/LLQ abdominal pain?
*What are 5 indications (AEIOU) for dialysis?
*What are causes of anion gap/non-anion gap metabolic acidosis?
*What's the most common cause of a small bowel obstruction? What about in a virgin abdomen?
*What's the treatment of hyperkalemia?
*What are the pros and cons of a femoral vs. IJ vs. subclavian central line?
*When do you use FFP vs. cryoprecipitate vs. platelets?
*What are the indications for placing an IVC filter?
*Why do you need a grounding pad when using a Bovie?
*What's the difference between PT and OT?
*When a patient has altered mental status, what are the first two things you should check for?
*What are the 5 Ws of post-operative fever?

And a few fun ones:

*Who was Bovie?
*Who was Apgar?
*Who performed the first laparoscopic appendectomy?

Obviously I have fond memories of getting pimped. 🙂 (It doesn't end when you become a resident, BTW.)

 

[Abilene85]

*What are the 5 Ws of post-operative fever?

Wind, Water, Wound, Walking, Wonder drugs

Grey's Anatomy pilot episode 😛

 

[DOme2009]

*What are the 4 Fs seen in a typical cholecystitis patient?
Fat, female, forty, fertile

*What are the reasons a fistula may not close?
Malnutrition, malignancy, high output, epithelialization of the tract

*What's the blood supply to the stomach?
Gastric aa (L+R), Gastroepiploic aa (L+R), Short gastrics

*What's the Parkland formula?
% burned x 4 x weight in kg = fluids for first 24 hours (use rule of 9s to get % burned)

*What are 5 indications (AEIOU) for dialysis?
Acidosis, electrolytes, ingestions, overload, uremia

*What are causes of anion gap/non-anion gap metabolic acidosis?
MUDPILES - methanol, uremia, DKA, paraldehyde, INH, lactic acidosis, ethanol, salicylates (all for anion gap acidosis, i forgot the ones for non-gap)

*What's the most common cause of a small bowel obstruction? What about in a virgin abdomen?
Post-op adhesions. Virgin abdomen - ???

*What's the treatment of hyperkalemia?
Sodium kayexalate, albuterol, insulin + D5, calcium gluconate (temp fix to protect the heart from potential arrythmias)

*What are the indications for placing an IVC filter?
Repeated PE despite anticoagulation or contraindication to coagulation (recent surgery, intracranial bleed, pregnancy, etc)

*When a patient has altered mental status, what are the first two things you should check for?
O2 sats and meds(?)

rock on!!

 

[domer621]

*What are the 4 Fs seen in a typical cholecystitis patient?

I got asked this yesterday!

*Who was Apgar?

I got asked about this on peds. A lot of people think it's an acronym, but it was invented by Virginia Apgar, an anesthesiologist.

 

[Blade28]

And if you're on the OB/GYN rotation, add a 6th W for Womb (endometritis).

 

[Blade28]

The common way of remembering the things that keep a fistula open:

"FRIENDS":

Foreign body
Radiation
IBD
Epithelialization
Neoplasm
Distal obstruction
Sepsis

 

[Blade28]

Nicely done! Yes, Apgar is Virginia Apgar, MD.

 

[Sureshot83]

*What are causes of anion gap/non-anion gap metabolic acidosis?
MUDPILES - methanol, uremia, DKA, paraldehyde, INH, lactic acidosis, ethanol, salicylates (all for anion gap acidosis, i forgot the ones for non-gap)


*What's the most common cause of a small bowel obstruction? What about in a virgin abdomen?
Post-op adhesions. Virgin abdomen - ???


*When a patient has altered mental status, what are the first two things you should check for?
O2 sats and meds(?)

1) Non-gap metabolic acidosis - most commonly from diarrhea or renal tubular acidosis. I think there may be another random cause like glue-sniffing or something.


2) I assume a "virgin abdomen" means no previous surgeries, and if so, the most common cause of SBO would be indirect inguinal hernia.


3) Altered mental status - Not sure about this one, but I would say you first do a proper physical exam to check for abnormal vitals (fever, shock, hypoxia) and/or focal neuro lesions (CVA, primary cancer, met cancer). If you were referring to lab tests, I would go with electrolytes (especially Na, Ca, Mg) and blood/urine cultures. Head CT is also routinely performed but would not be necessary if there is an obvious cause.

 

[Blade28]

2) I assume a "virgin abdomen" means no previous surgeries, and if so, the most common cause of SBO would be indirect inguinal hernia.


3) Altered mental status - Not sure about this one, but I would say you first do a proper physical exam to check for abnormal vitals (fever, shock, hypoxia) and/or focal neuro lesions (CVA, primary cancer, met cancer). If you were referring to lab tests, I would go with electrolytes (especially Na, Ca, Mg) and blood/urine cultures. Head CT is also routinely performed but would not be necessary if there is an obvious cause.

Hernias (along with colon CA) should always be considered in a virgin abdomen.

I was being more simplistic - you should ALWAYS rule out hypoxia and hypotension as causes of acute delirium (altered mental status).

 

[PeeWee137]

*What's the treatment of hyperkalemia?
Sodium kayexalate, albuterol, insulin + D5, calcium gluconate (temp fix to protect the heart from potential arrythmias)

i heart mnemonics

C BIG K:

calcium gluconate
bicarb
insulin and glucose
kayexalate


APGAR (i know who she was, but i learned it as a mnemonic):

Appearance
Pulse
Grimace
Activity
Respiration

and if someone presents with altered mental status, DONT wait, give them:

dextrose
oxygen
naloxone
thiamine

 

[Blade28]

APGAR (i know who she was, but i learned it as a mnemonic):

Appearance
Pulse
Grimace
Activity
Respiration

Yeah, that's why I asked. 🙂 Rare that a mnemonic comes out so nicely, so it's rare that people realize "APGAR" is really "Apgar, MD." 🙂

 

[Winged Scapula]

i heart mnemonics

C BIG K:

calcium gluconate
bicarb
insulin and glucose
kayexalate

A modification for ya:

C BIG K Die (a la " if you see high K, the pt could die")

Calcium gluc
bicarb, insulin, glucose
kayexelate (I also mentally add EKG here to remind myself to check it)
Dialysis

 

[Blade28]

A modification for ya:

C BIG K Die (a la " if you see high K, the pt could die")

Calcium gluc
bicarb, insulin, glucose
kayexelate (I also mentally add EKG here to remind myself to check it)
Dialysis

Yup, the dialysis bit is important for life-threatening/refractory hyperkalemia.

 

[Terpskins99]

What are the rule of 10's for pheochromocytoma?
10% bilateral
10% malignant
10% extra-adrenal

Name the actions of C5-T1?
(think of a basketball shot)
C5 - flex arm/elbow (take aim)
C6 - extend hand (cock your wrist)
C7 - extend elbow (launch the shot)
C8 - flex wrist (follow through)
T1 - spread your fingers

Most common causes of aseptic meningitis?
Enteroviruses, HSV, HIV, Crypto, Blasto, Toxo

Triad of mediastinitis?
Fever, SOB, chest pain

DOC Hypertension I? HCTZ
DOC Hypertension II? >= 2 drugs: HCTZ + diuretic

Most common causes of cardiac tamponade?
1 Pneumonia, 2 malignancy

What is pulsus paradoxus and how to evaluate?
Decrease > +10 mmHg systolic pressure with inhalation. To eval: increase pressure cuff to systolic blood pressure, and wait. As patient inhales, Korotkoff sound appears, as patient exhales sound goes away.

Most immediate treatment of tamponade?
1. Increase fluids (NEVER diurese) to increase venus return and buy time
2. Pericardiocentesis

 

[Blade28]

Nice, I like that "basketball shot" mnemonic!

 

[Winged Scapula]

MOST COMMON QUESTION I HEARD: "Where is my coffee cup?"

That was my job, to keep track of the resident's coffee cup when he would set it down on rounds!

 

[deleted29780]

for how long do you give anticonvulsant prophylaxis for a woman who has just had eclampsia?
i was asked this today on ob ward rounds

 

[Sureshot83]

DOC Hypertension I? HCTZ
DOC Hypertension II? >= 2 drugs: HCTZ + diuretic

Probably just a typo, but I believe you meant to write HCTZ + other (B-blocker or ACE-I)?

 

[Blade28]

MOST COMMON QUESTION I HEARD: "Where is my coffee cup?"

That was my job, to keep track of the resident's coffee cup when he would set it down on rounds!

On my Internal Medicine rotation, in addition to the usual med student scut, I was the Xerox monkey - any patient notes, H&Ps, write-ups, important Radiology dictations, journal articles, etc. that the team wanted - I was expected to rush to the nearest Xerox machine and start churning out collated, stapled copies.

I also had to pick up an OB/GYN resident's dry cleaning once. 🙁 😡 👎

 

[Winged Scapula]

On my Internal Medicine rotation, in addition to the usual med student scut, I was the Xerox monkey - any patient notes, H&Ps, write-ups, important Radiology dictations, journal articles, etc. that the team wanted - I was expected to rush to the nearest Xerox machine and start churning out collated, stapled copies.

I also had to pick up an OB/GYN resident's dry cleaning once. :( 😡 👎

What? That always amazes me...I would never ask anyoen to do that, even if you were going there (to the dry cleaners) and offered.

 

[DOme2009]

...I also had to pick up an OB/GYN resident's dry cleaning once. 🙁 😡 👎

that's what the pa's are for.

just kidding, i'm going to catch some heat for that one.

 

[Blade28]

What? That always amazes me...I would never ask anyoen to do that, even if you were going there (to the dry cleaners) and offered.

Yeah, well, this...how should I put it?...assertive, aggressive resident just ordered me to do it. She had been beating me down for the previous 2 weeks too. 🙁

(I'd love to describe her in more truthful terms, but there's no need.)

 

[Winged Scapula]

Yeah, well, this...how should I put it?...assertive, aggressive resident just ordered me to do it. She had been beating me down for the previous 2 weeks too. 🙁

(I'd love to describe her in more truthful terms, but there's no need.)

Ahhhh....she was a bitch, eh?

 

[surrender903]

wow.

my intern asked me to go get him breakfast, but it was 50 ft away and he had to present patients on our service and i really didnt mind doing it. He gave me a 20 and asked me to get something for myself too.

I was asked these on Tuesday:

what percentage of pts on clozaril exp agranulocytosis?
when is it most likely to occur?
what ADR is Trazadone most known for causing?
what is the rule of 4's regarding anti psychotics (i sort of made these up to remember side effects of the AntiPsych's)?

what are the 3 P's of labor?
what is the difference between baby blues and post partum depression?
which anti depressants are contraindicated in usage during pregnancy (this was from uptodate)?

 

[Blade28]

Ahhhh....she was a bitch, eh?

Exactly. 🙂

 

[DOme2009]

what percentage of pts on clozaril exp agranulocytosis?
when is it most likely to occur?
what ADR is Trazadone most known for causing?

i think it's like 1% of pts get agranulocytosis, and it happens between weeks 6-12.

priapism - trazadone is bad for your bone

 

[fuzzyerin]

And if you're on the OB/GYN rotation, add a 6th W for Womb (endometritis).

Actually, got a 7th for you from OB/Gyn - Woobies (Breast Engorgement/Mastitis/Milk Let Down).

When the attending told me this, I started laughing hysterically. Who says the word woobies?

 

[Gimlet]

This was asked to me during nearly every vaginal delivery on OB/Gyn:

What are the signs of placental separation?
Cord lengthening
Gush of Blood
Uterus takes on a globular shape and becomes palpable anteriorly.
(you can make the last one into two criteria if they ask for the "4 signs of placental separation.")

 

[deleted29780]

This was asked to me during nearly every vaginal delivery on OB/Gyn:

What are the signs of placental separation?
Uterus takes on a globular shape and becomes palpable anteriorly.
(you can make the last one into two criteria if they ask for the "4 signs of placental separation.")

traditionally the third sign is referred to as ... "slow rising of the uterine fundus."
sure it will be palpable anteriorly, it was palpable all through the stages of labour. The uterine fundus becomes a well defined solid palpable mass, which technically begins to rise due to the phenomenon of fundal dominance.

This is what has been taught since antiquity
lengthening of the cord
gush of blood
slow rising of the uterine fundus <<<<------

 

[deleted29780]

i think it's like 1% of pts get agranulocytosis, and it happens between weeks 6-12.

priapism - trazadone is bad for your bone

Please...from the op who asked this question. PLease dont use trade names ok...it will help you in your practice. The most important thing is the active chemical not what some dumb pharmaceutical company calls it. keep that in your head, it will help your practice i can assure you.

I just put two clues together when you said clozaril and agranulocytosis.... sounded like clozapine ( some dumb pharm company calls it clozaril, i am sure others will call it clozatil, clozapril ...nonsense). And its known that this particular antipsychotic causes agranulocytosis in about 1 percent of patients. its not a dose dependent toxicity.
Just for the record, please stop using trade names. thank you .

 

[Sureshot83]

what is the rule of 4's regarding anti psychotics (i sort of made these up to remember side effects of the AntiPsych's)?

what is the difference between baby blues and post partum depression?

which anti depressants are contraindicated in usage during pregnancy (this was from uptodate)?

1) 4 days - acute dystonia
4 weeks - akathisia
4 months - tardive dyskinesia
NMS can be "4ever" (i.e. can occur at any time, with first dose or after several years)


2) Baby blues - mild depression, usually resolves within 1 week post-partum. Post-partum depression - clinical major depressive episode, often persists ~1 month.


3) Guessing here, but wouldn't the answer be that ALL anti-depressants are contraindicated, because ECT is the first line therapy for pregnancy?

 

[surrender903]

Please...from the op who asked this question. PLease dont use trade names ok...it will help you in your practice. The most important thing is the active chemical not what some dumb pharmaceutical company calls it. keep that in your head, it will help your practice i can assure you.

I just put two clues together when you said clozaril and agranulocytosis.... sounded like clozapine ( some dumb pharm company calls it clozaril, i am sure others will call it clozatil, clozapril ...nonsense). And its known that this particular antipsychotic causes agranulocytosis in about 1 percent of patients. its not a dose dependent toxicity.
Just for the record, please stop using trade names. thank you .

wow dude relax. i said clozaril instead of clozapine. oh noes!!!!!!

im sure you wanted to give good advice but the way it came off sounded pretty bad.

 

[deleted29780]

wow dude relax. i said clozaril instead of clozapine. oh noes!!!!!!

im sure you wanted to give good advice but the way it came off sounded pretty bad.

oh really my bad...really sorry. I now remember i was feeling really down after a tough end of rotation exam. Thats right, reading the post again i think i took it too far. accept my apologies. 😳

 

[PeepshowJohnny]

Question I'm often hit with is "So what DID you learn in medical school?"

 

[Blade28]

Please...from the op who asked this question. PLease dont use trade names ok...it will help you in your practice. The most important thing is the active chemical not what some dumb pharmaceutical company calls it. keep that in your head, it will help your practice i can assure you.

While it's definitely important to know generic names (especially for the USMLE), in practice we often use trade names quite frequently. It's best to know both.