"Next Step in Management" Questions for Shelf Exams

[Kluver_Bucy]

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I had loads of these "Next Step in Management Questions" on my Family Medicine Shelf Exam. What is the key to getting these questions right? I heard that the Internal Medicine, and Neurology Shelf Exams have these same questions. Is there a rule of thumb to handle these questions?

It is so frustrating when you know the disease in the question and realize that it requires a blood test, pharmocological treatment, CT Scan, and Urinalysis for the workup, and all of the steps in the workup are included as answer choices yet you just don't know what is the "First Step in Management".

Thanks a bunch.

 

[Mike59]

If you use the right textbook/source, you should learn a stepwise workup to the patient problem. Unfortunately most books don't cover this but the good ones and textbooks of differential diagosis will (swanson's is my favorite). The "textbook" way of working up backpain, amenorrhea, pediatric fever, headache etc. is quite standard and once you apply the algorithm, those questions are a piece of cake. Of course, take everything you observe on rotations with a grain of salt because the workups seem to be overdone in real life depending on where you are.

 

[JMD]

Don't have muc advice for ya K_B... just wanted to vent about how badly these type of questions killed me on the surgery shelf.

It was my first shelf exam though and I think I'll have a better idea how to prepare for the next one... family med in my case.

Good luck... any advice for good sources that help you prepare for these questions in each rotation would be greatly appreciated.

 

[RonaldColeman]

Don't have muc advice for ya K_B... just wanted to vent about how badly these type of questions killed me on the surgery shelf.

It was my first shelf exam though and I think I'll have a better idea how to prepare for the next one... family med in my case.

Good luck... any advice for good sources that help you prepare for these questions in each rotation would be greatly appreciated.

For Surgery Shelf: Common Surgical Diseases: an algorithmic approach to problem solving by keith w millikan and theodore j. saclarides...

Awesome! This book was perfect for all of the next step questions on the shelf.

Another book that is good for the next step questions on IM, Family, and Neuro tests is the harrison's manual of medicine. The first section covers common presenting complaints (chronic cough, joint pain, back pain, etc.) and gives you the appropriate step by step management plan.

 

[opus03]

For Surgery Shelf: Common Surgical Diseases: an algorithmic approach to problem solving by keith w millikan and theodore j. saclarides...

Awesome! This book was perfect for all of the next step questions on the shelf.

yeah that book was written by some of our surgeons so we were "required" to buy it. Unfortunately I didn't put any time into actually looking at it!
I've only taken one shelf (surgery) so far so I can't give too much advice but as I'm studying for the peds shelf I feel that doing ?'s (pretest in this case) really is helping me improve my knowledge and ability to do well on this exam...we'll see.

 

[EM Junkie]

Rule of thumb....

1. Always check and correct ABC's first (Airway, breathing, circulation)
2. Always pick the most conservative diagnostic/treatment option if you are torn between two (ex: don't pick CT abd/pelvis when an abdominal series will do).

A good series for these types of questions is the Case Files books by Eugene Toy, MD.

Good luck!

-Scott, MS4

 

[Samoa]

More rules of thumb:

Go for the cheapest, least invasive test with the highest sensitivity and specificity. Unless the case is emergent, and then go for highest specificity regardless of cost, but only if a) you have time before intervention is required and b) it will change your management significantly. Otherwise, intervene and let the response determine your diagnosis.