O.K., let's all go over the inservice exam.

[edinOH]

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Overall I thought it was easier than last year. Don't know if this means it was really easier or if I just know more. I hope it's the latter.

Regarding the Stims...

Was the EKG a Mobitz I or II? I called it a Wienkebach and thus did nothing. Others swore it was a II and went with transvenous pacing. For the most part we were evenly split on this one.

What about the chest xray? The COPD pt. Most of us thought it was lobar atelectasis, some thought they saw PTX or wedge consistent with PE.

I thought the splenorenal U/S was for crap. Poor film. Called it normal. Could have been convinced there was fluid there. The choice would have then been perirenal hematoma I believe.

Did that kid have Stevens-Johnson's or HFM? Alittle old for HFM I think. Could be wrong.

Did you transfuse the Jehova's Witness kid or get a court order?

There are pleny others...

 

[WilcoWorld]

[edit] Big Brother Is Watching [/edit]

 

[Pelivar]

Overall I thought it was easier than last year. Don't know if this means it was really easier or if I just know more. I hope it's the latter.

Regarding the Stims...

Was the EKG a Mobitz I or II? I called it a Wienkebach and thus did nothing. Others swore it was a II and went with transvenous pacing. For the most part we were evenly split on this one.

What about the chest xray? The COPD pt. Most of us thought it was lobar atelectasis, some thought they saw PTX or wedge consistent with PE.

I thought the splenorenal U/S was for crap. Poor film. Called it normal. Could have been convinced there was fluid there. The choice would have then been perirenal hematoma I believe.

Did that kid have Stevens-Johnson's or HFM? Alittle old for HFM I think. Could be wrong.

Did you transfuse the Jehova's Witness kid or get a court order?

There are pleny others...

We might be sent to jail for discussing the test, but I guess that will give me a chance to catch up with my patients.

Overall I do think the tests was a little easier, but it still had some difficult parts. It seemed like more pictures this year.

As far as the individual questions:
I thought it was Mobitz II but I only observed because the pt was stable.
I agree with atelectasis, I didn't see enough there to call it PE
The U/S was crap, but normal was the only good answer
The kid had Stevens-Johnson's, the lesion didn't look like HFM
I transfused the Jevovah's Witness. I think the law states we can treat minors in life threatning situations even when the parents disagree.

That weird eye picture threw me for a loop for a second. (I thought it was a pterygium)

Pelivar

 

[edinOH]

Pelivar,

Looks like we agree except the Mobitz II. In hindsight I think that was the correct answer.

I chose to transfuse the JW kid. I agree that since he was a minor, our duty would be to tx as appropriate and sort it all out later. It so happens that after the test many of us were sitting in the physician's lounge discussing the case and one of our pediatric intensivists was there. She felt the correct answer would be to get the court order and then proceed. I respect her opinion obviously but I still disagree.

Regarding the most common dysrhythmia in COPD (not previously discussed). I felt it was a slam-dunk MAT but one of our very brilliant and very well respected adult intensivists (who was also in the lounge...don't these people have pts. to see? 🙂) felt the correct answer was sinus tach. Again I respectfully and humbly disagree.

That eye picture was definitely a pterygium.

Too bad ABEM will not give us specific feedback.

I don't think we are breaking any rules discussing the test in this setting. I think if the program were to officially reconstruct or reproduce the test, that would be against the rules.

 

[Pelivar]

Regarding the most common dysrhythmia in COPD (not previously discussed). I felt it was a slam-dunk MAT but one of our very brilliant and very well respected adult intensivists (who was also in the lounge...don't these people have pts. to see? 🙂) felt the correct answer was sinus tach. Again I respectfully and humbly disagree.
QUOTE]


I picked PVCs for that question because they are so common and are usually the right answer in most commor arrythmia questions.

 

[Apollyon]

I don't think we are breaking any rules discussing the test in this setting. I think if the program were to officially reconstruct or reproduce the test, that would be against the rules.

I think you are - just FYI.

It's like what one of our attendings said when he was going to take the written exam, as far as the EMTALA questions go - "I'll look for the most painful, convoluted answer, and that's the one I pick".

 

[edinOH]

Maybe so.

It isn't like we are discussing classified information which directly effects the future of the free world. Just a bunch of test questions. If they would actually provide feedback after the test, much of this wouldn't be necessary. After all isn't the point of the test, not to mention residency, to learn to practice EM? I've found the discussion of the questions and the logic behind the answers to be very educational.

Then again, now that you mention it, I think the second paragraph of the rules on the inside cover that we were all required to read mentioned something about the rules of the test. Paraphrasing here...

"The first rule of the ABEM inservice exam is you do not talk about the ABEM inservice exam."

(sorry, pathetic Fight Club rip-off there)

 

[Apollyon]

Maybe so.

It isn't like we are discussing classified information which directly effects the future of the free world. Just a bunch of test questions. If they would actually provide feedback after the test, much of this wouldn't be necessary. After all isn't the point of the test, not to mention residency, to learn to practice EM? I've found the discussion of the questions and the logic behind the answers to be very educational.

Then again, now that you mention it, I think the second paragraph of the rules on the inside cover that we were all required to read mentioned something about the rules of the test. Paraphrasing here...

"The first rule of the ABEM inservice exam is you do not talk about the ABEM inservice exam."

(sorry, pathetic Fight Club rip-off there)

No, dude, I totally agree with you - the educational aspect is great, but I remember what one of my attendings said 2 years ago - I said, "on the inservice", and he interrupts me and says "you mean, hypothetically on the inservice, right" (in an exaggerated histrionic way). It minorly pisses me off when I think of the policy wonks that hang board certification over your head, and I would hate for a colleague to get a major league penalty for a minor "crime".

 

[bulgethetwine]

No, dude, I totally agree with you - the educational aspect is great, but I remember what one of my attendings said 2 years ago - I said, "on the inservice", and he interrupts me and says "you mean, hypothetically on the inservice, right" (in an exaggerated histrionic way). It minorly pisses me off when I think of the policy wonks that hang board certification over your head, and I would hate for a colleague to get a major league penalty for a minor "crime".

So, hypothetically if i took the inservice yesterday...

I agreed with pterygium (glad I just had to fill in a letter circle, and not spell it), the u/s looked normal to me, and I thought it was Stevens-Johnson, too. I'd transfuse the Jehovah's kid. Wasn't sure about the Mobitz, but I did nothing because of the stable nature of the patient, too.

And what in the hell, hypothetically of course, was that radioopaque ball of glowing opacity in the bladder of that poor unfortunate patient?!?! 😱

 

[samdaman]

So, hypothetically if i took the inservice yesterday...

I agreed with pterygium (glad I just had to fill in a letter circle, and not spell it), the u/s looked normal to me, and I thought it was Stevens-Johnson, too. I'd transfuse the Jehovah's kid. Wasn't sure about the Mobitz, but I did nothing because of the stable nature of the patient, too.

And what in the hell, hypothetically of course, was that radioopaque ball of glowing opacity in the bladder of that poor unfortunate patient?!?! 😱

It was body jewellery 🙂

 

[Pelivar]

And what in the hell, hypothetically of course, was that radioopaque ball of glowing opacity in the bladder of that poor unfortunate patient?!?! 😱

We are talking about the questions somewhat vaguely as well, so hypothetically I think we will be fine.

I thought the glowing ball was a calcified fibroid.

P

 

[gree0411]

I answered that the glowing ball was a 75 karat diamond being smuggled into the US from the Congo. I figured it was placed in the bladder retro-urethrally.

 

[sweetfynesse]

definitely a rock in the bladder

 

[NinerNiner999]

Vesicular stone.
I got a court order for the transfusion.
Westermark's sign on lateral view of PE.
Normal Ultrasound.
SJS.
Mobitz, no treatment if stable.
Pterygium, does not effect vision.
Thoracotomy in ED.
Check glucose with otitis externa.
Esmolol before Nitroprusside before surgery for dissection.
Poison Ivy.

Someone refresh my memory...

 

[ER-ER-Oh]

We might be sent to jail for discussing the test, but I guess that will give me a chance to catch up with my patients.

Overall I do think the tests was a little easier, but it still had some difficult parts. It seemed like more pictures this year.

As far as the individual questions:
I thought it was Mobitz II but I only observed because the pt was stable.
I agree with atelectasis, I didn't see enough there to call it PE
The U/S was crap, but normal was the only good answer
The kid had Stevens-Johnson's, the lesion didn't look like HFM
I transfused the Jevovah's Witness. I think the law states we can treat minors in life threatning situations even when the parents disagree.

That weird eye picture threw me for a loop for a second. (I thought it was a pterygium)

Pelivar

Weird eye thing was a pterygium, only know cause I have one.

 

[ER-ER-Oh]

Also:
-probably
-I'm not sure
-could have been
-hunh?
-yes, he got the coffee cup up his ass after falling off a ladder while hanging the curtains in the nude
-because his pants caught on fire
-Stevens-Johnson, or Steven's johnson