Pimp questions in Clinicals
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Rotation: Surgery
Question: What's this I'm pointing at?
Question: What's this I'm pointing at?
Rotation: Surgery
Question: What is the name of this song? x100
Question: What is the name of this song? x100
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What are the indications for dialysis?
What are the layers of the abdominal wall?
Explain the difference between an indirect and direct inguinal hernia.
What are the layers of the abdominal wall?
Explain the difference between an indirect and direct inguinal hernia.
So true. I got through gen surg on my knowledge of classic rock.
As an anesthesiologist, I can tell you (from the other side of the drape), surgeons love to repeat the same pimp questions. Talk to med students or residents to find out what they are.
Why are anesthesiologists in general super nice and love to teach? Is this just at my school, or is that just the general vibe in anesthesia?
The anesthesia guys were probably one of the only departments who never made fun of me for saying I wanted to do EM. They even started always letting me do the intubations on all my patients during OB and surgery to get practice.
Probably more of a general vibe. Or a gas leak from the machine.
I can't wait for my Psych rotation. Maybe I'm completely naive, but I feel like it could be really interesting.
I'll go for the former. On that note, I just realized I have logged over 120 intubations, 7 central lines, and too many iv's to count because of you guys. You guys were probably the best thing about the ob/surg rotations.
Although, i do remember 2 incidents where i got the anesthesiologist super angry. First was a tooth I cracked early on, and the second was moving the patient to the other bed before anesthesia told me to. The funny thing is that the anger that was expressed was less than the least form of anger shown from the surgeons.
It's way more interesting than I imagined, I'll tell you that.
Yeah, I would be upset if you damaged a tooth on an intubation attempt. Besides having to explain it to the patient, it's also a safety issue. If you knock out a tooth, it tends to bleed like stink and can make it difficult to intubate. My first intubation was on an edentulous guy - not an issue!
So what's the answer? I would guess MJ/PCP???
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Wait I bet it's a trick question - those sneaky psychiatrists!
Better in which way? Better chances of surviving overdose, better treatment options, or better buzz?
Lol. In regards to the latter, I would probably avoid any combination that included PCP; it's never fun trying to fight off the cops naked. Talk about a buzz kill.
I had no idea what PCP did until I started doing practice questions and every single one involving PCP had the person in a psychotic rage beating the living crap out of someone or something.
I had no idea what PCP did until I started doing practice questions and every single one involving PCP had the person in a psychotic rage beating the living crap out of someone or something.
Life almost never happens like practice questions, though
I know, it just surprised me. Although the people overdosing and showing up in your ED are more likely to be the psychotic ones than the ones "enjoying" their experience at home.
Agree. When I was an obgyn resident, I used to envy the anesthesia resident getting a break while the attending took over. Back in my days, we had to do 36+ hours calls. I just wanted to sneak some food in between OR cases. The anesthesia attendings would always stand up for their residents. I can't say that always happened for us, obgyn residents.
Bring it back, huh? Seems like most of the heavy-duty pimping happens on surgery, so here's one I got asked during several appendectomies:
Question: Where is the appendix?
Answer: At the confluence of the taenia coli.
Question: Where is the appendix?
Answer: At the confluence of the taenia coli.
Surgery:
Know the layers of the abdominal wall, in order.
Know the difference between a direct and indirect hernia.
Know the most common types of hernias (inguinal, femoral, incisional) and differentiate them based on visible (incisional) vs non-visible (hiatal)
Know what structures you need to isolate and have good view of for a cholecystectomy and around where they should be.
Understand why the patient is put into trendelenberg for a cholecystectomy.
Understand contraindications for putting a mesh in a patient (primarily, if pt has an infection at the time)
General OR stuff: Know why the patient is getting x procedure. Read up on indications of x procedure (I mentioned specifically hernias/cholecystectomies b/c those + Trach/PEGs were 95% of my 3 weeks of gen surg). Talk to the patient before heading back to the room. Write your name on the board (or at least attempt to). Introduce yourself to staff, ask scrub tech if they need gloves/gown for you (generally they will unless they know you) and pull your gloves/gown as necessary in a sterile fashion.
However, first and foremost - Respect the sterile field. Know how to remain sterile, and know to call out whenever YOU contaminate something and you know it. If you feel an attending/resident has contaminated themselves.... I don't know what the best course of action is. I haven't had to call out a resident/attending on them contaminating themselves. Some scrub techs don't want you touching the mayo, period. Others will let you grab suture scissors off the edge as that will likely be most of your responsibility in non-lap cases. Titrate what you do based on what the scrub tech allows.
Know the layers of the abdominal wall, in order.
Know the difference between a direct and indirect hernia.
Know the most common types of hernias (inguinal, femoral, incisional) and differentiate them based on visible (incisional) vs non-visible (hiatal)
Know what structures you need to isolate and have good view of for a cholecystectomy and around where they should be.
Understand why the patient is put into trendelenberg for a cholecystectomy.
Understand contraindications for putting a mesh in a patient (primarily, if pt has an infection at the time)
General OR stuff: Know why the patient is getting x procedure. Read up on indications of x procedure (I mentioned specifically hernias/cholecystectomies b/c those + Trach/PEGs were 95% of my 3 weeks of gen surg). Talk to the patient before heading back to the room. Write your name on the board (or at least attempt to). Introduce yourself to staff, ask scrub tech if they need gloves/gown for you (generally they will unless they know you) and pull your gloves/gown as necessary in a sterile fashion.
However, first and foremost - Respect the sterile field. Know how to remain sterile, and know to call out whenever YOU contaminate something and you know it. If you feel an attending/resident has contaminated themselves.... I don't know what the best course of action is. I haven't had to call out a resident/attending on them contaminating themselves. Some scrub techs don't want you touching the mayo, period. Others will let you grab suture scissors off the edge as that will likely be most of your responsibility in non-lap cases. Titrate what you do based on what the scrub tech allows.
My favorite to ask students-
This person's K is low, what else should we look at? How do we replace it?
(Magnesium, 10 mEq of K+ increases by 0.1)
Simple and practical knowledge regardless of what they go in to
Also they will inevitably point out that the calcium is low on some little old malnourished lady so that is a good opportunity to go over calculating the corrected Ca - (4-Alb)*0.8+Calcium = Corrected Calcium
Survivor DO
This person's K is low, what else should we look at? How do we replace it?
(Magnesium, 10 mEq of K+ increases by 0.1)
Simple and practical knowledge regardless of what they go in to
Also they will inevitably point out that the calcium is low on some little old malnourished lady so that is a good opportunity to go over calculating the corrected Ca - (4-Alb)*0.8+Calcium = Corrected Calcium
Survivor DO
Some good medicine pimp questions I got asked
How should you initially manage hyperkalemia?
Varied, but usually the answer was, check an EKG, if you see changes, push calcium gluc and start D5 + insulin, beta agonists, and kayexelate in any case.
Other ones off the top of my head -
What are the medications for first line therapy of h. pylori ulcer disease?
Being able to identify all the different chambers and valves on different axial views of an echocardiogram
What are the SIRS criteria?
What are the principles of early goal directed therapy in the treatment of septic shock?
For a patient with ARDS, what sort of ventilator settings would you prefer?
etc
How should you initially manage hyperkalemia?
Varied, but usually the answer was, check an EKG, if you see changes, push calcium gluc and start D5 + insulin, beta agonists, and kayexelate in any case.
Other ones off the top of my head -
What are the medications for first line therapy of h. pylori ulcer disease?
Being able to identify all the different chambers and valves on different axial views of an echocardiogram
What are the SIRS criteria?
What are the principles of early goal directed therapy in the treatment of septic shock?
For a patient with ARDS, what sort of ventilator settings would you prefer?
etc
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*Points at EKG* "What is irregular here and what does it indicate?"
*Points at EKG* "What is irregular here and what does it indicate?"
Or better yet..."interpret this EKG."
Attending hands medical student a completely normal EKG.
On the same lines, I got asked during a circumcision how does betadine work?
Also seen with CXRs.
Student: "Well, there's some patchy infiltrate right there."
Attending: "Nope, normal pulmonary vascular markings."
Never really got this especially when you can actually measure an ionized calcium and the correction is usually wrong when you actually get an ionized calcium...
All. the. time.
I'm guilty of chasing zebras there... I go over EKG's with my dad and it's amazing how a normal qrs can look like wolf-parkinson's...or how atrial flutter/fib is just normal do to the patient moving...
"Omg, that's torsades!"
My dad - "Yes, and I'm here casually looking at it on my couch at home..."
First day of third year on medicine...
Attending: "Ok, present your patient"
Student: "The patient is a..."
Attending: Cuts me off and discusses entire case with senior resident
Attending: "Ok, present your patient"
Student: "The patient is a..."
Attending: Cuts me off and discusses entire case with senior resident
Let's be honest, you probably were going to waste their time anyway
Except our tuition is suppose to be paying for their time.
Sadly, the only people that are concerned about the tuition are the med students.
lol, such is the life of a third year med student
this is going to make it seem like i only have deadbeat techers, so I must say i love the quality of my education this year so far and I've learned a lot. Anyway, last summer they had this hospitalist as our medicine team's attending, and she basically said absolutely nothing for 2 weeks, just getting a 1-liner from the resident and rounding on our 15 patients in about 25 mins. No medicine dilly-dally, no pimping, basically conducting surgery rounds lol. This was great for me for those 2 weeks to say the least, but I don't know how this educational system would sustain itself if everyone taking academic positions were like that
Rotation: Surgery
Question: What is this? *points to ligament of Berry*
Question: What stomach pathology is associated with TBI?
Rotation: Medicine
Question: Tell me how lisinopril works.
Question: What is this? *points to ligament of Berry*
Question: What stomach pathology is associated with TBI?
Rotation: Medicine
Question: Tell me how lisinopril works.
Your tuition does not pay the residents or attendings for their time.
Anyway, one of the questions I got on my third-year IM rotation was "why can corticosteroids cause leukocytosis"?
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what is the answer?
Radiologist: "Nope. Subtle Kerley lines. Try again."
They cause release of the leukocytes being sequestered (mostly on the vascular walls).
I beg to disagree. The attendings are assistant or full professors of our school. Our school pays them a salary. Our tuition comprises a principal amount of that. Hence we are paying for their time. This is how most med schools with an attached teaching hospital function.
Even they weren't paid they are in an ACADEMIC OR TEACHING HOSPITAL. If they want to speed through patients then there are plenty of private hospitals they could of gone to. Their job description is to teach residents and med students. If they don't do that then they are doing part of their job pretty ****ty.
And part of the resident's job description is to teach med students (at least at my school).
