# qbank qs

Discussion in 'Step I' started by stang, Apr 16, 2007.

1. ### stang Member

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Hopefully someone smarter (or more experienced) than me can explain a coulple of qbank questions that are frustrating me.

1. asked me to calculate anion gap, which I always thought was (Na + K) - (Cl + HCO3). The question gave me Na, Cl, and HCO3, so I figured I would plug in a reasonable number for K and choose the closest answer. I got this one wrong because they used the equation (Na) - (Cl + HCO3).
So did I just learn the equation wrong, or is there a time when you would include K?

2. I got two behavioral questions about performing surgery on a woman with abdominal complaints and accidentally finding a mass on her ovary, which asked what would be your next coarse of action. One answer was to end the surgery and get consent from the woman, but another said to immediately remove the mass. Did anyone else get these two questions and figure out why they are different?

Also, does anyone have any general advice for answering behavioral questions? I try to think of it like: What would the nicest Dr. in the world do? and answer them that way, but this doesn't always work.

Thanks for your help.

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3. ### lord_jeebus 和魂洋才 Moderator Physician

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(Na) - (Cl + HCO3) is more common, but it doesn't matter what you use. The important thing is to recognize when anion gap is abnormal, and this can be done with either formula. You are not given normal values for anion gap so remember the normal range for whichever formula you choose.

4. ### Anka Senior Member

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Hi,

I know the question you're talking about... both formulae are correct as has already been pointed out. Kaplan asks for the number, though. I guess the important thing is to realize it can be done both ways, and you only had the numbers available for the right answer.

As far as the behavioral sciences questions -- they seem like a total crap shoot most of the time. The big thing it seems like they're worried about isn't your being nice, or even doing what most people in the world would do, but rather to make sure you know what legal rules apply when. A second year surgery resident would never not call in the attending surgeon on finding something like that!

Best,
Anka

5. ### Idiopathic Newly Minted Lifetime DonorClassifieds Approved

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The Steps seem very odd to me. Step I expects you to think like an attending, step II like a resident and step III like an intern. As far as the AG goes, you are right on the money, maybe you just added wrong.

An important point to remember for procedural matters is you only have consent to perform a 'listed' procedure, at least in the eyes of the NBME. If you didnt consent someone for an appy or a gall bladder and you get in there for endometriosis ablation and decide one of them should come out, you SHOULD NEVER DO IT WITHOUT EXPLICIT CONSENT (i.e. it is not implied that you will also yank out any weird looking mass or ovary or whatever without discussing it with me first, no matter how convenient it is). That question is a slam dunk.

The only difference would be in the case of a life threatening emergency (renal artery or ureter laceration may necessitate urgent nephrectomy without explicit consent).

6. ### vtucci Attending in Emergency Medicine Moderator Emeritus

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I remember seeing those behavioral questions. One was supposed to be an ovarian cancer-- which is why you could biopsy it and close her back up and then get her consent to take it out. The other question dealt with an ectopic pregnancy if I recall the details properly so it was an emergency and could be done without consent because of the likelihood of rupture and needing to be addressed immediately.

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