Questions regarding "next step in management" type of questions.

[DrMetal]

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Hello, I have a questions regarding the "next-step-in-management" type of questions for Step II:

When you're asked this, are they literally asking for the next step? If "Taking vitals" or "Administering fluids" is an answer choice (and there's no indication that that's already been done), would you select that? (seems kind of an obvious thing to do . . .thus it might not be the right answer . . but that is the literal "next step" in many situations, no?)

I was doing a Kaplan surgery question (qiD m000858). The vignette described an elderly woman, vomitting a lot, CXR shows free air . . .basically in need of an exploratory laparotomy. Question stem was, "What's next step in management?" . An ex lap was the correct answer choice. An incorrect choice was "NPO-fluids-NG tube", which I selected.

The answer explanation states that "NPO-fluids-NG" is incorrect, b/c it's not a good form of definitive treatment in this case. Well duh?! I didn't select it b/c it's the most definitive, I selected it b/c it's the "next step", as asked for in the question stem. It's probably something you'd do en route to the OR for an ex lap . . . but is it not correct to say that NPO-fluids-NG is the next step?

thanks for the help.

 

[OveractiveBrain]

Hello, I have a questions regarding the "next-step-in-management" type of questions for Step II:

When you're asked this, are they literally asking for the next step? If "Taking vitals" or "Administering fluids" is an answer choice (and there's no indication that that's already been done), would you select that? (seems kind of an obvious thing to do . . .thus it might not be the right answer . . but that is the literal "next step" in many situations, no?)

I was doing a Kaplan surgery question (qiD m000858). The vignette described an elderly woman, vomitting a lot, CXR shows free air . . .basically in need of an exploratory laparotomy. Question stem was, "What's next step in management?" . An ex lap was the correct answer choice. An incorrect choice was "NPO-fluids-NG tube", which I selected.

The answer explanation states that "NPO-fluids-NG" is incorrect, b/c it's not a good form of definitive treatment in this case. Well duh?! I didn't select it b/c it's the most definitive, I selected it b/c it's the "next step", as asked for in the question stem. It's probably something you'd do en route to the OR for an ex lap . . . but is it not correct to say that NPO-fluids-NG is the next step?

thanks for the help.

Think of the "next step" like this

1. Is it an emergency? If yes, choose emergent intervention
2. Is the diagnosis certain? Therapy
3. Is more information needed? Diagnosis

Therapy
1. Real life. There are guidelines as to when to start something versus somethign else. Like a BP of 142/84 gets HCTZ whereas a BP of 170/101 is going to get a combo of therapies based on comorbidities, even though both are "hypertension." This is just stuff you have to know

Diagnosis
1. Choose the next step. Not the best test, but the next step. You think its an MI. You dont go to cath. You get Troponins and Twelve leads. If they were negative, you get a stress. If that was positive, you go to cath. You have to know the flow of diagnosis.

Usually they ask you to choose WITHIN one category, not between them. As in, you will be asked either to intervene OR to diagnose. Then its up to you decide how much has been done and what the next step needs to be, always keeping in the back of your mind "is this an emergency?" If it is, emergency trumps everything else and you go for definitive treatment (which is why your Kaplan answer you got wrong)

 

[PMPMD]

Hello, I have a questions regarding the "next-step-in-management" type of questions for Step II:

When you're asked this, are they literally asking for the next step? If "Taking vitals" or "Administering fluids" is an answer choice (and there's no indication that that's already been done), would you select that? (seems kind of an obvious thing to do . . .thus it might not be the right answer . . but that is the literal "next step" in many situations, no?)

I was doing a Kaplan surgery question (qiD m000858). The vignette described an elderly woman, vomitting a lot, CXR shows free air . . .basically in need of an exploratory laparotomy. Question stem was, "What's next step in management?" . An ex lap was the correct answer choice. An incorrect choice was "NPO-fluids-NG tube", which I selected.

The answer explanation states that "NPO-fluids-NG" is incorrect, b/c it's not a good form of definitive treatment in this case. Well duh?! I didn't select it b/c it's the most definitive, I selected it b/c it's the "next step", as asked for in the question stem. It's probably something you'd do en route to the OR for an ex lap . . . but is it not correct to say that NPO-fluids-NG is the next step?

thanks for the help.

Free air in this setting is a surgical emergency. Straight to OR. "npo-fluids-ng" implies waiting; pt dies.

 

[DrMetal]

Think of the "next step" like this

1. Is it an emergency? If yes, choose emergent intervention
2. Is the diagnosis certain? Therapy
3. Is more information needed? Diagnosis

thanks, this is very helpful