"what is the next management" questions

[1dayatatime]

So i really have no idea what to do about the q's that ask what the next appropriate management or treatment is (i am only a MS2 after all). i've had no experience with the wards. should i pick up a step 2 textbook (people say no to this usually but i can't help thinking it might help) or is there a website where it just has Treatment/next best step + disease in two columns that i can quickly memorize? That would be stellar.

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[DermViser]

So i really have no idea what to do about the q's that ask what the next appropriate management or treatment is (i am only a MS2 after all). i've had no experience with the wards. should i pick up a step 2 textbook (people say no to this usually but i can't help thinking it might help) or is there a website where it just has Treatment/next best step + disease in two columns that i can quickly memorize? That would be stellar.

On Step 1 or Step 2 CK? You said you're an MS-2 so I wasn't sure where you are curriculum wise. Management and Treatment usually isn't on Step 1, but on Step 2.

 

[1dayatatime]

Step 1. Apparently they have been asking these types on step 1 lately. Ppl have said they took step 1 and Googled qs that were similar concepts that said step 2. For ex I got a q that asked what the best management of orthostatic hypotension was. Is it 0.9% nacl or alpha agonists or 5% dextrose?

 

[Venko]

They could be testing some questions. Also, some things regarding management may be more of an M1 level. I remember that there were management plans that tied to key anatomical things, or pharmacology, or path. Management is not universally step 2 but if you feel these were way out of bounds they could be questions that the board is testing out.

 

[001100010010011]

Yeah, I'm banking on getting a question like maybe doing an ECG for a patient with Kawasaki's etc. but I don't tend to do well on these questions.

 

[1dayatatime]

yikes i didn't even know that one...so we should do EKGs on Kawasaki patients? and give them ASA. I hope they're experimental!

 

[NeuroLAX]

I would think (and hope) that these are mostly experimental questions, but I can certainly see their appropriateness when they are testing a more basic concept. We had a surgeon who loved to ask Step 2 management questions on our course exams. They always threw us for a loop because we have no frame of reference (yet)!

 

[001100010010011]

yikes i didn't even know that one...so we should do EKGs on Kawasaki patients? and give them ASA. I hope they're experimental!

I only knew that because of a qbank. Haha.

Hopefully, the other answer choices would be absurd enough to make us to make us choose the right answer. I pray they don't put an ECG, aspirin, and immunoglublins as separate answer choices in the same question.

I would think (and hope) that these are mostly experimental questions, but I can certainly see their appropriateness when they are testing a more basic concept. We had a surgeon who loved to ask Step 2 management questions on our course exams. They always threw us for a loop because we have no frame of reference (yet)!

Yeah, that sounds pretty frustrating.

 

[Apoplexy__]

So i really have no idea what to do about the q's that ask what the next appropriate management or treatment is (i am only a MS2 after all). i've had no experience with the wards. should i pick up a step 2 textbook (people say no to this usually but i can't help thinking it might help) or is there a website where it just has Treatment/next best step + disease in two columns that i can quickly memorize? That would be stellar.

Step 2 book would be way too low-yield.

I've found Goljan lectures very helpful for patient management questions. They're sprinkled throughout. If you're not in dedicated studying yet, definitely give them a listen.

I wouldn't stress too much about them honestly. A true Step 2 management question would be like "Patient presents with RUQ pain radiating to shoulder: Do an ultrasound or x-ray?". I find that with our level of management questions, they're usually asking "What needs to be ruled out?" (similar to "What is the leading differential?") or "What is the most significant complication?". Viewing them in that light, they become a lot more intuitive.

EDIT: To anyone that happens to read this post, I just wanted to update that I've since taken Step 1 and, incredibly ironically, the very same "RUQ pain --> gallbladder ultrasound" question that I said would NOT be something that would be tested actually showed up practically verbatim on my exam. It's not too high-yield of a pursuit to study for these types of questions, and my recommendation would be to check out Goljan lectures or RR if you wanted to.

 

[1dayatatime]

So the Goljan ones are the ones he did for Kaplan right?

Also can someone who's more experienced tell me how to answer the q about how to treat orthostatic hypotension please? do you give 0.9 nacl, 0.5% dextrose, or an alpha agonist? Thanks!

 

[bwmd]

There are a few approach considerations for these types of questions that I think apply regardless of the level of management being tested.

 

[Lavan]

So the Goljan ones are the ones he did for Kaplan right?

Also can someone who's more experienced tell me how to answer the q about how to treat orthostatic hypotension please? do you give 0.9 nacl, 0.5% dextrose, or an alpha agonist? Thanks!

It's treated with normal saline. Normal saline is the answer to a lot of Step questions. Unless you have a definite reason to pick a different fluid, always default to normal saline.

 

[GadRads]

It's treated with normal saline. Normal saline is the answer to a lot of Step questions. Unless you have a definite reason to pick a different fluid, always default to normal saline.

Is this for hypovolemic orthostatic hypotension? If so this makes sense. What if it is due to an alpha1 receptor issue?

 

[Lavan]

Always treated first with fluids, which typically help regardless due to volume expansion. For someone who has taken an alpha blocker etc, you give fluids and wait out the effects of their medications. If a patient doesn't respond to fluids and is severely hypotensive, then pressors are given in an inpatient setting (unlikely to be on Step). For patients with chronic orthostasis (eg Parkinson's) who do not respond to conservative management (drink a lot, avoid excessive heat, etc), treatment with fludricortisone or midodrine is not uncommon (also unlikely on Step).

 

[pdxhopeful]

I've come across a couple of questions along these lines that are patient safety things... something like a diabetic coma patient coming in, and considering the airway first so they don't die while you're getting meds in.

 

[1dayatatime]

Where can I get practice with these patient safety qs? Thanks!

 

[dextor2003]

Bump. Having a lot of trouble with these types of questions for class exams. Any good resources out there with practice questions for these?

 

[Transposony]

I was discussed in this thread

 

[dextor2003]

I was discussed in this thread

That thread doesn't have what I'm looking for. I'm looking for actual next step in management practice questions. For example, which treatments to use in particular situations of leukemia; best first test to use for someone suspected of pneumonia, etc.

 

[Transposony]

That thread doesn't have what I'm looking for. I'm looking for actual next step in management practice questions. For example, which treatments to use in particular situations of leukemia; best first test to use for someone suspected of pneumonia, etc.

In that case I suggest Master the Boards USMLE Step 2 CK.

 

[dextor2003]

In that case I suggest Master the Boards USMLE Step 2 CK.

This is exactly what I needed, thank you!