Favorite Pimping Questions

[Raidergate]

Isn't breast milk also deficient in certain vitamins (D maybe?) that preemies aren't able to metabolize yet? I remember hearing something to that effect, but that was a long time ago.

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[Arctic Char]

Centigrade, Fahrenheit, or Kelvin? Isn't zero K a hypothetical and can't be measured?

thats what i said. then i got "NO . . . blah blah blah" some crazy response that angered me so much i couldn't commit it to memory.

how about this one:

why does neurohypophysis develop? (WHY . . . not HOW)

. . . 'cause baby jesus wanted it to? f**k if i know

 

[MediCane2006]

"Walk me through the clotting cascade..."

This on my surgery sub-I when I was scrubbed into a liver resection - I'd committed the entire anatomy of the abdominal cavity to memory the night before, but darned if I remembered what Loki-Lorand factor did. And of course that was the only question the surgeon asked the entire surgery....

 

[user2]

My favorites:

"Describe the pathophysiology of anemia of chronic disease. Be brief."
"Which state is the shape of a perfect square?"

ACD:
1. Hepcidin is increased in ACD and its function is to block the release of Fe from macrophages.
2. Cytokines that are released in inflammation decrease erythropoiesis.
3. IL-1 releases lactoferrin, which binds Fe better than transferrin, thus leading to ACD.

 

[Purifyer]

Nice Bill

with the 'mesial' hippocampal sclerosis the actual question went something along the lines of 'someone with epilepsy - scans normal... what are you thinking/next step in management? (after he had rejected every epiltogenic scenario I could conjure)' [me: idiopathic? 'NO' psychogenic 'NO' ],It was so far over my head I can't even remember the question properly but essentially he wanted 'measure the volume of the hippocampi on MRI' or something similar, with one hippocampus being smaller than the contralateral one.

I said yes to the radiosurgery one as well but he wanted a 'no'. Depends on the definition of 'effective' - radiosurgery does decrease risk of haemorrhage from cavernomas but doesn't cause involution/reduction in size.

Diffusely inverted T waves - SAH neurocardiogenic effects, acute coronary syndromes... my registrar (resident) also mentioned hypokalaemia but I doubt that's correct.

With the neurocutaneous syndromes he wanted me to list them, whether autosomal dominant/not and the typical phenotypic effects. One thing I learnt from this pimping was that there are ALOT more neurocutaneous syndromes than just NF1 NF2 Tuberous sclerosis, Sturge-Weber, ataxia-telangiectasia and VHL.

Another random fact - SAH can cause fever (obvious I suppose).

 

[DropkickMurphy]

Doxapram has been tried without much success. Caffeine is both safe and effective.

Regards

OBP

What about aminophylline?

 

[oldbearprofessor]

What about aminophylline?

The drug of choice in the 1980's! Worked well, but we needed to monitor levels carefully.

Caffeine has the same effect with a greater safety margin - less tachycardia.

Also, breast milk is low in vitamin D - that's why all breast fed babies, preterm or fullterm get supplemental vitamin D. Initially, the metabolism (i.e. conversion to the active form) is minimal in preterms but then it increases after a couple of weeks.

However, that isn't really why we use human milk fortifier.

 

[DropkickMurphy]

The drug of choice in the 1980's! Worked well, but we needed to monitor levels carefully.

Caffeine has the same effect with a greater safety margin - less tachycardia.

Also, breast milk is low in vitamin D - that's why all breast fed babies, preterm or fullterm get supplemental vitamin D. Initially, the metabolism (i.e. conversion to the active form) is minimal in preterms but then it increases after a couple of weeks.

However, that isn't really why we use human milk fortifier.

Duly noted.....seeing as I've never worked NICU, that would explain why I'm not up to speed on neonatology. Thanks for the clarification.

 

[uacharya]

wasn't this the interview question in harold and kumar? or was it about the symptoms?

It was about the symptoms! "There would be some diarrhea; epigastric pain radiating to the back, etc " lol

 

[Bill59]

With the neurocutaneous syndromes he wanted me to list them, whether autosomal dominant/not and the typical phenotypic effects. One thing I learnt from this pimping was that there are ALOT more neurocutaneous syndromes than just NF1 NF2 Tuberous sclerosis, Sturge-Weber, ataxia-telangiectasia and VHL.

Yeah, that's the problem -- if you're up against a seasoned pimper, you can't win. If you would have listed and describe each one, he would have just asked an even more in-depth and obscure question about one of them.

 

[wraith777]

yeah, you're right, hypokalemia causes flattened, not inverted T waves...

Nice Bill

with the 'mesial' hippocampal sclerosis the actual question went something along the lines of 'someone with epilepsy - scans normal... what are you thinking/next step in management? (after he had rejected every epiltogenic scenario I could conjure)' [me: idiopathic? 'NO' psychogenic 'NO' ],It was so far over my head I can't even remember the question properly but essentially he wanted 'measure the volume of the hippocampi on MRI' or something similar, with one hippocampus being smaller than the contralateral one.

I said yes to the radiosurgery one as well but he wanted a 'no'. Depends on the definition of 'effective' - radiosurgery does decrease risk of haemorrhage from cavernomas but doesn't cause involution/reduction in size.

Diffusely inverted T waves - SAH neurocardiogenic effects, acute coronary syndromes... my registrar (resident) also mentioned hypokalaemia but I doubt that's correct.

With the neurocutaneous syndromes he wanted me to list them, whether autosomal dominant/not and the typical phenotypic effects. One thing I learnt from this pimping was that there are ALOT more neurocutaneous syndromes than just NF1 NF2 Tuberous sclerosis, Sturge-Weber, ataxia-telangiectasia and VHL.

Another random fact - SAH can cause fever (obvious I suppose).

 

[Purifyer]

Pimp Question : Why is the left hilar higher than the right hilar?


I know that the left main bronchus is more horizontal than the right main bronchus, and that the pulmonary vessels arch over this more horizontal bronchus, ergo higher hilum.

He wants an embryological answer. All I've managed to find out* is that the ventral 'primordial' pharynx offshoots to the sulcus laryngotrachealis from which the lung primordium then grows from. This primordium then splits into the left and right main bronchi but I have no idea why the left 'primordial' main bronchus decides to grow horizontally.

*NB. all from memory. good chance of error. Please be kind

 

[beastmaster]

1) What happens when you answer a pimp question correctly ?

2) What happens when you don't ?

 

[cytoskelement]

Are more babies born with Trisomy 21 of mothers less than 35 or greater than 35?

 

[Doggie]

What is the most common EKG finding in pulmonary embolism?

I think it's S1Q3T3.

 

[deleted87716]

1) What happens when you answer a pimp question correctly ?

2) What happens when you don't ?

It depends on whether or not the person pimping you expected you to know the answer. If they did, you're off the hook if you answer correctly. If they didn't, a correct answer will probably earn you another (tougher) question.

Either way, if you don't know the answer, you'll probably be asked to prepare a brief lecture on the topic for rounds the next morning.

 

[Igor]

The most common EKG finding in PE is sinus tachycardia.

My favorite pimp questions, honest are:

what are the 5 ways to become hypoxic
ANS: diffusion impairment, shunt, V/Q mismatch, breathing air that has low pO2 (only relevant if you're a sherpa) and hypoventilation

List 5 causes of chest pain that can kill the patient
ANS: MI, pneumothorax, aortic dissection, ruptered esophagus, pneumonia (there are others as well)

Tell me 10 animals that only have 3 letters in their name
I had a student who had been a zoology major that couldn't get this one!

 

[ShyRem]

gnu
elk
cat
dog
rat
emu
ant
man

umm...

roc


ummmmm....

ok. I gotta think some more about the animal one.

PIG!

that's ten if roc counts. if it doesn't, add cow.

 

[yobynaes]

b - "Which state is the shape of a perfect square?"

b - I guess a perfect square is in a state of total harmony and equilibrium? (no idea)

Colorado ?

 

[yobynaes]

Colorado ?

close enough

 

[Nerdoscience]

Nice Bill

Diffusely inverted T waves - SAH neurocardiogenic effects, acute coronary syndromes... my registrar (resident) also mentioned hypokalaemia but I doubt that's correct. QUOTE]


HypoK can flip your Ts, as can many different intracranial processes, SAH only being the most classic.

 

[closertofine]

Are more babies born with Trisomy 21 of mothers less than 35 or greater than 35?

Less than 35...just because there are more of them. Right?

 

[closertofine]

The drug of choice in the 1980's! Worked well, but we needed to monitor levels carefully.

Caffeine has the same effect with a greater safety margin - less tachycardia.

Also, breast milk is low in vitamin D - that's why all breast fed babies, preterm or fullterm get supplemental vitamin D. Initially, the metabolism (i.e. conversion to the active form) is minimal in preterms but then it increases after a couple of weeks.

However, that isn't really why we use human milk fortifier.

Is it iron? Can't remember exactly, but something like breast milk has some iron, but it's not easily absorbed by babies?

 

[raptor5]

ENT Rotation

Wharton's duct
Stensen's duct
Cholestetoma
Easy if you read surgical recall.

Torus Palitunus (not in surgical recall), Torus Mandibularis (not in surgical recall) saw a case and diagnosed it. I looked like a superstar, just make sure you put on a glove and feel the bony prominence for both to confirm.

 

[oldbearprofessor]

Is it iron? Can't remember exactly, but something like breast milk has some iron, but it's not easily absorbed by babies?

Breast milk is low in iron - full-term infants don't need much in the first 6 months of life as they primarily rely on liver stores. It is well absorbed however. Preterm babies miss out on the iron storage part of in utero development so they need extra iron after birth, although for several reasons we are cautious about providing too much too soon. Of the two available commercial human milk fortifiers, one has extra iron the other doesn't (for babies who get that fortifier, iron drops are used).

But that isn't the main reason for fortifying mother's milk for premature babies.

 

[mcdonalds321]

funny thread!

 

[racerx]

I still remember some psychiatry pimp questions:

3. Which antibiotic is chemically closely related to an MAOI, disallowing the patient to eat foods containing tyramine?

Isoniazid?

 

[arroser]

Breast milk is low in iron - full-term infants don't need much in the first 6 months of life as they primarily rely on liver stores. It is well absorbed however. Preterm babies miss out on the iron storage part of in utero development so they need extra iron after birth, although for several reasons we are cautious about providing too much too soon. Of the two available commercial human milk fortifiers, one has extra iron the other doesn't (for babies who get that fortifier, iron drops are used).

But that isn't the main reason for fortifying mother's milk for premature babies.

Premed research assistant on feeding in preterms here... and I'm totally guessing.

Mother's milk has everything the babies need, but not concentrated enough? I know a lot of the subjects I work with are restricted to about 150ml/kg. Fortifying gets more nutrients for the volume?

 

[oldbearprofessor]

Premed research assistant on feeding in preterms here... and I'm totally guessing.

Mother's milk has everything the babies need, but not concentrated enough? I know a lot of the subjects I work with are restricted to about 150ml/kg. Fortifying gets more nutrients for the volume?

Too vague an answer....what specific macro or micor nutrient(s)?

OBP

 

[arroser]

Too vague an answer....what specific macro or micor nutrient(s)?

OBP

OK, it isn't primarily calories, so I'll cross off fats. Vitamin D is wrong. So... Vitamin E, I think, is often deficient in premies. I'll go with calcium and phosphorus too, plus protein, since the babies are (hopefully!) growing.

 

[oldbearprofessor]

OK, it isn't primarily calories, so I'll cross off fats. Vitamin D is wrong. So... Vitamin E, I think, is often deficient in premies. I'll go with calcium and phosphorus too, plus protein, since the babies are (hopefully!) growing.

We have a winner....

30% or more of small premies who get only mother's milk would develop severe bone loss (osteopenia) or frank rickets. Human milk doesn't have the levels of calcium and phosphorus needed to support the high rate of bone growth that occurs in utero when the minerals are actively transported across the placenta.

Protein is the second reason. Rapid tissue growth in premies requires much more protein than is found in human milk.

 

[enanareina]

Name the borders of the triangle of Calot
-cystic duct, common bile duct, liver edge (if you say cystic artery like it says in Surgical Recall they look at you like you're nuts)

What is found within the triangle of Calot?
-cystic artery, Calot's node

Charcot's triad of cholangitis:
-RUQ pain, jaundice, fever

Reynold's pentad of septic cholangitis:
-Charcot's triad + hypotension and mental status changes

What percentage of gallstones show up on plain film?
-10-15%

What percentage of renal stones show up on plain film?
-85-90%

What segments of the liver are adjacent to the gallbladder?
-4 and 5, I believe

Different histological types of DCIS:
-Solid, cribriform, comedo, micropapillary (some texts add papillary)

How often does the comedo-type become invasive carcinoma?
-I pulled the "10-15%" rule, he said 3%, the text says up to 20%??

Which gene, BRCA-1 or BRCA-2, is more often associated with ovarian CA?
-BRCA-1 has twice as much association with ovarian CA than BRCA-2

What blood test determines if a patient has MEN-II?
-look for the ret gene

What is Hohman's sign?
-pain on dorsiflexion of the foot when the patient has a DVT

How sensitive/specific is Hohman's sign for DVT?
-not very (I don't know numbers)

When do you give a patient with acute pancreatitis antibiotics/tube feeds past the duodenum/abdominal CT?
-with necrotizing only

How do you treat acute pancreatitis?
-NPO, fluids/resuscitation, watch their ventilation, etc

What are Ranson's criteria?
-prognostic indicators of acute pancreatitis at admission and at 48 hours

What are Grey's and Turner's signs?
-discoloration near the umbilicus or the flank from hemorrhage into the skin, seen in acute hemorrhagic pancreatitis

In a patient with asymptomatic carotid stenosis, at what degree of stenosis do you operate? with symptoms?
->60-70% (the data are changing to 60) without symptoms, >50% stenosis with symptoms

****That's all I can remember at the moment--if I've made any mistakes, let me know, I was doing these all from memory--can you tell I've scrubbed into a TON of lap choles?*****

 

[Shane2150]

My favorite pimp questions, honest are:

...

Tell me 10 animals that only have 3 letters in their name
I had a student who had been a zoology major that couldn't get this one!

"Name 10 parts of the body that only have 3 letters in their name.
(Must be common, i.e. layman's, terms; all are G-rated)"

 

[beachbunny]

"Name 10 parts of the body that only have 3 letters in their name.
(Must be common, i.e. layman's, terms; all are G-rated)"

Ok, I think I got it....
ear, eye, arm, rib, gut, rib, hip, ass, leg, toe

 

[deleted87716]

Ok, I think I got it....
ear, eye, arm, rib, gut, rib, hip, ass, leg, toe

G-rated...lip.

 

[Shane2150]

Excellent, Beachbunny and KentW!

(It took me about half a day to figure out the last couple)

 

[NKMU]

Name 15 causes of complete heart block.
-A resident and I came up with a few more than 15, but he called some of them "cheap."

Which chromosome is involved in cystic fibrosis?
-Upon answering: How many mutations have been identified for that disease?
Me: ?

On which side of the chest is catemenial pneumothorax more common?
-wtf cares??

Name at least five side effects of amiodarone.
-Finally, one I could do easily!
Followup question: describe in detail the mechanism of each of those side effects. Clearly I fumbled, then he rattled them off.

 

[Dunce]

Sorry if this was already posted but I'm too lazy too sift through the whole thread.


Here's one I got during a colposcopy this morning:

Q: What is the term for the stretchy/stringy quality of cervical mucus?

A: spinnbarkeit

 

[toofache32]

Name at least five side effects of amiodarone.
-Finally, one I could do easily!
Followup question: describe in detail the mechanism of each of those side effects. Clearly I fumbled, then he rattled them off.

Sounds like one of those questions they think about ahead of time. A medicine attending got irritated with me when I asked him if he ever asked questions he didn't already know the answer to.

 

[yobynaes]

ok, help, i got quizzed on this question and can't find answer to it.

what's the percentage of the population have no anterior tibial artery?

thanks,
yobynaes

 

[oldbearprofessor]

What are the MEDICAL (baby or mom) absolute or strong relative contraindications to breast-feeding or providing mother's own milk for a baby? (hint, there are very few, but some exist).

Among formula-fed babies, what are the indications for using special formulas such as soy, lactose-free, hypoallergenic or transitional formulas?

 

[medgirl20]

What are the MEDICAL (baby or mom) absolute or strong relative contraindications to breast-feeding or providing mother's own milk for a baby? (hint, there are very few, but some exist).

Mom: HIV infection
Active TB
CMV
Hep B/C
HTL Virus type I and II
Cytotoxic drugs
Immunosuppresive drugs
Other drugs that pass into the breast milk (high conc in milk)

 

[oldbearprofessor]

What are the MEDICAL (baby or mom) absolute or strong relative contraindications to breast-feeding or providing mother's own milk for a baby? (hint, there are very few, but some exist).

Mom: HIV infection
Active TB
CMV
Hep B/C
HTL Virus type I and II
Cytotoxic drugs
Immunosuppresive drugs
Other drugs that pass into the breast milk (high conc in milk)

http://www.cdc.gov/cmv/facts.htm

50-80% of adults in the US are CMV positive. It would be a challenge to meet the goal of 80% breast-feeding if we eliminated these moms from breastfeeding.

Hepatitis C may not be an issue either. http://www.medicalnewstoday.com/medicalnews.php?newsid=32915

Almost all "drugs" pass into human milk, most at unknown or highly variable concentrations. What defines "high" concentration? How would one decide whether to permit breast-feeding? Would it matter if the drug was a legal one???

Some of your others are reasonable. I'll let others take a shot at this before commenting further. The HIV issue is complex.

OBP

 

[medgirl20]

If the drug was illegal contraindication to breast feeding
For other drugs I'd refer to my BNF

 

[razorback831]

Here's a couple I got in medicine:
How many calories in a peanut???
How many cigarettes must you smoke to equal the lung damage of smoking one marijuana cigarette???





His answers, which I cannot and will not try to validate
3 and 1/2 and 22

 

[goodies]

so if you get asked an easy question and you don't know the answer, what happens? what if you get a lot of questions wrong in a row?

 

[Woots32]

In Rheumatology clinic (CC was gout): "So if this patient had a spleen four times normal size and had just returned from Brazil, what would that make you think of?"

Me: "Some funky parasite?"

Staff: "Well, which "funky" (said very derisively) parasite?"

The correct answer is leishmaniasis.

 

[Baby Einstein]

What are the MEDICAL (baby or mom) absolute or strong relative contraindications to breast-feeding or providing mother's own milk for a baby? (hint, there are very few, but some exist).

Among formula-fed babies, what are the indications for using special formulas such as soy, lactose-free, hypoallergenic or transitional formulas?

Contraindications on baby's part: galactosemia + maybe structural abnormalities like cleft palate (although could get expressed breast milk).

Formulas:
- soy if baby is allergic to cow's milk proteins
- lactose free if baby is lactose intolerant (duh!)
- hypoallergenic if baby is allergic to both cow's milk and soybean (guessing)

 

[oldbearprofessor]

Contraindications on baby's part: galactosemia + maybe structural abnormalities like cleft palate (although could get expressed breast milk).

Formulas:
- soy if baby is allergic to cow's milk proteins
- lactose free if baby is lactose intolerant (duh!)
- hypoallergenic if baby is allergic to both cow's milk and soybean (guessing)

Unfortunately, a lot of this type of advice that many families get from pediatricians is not exactly scientifically based. About 1/3 of babies allergic to cow milk protein are also allergic to soy. Many (including me) do not recommend soy for this indication as severe cross-over reactions are common. Babies are not generally known to be lactose intolerant, so there is little if any indication for lactose-free formula. It is a choice some parents make as they are intolerant or their older children are, but this is rare if it ever exists in babies.

Good call on galactosemia.

 

[oldbearprofessor]

If the drug was illegal contraindication to breast feeding
For other drugs I'd refer to my BNF

If a mother admitted to occaisional use of marijuana, would you prohibit her (how could you do this anyway?) from ever breast-feeding her infant? What about tobacco, alcohol and high-dose narcotic pain relief. None of these are absolute contraindications, but all may be problematic. Unfortunately, no guide-book can answer this.

There are many grey areas in these discussions.

Regards

OBP