Favorite Pimping Questions

[Baby Einstein]

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.

Thanks for the info about formula. I found many pediatricians tell parents to "experiment" with different formulas if baby doesn't tolerate one. Not very scientific either, huh?

So what about a breastfed 12-month old who doesn't tolerate cow's milk, yogurt, or cheese (diarrhea within 30 minutes, every single time), but tests negative for cow's milk allergy (despite strong family history of various food allergies)? Could that be lactose intolerance? What do you give him when it's time to wean?

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[nabeya]

Sounds like you pulled that directly from Surgery recall? lol

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?*****

 

[oldbearprofessor]

Thanks for the info about formula. I found many pediatricians tell parents to "experiment" with different formulas if baby doesn't tolerate one. Not very scientific either, huh?

So what about a breastfed 12-month old who doesn't tolerate cow's milk, yogurt, or cheese (diarrhea within 30 minutes, every single time), but tests negative for cow's milk allergy (despite strong family history of various food allergies)? Could that be lactose intolerance? What do you give him when it's time to wean?

Could be, but I'd see a pediatric gastroenterologist to consider a biopsy (if not already done) to make sure it wasn't cow milk protein allergy. Could try lactase when the baby was a bit older and see what happens. Also would need more history such as whether the baby reacts to dairy in mom's diet. Calcium-fortified soy milk could be tried as a weaning milk or one could use elemental formulas.

But SDN isn't the place for medical advice and 12 mo old are out of my usual scope of medical practice anyway - so I'd see a pedi GI doc on this one!

Regards

OBP

 

[enanareina]

Sounds like you pulled that directly from Surgery recall? lol

Maybe I am Surgical Recall.

 

[Nerdoscience]

Abx which is an MAOI: linezolid

 

[baya]

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

Mom smoking > 1 pack a day has been associated with neonatal nicotine poisoning. If she was into the breast feeding idea, I'd use that to try to get her to cut back to at least less than a pack a day - better for both of them than her being a chimney and kid being on formula. If she can quit entirely, obviously that would be best, and she should never smoke in the presence of the kid. If she simply must smoke 3 packs a day, I'd try to make sure there's another caregiver who can watch the kid while she's outside smoking and that the kid's getting formula.
How does that sound?

 

[lizmid152]

My favorite pimp question....

Where do we get protamine?

Salmon roe

 

[Nerdoscience]

My favorite pimp question....

Where do we get protamine?

Salmon roe

No, it's the OTHER stuff. The MALE stuff...

 

[katrinadams9]

I'm on my ob/gyn rotation and in the OR doing Gyn this month. I scrubbed in for a surgery with a doc who proceeded to ask me "What are the general principles of surgery?" I had no idea what he meant because the question was so vague. After about 5-10 min of ackward silence I mumbled something about needing a reason for the surgery, trying to minimize infections and not damaging the surrounding structures. I've never been pimped in such a vague way before. Really threw me for a loop.

The answer he was looking for: Indication, Sterility, Anesthesia, Exposure, Avoiding Injury, Recovery, Pain Control, etc.

Anyone else get pimped with very vague questions?

 

[johankriek]

how about posting the answers to the pimp questions as well?!

dude if the question has an answer its not a pimp question......

 

[Bertelman]

So, at the END of our third year, on surgery (he11s yeah!), a fellow student was asked why B-blockers are given to patients pre-op. This was during rounds, so the entire team was there, including nurses. She said, with a hint of doubt in her response, "to prevent aspiration?"



OMG, silence followed by the sound of 7 jaws hitting the floor to that response. It got worse- the attending gave her another guess at each room. It really took her 4 rooms to figure it out.

 

[GuP]

I'm on my ob/gyn rotation and in the OR doing Gyn this month. I scrubbed in for a surgery with a doc who proceeded to ask me "What are the general principles of surgery?" I had no idea what he meant because the question was so vague. After about 5-10 min of ackward silence I mumbled something about needing a reason for the surgery, trying to minimize infections and not damaging the surrounding structures. I've never been pimped in such a vague way before. Really threw me for a loop.

The answer he was looking for: Indication, Sterility, Anesthesia, Exposure, Avoiding Injury, Recovery, Pain Control, etc.

Anyone else get pimped with very vague questions?

Ya...one time I was asked the meaning of life during rounds in medicine and I quickly responded "DISCHARGE"

 

[johankriek]

on gyn oncology i remember for 3 weeks straight every single day i was asked all the different stages and grades of all the gyn malignacies.. man.... i still dont remember.. i remember stage 3b cervical ca is extension to the pelvic side wall.. or hydronephrosis... were going back almost 10 years

 

[Dr JPH]

Here are some of my favorite surgical pimp questions.

What are the borders of Calots Triangle?

What is the anatomical significance of the cystic vein?

What is Daikins solution?

What visual clues do you use to identify healthy bowel from ischemic bowel?

What are (all) the causes of pancreatitis?

Oh...and anything concerning the blood supply of the thyroid.

 

[HouseHead]

My favorite pimp question so far was posed by the chair of our dept of medicine:

"Here's one none of you will get: What do you call a woman who has sex for drugs?"



Methinks, is he serious? "A strawberry."

He was amazed that I knew the answer. I was amazed that no one else did.

 

[gagolden]

Ok, heres mine

1) what two amino acids contain sulfur?
a) ok, you got that right, how many sulfur atoms are in each one?

bastard

2) what's the MOA of lasix
a) ok, got that right, describe the movements of all the ions involved (Ca, Mg, Na, Cl ect)
b) ok, got that right, which transporter does it bind too?
c) ok, got that right, which side of the membrance does lasix bind to?- guess
d) ok, got that right, what subunit?

bastard

some guys just gotta prove how smart they are.


oh yeah, I spent a day with a pediatrician who is getting ready to retire (thank GOD- read on) who asked, whats your drug of choice to treat MRSA. Simple right, no she wanted Amoxacillin or Augmentin if it Amox fails. WTF. "I use Amox all the time and it works, I've been doing it for years" It took everything I had not to smack her right there. Instead, I just tell everyone about that question.

 

[Nerdoscience]

And you're sure they weren't saying MSSA?

 

[gagolden]

And you're sure they weren't saying MSSA?

Nope gaurentee it. We just saw a kid who had MRSA positive impetigo, by culture. She didn't believe the culture and sensitivity report that came back saying methcillin resistant etc. And she refered me to a article, which she hadn't read yet, about the rise in community acquired MRSA.

 

[Dr JPH]

some guys just gotta prove how smart they are.

No kidding.

 

[(nicedream)]

No kidding.

 

[FutureNavyDOc]

No kidding.

Pot, meet kettle. Please notice the similarities of your complexion.

 

[Dr JPH]

Pot, meet kettle. Please notice the similarities of your complexion.

 

[ramonaquimby]

can someone explain to the "slow girl" the strawberry joke?

 

[Dr.ImCute]

i just thought this was cute-

Q: a mom has blood type A pos, and dad is O neg... when should you give RhoGAM during the pregnancy?

hahaha- silly attendings...

 

[FutureNavyDOc]

Attending's question while looking at a Chest X-ray of a pt with a pacemaker:
Q: Where in the heart are the 3 leads of a pacemaker placed?
Me: RA, RV, and Coronary Sinus

Me: What is the function of the lead in the Coronary Sinus?
Attending radiologist: Ummm... dunno. Maybe to just hold on? I'll look it up and get back to you.... wait a minute, that's your job, look it up and tell me.



FYI: It's to pace the LV in medicinal refractory heart failure.

 

[HouseHead]

can someone explain to the "slow girl" the strawberry joke?

Not a joke. That's what they're called.

Funny to me that no one else knew that though. Like not knowing the the worst job on the planet is assistant crack *****.

Maybe I'm just dating myself??