PIMP

PPX
 In the beginning of 3rd year I quickly found that theres a big
difference between all that knowledge we just crammed into our heads
for Step 1, and what they actually asked us on the spot in front of
everyone on the floors. This book is not to teach you the content you
will need to learn for your rotations. There are much better books for
that. This is to help you focus on the kinds of questions that are
actually asked on the wards, and to help you prepare for them. It
doesnt come with answers because then you will just read them and
forget them. Instead, look them up, or better yet, find a relevant
article, if applicable. Please pass this book on from year to year: edit it,
update it, and improve it. This will be one of the most exciting and
important years of your career, enjoy it!

- Andrew Fried and the Class of 2016

 Surgery
- What are the causes of post op fever? (5 Ws)

- What are the causes of pancreatitis?

o GET SMASHED

- What is the best first test for RUQ pain?

- What is the Ddx for ____ pain? (RLQ, RUQ, LLQ, LUQ)

- What is the most common cause of SBO? The next two most
common causes?

- What separates the upper GI tract from the lower GI tract?

- What makes up Calots triangle?

- What is the difference between an AV fistula and AV graft?

- What is the management of Type A vs Type B aortic dissection?

- What is the size threshold to operate on an AAA?

- What is the % of stenosis to operate on carotid stenosis?

Symptomatic vs asymptomatic?

- What is the first step in a hypotensive pt with penetrating trauma

to the abdomen?

- What is this patients GCS?

- What is the best type of line to resuscitate a patient? Triple

lumen central line vs 18 gauge peripheral line? Why?

- What is the difference between colloid and crystalloid fluid?

- How much urine should someone make in an hour?

- What are risk factors for Cholecystitis? (four Fs)

- What is the triad of cholangitis?

- Is this a direct vs. indirect hernia?

- What is the most common hernia in women? (It is not femoral

though femoral hernias are much more common in women)

- What is the workup of for a breast lump?

- What are indications for mastectomy vs lumpectomy? And who

needs radiation/chemo/hormone tx?

- What is the rule of 9s for burns?

- Calculate how much fluid this burn patient needs

- What is the first test to order if you suspect tension

pneumothorax? (trick question)

- What are the components of a FAST exam?

- What type of brain bleed has a lucid interval?

- What are physical signs of a basilar skull fracture?

 IM
- EKG stuff:
o You will be asked to read an EKG in front of your team. If
you dont start with rate, rhythm, axis, intervals, segments,
ischemia, hypertrophy you will be asked to stop and do it
systematically!

o Most commonly asked EKGs normal sinus rhythm, sinus

tach, A fib, signs of ischemia (T wave inversions), bundle
branch blocks

o Most important things to consider when looking at EKGs.

You can get most EKGs right if you ask yourself these
three questions:
Fast or slow?
Wide or narrow QRS?
Regular or irregular?

o What is the Cornell criteria?

S in V3 + R in aVL
> 28 in men = LVH
> 20 in women = LVH

o J point elevation vs. ST segment elevation?

o What are the EKG changes in hyperkalemia? How do you

treat hyperkalemia?

- What are the criteria for HCAP vs CAP vs VAP?

o What are the abx for each?

- What is your patients CHADS-VASC score?

- New A fib Shock vs meds? Rate control vs rhythm control? Strict

rate control or lenient rate control?

- What is diagnostic criteria for DKA?

o How do you treat? Know how to start insulin drip, when to
switch from NS to D5, when to replete K+, when to give
HCO3. Theres a great algorithm on UpToDate
- What is this patients FENa? (yes you actually have to calculate
this sometimes, just go to mdcalc on your phone)

- At what Hg do you transfuse blood?

- At what Platelet level do you transfuse platelets? What if you

suspect active bleeding?

- What are the risk factors for DVT/PE? What is this patients Wells
score?

- What is a type 2 MI?

- What are indications for emergent dialysis?

o A
o E
o I
o O
o U

- What are the criteria for HIT? What should you do if you diagnose
it?

- What is secondary hyperparathyroidism?

- What are the normal values in a right heart cath? (Theyre on the
first couple pages of your little purple/green book)
 OB/GYN
- What stage of labor is she in?

- What kind of decelerations are those?

o What do they indicate?
V C
E H
A O
L P

- What age for pap smears, how often, what to do with results?

- What are the guidelines for mammograms ACOG vs USPSTF

- What are the pHs and wet mount findings for BV vs trich vs
candida?

- Dx of preeclampsia? What drug do you give to prevent seizures?

- What is this babys APGAR?

- How much should a serum B-HCG level increase by in 48 hrs in

normal early pregnancy?

- Who should get Gardasil? (ages, sex)

- What are the layers of abdominal wall?

- We give steroids to a mom going into premature labor until she is

how many weeks along?
o Why? What does it help prevent?

- Does this mom need rhogam? If so, when?

- What are criteria for gestational diabetes?

- What are the first signs of Mag toxicity?

- When do you test for GBS? How do you treat? What do you do if
GBS status is unknown?

Peds
- Acute otitis media:
What are the 3 most common bugs?

o Based on clinical signs, ages, laterality, previous Rx when

to:
Wait and watch
Amox
Amox/Clav

- GAS pharyngitis
o What is this patients Centor Score?
o Abx / steroids?

- What is sinus arrhythmia?

- What temperature is a fever in a kid?

- What is the workup for fever in newborn?

- What drugs are contraindicated in kids?

- What is this patients asthma severity? rule of 2s

- What are the complications of premature birth?

- What is the work up and disposition of a febrile seizure? What

factors does it depend on?

- What are some red flags for non-accidental trauma?

- By when should a baby regain its birth weight?

- What are absolute contraindications to breastfeeding in mom?

- What are the causes of symmetric vs asymmetric IUGR?

 Neuro
- What are the two types of strokes, and what percentage of
strokes do they account for?

- What is the first imaging test for a suspected stroke?

- What kind of brain bleed is this? (while showing you imaging)

- What are the CSF findings in GBS?

- What are the CSF findings in meningitis? Viral vs bacterial vs

fungal?

- What is Brown-Squard Syndrome?

- What is the formula for cerebral perfusion pressure?

- What are the risk factors for Idiopathic Intracranial Hypertension

(pseudotumor cerebri)?
o How to make Dx?
o What is the Tx?

- Which way should eyes deviate during cold calorics in pt with

normal function vs cortical dysfunction, vs brainstem
dysfunction?

- What are dolls eyes?

- How do you differentiate peripheral from central causes of

vertigo? (5 Ds)

- MS What is the treatment? What is the dreaded complication of

that Rx?

- What are DWI, FLAIR, T2 and T1, and what are they best for?

- What is the imaging finding for toxoplasmosis?

 Psych
- What are the symptoms and treatment of NMS?

- What are the symptoms of extrapyramidal side effects?

o What is the treatment for these?

- What is the difference between typical and atypical

antipsychotics?

- What is the difference between delirium and dementia?

 Family Medicine
- Who gets statins with the new ASCVD guidelines / what is this
patients 10 year risk?
o ascvd risk estimator (get the app)

- How do you diagnose diabetes, what are the cutoffs?

- What are the major side effects of the different diabetes meds?

- What are the side effects of long-term steroid use?