MedSurg Exam 2

Discussion started on potential specific questions students have regarding the upcoming exam.
Instructor shared a blueprint of the exam's structure and components.

Time Allocation:
- Teams will have 15 minutes total.
- A short 1-2 minutes break will be given for groups to discuss before presenting.
Preparation Material:
- Students are expected to fill out a jigsaw paper as prep work for the oral exams.
- Handoff report will provide crucial patient information to prioritize discussions.
Differences Between Groups:
- Each group will discuss different patients (either patient A or patient B) to prevent answer sharing between classes.
- Small variations in conditions may exist to further mitigate collaboration.
Sign-up Process:
- Sign-ups posted with an announcement; completion expected by Sunday for scheduling on Monday.
- Group oral exams will be conducted in Rooms 98 or 99, near testing areas.

Question Structure:
- Historically, the exam questions increased from 50 for the first exam to 80 for later exams.
- All exams will consistently have 50 questions moving forward.
- Expected testing duration: 60-65 minutes for multiple-choice.
- Oral exam duration: 15-20 minutes
Content Covered:
- Theoretical topics will encompass new respiratory content and potentially previous subjects like CHF, CAD, etc.
- Emphasis on acute kidney injury (AKI) only, CKD details will not be included.

Specifics on assessing adventitious breath sounds:
- For instance, wheezing in bilateral upper lobes on inspiration & expiration likely indicates asthma.
- Related findings with pneumonia yield crackles and rhonchi at lung bases.
Medications & Treatments:
- Typical PRN medications include bronchodilators for asthma management.
- Assessment should compare findings pre and post-intervention for efficacy.

Format for questions:
- Patients will be given specific ABG values with a brief clinical condition.
- Students will interpret the ABG in context, e.g., determining acidosis or alkalosis from data provided.
- Expect at least four ABG-related questions on the exam.

Differentiation between types:
- Focus on the characteristics of prerenal, intrarenal, and postrenal AKI is essential.
- Understanding manifestations for oliguric and diuretic phases of AKI is critical;
- Oliguric phase: characterized by decreased urine output and elevated BUN/creatinine levels.
- Diuretic phase: increased output requires monitoring for dehydration and electrolyte imbalances.

About prioritizing care during handoff reports:
- Assessing acute from stable conditions is vital during triage scenarios.
- Questions may involve scenarios of patients with stable surgery versus exhibiting abnormal signs needing urgent care.

Gold standard tests for TB diagnosis include:
- Sputum test (AFB), requiring sampling three times in one morning for accuracy, while airborne precautions with N95 masks are critical.
Patient teaching for TB discharge includes stressing adherence to full medication courses to mitigate spread.

In cases of chest trauma (e.g., flail chest):
- Key assessments include equal chest wall movement and potential need for intubation due to compromised airway and ventilation.
Interventions for emergencies may include:
- Needle decompression and chest tubes for pneumothorax or hemothorax.
Identify that pain at the insertion site is expected with a chest tube, along with monitoring for air leakage.

Calculators will be provided for potential dosage calculations during the exam based on sample metrics.
Example given: Patient requiring careful conversion, e.g. 10,000 units in 10 ml requiring 7.2 ml administration.

UTI vs Pyelonephritis differentiation based on systemic symptoms; CVA tenderness indicates possible upper tract infection.
Geriatric patient assessments may include changes in mental status due to infection, notably a higher risk of UTIs.

Roles in the group oral exam include:
- Assessment, Diagnostics, Intervention, and Education roles.
- Students will draw roles on the day of the exam and must be prepared to discuss respective patient care plans based on their designated role.