Hospitalist Medicine I

Question 1

closed vs open ICU

Answer 1

Open ICU rural- hospitalist runs ICU
Closed ICU- Pulmonologist runs ICU

Question 2

2 MC procedures done by hospitalists?

Answer 2

Thoracentesis
Paracentesis

Question 3

Why was the hospitalist role made (2)?

Answer 3

Resident work hour restrictions
Increase safety

Question 4

H&P note or Progress note?
Admitting pts

Answer 4

H&P note

Question 5

H&P note or Progress note?
Hand off

Answer 5

Progress note

Question 6

Time when Handoff may need t be more meticulous

Answer 6

Night shift handoff

Question 7

Acronym for admisison orders?

Answer 7

“ADC VANDALISM”
Admit to
Dx
Condition
VS
Allergies
Nursing orders
Diet- imp for pt
Activity
Labs- BMP & CBC QD AM
IVOp fluids- fine teeter/totter
Special Studies- Misc Rn orders
Medications

Question 8

Most important part of d/c or pts? (tells the pt exactly what happens next?

Answer 8

DC summary:
including follow up

Question 9

What documentation tells the story of the hospital course?

Answer 9

DC summary

Question 10

How often does hospitalist assess VS, LAbs, imaging & consults?

Answer 10

Daily

Question 11

ICU or Floor?
Ventilator, BiPAP

Answer 11

ICU

Question 12

ICU or floor:
Central lines, pressors, drips

Answer 12

ICU

Question 13

ICU or Floor?
Nursing needs:
(insulin drip, heparin drip, eye drop administration)

Answer 13

ICU

Question 14

ICU or Floor?
Risk of decompensation
(e.g. threatened airway)

Answer 14

ICU

Question 15

Hyper/hypoglycemia
Hyperglycemia (>400) without anion gap? ICU, PCU, Floor?

Answer 15

Floor

Question 16

Hyper/hypoglycemia
DKA but pH > 7.2 and resolving anion gap

Answer 16

PCU

Question 17

Hyper/hypoglycemia
DKA with multi-organ dysfunction, pH < 7.2

Answer 17

ICU

Question 18

Nursing pt ratio? ICU, PCU, Floor?

Answer 18

Floor: 1:4+
PCU: 1:3+
ICU: 1:1 or 1:2

Question 19

Hospitalists are captains of the ship why? (4)

Answer 19

Admit pts
Coord consults
d/c pts`
arrange OP f/u

Question 20

Lab Draws (Floor, PCU, ICU)?

Answer 20

Floor: Daily, BID
PCU: Q2h
ICU: <Q2h

Question 21

ICU or Floor?
Chronic hemodialysis/ non-emergent

Answer 21

Floor

Question 22

ICU or floor?
Emergent dialysis, CRRT, K > 6.0 with EKG changes, any K > 7.0

Answer 22

ICU

Question 23

ICU or Floor?
Stable hemodynamics (HR 50-130, SBP 85-200, RR 10-30)

Answer 23

Floor

Question 24

ICU or FLoor?
Hemodynamically unstable; hypertensive emergency; IV antihypertensives

Answer 24

ICU

Question 25

ICU or Floor? Chronic stable NPPV overnight (CPAP for OSA)

Answer 25

Floor

Question 26

ICU or Floor? NIPPV (BiPAP, CPAP); intubated; impending respiratory failure; threatened airway

Answer 26

ICU

Question 27

How to determine inpatient or observation?

Answer 27

2 midnight rule

Question 28

Always have at least __ DDx

Answer 28

3

Question 29

Dont forget to ask about

Answer 29

CODE STATUS

Question 30

Daily life of a PA: 4 thing to do during shift

Answer 30

*Daily (at least) re-evaluation of patients *Adjustment of treatment plan *Communication with consultants *Discharge planning / longer-term plan

Question 31

Do hospitalist notes need to be done before handoff?

Answer 31

you bet

Question 32

Who: Home health, Outpt IV ABX setup, durable medical equipment, transfer to outside hospital/SNF/placement

Answer 32

Case Manager

Question 33

Who: takes care of Homelessness Uninsured helps pts get insurance Undocumented Substance abuse DH inpt addiciton team Adjustment to illness counseling Complex social issues Legal issues/guardianship

Answer 33

Social Worker

Question 34

Who: Medical necessity review Inpatient vs. OBS

Answer 34

Utilization management

Question 35

Who: Assess/improve ADLs, mobility Cognitive screens, MOCA

Answer 35

OT

Question 36

Who: Ventilator and NIPPV management Home oxygen evaluations Nebulizers, chest PT (Physiotherapy) OSA screens Sometimes intubate

Answer 36

RT

Question 37

Who: *Patient assessment *Medication administration *Care coordination *Front line for patient/family interaction *Discharge logistics and education

Answer 37

RN

Question 38

Who: *Confirmation of all inpatient med orders Med reconciliation *Clarification of orders with providers *Preparation of medications *RRT/MET/code involvement

Answer 38

Pharmacy

Question 39

What will the consultant contribute (3)?

Answer 39

*Procedures *Advice on workup *Advice on treatment

Question 40

Any ___ findings on a head CT warrant a PE and neurosurg consult

Answer 40

New

Question 41

___ communication is key to prevent bad patient outcomes

Answer 41

clear

Question 42

If a pt is on O2, what is a good question to ask?

Answer 42

What is their baseline O2 requirement?

Question 43

What position helps pts with COVID lungs

Answer 43

Prone "swimming"

Question 44

Can you do heated high flow on the floor?

Answer 44

yes

Question 45

DIscharge details Collaboration withattending goes in:

Answer 45

discharge summary

Question 46

Discharge Details *Follow up scheduled- f/u w/____

Answer 46

PCP! within a week

Question 47

Discharge Details *Coordinating DC meds- see if pts need ___

Answer 47

refills on home meds

Question 48

Discharge Details make sure you add:

Answer 48

STRICT PRECAUTIONS ie would care (supplies, packing, whether you can get the area wet).

Question 49

Calc serum anion gap Normal?

Answer 49

Serum anion gap = Na - (Cl + HCO3) 4-12