Board Question For You:

You are working in the ED one afternoon, when the ambulance brings in a woman who was found unconscious on the sidewalk near a park. Witnesses in the park say they saw her run past, then she stopped and slumped to the ground. When EMS arrived, she had regained consciousness, but was feeling shaky and dizzy. Initial vital signs showed temperature of 39 C, heart rate of 195, respirations of 24, blood pressure of 110/55. She received 500 mL of normal saline en route to the hospital and her heart rate is now 100. On questioning, she tells you that she is a resident who had taken her licensing boards earlier that day after many days of studying. After the test, she went for a run to wind down. Admits to feeling weak and lightheaded befroe she passed out, and had noted tingling in her fingers and had stopped sweating. Denies any headache, vision problems. Physical exam notable for tachycardia and sluggish capillary refill. She hadn't been sleeping well lately, and had been drinking 8-9 caffeinated drinks a day, and no water. Denies smoking or other medications or illegal drugs. Drinks 1-2 glasses of wine a week. What is the appropriate initial step?
A. Electrocardiogram
B. Chest x-ray
C. Stress echocardiogram
D. Fluid resuscitation
E. Tell her what an idiot she is

While the real-life answer may be some combo of A-D in this case, the right answer is E. Because, of course it is me we're talking about! I didn't actually pass out. But I certainly felt light-headed and numb/tingly. Yeah. Water is a good thing, Brenna. That's my new mantra. Especially when it is 89 degrees outside. Oh yeah, apparently it was 89 degrees out. (I had no idea)

My test is over! The first day was pretty rocky - starting with me showing up a whole hour early (Who starts taking tests at nine?? That just makes no sense!) Step 3 has SO MANY WORDS for each question. They just go and go and go and go, and by the time you get to the question, you have to go back to the beginning to see what the heck the presenting symptom was. 336 of those questions day one. Mind-numbing. And at the end of the day, you don't even get that 'thank God I'm done and I don't even care if I failed' release, because you have to come back for more!

Today was not nearly so bad. Either the questions were easier, or I was smarter, because I didn't feel as idiotic today. There were only 144 questions today, plus the - dare I say it? - fun (!) part of the test. The "interactive" part. And interacting is always more fun than... not... interacting. They'd give you (me) a bit of background information on a patient, then you had to choose which tests to order, and which medicines to start, and whether to admit them to the hospital, or send them home. It was kind of scary, but also kind of fun. Chest pain? Get an EKG! Chest x-ray! Echo! Labwork! Look, she had a heart attack! Admit her to the ICU! And why not get some angioplasty! And counsel her about exercise! Now send her home (okay maybe not just yet).

I did a lot of "counsel patient/family" and "reassure patient." Because I like to talk, and I thought that my virtual patients should get the same treatment as my regular patients. Thankfully, three of my nine patients were pediatric patients. I was all over that business! (at least I hope)

I'm not guaranteeing that I passed. In fact, I really don't feel terribly confident. Sigh... I really, really don't want to take this test over.

Speaking of doing things over - remember how I won that iPod shuffle a while back? They accidentally sent me another one! How funny is that?? I never win anything, but when I do, I guess I get it twice! Sadly, they've requested I return it. Ah, well. I just hope that didn't count as my next 'lucky' thing. Lucky things only happen to me every 20 years or so!

I'm going to go drink more water now. Because water is a good thing.