Gastroenterology and Hepatology
Know the approach to GI bleeding, pancreatitis, liver disease, and hepatic encephalopathy. For upper GI bleeding, resuscitate, risk-stratify (Glasgow-Blatchford), and arrange endoscopy after stabilization. For acute pancreatitis, provide aggressive fluids, analgesia, and early enteral nutrition when tolerated; recognize that antibiotics are not routine unless infected necrosis is suspected. Understand cirrhosis complications: ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy. Diagnose SBP with ascitic fluid PMN ≥250 cells/mm³ and treat with a third-generation cephalosporin plus albumin in high-risk patients.
Traps
Questions test when not to intervene. Do not give antibiotics routinely in pancreatitis without infection. Do not perform paracentesis without addressing coagulopathy concerns - but recognize that routine correction is not needed for diagnostic paracentesis. Watch for the patient with cirrhosis and GI bleeding - give prophylactic antibiotics and vasoactive therapy before endoscopy. Recognize that hepatic encephalopathy can be precipitated by GI bleeding, infection, or electrolyte disturbance, and treat the precipitant.
Rule of thumb
In cirrhosis with ascites and fever or abdominal pain, always perform diagnostic paracentesis - SBP can be silent and is treated with PMN ≥250.
Quality Improvement, Patient Safety, and Systems-Based Practice
Understand the frameworks that drive hospital safety: the Model for Improvement (Plan-Do-Study-Act), root cause analysis, and failure mode and effects analysis. Know the common sources of harm - medication errors, hospital-acquired infections, falls, pressure injuries, and diagnostic errors - and the interventions that reduce them (checklists, handoff standardization, bundle compliance, and closed-loop communication). Recognize the importance of transitions of care, discharge medication reconciliation, and readmission reduction strategies.
Traps
Questions test whether you distinguish a system problem from an individual blame problem. Root cause analysis seeks system fixes, not punishment. Watch for questions about handoffs - the SBAR framework and structured sign-out reduce errors. Recognize that a single incident report is not a quality metric; trends and denominators matter. Understand that patient safety culture depends on psychological safety and reporting without fear.
Rule of thumb
When a safety event occurs, ask what system allowed the error, not who to blame. Use PDSA cycles for improvement and measure with clear numerators and denominators.