ERES Bonaerense Medicina common mistakes
ERES Bonaerense Medicina · Understand the traps and how to avoid them.
Choosing the diagnostically 'correct' answer even when the question asks for the immediate next step, empirical first-line treatment, or the action that must precede confirmation.
Candidates study diseases as diagnostic categories and default to the most precise test or definitive diagnosis, ignoring that emergency and clinical stems are asking about sequencing and initial management under uncertainty.
What to do instead
Before reading options, underline the exact task verb in the stem (confirmar, iniciar, derivar, estabilizar, notificar). If it is an action verb, eliminate any option that is a diagnostic confirmation rather than the requested action, and justify the remaining choice by the ABC/severity of the scenario.
Answering pediatric questions with adult dosing, adult vital-sign thresholds, or adult fluid volumes instead of weight-based calculations and age-adjusted normal ranges.
Most study time is spent on adult medicine, and pediatric content is often skimmed, so adult schemas are applied automatically without recalculating per kilogram or per age band.
What to do instead
For every pediatric item, write the weight (or estimate from age) and compute mg/kg and mL/kg explicitly before looking at options; memorize the age-specific respiratory and heart rate ranges and the 20 mL/kg bolus rule as anchors.
Selecting a drug without checking the contraindication or adjustment embedded in the stem (renal or hepatic impairment, pregnancy, lactation, elderly, allergy, QT prolongation, asthma).
Pharmacology is recalled as drug-class-effect associations rather than as prescribing decisions conditioned on patient factors, so the 'best known' drug is chosen over the 'safe for this patient' drug.
What to do instead
Treat each pharmacology stem as a prescribing checklist: scan the patient description for the one modifier (pregnancy, CrCl, age, comorbidity), then eliminate any option contraindicated by that modifier before comparing efficacy.
Missing the single most urgent finding in a multi-finding emergency vignette and choosing a management step that addresses a less lethal problem first.
Vignettes are dense and candidates process findings in the order written rather than triaging them by threat to airway, breathing, circulation, or time-critical organ loss.
What to do instead
After reading the vignette, list findings and rank them by immediate lethality; the correct answer almost always addresses the top-ranked threat. Practice by writing the one-line 'what kills this patient first' before reading options.
Confusing sensitivity, specificity, predictive values, and likelihood ratios, and misinterpreting a test result when prevalence changes.
These are learned as formulas to memorize rather than as properties of testing in a population, so questions that shift prevalence or ask 'what does a negative result mean here' are answered by formula recall instead of reasoning.
What to do instead
Anchor on two facts: sensitivity and specificity belong to the test and do not change with prevalence, while predictive values do. For any item, identify whether the stem gives prevalence and whether it asks about the test or the patient, then reason from a 2x2 table you sketch on scratch paper.
Failing to separate the legal duty to report or obtain consent from the ethical duty of confidentiality, and choosing 'maintain confidentiality' when mandatory notification or a legal exception applies.
Confidentiality is over-learned as an absolute principle, while the statutory exceptions (notifiable diseases, suspected abuse, imminent risk to third parties, judicial order) are under-rehearsed and feel like violations.
What to do instead
Build a short list of legally mandated exceptions and, for each ethics item, ask two separate questions: what does the law require, and what does the patient prefer. When they conflict, the legal obligation and the protection of life or a third party take precedence; state that reasoning explicitly.
Reading a radiology or ECG description and committing to a diagnosis from a single feature instead of systematically checking the standard search pattern.
Image and tracing items reward a habitual sequence, but candidates pattern-match to the most salient finding and stop, missing a second finding or a benign mimic that changes the answer.
What to do instead
Apply a fixed checklist every time: for ECG, rate, rhythm, axis, intervals, hypertrophy, ischemia; for chest imaging, airway, breathing/lungs, circulation/mediastinum, bones, soft tissue. Only after the checklist is complete should the leading diagnosis be selected.
Applying a guideline threshold or cutoff from memory without confirming which population or setting it belongs to (ambulatory vs emergency, adult vs pediatric, first episode vs recurrent).
Numbers are memorized in isolation, so a cutoff learned for one context is transferred to another where the threshold or the recommended action differs.
What to do instead
When a numeric threshold appears in an option, attach the context to the number as a single memorized unit (for example, 'this cutoff, this population, this action') and reject options that pair a correct number with the wrong setting or next step.
Managing a surgical problem medically or delaying source control, choosing antibiotics or observation when drainage, decompression, or surgery is the definitive treatment.
Medical training biases toward pharmacological solutions, and the principle that antibiotics cannot penetrate an undrained collection or relieve a closed-space obstruction is not applied consistently.
What to do instead
For any surgical vignette, ask whether there is a collection, obstruction, ischemia, or perforation that antibiotics cannot fix; if yes, the answer involves source control. Use the rule that the definitive treatment removes the anatomic problem, and reserve antibiotics as adjuncts.
Answering obstetric items without first establishing maternal stability and gestational age, and choosing fetal-directed management when the mother is unstable or the pregnancy is pre-viable.
Obstetric vignettes invite focus on the fetus, and candidates under-weight the principle that maternal resuscitation precedes fetal assessment and that management differs sharply by trimester.
What to do instead
For every obstetric item, state two things first: is the mother stable, and what is the gestational age. Then apply the rule that maternal stabilization comes first, and eliminate options whose intervention is inappropriate for that gestational age before comparing the rest.