High-Impact Orders That Separate Good Scores from Great Ones
🚀 Key Insight: These orders are low-effort, high-reward. They show you're thinking like a safe, holistic physician.
Total Orders
25
Bonus Points
100%
Cases Covered
95%+
Commonly Missed
85%
LMWH, heparin, or SCDs if contraindicated
📌 All admitted patients unless actively bleeding
Proton pump inhibitors for at-risk patients
📌 ICU patients, on vents, steroids, coagulopathy
Influenza, pneumococcal, tetanus, Hep B, HPV, MMR/rubella
📌 Outpatient/Discharge for nonimmune patients
Essential nutrients for pregnancy
📌 All pregnant patients
Regular patient assessment
📌 q2–4h to show active monitoring
Track fluid balance and weight changes
📌 CHF, renal failure, sepsis
Neurological assessment
📌 Stroke, meningitis, head trauma
Blood pressure changes with position
📌 Syncope, dehydration, GI bleed
Measure lung function
📌 Asthma management
Alcohol withdrawal assessment
📌 Alcohol withdrawal management
Surgical evaluation
📌 Acute abdomen, appendicitis, trauma
Obstetrics/Gynecology evaluation
📌 Ectopic, pregnancy complications
Cardiac evaluation
📌 ACS, unstable arrhythmia, CHF exacerbation
Psychiatric evaluation
📌 SI/HI, new psychosis
Infectious Disease evaluation
📌 Endocarditis, resistant infections, HIV opportunistics
Help patients quit tobacco
📌 Any smoker, inpatient or outpatient
Support for reducing alcohol use
📌 After detox, during outpatient follow-up
Nutritional guidance
📌 Low-salt (CHF), diabetic (DM), low-fat (CAD)
Physical activity recommendations
📌 Stable CAD, obesity, diabetes
Sexual health education
📌 STIs, PID, HIV
Support for taking medications as prescribed
📌 Chronic conditions like HTN, DM, HIV
Nothing by mouth
📌 Abdominal pain, possible surgery
Appropriate analgesia
📌 Don't let patient suffer; opioids or NSAIDs when appropriate
Safety measures for pregnant patients
📌 Avoid ACE inhibitors, statins, radiation; order folate
Safety measures for at-risk patients
📌 If patient is a danger to self/others (use sparingly)
Guidance for when to seek further care
📌 For outpatients ("Go to ER if...") — exam loves this
Transition of care arrangements
📌 Outpatient follow-up, referrals, home health, PT/OT
These orders are rarely the first things you order, but they're the extra credit that push your score from "passing" to "top tier."
They show the computer that you're not just treating disease, but also thinking like a safe, holistic physician.
Forgetting these orders can silently chip away at your score without you realizing it.
These are the small details that examiners sneak in to test your comprehensive knowledge.