AM I Screwed?

[Sivastraba]

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I took the test on July 2 and 3. I left approx 18-20 questions unanswered in the entire 2 day test. I just didn't have enough time to cover all of them. I had one block in which almost all the questions were very long. I don't know if this has happened to other people.

In addition, I don't think I met the entire management guidelines for 2-4 of the CCS patients. I had the pt with Aortic stenosis and I consulted him to surgery but they didnt do crap. I should have done it myself, but I forgot about it during the test. Anyway I gave him B-B and he passed out. I frieked out so I admitted him, but didnt operate. I am very silly.

Any support guys. I am not sure but having to repeat this test would suck. I am tired of these USMLE's and the money I give away to NBME.

 

[jakesaw]

I can totally relate to the agony of realizing your mistakes in the days and weeks following the exam. I imagine most people who've taken it can also. I realize I'm not sharing any great insight here, but obviously whether you passed or failed cannot be changed now, so don't torture yourself before you know anything for sure. While missing 18-20 questions is not good, it's out of your hands now.

As for the CCS cases, I had read that sometimes a patient crashing is just part of the case, not necessarily the result of mistakes on your part. They may just be testing your ability to deal with such circumstances. You just don't know. And of course you do receive partial credit.

My advise, don't beat yourself up and have a drink on me for now🙂

Best Regards...J/S

 

[NuMD97]

I took the test on July 2 and 3. I left approx 18-20 questions unanswered in the entire 2 day test. I just didn't have enough time to cover all of them. I had one block in which almost all the questions were very long. I don't know if this has happened to other people.

In addition, I don't think I met the entire management guidelines for 2-4 of the CCS patients. I had the pt with Aortic stenosis and I consulted him to surgery but they didnt do crap. I should have done it myself, but I forgot about it during the test. Anyway I gave him B-B and he passed out. I frieked out so I admitted him, but didnt operate. I am very silly.

Any support guys. I am not sure but having to repeat this test would suck. I am tired of these USMLE's and the money I give away to NBME.

This is such a strange question. AS is not treated medically in any optimal sense. It's a surgical case. Giving beta blockers can cause the patient to stroke out. (I'm guessing that's what happened to your patient.) I can see this as a MCQ question, but not as a CCS case. What the heck do they expect you to do besides consult surgery? You're supposed to take this test as a primary care physician, for heaven's sake.

This is not meant to scare you, but hopefully someone can give some insight into this bizarre case scenario.

 

[BitterPill]

I think a cardiology consult should have been asked before consulting surgery, for measuring the pressure gradient across the valve by Doppler echocardiography (if greater than 80, requires valve replacement unless pt is symptomatic, in which case sx is indicated anyway). In the meantime, cardiac failure should be treated if present.

Dont worry about screwing up CCS.....its only 20% of the total score. I didn't write the diagnosis for my 1st 2 CCS cases because I just zoned out. In another case of stable angina, my pt passed out on oral nitrates. None died, but initially all those things were unnerving. I ended up passing the test anyway. Missing 18-20 questions.......depends on how you did the other 200+.

Relax for the next 4 weeks and then start worrying about the results🙂

 

[NuMD97]

I think a cardiology consult should have been asked before consulting surgery, for measuring the pressure gradient across the valve by Doppler echocardiography (if greater than 80, requires valve replacement unless pt is symptomatic, in which case sx is indicated anyway). In the meantime, cardiac failure should be treated if present.

You're absolutely right. That's the answer: Dopplers, cards consult, then surgery.

Thanks for your input.

 

[Faebinder]

Guideline for Aortic stenosis depends on symptomatic vs asymptomatic but it does sound like it was part of the case not a wrongful way of managing it.

I don't know about leaving questions unanswered. Did you at least guess those questions?

 

[Blade28]

I probably would have ordered an echo (TTE vs. TEE), Cards consult, CT Surg consult. You're not supposed to operate yourself!

 

[l&usibari]

I had the aortic stenosis case on my Step 3 exam today. After I ordered an echo (as an outpatient), he reported that he was getting lightheaded, so I admitted him, got a cardiology consult, then ordered an aortic valve replacement. I was then told the surgery was being done and I had to just continue the medical management.