CCS question

[Tastebuds]

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On CCS, to move the clock forward, I always pick next available lab result. Is this the way to go?
Also, If you know the diagnosis, should you order the tests and treatment right away. For example, you know the diagnosis is SBO...and you order KUB which confirms the diagnosis should you also order EKG, CXR? Based on USMLE world CCS, you will not do well if you dont order all the extraneous information. But on the USMLE CD CCS cases, it doesn't like it if you know what the diagnosis is, and you still order other stuff!
Anyone have any insight to this? 🙁

 

[Law2Doc]

On CCS, to move the clock forward, I always pick next available lab result. Is this the way to go?
Also, If you know the diagnosis, should you order the tests and treatment right away. For example, you know the diagnosis is SBO...and you order KUB which confirms the diagnosis should you also order EKG, CXR? Based on USMLE world CCS, you will not do well if you dont order all the extraneous information. But on the USMLE CD CCS cases, it doesn't like it if you know what the diagnosis is, and you still order other stuff!
Anyone have any insight to this? 🙁

Next available result is fine if you are waiting for something. But if the patient has something where you really just want to see what happens to them in 10-14 days (ie if you are starting a course of antibiotics), then you really are going to want to schedule something.

As for ordering confirmatory tests, your goal is to approach this case like the typical resident. So you order certain general things first and then can hone in on the diagnosis. Once you do a more specific test and it shows, say, SBO, you wouldn't go back and order more general things. However I suspect you lose points by jumping right to a diagnosis or treatment. So really you need to approach it the way you would as an intern.

 

[Droopy Snoopy]

In general you want to throw a wide net for the initial diagnostic workup. Most of the time you'll get points as well as pertinent positive and negative info. But even if you don't gain any points, stuff like that is usually not going to lose you anything on CCS because it's noninvasive, cheap, and it takes no time at all. Besides, it's not like it's a bad idea to get an EKG and CXR on a possible pre-op patient.

 

[drkeller]

On CCS, to move the clock forward, I always pick next available lab result. Is this the way to go?
Also, If you know the diagnosis, should you order the tests and treatment right away. For example, you know the diagnosis is SBO...and you order KUB which confirms the diagnosis should you also order EKG, CXR? Based on USMLE world CCS, you will not do well if you dont order all the extraneous information. But on the USMLE CD CCS cases, it doesn't like it if you know what the diagnosis is, and you still order other stuff!
Anyone have any insight to this? 🙁

Advancing the clock with next available result is a good option but if you know the "report" time of your next important test, you can advance the clock to that time by choosing "on" option. This will save you "real time" . If you are comfortable with "next available result", that is fine as well.

One can not be 100% sure of the differential diagnosis. So, tests must be ordered to confirm your diagnosis under consideration ( KUB in your example) but tests should also include routine stuff always ( A CXR may reveal gas under the diaphragm in possible perforated viscus which can present with features similar to SBO, an EKG may be required in any elderly person since rhythm disturbances like afib may point to underlying pathology such as mestenteric ischemia or ischemic colitis. Also, an EKG may reveal abnormalities consistent with electrolyte distrubbances in a case of SBO as SBO can sometimes have, electrolyte disturbances. ) So, all these routine tests are useful adjuncts in the management of your principal diagnosis under consideration and carries points especially, if the CCS case is set in a way that one of these tests come up abnormal. Hence, such routine necessary adjunctive work-up must be carried out in all cases. ( My source: ********** workshop) .

An important point Archer brings up is that " you will not lose points for ordering unnecessary tests as long as they are NON-INVASIVE". An invasive unnecessary test will cause loss of score but a non-invasive unnecessary test will not cut your score as long as you manage the case in appropriate simulated time. Going by this, routine orders like CBC, CMP, U/A, CXR, EKG will not cause you to lose points when they are unnecessary but you will gain points if they happen to turn out abnormal and necessary for that case. So, I order them routinely for most ER cases.