not the question...the case can end but at the end of each case after the 5min mark has already come up you have a chance to revise orders or enter new orders. medications such as antibiotics continue to show up on that list in the uworld cases. i was asking whether at this time, would you delete the antibiotics in that final screen before you enter your final diagnosis.
Let me answer your question more from what I learned. First, discard overactive brain's comments from your mind ( those are UW thoughts which give zero score).
The 2 min screen ( new version has 2 min screen) is a very important screen - it is not for struggling people or scrambling people. The 2 minute screen is intended to monitor the patient. "Monitoring" is very important on Step 3 CCS cases to see if your treatment is having any adverse effects or if your treatment is successful. You can do this monitoring on earlier screen but you will not have "later" option when you are actively managing the patient. The options you get when you put in orders on initial screen are either "routine" or "stat" . There is no "later" monitoring. The 2 minute screen provides that important advantage - You can not do this "later" monitoring here. When you click on "later" option on 2 min screen, a calender comes up and you can choose the exact dates when you would like a test to be done. This is important. An example : A case of hypothyroidism where you start patient on levothyroxine. The software expects that you monitor if the patient is receiving adequate therapy . We are supposed to check TSH level 4 to 6 weeks "later" i.e; 6 wks after starting levothyroxine before we adjust the dose of therapy. When case ends and you reach "2" minute screen, choose "later" , select approximately 42nd day on calender and order TSH. This is only of the examples. There are many cases on CCS where "later" monitoring is needed and not doing it , we lose score.
Specifically, to answer your question about discontinuing the antibiotics on "2" min screen : This is where the concept of simulated time comes in which "overactivebrain" always argues with me here because UW ignores that concept. If you check primum (
www.usmle.org); you will see that huge portion of scoring is based on Simulated time. Ignoring the importance of simulated time is like losing half the case. You can go very far in smulated time in just 15 minutes of real time and that can end the case. Simulated time is the time in patient's life, real time is the time given to us to complete the case. While adjusting the orders on 5 minute screen, you should check simulated time first because this is the "point" time in patient's life ( i copied this matter from another forum)
Now, when we reach 2 minute screen, we should first look at "simulated time" . When you reach 2 minute screen on Primum, it will tell you to enter orders that are important "NOW" - The word "NOW" is important because they want you to enter orders or discontinue orders as appropriate at that "point" simulated time. Because simulated time is defined as the time since patient's arrival in ER , you should not discontinue any of the needed orders if the appropriate number of days ( total course of abx) have not passed .
For example; if your patient needs 7 day antibiotic and case ends, you should check the simulated time on the 5 minute screen to make sure it is not showing 7 days yet. If it is showing 7 days, take off the IV abx. If simulated time shows < 7 days, do not d/c the IV abx.
If it is not clear, please ask. Will explain
