FA for CS2:Has> 5 DD & 5 work-ups.What to believe

[Nellyakgo]

I'm using FA for Step 2. The sample cases it gives it lists mostly 6 sometimes up to 8 differential diagnoses (DD) and same for work ups. For the text we are supposed to have max. 5 for each. So what am I to take as accurate? Why so many listed?

Separete question:
It lists some work ups and some DD which in my opinion are really extreme.

E.g. 50 yo female, recurrent episodes of bilateral squeezing headaches that occur toward the end of her workday. She is experiencing significant stress in her life. Suggested work up is CBC, electrolyts, ESR, head CT. Fine up to here. It also suggests LP. I'm thinking, really? Woudl I go ahead and do an invasive test before getting back the results of the others which are adequate for fist line?

Another example:
45 yo female, presents w/retrosternal burning that occurs after heavy meals and when lying down. Her symptoms are relieved by antacids. In the DD it lists GERD, Eosophagitis, peptic ulcer, eosaphageal spasm. Fine until here and that makes 4 DDs. Then it also lists MI and angina. Really? This is such a classic case of GERD. Then in the work up it lists 1)ECG, 2)Barium swallow 3)Upper endoscopy 4)Eosophageal pH monitoring. Really? Would you really spend all that money and order those invasive tests right away rather than diet, practical tips, antacids and monitor progress for a while?

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[Proverbs31]

I'm using FA for Step 2. The sample cases it gives it lists mostly 6 sometimes up to 8 differential diagnoses (DD) and same for work ups. For the text we are supposed to have max. 5 for each. So what am I to take as accurate? Why so many listed?

Separete question:
It lists some work ups and some DD which in my opinion are really extreme.

E.g. 50 yo female, recurrent episodes of bilateral squeezing headaches that occur toward the end of her workday. She is experiencing significant stress in her life. Suggested work up is CBC, electrolyts, ESR, head CT. Fine up to here. It also suggests LP. I'm thinking, really? Woudl I go ahead and do an invasive test before getting back the results of the others which are adequate for fist line?

Another example:
45 yo female, presents w/retrosternal burning that occurs after heavy meals and when lying down. Her symptoms are relieved by antacids. In the DD it lists GERD, Eosophagitis, peptic ulcer, eosaphageal spasm. Fine until here and that makes 4 DDs. Then it also lists MI and angina. Really? This is such a classic case of GERD. Then in the work up it lists 1)ECG, 2)Barium swallow 3)Upper endoscopy 4)Eosophageal pH monitoring. Really? Would you really spend all that money and order those invasive tests right away rather than diet, practical tips, antacids and monitor progress for a while?

FA lists EVERY POSSIBLE differential for you. You have to consider WORSE case scenario - i.e. what might kill this patient. Its not suggesting you do every single test - its giving you a list of all the reasonably prudent tests you should or could order. GERD many times mimics signs and symptoms of MI. Dont be so hard pressed to automatically think its a clean cut GERD case. You dont have other info, such as if pt was diabetic. Diabetes muffles the common presenting signs in many a patient. You would only get that info from asking the pt in the encounter usually.
Just use FA as examples to help you enlarge your differential and include the Worse case scenario differentials and their potential tests....If a pt had compromised renal and liver function or was on dialysis, you may have to do a LP first...just depends on your pt. Use FA as a GUIDE only. Hope that helps

 

[Nellyakgo]

Thanks for the feedback. I understand what you're saying.

I'd read somewhere though (Kaplan or FA) that on the CS 2 the cases will always be only straightforward cases with no compunding diseases. i.e. only 1 disease at a time. Does this still hold true?
So for example a patient with renal insufficiency wouldn't present with complaints of a possible migraine, and so on..

 

[Proverbs31]

Thanks for the feedback. I understand what you're saying.

I'd read somewhere though (Kaplan or FA) that on the CS 2 the cases will always be only straightforward cases with no compunding diseases. i.e. only 1 disease at a time. Does this still hold true?
So for example a patient with renal insufficiency wouldn't present with complaints of a possible migraine, and so on..

Well to be honest, Im not 100% certain on that....I dont know if a patient could present with a PMH of uncontrolled DM, HTN, etc....and their Chief Complaint to you is Headache....? I might think to be cautious with a CT in that pt...not sure...Good Question. Wish I was better help. Maybe someone else can clarify.