Help!! Regarding differential diagnosis on Step 2 CS

[themotions]

Hi guys,

I am really worried about this part. I keep trying to narrow it down to three differentials, but sometimes, they just aren't likely!

My questions:

1.Is it ok to write the reason (next to Diagnosis 2 and 3) it is less likely? Or, will be penalized? (see bolded writing in example below)

2.How much history and PEx support is necessary for a diagnosis?

EXAMPLE:

Patient w/ painless hematuria in FA (pg. 264)
Diagnosis 1: Bladder CA
Hx and PEx support: Painless hematuria; possible obstruction of R ureter; strong smoking hx; CVAT
Diagnosis 2: Urolithiasis - less likely in absence of acute flank pain. Hematuria is usually microscopic
Hx and PEx support: Hematuria; R CVAT
Diagnosis 3: BPH- may be concomitant issue; however, does cause hematuria usually.
Hx and PEx support: Obstructive urinary symptoms, chronic


I truly appreciate your feedback!!! Thank you, thank you, thank you!!!

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[y2potato]

No i would n't do that. Also in your actual exam, their symptoms and signs are vague enough that at least two or three diagnoses will be considered. Please someone respond to it if you dont agree with me.

 

[evilbooyaa]

Most times at least 2 things are reasonable. I just took it and there were a couple cases where my differential was only one thing. Any time I felt I could rule a disease out, or didn't have any supporting history/PE findings for it, I left it out. I had 3 diagnoses for maybe 1/3rd of my cases, and 1 diagnosis on 2 of them I believe.

All this being said, I don't think you should write reasons why smoething is more or less likely. Just put all your positive evidence (both positive and negative findings) in your most likely diagnosis.

 

[CSdude]

A differential diagnosis can be included even if it does fulfill all the criteria enlisted for that particular DD . For eg if in a case of appendicitis you have fever, pain RIF, nausea/vomiting. You can enlist it even if there is no fever (dont have to give your reasoning or say less likely etc).