How detailed do you need to go with the diagnosis on Step 2 CS?

[Medstart108]

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For example, on FA, they suggest cardiac arrhythmias or hepatitis as the differential diagnosis in some of the mini cases.

In the exam, are they looking for you to provide more detail? For example, for an arrhythmia, would saying a-fib or vtach be something better?

Also, will they negatively look on you if you split something up into multiple diagnoses. For example, if you put ur top ddx as A-fib, your second as A-flutter and your 3rd as V-tach, would they count them all as one dx?

Also, sometimes in FA they write "secondary to" in their ddx. For example, if you have a history that sounds like HIV with a low CD4 count and you have a new pneumonia. Are they expecting you to write, pneumonia secondary to HIV infection? Or are they looking for MAC secondary to HIV? or are they looking for simply, MAC?

The reason i'm asking is also because I read on this forum that a computer is the one that first marks the ddx, which makes me worried since then you need to write exactly what the computer is looking for.

 

[NYCdude]

How on earth would you know what kind of arrhythmia it was with just a (fake) physical exam? lol

FA was pretty stupid with how they would randomly put specific or general diagnoses.

The best advice I can give you is just put the best diagnoses. That means, the first diagnosis has the most evidence, the second diagnosis the second most evidence, etc. Don't feel the need to list a 3rd diagnosis for no reason unless there is actual supporting evidence.

In terms of specificity, try to be as specific as possible and don't put "secondary to." If you think someone has MAC, then just write MAC pneumonia and list HIV as one of the supporting findings instead.

 

[Medstart108]

How on earth would you know what kind of arrhythmia it was with just a (fake) physical exam? lol

FA was pretty stupid with how they would randomly put specific or general diagnoses.

The best advice I can give you is just put the best diagnoses. That means, the first diagnosis has the most evidence, the second diagnosis the second most evidence, etc. Don't feel the need to list a 3rd diagnosis for no reason unless there is actual supporting evidence.

In terms of specificity, try to be as specific as possible and don't put "secondary to." If you think someone has MAC, then just write MAC pneumonia and list HIV as one of the supporting findings instead.

Ok, thanks! Another question I had was, I've read that there may be stations where there is a mannequin and all you need to do is a full physical examination.

Is this true? and if so, are these likely to be only 1 station at most? Also, would they ever make you do a newborn or infant exam on a mannequin for one of those stations or will they just be adult exams?

 

[NYCdude]

Ok, thanks! Another question I had was, I've read that there may be stations where there is a mannequin and all you need to do is a full physical examination.

Is this true? and if so, are these likely to be only 1 station at most? Also, would they ever make you do a newborn or infant exam on a mannequin for one of those stations or will they just be adult exams?

whaa? I literally never heard of mannequins being on the exam lol.

For peds cases, it'll probably be either a phone call station or there will be a young actor with a parent.

 

[Medstart108]

whaa? I literally never heard of mannequins being on the exam lol.

For peds cases, it'll probably be either a phone call station or there will be a young actor with a parent.

Ah i see, and if it is a young actor with a parent, do we talk to the parent only or the young actor? Would we have to do the "ask the parent to step out and speak to the kid alone about social history" thing?

 

[NYCdude]

Ah i see, and if it is a young actor with a parent, do we talk to the parent only or the young actor? Would we have to do the "ask the parent to step out and speak to the kid alone about social history" thing?

Just do what you would do in real life, i.e. talk to them both. And yeah, ask the parent to step out to ask about the sensitive stuff and tell the kid that everything is confidential, etc.