I tried the search function, I don't see a dedicated thread... so I'll ask herein.
How do you guys recommend using FA for Step 2CS? I feel like I have no problem asking the right questions and reaching the actual diagnosis, but "expanding" (i.e. bullsh*tting) the ddx and coming up with the "next steps" is really hard...
The first issue is in purposely finding wrong answers to fill in my differential (FA is a perfect example for this; it will describe temporal arteritis perfectly, then put something that doesn't fit well at all -- like trigeminal neuralgia -- in the differential).
The second issue, and the more difficult one, is deciding what tests/imaging to order. For instance, FA says that carotid dopplers should be done on the temporal arteritis patient, but I assume this is only b/c carotid dissection is ALSO on the differential. I already KNOW trigeminal neuralgia and carotid dissection don't fit the clinical picture, so I don't feel right ordering superfluous tests to evalutate them in my 2CS workup.
If you follow FA, every patient with a headache should have a CT or MRI, ESR, and often an LP. I find this to be ******ed.
Overall, my questions are:
(1) do you have any suggestions on how to actually get meaningful information from FA for 2CS?
(2) how do I decide what to order, in light of ******edly expanded differentials (required by 2CS) that are almost not certainly consistent with the complete clinical picture?
Thanks!
How do you guys recommend using FA for Step 2CS? I feel like I have no problem asking the right questions and reaching the actual diagnosis, but "expanding" (i.e. bullsh*tting) the ddx and coming up with the "next steps" is really hard...
The first issue is in purposely finding wrong answers to fill in my differential (FA is a perfect example for this; it will describe temporal arteritis perfectly, then put something that doesn't fit well at all -- like trigeminal neuralgia -- in the differential).
The second issue, and the more difficult one, is deciding what tests/imaging to order. For instance, FA says that carotid dopplers should be done on the temporal arteritis patient, but I assume this is only b/c carotid dissection is ALSO on the differential. I already KNOW trigeminal neuralgia and carotid dissection don't fit the clinical picture, so I don't feel right ordering superfluous tests to evalutate them in my 2CS workup.
If you follow FA, every patient with a headache should have a CT or MRI, ESR, and often an LP. I find this to be ******ed.
Overall, my questions are:
(1) do you have any suggestions on how to actually get meaningful information from FA for 2CS?
(2) how do I decide what to order, in light of ******edly expanded differentials (required by 2CS) that are almost not certainly consistent with the complete clinical picture?
Thanks!
