How to Use Minicases in Firstaid Step 2 CS

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workhard123

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Hello, I am a 4th year starting to study for step 2CS using firstaid. I have 25 days before my practice test offered by my school and about 2 months before the actual test. I want to study for the practice as if I am preparing for the actual test. I won't have a partner to study with until a little over a month from my test date which is Jan 23rd 2018.

I have a question regarding the firstaid book. I understand that doing the 40 full length cases with a partner are a must. however, the differential diagnosis associated with a complaint based on those 40 cases alone is quite limited.

For example--for CC of Headache, the differential dx for that case is limited to three actual possibilities based on the standardized pt's answers which are migraine, Tension headache, and intracranial mass lesion. Some additional DDx that are listed for reference are depression, pseudotumor cerebri, cluster headache, and sinusitis. Again- this seems limited to me.

Is this where the minicases come into play? I don't really understand how to incorporate the minicases into my study plan. Obviously, the minicases section doesn't go into detail about each of those differential possibilities. should I learn the details (the clinical features, maybe some epidemiology, which tests to order) for each of them on my own?

Should I read minicases pertaining to each CC first followed by the full length cases?

The minicases are really confusing me as to their utility and purpose.

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Hello, I am a 4th year starting to study for step 2CS using firstaid. I have 25 days before my practice test offered by my school and about 2 months before the actual test. I want to study for the practice as if I am preparing for the actual test. I won't have a partner to study with until a little over a month from my test date which is Jan 23rd 2018.

I have a question regarding the firstaid book. I understand that doing the 40 full length cases with a partner are a must. however, the differential diagnosis associated with a complaint based on those 40 cases alone is quite limited.

For example--for CC of Headache, the differential dx for that case is limited to three actual possibilities based on the standardized pt's answers which are migraine, Tension headache, and intracranial mass lesion. Some additional DDx that are listed for reference are depression, pseudotumor cerebri, cluster headache, and sinusitis. Again- this seems limited to me.

Is this where the minicases come into play? I don't really understand how to incorporate the minicases into my study plan. Obviously, the minicases section doesn't go into detail about each of those differential possibilities. should I learn the details (the clinical features, maybe some epidemiology, which tests to order) for each of them on my own?

Should I read minicases pertaining to each CC first followed by the full length cases?

The minicases are really confusing me as to their utility and purpose.
I think you're missing the point of the test a little. On the exam, you can only list 3 possible diagnoses at most, and the ones with the most evidence/likelihood are the ones they want to see. The cases are structured such that there is a clear "most likely" diagnosis as well as pretty clear "likely" diagnoses. The point of the mini cases is to practice being able to narrow down the differential to half a dozen things in the first moments of the case so that you can ask the right questions and do the right physical exam components to rule out some of those and develop a clear hierarchy of likelihood. The most challenging part about this test is not the clinical knowledge per se, it's the time management. You don't need to come up with the most inclusive headache differential imaginable, you need to be able to talk to and examine the patient in 10 minutes and have enough info to reach a clear most likely answer.

Common things are common, hoof beats=horses not zebras are cliches for a reason. Those differentials are not "limited."
 
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I think you're missing the point of the test a little. On the exam, you can only list 3 possible diagnoses at most, and the ones with the most evidence/likelihood are the ones they want to see. The cases are structured such that there is a clear "most likely" diagnosis as well as pretty clear "likely" diagnoses. The point of the mini cases is to practice being able to narrow down the differential to half a dozen things in the first moments of the case so that you can ask the right questions and do the right physical exam components to rule out some of those and develop a clear hierarchy of likelihood. The most challenging part about this test is not the clinical knowledge per se, it's the time management. You don't need to come up with the most inclusive headache differential imaginable, you need to be able to talk to and examine the patient in 10 minutes and have enough info to reach a clear most likely answer.

Common things are common, hoof beats=horses not zebras are cliches for a reason. Those differentials are not "limited."



I don't think the OP is missing the point. I agree with everything you said, and I could't agree more that the test is not about clinical knowledge, but about the time management and communication skills. But I completely get what the OP is asking. First Aid is not comprehensive source of all the possible differential diagnoses, just the most likely ones for that patient in that specific case. What if the patient with the headache presented with "the worst headache in their life", or with periorbital pain and ipsilateral nasal congestion, for example, or with fever and positive Brudzinski.. Then your list of most likely diagnoses would be quite different than the one presented in FA..
 
I don't think the OP is missing the point. I agree with everything you said, and I could't agree more that the test is not about clinical knowledge, but about the time management and communication skills. But I completely get what the OP is asking. First Aid is not comprehensive source of all the possible differential diagnoses, just the most likely ones for that patient in that specific case. What if the patient with the headache presented with "the worst headache in their life", or with periorbital pain and ipsilateral nasal congestion, for example, or with fever and positive Brudzinski.. Then your list of most likely diagnoses would be quite different than the one presented in FA..
Maybe I'm misremembering the mini cases but what you described is what they are. It's not just "headache" it's an entire section of various headache complaints. First it's "25F w/ 8 hours of severe headache with nausea, visual aura, and photophobia" and then the next one is "College student with headache, fever, nausea, vomiting and neck stiffness" then it's "Overweight 32F with headache and pulsatile tinnitus" etc. You don't need a 15 item differential for those, and if certain scenarios are completely absent from the book, that's because it's extremely unlikely to be on the test. I remember feeling like multiple cases on CS were identical to ones in FA and the rest were similar enough that nothing was a surprise. It is nothing more than a test prep book, and it is anything but "too limited."
 
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