Step II Question about Step 2 CS orders

[pepes1lv1a]

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Are we supposed to include items in the workup that don't correspond to anything in our Ddx?

Example (taken from FA):

45 yo F presents with a retrosternal burning sensation that occurs after heavy meals and when lying down. Her symptoms are relieved by antacids.

Ddx: GERD, esophagitis, peptic ulcer dz, esophageal spasm, MI, angina

Workup: EKG, barium swallow, upper endoscopy, esophageal pH monitoring​

On the actual test, we're only supposed to include 3 differential diagnoses. Let's say those are GERD, esophagitis, and peptic ulcer dz. Is it better to include an EKG even though an MI isn't in the top 3 ddx, or to omit it because it doesn't correspond to any of the diagnoses we listed?

 

[gqman1234]

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[Major procrastinator]

Are we supposed to include items in the workup that don't correspond to anything in our Ddx?

Example (taken from FA):

45 yo F presents with a retrosternal burning sensation that occurs after heavy meals and when lying down. Her symptoms are relieved by antacids.

Ddx: GERD, esophagitis, peptic ulcer dz, esophageal spasm, MI, angina

Workup: EKG, barium swallow, upper endoscopy, esophageal pH monitoring​

On the actual test, we're only supposed to include 3 differential diagnoses. Let's say those are GERD, esophagitis, and peptic ulcer dz. Is it better to include an EKG even though an MI isn't in the top 3 ddx, or to omit it because it doesn't correspond to any of the diagnoses we listed?

only need EKG if they have chest pain. In your case GERD is likely but, angina could be 3rd ddx if they complain of any CP and then EKG is a must. if its just a burning sensation, and no cp with exertion or at any other time no need for EKG. your workup is to diagnose your differentials nothing else should be there.

For example if someone comes in for fatigue but your thinking cancer, anemia, diabetes then you cant and should not put TSH, free T3, T4 in your workup because those dont support any of your ddx