Step 2 CS question about work-up

[DrShazam]

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Based on FA, it seems like the more is better. Is that right or are we supposed to pick tests prudently, trying to get the diagnosis with the least amount of tests?

 

[H Y F R]

I have the same question. I'd love to know, considering I'm taking it on Saturday....

 

[cbrons]

I thought the cheapest/least invasive was best.

I think the High Value Care Recommendations in the IM Essentials book (or the online version from ACP) are really good for stuff like this. Just some examples:

• Routine resting electrocardiograms (ECGs) are not recommended if there have been no changes in symptoms, examination findings, or medications. A repeat stress test is indicated if there is a change in symptoms but should not be performed routinely.
• Echocardiography should not be used to screen for heart failure in asymptomatic patients without murmurs.
• Echocardiographic reassessment of ejection fraction is most useful when there is a notable change in clinical status rather than at regular or arbitrary intervals.
• Routine serial echocardiography is not needed in asymptomatic patients with prosthetic heart valves.
• Sputum Gram stain and culture are not indicated in hospitalized patients with less severe pneumonia, but they should be obtained for any patient at risk for infection with drug-resistant or unusual pathogens or those with severe pneumonia.
• Only obtain a chest radiograph after initial therapy for community-acquired pneumonia if the patient does not respond to treatment, or to document resolution of pneumonia with risk factors and suspicion of an underlying disease, such as malignancy.
• Urinalysis should not be ordered as part of a routine well care examination in men and nonpregnant women.
• In clinical practice, the diagnosis of osteoarthritis should be based primarily on history and physical examination findings. Laboratory tests are not helpful for diagnosis.
• Due to low sensitivity, the absence of findings on plain radiography does not rule out symptomatic disease in any joint.