Step 2 CS - work up question

[smz813]

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I'm taking CS next week and I'm a little bit confused about what they want. I've read Kaplan Core Cases and now I'm reading FA. In FA they list ridiculous work ups - for a patient with GERD who in real life, based on current guidelines, needs a trial of PPIs, they list a barium swallow, upper endoscopy, etc. For a patient with most likely tension HA they list LP, CT head etc.

Do they want us listing every single possible thing the patient may need in the future? Should we be saying based on results of CXR, then possible CT chest?

Also, if FA is correct in their work ups, isn't CS teaching bad medicine?

Any advice is greatly appreciated!

 

[hoopie]

Something to consider is that for this test you're not really going to have clear cut diagnoses. You're supposed to come up with 2-3 differentials for your patients and then your work-up is based around those. So if for example you have a headache patient and your most likely differential is migraine but you also put brain tumor in your differential, you're going to put like MRI and whatever in your work-up, even if in real life you wouldn't necessarily go to that without particular signs/symptoms present, but for the purposes of this test putting a brain tumor is an easy/reasonable differential to include and that would be part of the workup.

Supposedly they do take ordering appropriate and cost-effective tests into consideration for your grade so you are discouraged from listing every possible test available if they aren't really necessary. Me, I kind of just went with the list as much as I could think of within reason approach and it turned out fine. Unfortunately they don't tell you any breakdown so I don't know what things I missed points on.