Step II Step 2CS - initial vs all tests

[pseudonymcerebri]

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Hi all, couldn’t find this in another thread but apologies if it has already been answered:

How would you suggest approaching ordering tests when your work-up depends on the results of initial tests?

For example: patient presents with amenorrhea I would do a urine bHCG first and decide on which other tests to do depending on the results... Or someone has rectal bleeding I would perform an exam before deciding on doing any other tests (most of the time)

Thanks for your advice!

 

[GunnerBMS]

For example, in amenorrhea case, when you get to the diagnostic tests portion of the patient note you would list: 1. urine bhCG. 2. Serum FSH 3. Serum TSH 4. Serum Prolactin.

In the real world, you would order pregnancy test first then move onto the Fsh, TSH, prolactin next if pregnancy test was negative. But on the test you have to show you know something about the chief complaint and how to work it up. Ordering a FSH, TSH and prolactin would be reasonable for chief complaint of amenorrhea. The way you communicate to the grader that you know the pregnancy test comes first is by ranking it first in your list of diagnostic tests then listing those other tests after to show that they are secondary to the inital test.

Honestly, as long as you order reasonably indicated tests then it is okay to list them. No one is going to order an MRI on a women with amenorrhea initially, so there is no reason to list it.

 

[chickensoupdr]

So should the work up be everything you would do to rule in/out the three differential diagnoses? Or should it consider more than the three that you listed?

 

[medlife10]

For example, in amenorrhea case, when you get to the diagnostic tests portion of the patient note you would list: 1. urine bhCG. 2. Serum FSH 3. Serum TSH 4. Serum Prolactin.

In the real world, you would order pregnancy test first then move onto the Fsh, TSH, prolactin next if pregnancy test was negative. But on the test you have to show you know something about the chief complaint and how to work it up. Ordering a FSH, TSH and prolactin would be reasonable for chief complaint of amenorrhea. The way you communicate to the grader that you know the pregnancy test comes first is by ranking it first in your list of diagnostic tests then listing those other tests after to show that they are secondary to the inital test.

Honestly, as long as you order reasonably indicated tests then it is okay to list them. No one is going to order an MRI on a women with amenorrhea initially, so there is no reason to list it.

Shouldn't it be:

1-Pelvic exam
2-Urine Bhcg
3-U/S- Abdomen/Pelvic
4-FSH/LH/Prolactin
5-TSH, Free T4

 

[GunnerBMS]

Shouldn't it be:

1-Pelvic exam
2-Urine Bhcg
3-U/S- Abdomen/Pelvic
4-FSH/LH/Prolactin
5-TSH, Free T4

Ya, that is a correct