Step 3 ccs/consults?

[Awarara]

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Just did a question on uworld where patient needs a endarterectomy. I consulted vascular surgery but they said no recommendations at this time, even after getting a carotid ultrasound. I was reading up on previous threads and not sure what the right move is.

On the real test, am I supposed to proceed with the endarterectomy if the consultant doesn't give any recommendations, or are they always supposed to give a recommendation if you sequence everything correctly on the real thing?

 

[bluemagik5]

Had a case that involved cholecystitis. I consulted surgery and the message goes “does not have recommendations.” However, the labs and presentation indicated they need it so I ordered a cholecystectomy (made sure to order NPO, type and cross, PT/PTT, INR, and preoperative antibiotics beforehand). Case ended and moved on to the next case. More often than not when you consult they don’t have recommendations. Just make sure if you are going to perform the procedure they REALLY need it.

 

[steveme]

Yes. Go by ********** for the consults and how actual exam software works. As shown in **********, you must place surgical consult first and then wait until you get a response "patient will be accepted for surgery". Software like UWorld are filled with errors and do not accept patient for surgery even when surgery criteria are met so that can be confusing. But on the actual exam software, you will receive a message "patient will be scheduled for surgery, proceed with medical management"once you meet the criteria for surgery. Meeting the criteria for surgery varies from case to case. In a case of thoracic aorta dissection, criteria for surgery can be as simple as proving that it is in ascending thoracic aorta by getting a CT Chest or TEE timed PRIOR to asking surgery consult --- this is referred to as exact sequencing in **********.
When you sequence that way, your result comes before surgeon sees the patient. You then get acceptance message. Once you get acceptance message, place the pre-op orders - TYPE/CROSSMATCH; NPO, IV NS, PT/PTT, NAME OF SURGERY ITSELF
So much goes in to this! But once you know the strategy, it is very easy to play with the actual exam software. Practice on USMLE exam software materials and when you use archer strategy with the software, the exam software moves smooth and this is how I got most of the above tricks from. Uworld software is a practice software but is not an exact replica of exam software so you are seeing the above mentioned problems. At least the criteria for surgery must be met before you enter the surgery name. On exam, the only way you know you met the criteria is when you get that acceptance message. Please note if you entered invasive surgery order without getting an acceptance message (means you have not met surgery criteria) and you may have ordered a surgery on someone who did not need it ( This is where UWorld errors can totally mess up the case for you).