USMLE CS workup question

[palakas]

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This is concerning the Mini cases found in the FA CS book.

I came across quite a few examples where the workup seemed pretty extreme and unnecessary considering the top three differentials given (which is what we will be writing in our notes)

For example
The vignette illustrates the typical panic attack scenario so the differential is
Panic attack
Generalized anxiety
disorder
Acute stress disorder
Specific phobia
Hyperthyroidism
Agoraphobia
Substance abuse/
dependence
Mitral valve prolapse
Pheochromocytoma

Now the work that follows is almost as long.

CBC
Electrolytes
TSH, FT4
ECG
Echocardiography
Urine toxicology
24-hour urinary
catecholamines

In the context of the actual CS exam. What would be actually appropriate for a patient with a very typical panic disorder scenario?

The reason I am asking this is that the USMLE CS manual specifically states that we will be docked marks for unnecessarily expensive workups (ie: CT Head/neck for sore throat)

How did you guys go about this particular challenge?

Thanks for your input guys

 

[Phloston]

This is concerning the Mini cases found in the FA CS book.

I came across quite a few examples where the workup seemed pretty extreme and unnecessary considering the top three differentials given (which is what we will be writing in our notes)

For example
The vignette illustrates the typical panic attack scenario so the differential is
Panic attack
Generalized anxiety
disorder
Acute stress disorder
Specific phobia
Hyperthyroidism
Agoraphobia
Substance abuse/
dependence
Mitral valve prolapse
Pheochromocytoma

Now the work that follows is almost as long.

CBC
Electrolytes
TSH, FT4
ECG
Echocardiography
Urine toxicology
24-hour urinary
catecholamines

In the context of the actual CS exam. What would be actually appropriate for a patient with a very typical panic disorder scenario?

The reason I am asking this is that the USMLE CS manual specifically states that we will be docked marks for unnecessarily expensive workups (ie: CT Head/neck for sore throat)

How did you guys go about this particular challenge?

Thanks for your input guys

I haven't even taken the CS yet (mine is in 1.5 weeks) and can tell you the FA DDx and investigations are incredibly off and superfluous.

This is a huge flaw of the FA book because this for sure is not what is wanted on the real exam, and as you've pointed out, the USMLE website specifies this. I've been using the blank note form on the USMLE website to write up the FA cases and will typically have 2-3 DDx, each with 2-3 points from the Hx (some of them essentially repeat Hx points), and sometimes zero to 2 examination findings. It's tricky because I can't tell if they want relevant negatives for the examination findings (e.g., no cold intolerance, etc.) if you list depression as the DDx. But in short, the FA DDx and Ix are horribly superfluous and would definitely result in point deductions.