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Old 04-21-2012
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Unhappy Best next step questions; best initial or best accurate?

hello
I am having a tough time with a certain aspect of CK prep which is what is the most appropriate next step?
can some kindly explain how to answer that kind of question. for example theres a case in mtb 2 in which a man clearly has acute mesenteric ischemia and you are to select the most appropriate next step. the options include CT scan of abd (the best initial test for ischemic bowel dx) and angiography (the most accurate test also for ischemic bowel dx). the answer was angiography, my confusion is when do you select the best initial test (BIT) as the most appropriate next step and when do you select the most accurate test(MAT) as the most appropriate next step.
another example is a case that from the description is clearly acute pancreatitis, and you are asked most appropriate next step with both serum amylase & lipase and CT scan as options.
thanks
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Old 04-21-2012
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I am also loosing q over similar confusion. I thought to go with noninvasive test rather than invasive when q asks best next step. most appropriate means most diagnostic and most confirmatory means most accurate . and in emergency scenario single most which is diagnostic but less invasive...helps me in some case scenario but still missing some q...please can any one give any tip or help in tackling this scenario??
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Old 04-21-2012
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i think its about whether the Question you have is an emergency or not..
in an emergency u wud like to do only one test which wud be most accurate...

if u hv the time.. u'd hv the time to go thru the best initial and then the rest of the steps..

make sense?
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thanks mbbs
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Old 04-21-2012
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Default most approprite

in most approprite means u have now both option test or treatment so now its upon qs which case is presentating in front of us, e.g if pt is present with headache, temporal tenderness and slight vision disturb suspecting dx temporal arthritis now what u do, u dx this case with ESR or temporal biopsy or u tx this with high dose prednisone, tx this case, so most appropriate means both option we have, its not most accurate test, i hope u got, this is step 2 ck we have to tackle situation on status of pt...
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