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Old 03-27-2014
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Default confusing concepts for IM

hi guys i have started on Im and noticed when going though various books including Step up, MTB2,3, kaplan lecture notes, videos, CMDT for example, that a lot of books mention different things in terms of next best step in diagnosis.

for GERD--after PPIs are given and the pt isn't getting better the next step is to do endoscopy--according to CMDT, but MTB2,3 say to do 24 hr ph monitoring, while step up to medicine says something different.

for lower gi bleed-- MTB 2,3 say to use endoscopy first for a lower gi bleed, but many people on the various usmle forums/ UW say to use the RBC labelled scan, but the CMDT says colonoscopy. And to make things more complicated, some books recommend that we do angiography if there is massive bleed, but CMDT says colonscopy can be done even if massive bleed....

for solitary pulmonary nodule---after getting an old xray, and the pt being asymptomatic, the kaplan videos say to monitor with repeat cxr every 2-3 months, but the step up to medicine says to use CT or a PET based on size, but some people on the usmle fourms say to do biopsy, while others think to do a PET scan or just reassure the pt

for DVT-- if there is high suspicion of DVT-- MTB2,3 say to do a CT but step up says to do a v/q, while IM kaplan lecture notes says CT, but some people on the forums say v/q is better....

so as you can see I am really confused here, I really appreciate what people say on the forums, because its very interesting and educational, but it also is starting to freak me out, I feel as if there is no one resource which I can be 100% sure is the correct way of doing things...

my question is that why are all of these books/ resources different (shouldn't there be a standardized way of doing things in medicine, maybe not in the real world but at least for the exam), and these areas of confusion ----can the real exam ask this stuff even though different resources(UW, kaplan notes, MTB, etc.) disagree on the next step?
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Old 03-27-2014
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Ive experienced some of this also, especially some differences between the kaplan qbank and uworld.

I think for this exam if you use multiple sources, this kinda thing happens a lot. I think its one argument for just picking one qbank (uworld), and one reference text, and just going with that.

My hope is that on the real exam the questions wont make you choose between options which are very reasonable and preferred differently in different texts without giving you at least some hint / clue in the question as to why one choice might be better than the other.

Having done all the NBMEs for CK now i didnt once come across a question were this type of discrepancy in first / next / best step was an issue...there's always something to lead you down one particular road. I think if you just recognize situations like you've described, and know the pros and cons of each option, hopefully will be able to work through any question on it.

Thats what im really hoping anyway, my exam is in 4 days now so its a bit late to go any other way!
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Old 03-27-2014
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It would be very useful to hear from anyone whos done the exam and found this to be an issue on the real questions or not?
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