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Old 01-04-2010
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Question 5 differentials and 5 work ups, is it a must?

Is it a must that we write down 5 differential diagnoses and 5 work up plan points?
What if the case straight forward fracture humerus for example! where do I find other diagnoses to fill up the other four?

Also, how do they score us in this regard. Are we going to miss points if we write wrong 2nd, third, fourth, or fifth differential or it's only the first diagnosis that matters and they are looking for that only.

Also, are they going to regard it as a mistake if you put for example the most obvious diagnosis as number two or three?

Thanks for your great help
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Old 01-04-2010
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Quote:
Originally Posted by obgynaim View Post
Is it a must that we write down 5 differential diagnoses and 5 work up plan points?
What if the case straight forward fracture humerus for example! where do I find other diagnoses to fill up the other four?

Also, how do they score us in this regard. Are we going to miss points if we write wrong 2nd, third, fourth, or fifth differential or it's only the first diagnosis that matters and they are looking for that only.

Also, are they going to regard it as a mistake if you put for example the most obvious diagnosis as number two or three?

Thanks for your great help
USMLE exam is structured in a way that each thing that u do on it has a significance, since you are aware of these mistakes , you know that they do have some significance in the exam that is why you are asking them in first place, the answer to all the question is BIG yes.... all these are mistakes but how big are these would be subjective, cannot be commented in "one size fits all" way , so the moral of the story..... try not making them , since you are aware they are mistakes(i am assuming,many would not even know they are....)
regarding your assumption of a case on cs being straight forward(fracture)i would say you have high expectations, you will not have straight forward cases, you would have cases that have 5 differentials... great luck practicing and learning about CS....
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Old 01-05-2010
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Default 5 Differentials in CS exam

Quote:
Originally Posted by obgynaim View Post
Is it a must that we write down 5 differential diagnoses and 5 work up plan points?
What if the case straight forward fracture humerus for example! where do I find other diagnoses to fill up the other four?
Yes, it's better to write all the 5 to be on the safe side. However, some teachers think that three is the threshold to safety but I disagree with that.
You can always find other differentials even if it's straight forward fracture, like you can say a dislocation of the joint above or below, muscle strain, ligament tear, bone tumor, physical abuse, ...etc
Also remember that your differential list may not be necessarily differentials in the strict sense, they can be problem list. For example; Angina pectoris, gastroesophageal reflux disease, hypothyroidism, elder abuse ...etc

Quote:
Originally Posted by obgynaim View Post
Also, how do they score us in this regard. Are we going to miss points if we write wrong 2nd, third, fourth, or fifth differential or it's only the first diagnosis that matters and they are looking for that only.

Also, are they going to regard it as a mistake if you put for example the most obvious diagnosis as number two or three?
The hierarchy of the list is very important and you have to put your most likely diagnosis as the first one. In fact, it is postulated that if you get the first diagnosis right then you are going to pass that case no matter how 'wrong' you are in the other differentials.
If you put the most likely diagnosis in a lower rank then you are definitely going to miss points from your score.
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