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Default 2 OR 3 DDx's on Step 2 CS exam

A third differential diagnosis earn more points than just 2 DDx on Step 2 CS exam?

Answer- NO: In grading the exam it really doesn't make any difference. More importantly is the history and physical findings that support your DDX. So do not over flog it. If the SP gives you much details that supports 3 or more diagnosis, great, then write the best closest 3 DDx and support them with enough history or physical findings. Otherwise, stick to 2 DDx's as much as you have findings that support them.
Having said that, some cases are clearly 3 DDx's cases and is vital you state your 3 DDX's for those cases. A no-no is having just 1 DDx. No clinical encounter is designed to have only 1 DDx, you must have at least 2 and at most 3 DDX's.

How do I know which case should have a 3rd DDX?

The clue is if you're struggling to make up a 3rd DDx then is a 2 DDx's case. With adequate studies and prep your DDx's should come to you few minutes during the encounter. That being said, most cases obviously would be a 2 DDx's case while some would be a 3 DDx's. Few instances of common cases that would be clearly 3 DDx's (most pain cases, dementia in an elderly pt on multiple meds or co-morbidities, most MSK cases etc ).

In conclusions, instead of scoring high by making up poorly supported third DDx, you might end up losing points and hurting yourself badly. Let's look at it this way: Having a DDX with no good supporting findings is like, you as an intern or resident and you presented a case of possible diagnosis to your attending physician and he asks 'can you tell me why you think this could be a possible diagnosis'' and you respond by 'I don't know I just feel like having it there'', sounds terrible right.
Recognize in your test, some cases would have 3 or even more DDx's. Choose the best 3 with as much supporting findings as possible, otherwise stick with the best 2DD'x you can support.

From Integrity Usmle Course, Good luck guys!
Keep in touch with us: iusmlecourse@gmail.com, learn more @ http://iusmlecourse.com
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