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USMLE Step 2 CS Forum USMLE Step 2 CS Discussion Forum: Let's talk about anything related to USMLE Step 2 CS exam


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Old 10-11-2012
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Question Recent test takers please advice on what to focus on

We have a lot of people, who just got their "pass" here. Guys please advice. Are we gonna do fine by concentrating on DDx in FA's 44 cases and on the first diagnosis in each minicase? Let me explain what I mean. Minicases have a lot of somewhat weird DDx like syringomyelia, schizoaffective disorder, delusional disorder etc. Do you think we can get a case with any of the above being the primary diagnosis?? Should we sweat with all the schizo's and mood disorders and differentiating among them? You know, differentiating schizoaffective vs schizophreniform disorder is tricky.
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FA will suffice for preparation in terms of variations in cases you will see on test day. Just think that they will more likely than not give you MOST COMMON cases you would see in a Family Med clinic (HA, back pain, fatigue, etc.) so don't worry about complicated diagnoses that only a specialist in the field would be able to diagnose. You're only limited to 3 DDx's with the new format, and on most of my cases I put maybe 2 that I could support with evidence from the H&P. My advice would be to practice typing the PN and timing yourself especially with this new format. Good luck!
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Thank you so much girldaph. So do you mean that you were listing only 2 DDx for most of your cases and that tactics worked? Was the primary diagnosis straightforward on most of your cases?
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Quote:
Originally Posted by Lotsahope View Post
Thank you so much girldaph. So do you mean that you were listing only 2 DDx for most of your cases and that tactics worked? Was the primary diagnosis straightforward on most of your cases?
Yeah...I mean if I could only come up with 2 DDx's that I could support with my findings from H&P, then that's what I did. I'm not saying that you SHOULD do the same...if you can come up with 3, I'm sure it will only help you more. Most of the cases will provide you with enough evidence to support more than one diagnoses For example: a pt c/o low back pain. From your findings there's paravertebral tenderness and negative SLR test and neuropathy...I think they do this JUST SO you can have several DDx's and can write in your PN the evidence that supports it. Of course you want to put the most probable Dx first, but if you've practiced the PN online, there's a little arrow that allows you to re-arrange the order of the Dx's.

Honestly, there were about 2 cases that I couldn't come up with a DDx on the spot...so when it came to closure, I would be very general like "well it looks like he may have an infection..." a Peds case where everything I asked was negative. But the rest will be straightforward.

Hope this helps!
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This helps a lot. Thank you
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Quote:
Originally Posted by Lotsahope View Post
We have a lot of people, who just got their "pass" here. Guys please advice. Are we gonna do fine by concentrating on DDx in FA's 44 cases and on the first diagnosis in each minicase? Let me explain what I mean. Minicases have a lot of somewhat weird DDx like syringomyelia, schizoaffective disorder, delusional disorder etc. Do you think we can get a case with any of the above being the primary diagnosis?? Should we sweat with all the schizo's and mood disorders and differentiating among them? You know, differentiating schizoaffective vs schizophreniform disorder is tricky.
I recently did the CS in LA and from my experience the approach to the cases are very straight forward. This exam is not about getting the 'right' diagnosis as most cases will have symptoms that fit in more than one diagnosis. I didn't encounter any weird things like syrinomyelia.

Keep in mind that this exam is mostly about how you approach a patient with certain symptom/s (bedside manners ect.) and how you would do the work-up for the most likely causes. I had 1-3 DDx and some of them were far-fetched. I still had high performances in all 3 subcomponents.

Hardly anybody will fail in this exam because of the DDx. I didn't find the mini-cases in FA very useful.
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Old 10-21-2012
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Quote:
Originally Posted by Lotsahope View Post
We have a lot of people, who just got their "pass" here. Guys please advice. Are we gonna do fine by concentrating on DDx in FA's 44 cases and on the first diagnosis in each minicase? Let me explain what I mean. Minicases have a lot of somewhat weird DDx like syringomyelia, schizoaffective disorder, delusional disorder etc. Do you think we can get a case with any of the above being the primary diagnosis?? Should we sweat with all the schizo's and mood disorders and differentiating among them? You know, differentiating schizoaffective vs schizophreniform disorder is tricky.
For the exam you tend to get easy things to put in your differential diagnosis. The cases are usually presented with cases you are highly likely to see if you have an office. The minicases in FA do give some strange far fetched things that they added; I think they did it as a just in case you can stretch it if you forget the common place things. However do be careful of putting things on your differentials that have absolutely NO evidence based on the chief complaint, your physical or the given history, as you can get deducted for something that is not at all likely. However given you need only up to 3 differentials this should not be a problem. Sometimes you do get a case where only 2 things seem to be likely so do not worry if you only come up with 2, 3 is better but 2 is just fine as well. Good Luck!
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