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Old 06-30-2013
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Question List the most fatal diagnosis first

Okay, so what I've gathered from the forums, most people say that we should list the most fatal diagnosis as the first one, so as to exclude it. How true is this idea?

For instance, FA case 27, its a classic case of disk hernia, but he has also symptoms of Prostate dz. Should we list Prostate cancer as first,even though in FA its #5?

Same goes for Epigastric pain in a DM. Should we put MI as first to rule it out? I am gonna put all the necessary workup anyway to exclude fatal causes even if they aren't in the differentials.

Or, chest pain in any patient, should we put MI/Angina as first to exclude it? Again, ECG/Enzymes will be mentioned in the workup anyway.

Let me know what you guys think about it.
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Old 06-30-2013
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I dont think you are required to put the most 'fatal' diagnosis as your first one. You first diagnosis should be your most likely diagnosis- the one for which you have the most evidence to support from the history/phys exam. For a female with RLQ pain, if most of her sxs are pointing toward Appendicitis (RLQ pain, N/V, Fever, Rebound tenderness, +Psoas/Rovsing etc) you would put appendicitis as the first one. Then proceed with other possible diagnosis (ovarian cyst, ectopic pregnancy etc). For a CP case, you can't use put MI/Angina for every patient. If it's a young female chances of her having an MI are very unlikely. What if the patient's CP varies with position/respiration, that would point out to classic 5P's diagnosis. FA's order of diagnosis is not always on point. I just went with the concept I mentioned above and passed.
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Old 07-01-2013
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Quote:
Originally Posted by Smashingdude View Post
Okay, so what I've gathered from the forums, most people say that we should list the most fatal diagnosis as the first one, so as to exclude it. How true is this idea?

For instance, FA case 27, its a classic case of disk hernia, but he has also symptoms of Prostate dz. Should we list Prostate cancer as first,even though in FA its #5?

Same goes for Epigastric pain in a DM. Should we put MI as first to rule it out? I am gonna put all the necessary workup anyway to exclude fatal causes even if they aren't in the differentials.

Or, chest pain in any patient, should we put MI/Angina as first to exclude it? Again, ECG/Enzymes will be mentioned in the workup anyway.

Let me know what you guys think about it.
From what I have heard there is no importance in the order in which you put things as long as all of them are there and you include the most fatal/morbid one.

My personal opinion is.. put as first the diagnosis that is most likely to be depending on the patient overall presentation.

Never put cancer as a first.. but include it (If it makes sense) and so on.

Dont worry to much about this, as long as whatever you put is within realm of logic and possibility you will be fine.

Another thing I did... I put as a first the diagnosis the one that had more histoy/PE findings and so on.. I did this just so that my PN note looked neat and cute

Last edited by XpaezX; 07-01-2013 at 04:20 AM.
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Old 07-03-2013
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Quote:
Originally Posted by Smashingdude View Post
Okay, so what I've gathered from the forums, most people say that we should list the most fatal diagnosis as the first one, so as to exclude it. How true is this idea?

For instance, FA case 27, its a classic case of disk hernia, but he has also symptoms of Prostate dz. Should we list Prostate cancer as first,even though in FA its #5?

Same goes for Epigastric pain in a DM. Should we put MI as first to rule it out? I am gonna put all the necessary workup anyway to exclude fatal causes even if they aren't in the differentials.

Or, chest pain in any patient, should we put MI/Angina as first to exclude it? Again, ECG/Enzymes will be mentioned in the workup anyway.

Let me know what you guys think about it.

always list the most likely diagnosis first!
This is from the official patient note entry form: "DATA INTERPRETATION: Based on what you have learned from the history and the physical examination, list up to 3 diagnoses that might explain this patient's complaint(s). List your diagnoses from most to least likely."
(link to the patient note entry form, which is what you should be practising with: http://www.usmle.org/practice-materi...practice2.html)
Please also note that it says "up to 3 diagnoses". A lot of people have been wondering if they have to put 3 - since it says "up to 3": no, you don't! But if you can think of three, definitely put all of them.

Please guys, try to read official information instead of listening to what 'most people' say... There are a lot of rumors going around. I know most people in here are trying to help but they don't always consider that telling people what they heard from someone (who heard it from someone else) is not always helpful...

Hope this helps!
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