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Old 01-20-2013
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Question USMLE world CCS issuess; help?

1. when I cancel orders after changing patient from ER to home, the patient goes back to his original state of distress. Should I be cancelling only after I reach the 2 min screen?
2. I am doing everything given in the explanation, sometimes even redoing the case making sure I get everything in. Despite that, the surgical consult always says "no recommendation. continue with..."

How do I circumvent this? Am I doing something wrong or is this a glitch in the software?
Did anyone else experience this? will I face this in the real exam if I follow the same steps?
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Old 01-21-2013
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Did the patient improve on your order? If that's the case then you'll get the 2 min screen before you finish your time and then you can cancel your order. If your patient is not improving or "slightly improving" on your medicine then you should pick some other meds.

For the surgical consult. If surgery is really needed, the software will tell you that surgery was done and they found bla bla bla.
But if surgery is not needed then you'll get "no recommendation, continue .." but that does not mean you are wrong, because some cases require surgical consultation yet surgery is not required at that point.

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Old 01-21-2013
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Originally Posted by tanujasalim View Post
1. when I cancel orders after changing patient from ER to home, the patient goes back to his original state of distress. Should I be cancelling only after I reach the 2 min screen?
2. I am doing everything given in the explanation, sometimes even redoing the case making sure I get everything in. Despite that, the surgical consult always says "no recommendation. continue with..."

How do I circumvent this? Am I doing something wrong or is this a glitch in the software?
Did anyone else experience this? will I face this in the real exam if I follow the same steps?
If you are doing UW CCS then in asking for consult there's a problem with there software, that's why its recommended to do USMLE sample cases. Having said that you still need to complete certain set of orders before asking for consult otherwise it will say no recommendations eg in case of Aortic dissection, if you have not ascertained that its proximal or distal, you will not get any recommendation, but once you have done then you will get recommendation.
Regarding cancellation of orders-if you discontinue the treatment or send the patient home early you will be told the patient deteriorated, so get an idea of when to send patient home or how long in a particular ds you must keep the treatment going in the patient......Hope this help.
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Old 01-21-2013
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Originally Posted by StepTaker View Post
Did the patient improve on your order? If that's the case then you'll get the 2 min screen before you finish your time and then you can cancel your order. If your patient is not improving or "slightly improving" on your medicine then you should pick some other meds.

For the surgical consult. If surgery is really needed, the software will tell you that surgery was done and they found bla bla bla.
But if surgery is not needed then you'll get "no recommendation, continue .." but that does not mean you are wrong, because some cases require surgical consultation yet surgery is not required at that point.

-
The patient improved completely. Like in the asthma case, he was fine, I observed him for four hours then changed location to home and cancelled the orders. A screen popped up with the same symptoms...

And the surgical consult says not recommended even if the surgery is needed. And when I do the surgery anyways, the patient recovers. I'm talking about Uworld CCS case...
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Old 01-21-2013
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Originally Posted by tanujasalim View Post
The patient improved completely. Like in the asthma case, he was fine, I observed him for four hours then changed location to home and cancelled the orders. A screen popped up with the same symptoms...

And the surgical consult says not recommended even if the surgery is needed. And when I do the surgery anyways, the patient recovers. I'm talking about Uworld CCS case...
That's what I was saying, there is problem in UW CCS software, this wont happen if you do USMLE sample cases (you can download them from official USMLE website) and this wont happen in real exam scenario, but make sure before consulting get the requisite tests/investigations otherwise in real software too it will say the same thing, refer to example given in my previous post.
Regarding Asthma you have to care longer than 4 hours, discharging in 4 hours is premature in asthma exacerbation and will cost you your score. Try reading recommendation of these diseases. One good tip for CCS is that if you keep monitoring enough and before the suitable time of discharge comes, in real test the case will usually and mostly end before that,...so that should be a relief for you....but for a rare case (usually 1-2 are tough ones) you must try to learn about time of care (but dont fret much on it)...........hope this helps
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Old 01-25-2013
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Quote:
Originally Posted by tanujasalim View Post
The patient improved completely. Like in the asthma case, he was fine, I observed him for four hours then changed location to home and cancelled the orders. A screen popped up with the same symptoms...

And the surgical consult says not recommended even if the surgery is needed. And when I do the surgery anyways, the patient recovers. I'm talking about Uworld CCS case...
I had same problem preparing for my exam (done with it this week).. so I understand perfectly, what you are saying. What I did was not to cancel any major treatment plan (unless maybe oxygen after repetitve good oximeter readings, or iv fluid when patient no longer having nausea or vomiting). This is because in the real exam, the patients' conditions never completely resolved and I didnt want to risk it. Once your case begins to improve,(and I think the software feels it's got the major or basic stuff it requires, it stops the case... most times in recuperating conditions. So I used the 2min screen to basically add counselling/education/ nothing.
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