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* The cases on the second day
  step32006 - 11/01/06 22:07
  Eight of my patients got better in the edn, but... First- Duodenal ulcer, got better, but still had discomfort. The second was Aortic stenosis, the patient lost councessness, I transferred him to ER, but the case finished and did not let me to write the Dx. The third the patient became better but again finished without Dx, not becouse I did not know it, but because I did not have an option to write. So, I consider that I have 6 cases right, and 3-not or questionable. Do you think is possible to pass the CCS?I will apretiate any responce. Thank you!  
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* Re:The cases on the second day
  genesismd - 11/01/06 23:33
  how did the questions go? people freak out too much about the ccs and underemphasize the mcqs.... generally people who do bad on ccs can still get a good passing score on the examination, and people who can do great on ccs can still fail the examination, so its like 80/20 mcqs/ccs
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* Re:The cases on the second day
  alan - 11/01/06 23:33
  Hi step 32006:
I want to know more about your cases if you don't mind.

first one, PUD, where is the location? office or ED? two different set of magt.

second, AVS, it sounds like ED case. see, Aortic valve stenosis in elderly (is he?), symptoms relates to the severity of the stenosis. your case, lose conciousness, what kind of acute events makes him loss conciousness relate to aortic valve stenosis? I can't say for sure, it bases on your story, what 's in mind: does he have ventricular arrhythmia or conduction abnormalities-3rd degree AV node block-ECG can tell? a long standing aoritic stenosis-calcification, may lead to CHF, acutely cause pulmonary edema-CXR and BNP, EF can also can be AMI, does he have CP, ECG ST changes, cardiac enzymes abnormal?

thrid case, not sure what to say, i think you will be fine if you clearly know what is going on with the patient and you have done what you need to do and pt is improving, and I heard Dx doesn't count points.

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* Re:The cases on the second day
  alan - 11/01/06 23:42
  case 2, does he loss conciousness in ED, or he complains he has syncope episodes?  
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* Re:The cases on the second day
  crk - 11/01/06 23:44
  hi step32006,
my case kinda similar to yours.i felt i did badly on 3 cases(i couldnt come to diagnosis in one case) and 6 i was sure i did the end it worked out fine for me.i cleared the test.the thing with CCS is doing the right thing at the right time.ur workup and approach is more if u did all required tests in a logical way u shud be alright.
all the best.
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* Re:The cases on the second day
  alan - 11/02/06 00:13
  step32006 and crk:

when you say you do not have chance to write Dx, does it mean you have used up 25 mins? or the case ends with your last 5 mins order sheet? please tell me, my exam in few days. Thanks and good luck.
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* Re:The cases on the second day
  step32006 - 11/02/06 08:17
  Hi, I just came. AS was a office patient who came because of his son, he had some light headache, after all tests and exams I let him go home and come for F/U, in the day of F/U he lost a councessness and I transfer to ED. Duodenal ulcer was also in the office. My cases finished like for 15 min,, and I do not have an idea, why I did not get time for DX, I mean I did not get the final screen with the Dx. The blocks of questions - A lot of them were similar to UW Q bank, the second day I did not have a time to finish first 2 blocks, I just put some answers. I am confused writh now, I am really not very confident with my exam. But now I can only wait. I am in NY and I am going to work, so will answer tonight. By the way I am not in residency.  
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* Re:The cases on the second day
  alan - 11/02/06 09:44
  hi step32006
thanks for sharing the info.
case two, you will be fine, it is just a story of aortic stenosis with syncope episodes which it is just happens to be in your office. it is symptomatic, so order a valvular replacement on top of other workup, send him to ED to R/O other possible complications as I mentioned above, it is resonable to end the case.
you always remember the qs you did not know in the exam, it makes you feel bad, but it doesn't mean you did not do well. GL
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* Re:The cases on the second day
  yas - 11/02/06 17:51
  congrats step3 2006 ,let us know the good news.

TO: alan , Hi you seems like you know what you doing ,would you minde tell US the first work ups in office and ER and clinic,this is very imp, thank you and best of luckToyou.
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* Re:The cases on the second day
  alan - 11/02/06 20:17
I assurmed you were talking about aortic stenosis. It all depends on the presentations. office, more likely pt C/O exertional SOB, mild CP, fatigue...very similar to CHF, so work up with casues of SOB, R/IN and R/O, also fatigue (anemia, endo, heart, lungs, depression), and I think PE with murmur, do ECHO, get the result of stenosis severity, if moderate-severe, selective valvular replacement. If pt in the office, complains about syncope episodes, more worrisome, I will admit him to ward to work up if he is stable, so I can monitor the pt in case another syncope before I have my results. but if he is unstable, there must be something complicated( as syncope suddenly loss conciousness and regain quickly, but pt hemodynamic still stable after the episode), send to ED, R/O all acute events and stablize the pt.
I feel like talking to myself here, hope you get my points, always let me know if I am wrong or share your idea here. I appreciate it.
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* Re:The cases on the second day
  step32006 - 11/02/06 20:36
  THANKS Alan and Yas, I will post my results when available, but thank you for the courage! Good luck to you!  
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