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  AMSA Test Prep Corner, in affiliation with the authors of First Aid and USMLERx  

Congrats! You Matched! Now What?
Developing your Assessment & Differential Diagnosis
First Aid/USMLE-Rx Spring Special

Congrats! You Matched! Now What?

OK, you can breathe easy- you have a job next year! But you also have less than three months to “get your affairs in order” before the craziness of intern year begins. What do you need to get done before residency orientation begins? Here’s a checklist that should get you started:

START DATE — For good or for bad, we start working before July 1. Figure out when your program holds their orientation, and make sure you’re moved into your new place in plenty of time.

HOUSING — To buy or to rent… what a huge question! Ask residents in your new program what they recommend. Try to ask residents in similar family situations as you.

LOANS — Meet with your school’s financial aid staff to discuss your loan repayment options. Paying off your loans over a longer period can let you invest some of your earnings and end up with more money in the long run. Be sure to tell your loan servicers your new address as soon as you know it.

BUDGETING — Careful! Your first paycheck probably won’t come until Aug. 1st or later. In the midst of your 4th year traveling and festivities, save money for rent, groceries, bills, emergencies, etc. until your first paycheck arrives. Even after you start making money, don’t go crazy — live within your means. Avoid credit card debt like the plague.

INSURANCE — When will your insurance (health and/or disability) through your residency program begin? Does the insurance cover pre-existing conditions? If there’s a gap in coverage between your med school and residency insurance, consider paying for a temporary extension of the med school insurance.

RESOURCES — Prepare your intern resources/tools before you need them. Choose:

  • One intern survival guide.
  • One pharmacology/meds app that is reputable, updated often, and works well for you
  • A note-taking app for important phone numbers, etc.
  • A to-do app for your daily to-do list – electronic is better than paper

“BRAIN ATROPHY” —Yeah, it’s tempting to take advantage of your last few months of “freedom” and never crack a book. But, on intern week one, you’ll be stressed and your patients won’t be in the best of hands.

Enjoy your free time, but commit to reviewing 1 key disease/diagnosis per day. Brushing up on common presentations, methods of diagnosis, and treatments for just a few minutes a day will make you stand out as an intern, as well as prevent dangerous errors.


Developing an Assessment & Differential Diagnosis

One of the major skills you must develop over the course of your 3rd year of medical school is the ability to formulate an assessment and differential diagnosis (DDx).
During the first couple of months, no one will expect much from your assessment and DDx. If you miss the actual diagnosis or include some obscure things on your DDx that aren’t really plausible or likely for the diagnosis, don’t worry…you’ll get better with practice. Just focus on basic techniques for developing an initial DDx, and then prioritize your prime suspects by what is most likely given the patient’s demographics, history, and presentation.

Remember: atypical presentations of common things are way more common than typical (or atypical) presentations of uncommon things.

The main component of a good assessment is a summary statement. This is similar to what you’ve been taught to do with your introductory statement forf your presentation. However, the summary statement will require that you pull in a few key points from the details of your H&P and really try to paint a picture of what you think is going on.

  1. Restate the patient demographics, pertinent medical/surgical history, and chief complaint.
    • Mr. Smith is a 56 yo black man with a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus who presents to the clinic complaining of increasing dyspnea on exertion over the last 6 months.
  1. Incorporate details from the HPI and ROS.
    • Mr. Smith is a 56 yo black man with a h/o HTN, HLD, DM2 who presents to clinic c/o increasing DOE over the last 6 months associated with paroxysmal nocturnal dyspnea, 4-pillow orthopnea, and bilateral pedal edema.
  1. Now throw in the salient points from your PE.
    • Mr. Smith is a 56 yo black man with a h/o HTN, HLD, DM2 who presents to clinic c/o increasing DOE over the last 6 mos a/w PND & 4-pillow orthopnea, who demonstrates bibasilar crackles, elevated jugular venous pressure to 6 cm, and bilateral 2+ pitting edema to the mid-calf on exam.
  1. Finally, give your thoughts about what is most concerning on your DDx.
    • Mr. Smith is a 56 yo black man with a h/o HTN, HLD, DM2 who presents to clinic c/o increasing DOE over the last 6 mos a/w PND & 4-pillow orthopnea, who demonstrates bibasilar crackles, elevated JVP to 6 cm, and bilateral 2+ pitting edema to the mid-calf on exam, concerning for new-onset congestive heart failure. DDx includes cor pulmonale secondary to COPD.

Once you have a good summary statement, the rest of your assessment should be easy. Simply list the problems that are being addressed in that particular clinic visit or actively treated during that particular hospitalization, starting with the one(s) you’re most concerned about.


First Aid/USMLE-Rx Spring Special

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Vol. 6, Issue 4
March 2014

Spring Special

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April 2014
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June 15-20, 2014
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