u/confusedcreator04

I'm getting confused on the NBME approach to the most appropriate next step questions. In this example, a 6 mo baby has chronic constipation with no stool in the rectal vault. The answer was to get a rectal manometry.

I figured getting a quick blood TSH testing to rule out a possible hormonal deficiency before more invasive testing was more appropriate than rectal manometry (which sounded invasive to me)... how should I be approaching these kinds of questions?

Is it even possible to dual apply in derm with a less competitive specialty as a backup? Was thinking of applying to derm and neuro, but I heard that PDs can see MS4 transcripts even after apps are submitted, so you can't really get away with doing late aways. Does anyone have any insight into this?