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USMLE Step 2 CS Forum USMLE Step 2 CS Discussion Forum: Let's talk about anything related to USMLE Step 2 CS exam


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  #1  
Old 01-05-2010
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Default Is there anything you want to add?

It's recommended that you ask the patient "is there anything you want to add?" or "is there anything else that we have not talked about?"...etc
Now my question is
Will the SP be honest and cooperative and tell me something that I missed in my history taking or physical exam.
If they are all such nice people reminding us of what we missed then by simply asking this question we will never miss anything.. Am I right about this?
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  #2  
Old 01-05-2010
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Default Two important questions to ask in CS encounter

Unless the patient is specifically instructed to answer only direct questions they will likely tell you when you ask that question.
But importantly, here to note, that they will tell you only if there's a crucial another chief complaint that they haven't mention before. They will not tell you that you forget to ask them about allergies to medications for example.

There two open ended questions that are very important in CS

1- Tell me more about it. This is useful after the patient tells you the chief complaint.
2- The question you just mentioned above. This is useful after concluding your history and again after finishing your physical examination.
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  #3  
Old 01-06-2010
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If you don't ask, they will not tell you
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  #4  
Old 01-06-2010
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now my take on this
this is a exam, dont expect help here especially of this sort, they will never tell u something from chief complaint or a very essential part of what you missed, they have to GRADE you FOR DATA GATHERING, how do you think they will be able to if they are themselves telling things you should have asked, so NEVER in the exam, THEY WILL LOOSE their job or would be warned by USMLE atleast, rather if you ask this, they may come up with a questions as do u think, doc, i should keep staying with my son......or do i have a cancer..... just to know how you answer them, they do that usually if they have to grade u on spoken english or CIS still more accurately.....
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Old 01-06-2010
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Default

Ok...
I highly highly recommend asking that question. is there anything else you would like to discuss that we have not already talked aobut?

that gives the patient a chance to ask a challenging question, give you more information, or guide you toward a differential you were not considering.

We had a student who used csevideo, she got a hallucinations case, she told us, ( and we have heard this many times) that she forgot what to ask. so she kept saying to the patient while washing her hands and before the physical exam she said" is there anything you would like to discuss that we have not already talked about?" the patient (finally) said to her, "yes, my sleeping patterns" then she proceeded to ask a series of questions related to his sleep.

another case: student asked while washing her hands same question " is there anything else you would like to discuss that we have not already talked aobut. Patient told her she was afraid to get up from the table as she might poop in her pants because she had lost her bowel control.

another case: student said, I would like to examine your heart now, is that ok, patient said ok, she untied the drape, and then the patient said would you like me to lift my breast to check my heart. sp was not suppose to do that, but she did.

this is not a promotion its a true story and we have had this scenario occur at least a dozen times
they all recently passed

good luck
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  #6  
Old 01-06-2010
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totally agree with cse video as always, asking would not hurt but as mentioned,try and be really prepared so that you dont miss a thing.... rather than expecting help form the standardized patient try to be really inclusive as far as data gathering is concerned......asking this question will give you another opportunity to prove that you are really aware what to say and when,,,,, so go ahead and put yourself out there , ready to be judged....
good luck....
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