Random Notes for the USMLE Step 2 CS
Random Notes for the USMLE Step 2 CS:
Mr...? nice to meet you, I am Dr...., I am the physician taking care of you today. Or; I am the physician in the office; if pediatric case. Weakness n numbness
Alcohol, smoking, recreational drugs, diet, exercise, occupation, sexual
Appetite n weight
Medications n allergies
Medical (recent disease, chronic diseases, hospitalization) n surgical history (hospitalization)
Family history (similar condition, parents alive, diseases or cause of death, "are they in good health?)
Ms.... Is that correct? Eye contact How can I help you Oh I know this must be concerning to you I promise I will help you to tackle this concern Can you tell me more about it "high scale" Ooh I am so sorry for that, we will work it out "Death" my condolence I am so sorry to hear that and thank you for sharing this with me I would like to ask you about your sexual life, everything you tell me is confidential so you don't have to worry about that
Female: gynecological history : Menarche, regular periods, when, how many days, number of pads; is this the usual, any cramping pain during menses, any bleeding between the menses, if sexually active; any bleeding after intercourse, last pap smear, any previous abnormal pap smear.
Retired: how is this going for you? Any feelings of depressed mood?
Alcohol: don't count or like everyday then cage, the need to cut down, annoyed by people criticizing you, guilt sensation, the need to drink directly after waking up .
Sexual: are you sexually active, with whom, if no; n why is that, how many partners did u have in the last year. Contraceptives, STDs, any urethral or vaginal discharge. If HIV a possibility and playful then ask do you relate to men, women or both?
Female: do you feel safe at home.
Elderly: do you feel safe at home, who does fix your meal, who does manage your pills, do you go to regular check ups.
Chronic disease follow up: how are you feeling today Do you have any problems at home or work? Any feelings if anxiety or stress? If he has DM, ask about HTN, heart disease, stroke (apply on all)
Pregnancy: do you have children, how many times have you been pregnant, history of abortions or miscarriages, during your pregnancy were you on regular check ups, have you been checked by ultrasounds, did you get any complications during the pregnancy, this is confidential were you using alcohol during pregnancy, were you smoking, were you using recreational drugs, what about the delivery was it on term, vaginal or by c section, hospital discharge was uneventful.
Pediatric: pregnancy history, growth normal, vaccination up to date, regular pediatric check ups, when was the last one; and how was it, does the child go to a day care center, do you know if there are ill contacts in the center.
When you suspect liver disease: Have you travelled recently, if yes; have you received vaccinations before travelling, have you received blood transfusion before, do you have a history of stones.
If suspicious about a psychiatric illness or his mood is depressed: Why is that, do you have a stressor going around, do you have any feeling of guilt, have you lost interest in things that use to interest you, do you feel it's getting difficult for you to concentrate, sometimes when we feel sad we may think about harming ourselves; have you thought about this before, Do you have a family history of mental illness.
Exam stuff: So tell me Mr... Do you have concerns that you would like to share May I untie your "gown"? Whenever I put this piece in your back please breath in and out normally. Are you ok Mr..., one more time "Murphy and rebound" I need to do one more test in that area and it's very important to illicit the cause of pain, I promise I will do it as fast as I can . Please be seated Thank you for your cooperation.
Closure: Now we are done with the physical exam I would like to share my clinical impression with you based on the information you have given me and the physical exam findings 1-most likely diagnosis 2-other diagnosis or less likely ones, and inv.
Smoking and drinking counseling and programs; alcohol and smoking are bad for your health and they can cause a variety of problems; alcohol can damage your liver badly and can even cause early dementia for examples, smoking can cause you a variety of cancers; like lung cancer and even kidney and bladder cancers; and lung and heart diseases, are you interested to be enrolled in such programs; if yes ok I congratulate you for this decision; I will arrange an appointment for you next you and inform you later.
Elderly: safety is my primary concern, assisted living community or an apartment complex for seniors, social worker will.
CT is a like a bigger and more advanced x ray machine, MRI is imaging using magnetic field, US is an advanced imaging technique, all give us a better visualization and idea about what's going on .
If hypertensive, diabetic ,previous stroke ,TIA or hypercholesterolemia: Council the previous about cessation of alcohol and smoking, I strongly recommend that you monitor and adjust your diet in a healthy way; I can arrange an appointment for you with our dietitian; is this something that may interest you Is this plan ok with you Do you have any questions Do you have further concerns that you would like to share
General exam: Eyes Tongue, sides Glands,swellings,tenderness in head or neck Pulses, hands
Neuro exam: Follow the pen Raise your eyes Show the teeth Feel my hands, equally? Shrug your. Hold my hands don't let go Make arms defensive push out, pull in Push legs out, pull in Reflexes elbows n knees Sharp or dull Babinski "it may feel a little bit tickling" Stand up; Romberg side, walk 3 steps forward n backward, touch my index with your index n then touch your nose do it as fast as you can frequently.
Abdominal: Inspection "distention, scars" Superficial palpitation, deep palpation, Palpate the. Percussion, measure the spleen, measure the liver, kidneys punch
Respiratory: Back; 99, auscultation, n then heart from the front
Cardio: Palpation Auscultation, front, left side, and if female ask her to raise her left breast.
Arm pain: Can you touch the back of your head like this, both arms. Can you touch the lower part of your back like this, both arms?
When you suspect liver disease: Can you stretch your hands like this, Murphy's sign
Knee pain: Inspect, feel the temperature, slightly palpate area, ask the patient to move it on their own; if can't then move it, ask to move it against resistance, feel the peripheral pulses.
If HTN, DM, Hypercholesterolemia, stroke, TIA : Check the eyes with fundoscopy Auscultation the neck vessels Check the foots; ask to push against resistance as if pushing a gas pedal.
Mental state examination: Do you know who am I; who, where are we, what part of the day this is, I will tell you 3 words and ask you to repeat them now and after a while; cat pen cat; can you repeat them, while you walk on the street you found a house on fire; what will you do, can you repeat the previous 3 words for me again.
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