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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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Old 05-04-2012
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Clock Do you have pain anywhere? Non-Specific questions to save time

Hi, guys!
I'm trying to develop a quick-and-easy system for covering all relevant points in history taking, physical exam and PN. My exam is on May, 16. And when my notes are finished, polished and tested, I'll be glad to share them with you
But for now I have some questions.

1. Do you think asking "Do you have pain in ANY part of your body?" will cover site-specific questions, like abdominal pain, joint pain or headache in sp checklist? Or one has to ask each question separately?
The same thing for allergies and meds. Is "Are you allergic to ANYthing?", "Do you take ANY medications?" enough?
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Old 05-04-2012
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Arrow Always think in the context of the case, nothing general

Your history taking should be focused on the chief complaint asking all the possible details and ins and outs of that chief complaint.

Then for the Review of Systems, again you might want to focus on relevant issues.

For example, a patient with cough and fever suggestive of either pneumonia or sinusitis, then it might not be relevant to ask about all the GI symptoms, maybe just asking about diarrhea if he was taking antibiotics or if you suspect cystic fibrosis but that's it, you don't need to ask about abdominal pain, constipation, dysphagia, heartburn, ..etc

About the allergy thing, I would prefer you ask twice, 1) do you have allergies such as allergic rhinitis, skin rashes? and 2) are you allergic to any medicine?

Some SPs are very sensitive about this issue they may check you off if you don't ask these two questions.

But again even for the allergy questions it should be in the context of the case, like for example if you have an asthmatic patient then you might want to really dig into the allergies one by one with details.

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Old 05-04-2012
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Sabio, thanks! Your answer is eloquent and straight to the point, as usual

But what if I get some follow-up case? For example, the case for HTN check-up in FA has 3 pain items in checklist: headache, chest and abdominal pain. Will asking about pain in any area of the body cover them all?
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I would ask about each and every one of them. SP's might not be very helpful, like if you can ask them do you have anywhere, they may say yes headache but they won't tell you about abdominal pain or muscular pain unless you specifically ask about them.

I mean if you think about it, it won't take more than 5 seconds for each pain question.

Again in HTN check up (which is the chief complaint here), all what you mentioned are relevant like headache can be seen in hypertensive crisis and/or encephalopathy, abdominal pain might be seen in aortic dissection or hypertensive renal disease, and chest pain can be due to hypertensive heart disease.

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