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  #1  
Old 04-25-2013
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Smile Casandra's exam experience - March/Chicago

Hi guys!

Below are just my 2 cents about my exam experience. I hope someone can benefit from any info/tips I’m sharing here.

I took CS in Chicago at the beginning of March. I stayed in one of the hotels recommended in the FA (I think in all those hotels the staff is used to students taking this exam hence they openly offer giving a lift to the center and are helpful with everything in general).

First of all I would like to answer the question that all exam-to-take students or those who have just recently taken it torture themselves with (I was in your shoes till yesterday): Is it possible to make mistakes and pass? YES it is! Below you will find a list of my mistakes. Feel free to use it a comfort zone J

My background: IMG, currently in a residency program in my home country
Prep time: 3 weeks
Materials: FA + CSE videos + usmle.org software for PNs
A little note about CSE videos: they are pretty good but be critical about their diagnosis and some PE elements. Imho they are not always 100% accurate.
Did I feel those materials were sufficient? YES!
Most important tip: PRACTICE, PRACTICE, PRACTICE! I can’t emphasize enough how crucial this is! Initially I started with my skype study partners (thank you Teona and Azka J))). In my 2nd week I started practicing with my live sp – he’s already a resident in US and his help was PRICELESS. All the tips and his harsh critic were my main impulse to take this exam seriously. Let your SP be your cruel judge that will help&guide you on how to improve rather than the SP on the exam. Practice writing PNs on the official software – you’re going to be using exactly the same one on the exam.
Did I use mnemonics? no. In a stressful environment I could forget some of them and that would throw me right into a panic zone. At first I felt kind of weird about not using them as almost all forum users here who had already passed the exam were using & recommending them, but I encountered exam experiences where people said: Use whatever suits you. And I went for it. And that is exactly what I’m sincerely recommending you guys – tailor your style, practice and see what works best for you and go for it!
Did I feel that SPs were friendly? Yes. I strongly believe they are there to help us, not to fail us (even if they are being/acting rude –they have a certain scenario to follow so they are just doing their job)

During the exam:
On the first break I confessed to one of my fellow takers that I felt as if I were a robot. Because I would enter each room within strict time intervals and start (almost) the same ritual. When I shared that, all other students confirmed they felt the same and as they were mostly AMGs that gave some confidence booster J

After the exam: my mind shifted from ‘I did some of the things right, I have made some mistakes’ (right after the exam) to ‘It’s hard to recall the things I did right, while my mistakes seam to haunt me in my dreams + distracting me from studying for CK’ (few weeks later on).

Mistakes I have made:
Encounters:
1) ran out of time in 2 cases (heard the beep signal right after finishing PE or right after starting counseling) – in each case I apologized a pt and said I had an emergency call and have to leave (in one case I think I said I would come back to them shortly). Pts were sad to hear that.
In one of those cases I was already counseling the pt when I was doing PE – I decided to do that as the pt was elderly, case was time-consuming, full neuro exam was necessary so I knew there’s a risk I could run out of time.
I was actually mentally prepared that could happen (running out of time) on my exam and keeping that in mind really helped me A LOT – I didn’t panic at all. I moved on to another case.
2) In one case I forgot to note down pt’s last name on my clipboard. I have no idea how that happened. Sufficient it did. When I entered the room I greeted pt with his name (I remembered it from the doorway information sheet) but when I looked down on my blueshit few seconds later my mouth went dry (from all the screaming inside my head). So I came up with some excuse and grabbed the info sheet that was inside the office on the table. That was my last resort I could think of. Afterwards I made sure I repeated his name couple of times loud and clear
PNs:
3) I gave only 1 diagnosis in 1 case. The rest of the notes in that case took me a while as it was really lengthy.
4) I don’t think all my diagnosis were 100% right + I wrote them down not necessarily in the order of descending probability in some cases.

Things I did right:
I knocked on the door, entered with a smile on my face, greeted the patient (most of them replied with a smile). I commented on the drape, asked if they felt comfortable in the room or whether there was something I could do to make them feel more comfortable. I would ask 2-3 open-ended questions in each case (always at the beginning + sometimes in the middle of the conversation depending on the case). I wore gloves in all case. When I was putting them on I always asked a pt if they had any questions/concerns. And they usually had at least 1-2 questions. I would do my best to answer those and made sure the pt understood and was satisfied with my explanations. I never rushed the pt even if I felt I might run out of time. I felt that establishing a good and comfortable relationship with a pt was of superb importance. I did focused PE + I briefly ausculated heart&lungs in all cases. I asked CAGE qs whenever it was relevant. I counseled all my pts about alcohol/drugs/cigarette use and sexual practices. I finished all my PNs on time (or ca. 2 minutes before the beep) & gave 2-3 dds (except one case I have already mentioned where I put only 1 diagnosis) and always wrote down full work-up. I would actually put the list of the tests to run right at the beginning of writing my PNs.

Feel free to ask me any questions. I will be happy to help J
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  #2  
Old 04-25-2013
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Hi casandra,

Thank you for your experience it was elaborate and really reassuring. I have a few questions ,please clarify them.
Do we need to do funduscopy in exam?
When you said you commented on the drape, what exactly did you tel them?
Is it okay if we are not sure of diagnosis in few cases?

thanks again..
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Old 04-25-2013
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Quote:
Originally Posted by nishaa View Post
Hi casandra,

Thank you for your experience it was elaborate and really reassuring. I have a few questions ,please clarify them.
Do we need to do funduscopy in exam?
When you said you commented on the drape, what exactly did you tel them?
Is it okay if we are not sure of diagnosis in few cases?

thanks again..
Hi nishaa! I'm glad you found it useful. As for you questions:
I did fundoscopic exam in 1 case where I thought it was relevant. Perhaps I should have skipped that (not to waste valuable time) and put it in my work-up list. I did what I did.

I commented on the drape meaning that if the pts were already draped I said: Oh, I can see you already have drape on your laps./I was about to offer you a drape but I can see you already have it on your laps.

What exactly do you mean by: Is it okay if we are not sure of diagnosis in few cases?
Like you are not sure at all and you don't put any diagnosis?
Or you have few diagnosis in your mind but not really sure which one should come as 1st,2nd etc? If the latter, I think that's the idea of this exam. You give few possible options -dds. You clarify what findings/hx elements support it and the list of the tests you want to run that should help in giving a final answer.
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  #4  
Old 04-25-2013
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Quote:
Originally Posted by Casandra View Post
Hi nishaa! I'm glad you found it useful. As for you questions:
I did fundoscopic exam in 1 case where I thought it was relevant. Perhaps I should have skipped that (not to waste valuable time) and put it in my work-up list. I did what I did.

I commented on the drape meaning that if the pts were already draped I said: Oh, I can see you already have drape on your laps./I was about to offer you a drape but I can see you already have it on your laps.

What exactly do you mean by: Is it okay if we are not sure of diagnosis in few cases?
Like you are not sure at all and you don't put any diagnosis?
Or you have few diagnosis in your mind but not really sure which one should come as 1st,2nd etc? If the latter, I think that's the idea of this exam. You give few possible options -dds. You clarify what findings/hx elements support it and the list of the tests you want to run that should help in giving a final answer.

Sorry about not being clear. i meant that if out of 3 DDx , i managed to fill in only 2 and left the other blank , is it okay?
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Old 04-25-2013
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You should do the fundoscopic exam if the patient is a hypertensive, diabetic, risk of stroke etc. Check for pupillary reflexes first and then fundoscopic exam.
In most cases, you'll be able to come up with 3 DDs. You can pick up something from the past medical history of patient and put that as the 3rd diagnosis. I did that a few times and it worked for me
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Old 04-26-2013
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Congrats!
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  #7  
Old 04-27-2013
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congrats
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