Please correct my PN for back pain - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CS Forum

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


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-04-2013
USMLE Forums Scout
 
Steps History: Not yet
Posts: 86
Threads: 20
Thanked 83 Times in 30 Posts
Help Please correct my PN for back pain

HPI-51 Y M C/O LOWER BACK PAIN X 1 WEEK
-STARTED AFTER LIFTING HEAVY BOXES
- PAIN IS SHARP,8/10,RADIATES TO LEFT THIGH AND LT FOOT.
- DIFFICULTY IN URINATION ,INCOMPLETE EMPTYING OF BLADDER
NO FEVER/CHILLS/HEMATURIA/INCONTINENCE/LOSSOF SENSATION IN LR EXT
ROS- NEGATIVE EXCEPT AS ABOVE
VS- WNL
PMH- INTERMITTENT BACK PAIN X 1 YR
PSH- NONE
ALLERGIES- NKDA
MEDICATIONS- TYLENOL
FH- NOT SIGNIFICANT
SH- 1 PPD X 18 YRS,ETOH OCCASIONALLY,NO ILLICIT DRUGS,CONSTRUCTION LABOURER,MONOGAMOUS WITH WIFE.

PHYSICAL EXAMINATION

PT IS IN PAIN
VS- WNL
HEENT- PERRLA
BACK- MILD PARASPINAL TENDERNES(+),LIMITED ROM
NEURO- LOWER EXT- STRENGTH: 5/5 THROUGHOUT,SENSATION:INTACT,DTRS-:2+B/L,GAIT: TOE AND HEEL WALKING-NL,SLRT-NEGATIVE
CHEST -CTA B/L
HEART- RRR,S1S2+
EXTR-PULSES 2(+)B/L

DISK HERNIATION
PAIN IN BACK
HX OF LIFTING HEAVY WEIGHT
PAIN RADIATING TO LEG AND THIGH

P/E
PARASPINAL TENDERNESS(+)
LIMITED ROM

Diagnosis #2
LUMBAR MUSCLE STRAIN
PAIN IN BACK
HX OF LIFTING HEAVY WEIGHT

P/E
PARASPINAL TENDERNESS(+)
LIMITED ROM

Diagnosis #3
ARTHRITIS -DEGENERATIVE

PT ABOVE AGE 50
PAIN IN BACK

P/E
LIMITED ROM

Diagnostic Study/Studies
XR- L SPINE,MRI-L SPINE
CBC,CALCIUM,BUN/Cr
PSA

I have posted my complete PN for back pain...had finished typing in 9 min...( I am an average typer)...
Experienced members plz comment and correct on my patient note..

Have my exam in 2 days...

Many thanks..
Reply With Quote Quick reply to this message




  #2  
Old 05-05-2013
Banned
 
Steps History: 1 + CK
Posts: 751
Threads: 133
Thanked 306 Times in 192 Posts
Reputation: 316
Default

Why did u include
CBC, Ca, BUN/Cr, PSA
if ur Ddx's don't include mets
from prostatic cancer or multiple myeloma
for eg.?
Ur tests should only support ur differential
diagnoses.
Reply With Quote Quick reply to this message
The above post was thanked by:
sudha1985 (05-05-2013)
  #3  
Old 05-05-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,086 Times in 1,046 Posts
Reputation: 2106
Default

Quote:
Originally Posted by sudha1985 View Post
Always start with CC 51 Y M C/O LOWER BACK PAIN X 1 WEEK
Then HPI-
-STARTED AFTER LIFTING HEAVY BOXES
- PAIN IS SHARP,8/10,RADIATES TO LEFT (L is acceptable) THIGH AND LT FOOT.
- DIFFICULTY IN URINATION ,INCOMPLETE EMPTYING OF BLADDER
NO FEVER/CHILLS/HEMATURIA/INCONTINENCE/LOSS OF SENSATION IN LR EXT (LE is acceptable)
ROS- NEGATIVE EXCEPT AS ABOVE
VS- WNL
PMH- INTERMITTENT BACK PAIN X 1 YR
PSH- NONE
ALLERGIES- NKDA
MEDICATIONS- TYLENOL (dose. duration?)
FH- NOT SIGNIFICANT
SH- 1 PPD X 18 YRS,ETOH OCCASIONALLY,NO ILLICIT DRUGS,CONSTRUCTION LABOURER,
Always write Sexual History (SxHx) separately from Social History (SH) MONOGAMOUS WITH WIFE. (can also write Sexually active with Wife only)

PHYSICAL EXAMINATION

PT IS IN PAIN
VS- WNL
HEENT- PERRLA
BACK-
No obvious deformity or signs of trauma
MILD PARASPINAL TENDERNES(+), No spinous process tenderness
LIMITED ROM
NEURO-
LOWER EXT- STRENGTH: 5/5THROUGHOUT (or MOTOR 5/5 LE B/L),
SENSATION (Must specify which sensation--dull. sharp or touch):INTACT,
DTRS (Must specify which DTRs patellar, achilles)-:2+B/L,
GAIT: TOE AND HEEL WALKING-NL,
SLRT-NEGATIVE
CHEST -CTA B/L
HEART- RRR,S1S2+
EXTR-PULSES(Must specify which -DP, PT) 2(+)B/L

DISK HERNIATION
PAIN IN BACK
HX OF LIFTING HEAVY WEIGHT
PAIN RADIATING TO LEG AND THIGH

P/E
PARASPINAL TENDERNESS(+)
LIMITED ROM

Diagnosis #2
LUMBAR MUSCLE STRAIN
PAIN IN BACK
HX OF LIFTING HEAVY WEIGHT

P/E
PARASPINAL TENDERNESS(+)
LIMITED ROM
SLRT-NEGATIVE (goes in favor of Diagnosis #2)

Diagnosis #3
ARTHRITIS -DEGENERATIVE

PT ABOVE AGE 50
PAIN IN BACK

P/E
LIMITED ROM

Diagnostic Study/Studies
XR- L SPINE,MRI-L SPINE
CBC,CALCIUM,BUN/Cr
PSA

I have posted my complete PN for back pain...had finished typing in 9 min...( I am an average typer)...
Experienced members plz comment and correct on my patient note..

Have my exam in 2 days...

Many thanks..
Must write pertinent Negatives to support your differential.
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (06-19-2013), Dr. Mexito (06-02-2013), sudha1985 (05-05-2013)
  #4  
Old 05-05-2013
USMLE Forums Scout
 
Steps History: Not yet
Posts: 86
Threads: 20
Thanked 83 Times in 30 Posts
Default

Many thanks.....Got your point....
Reply With Quote Quick reply to this message
  #5  
Old 05-05-2013
USMLE Forums Scout
 
Steps History: Not yet
Posts: 86
Threads: 20
Thanked 83 Times in 30 Posts
Default

Quote:
Originally Posted by Novobiocin View Post
Must write pertinent Negatives to support your differential.
Thanks a lot for the timely reply.....

I have a better idea now...
Reply With Quote Quick reply to this message
  #6  
Old 05-05-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,086 Times in 1,046 Posts
Reputation: 2106
Default

Quote:
Originally Posted by sudha1985 View Post
Thanks a lot for the timely reply.....

I have a better idea now...
Glad to be of help.
I have been told that as long as you get 65% of the info on PN you will pass. And you got over 90%, so your PN is very good.

One more important point:

For CVS : S1S2 WNL RRR NO M,R,G
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
  #7  
Old 05-05-2013
USMLE Forums Scout
 
Steps History: Not yet
Posts: 86
Threads: 20
Thanked 83 Times in 30 Posts
Default

Quote:
Originally Posted by Novobiocin View Post
Glad to be of help.
I have been told that as long as you get 65% of the info on PN you will pass. And you got over 90%, so your PN is very good.

One more important point:

For CVS : S1S2 WNL RRR NO M,R,G
Thanks again..
I have one more query...for chest examination

HEENT- PERRLA, MOUTH & THROAT- WNL,NO LAD.
CHEST- NON TENDER,CTA & P B/L,NO RALES/RHONCHI/WHEEZES,TVF-WNL

Is there any correction in this...could we write LAD for lymphadenopathy?

Thanks in advance
Reply With Quote Quick reply to this message
  #8  
Old 05-05-2013
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 88
Threads: 22
Thanked 15 Times in 14 Posts
Reputation: 25
Default

Quote:
Originally Posted by sudha1985 View Post
HPI-51 Y M C/O LOWER BACK PAIN X 1 WEEK
-STARTED AFTER LIFTING HEAVY BOXES
- PAIN IS SHARP,8/10,RADIATES TO LEFT THIGH AND LT FOOT.
- DIFFICULTY IN URINATION ,INCOMPLETE EMPTYING OF BLADDER
NO FEVER/CHILLS/HEMATURIA/INCONTINENCE/LOSSOF SENSATION IN LR EXT
ROS- NEGATIVE EXCEPT AS ABOVE
VS- WNL
PMH- INTERMITTENT BACK PAIN X 1 YR
PSH- NONE
ALLERGIES- NKDA
MEDICATIONS- TYLENOL
FH- NOT SIGNIFICANT
SH- 1 PPD X 18 YRS,ETOH OCCASIONALLY,NO ILLICIT DRUGS,CONSTRUCTION LABOURER,MONOGAMOUS WITH WIFE.

PHYSICAL EXAMINATION

PT IS IN PAIN
VS- WNL
HEENT- PERRLA
BACK- MILD PARASPINAL TENDERNES(+),LIMITED ROM
NEURO- LOWER EXT- STRENGTH: 5/5 THROUGHOUT,SENSATION:INTACT,DTRS-:2+B/L,GAIT: TOE AND HEEL WALKING-NL,SLRT-NEGATIVE
CHEST -CTA B/L
HEART- RRR,S1S2+
EXTR-PULSES 2(+)B/L

DISK HERNIATION
PAIN IN BACK
HX OF LIFTING HEAVY WEIGHT
PAIN RADIATING TO LEG AND THIGH

P/E
PARASPINAL TENDERNESS(+)
LIMITED ROM

Diagnosis #2
LUMBAR MUSCLE STRAIN
PAIN IN BACK
HX OF LIFTING HEAVY WEIGHT

P/E
PARASPINAL TENDERNESS(+)
LIMITED ROM

Diagnosis #3
ARTHRITIS -DEGENERATIVE

PT ABOVE AGE 50
PAIN IN BACK

P/E
LIMITED ROM

Diagnostic Study/Studies
XR- L SPINE,MRI-L SPINE
CBC,CALCIUM,BUN/Cr
PSA

I have posted my complete PN for back pain...had finished typing in 9 min...( I am an average typer)...
Experienced members plz comment and correct on my patient note..

Have my exam in 2 days...

Many thanks..
hey u cn put vitals in physical finding also in physical finding if u cnt think of anything to support,also in PMH- u cn put nka,any meds and if sp some medical condition u cn mention.it would save u lines n u cn the write more on hpi.
Reply With Quote Quick reply to this message
The above post was thanked by:
sudha1985 (05-06-2013)
  #9  
Old 05-05-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,086 Times in 1,046 Posts
Reputation: 2106
Default

Quote:
Originally Posted by sudha1985 View Post
Thanks again..
I have one more query...for chest examination

HEENT- PERRLA, MOUTH & THROAT- WNL,NO LAD.
CHEST- NON TENDER,CTA & P B/L,NO RALES/RHONCHI/WHEEZES,TVF-WNL

Is there any correction in this...could we write LAD for lymphadenopathy?

Thanks in advance
AFAIK Can't write MOUTH & THROAT- WNL---> Must specify

Complete HEENT- (pick and choose depending on relevance of the case)
Head: NC/AT
Eyes: EOMI, PERRLA, Fundoscopy WNL, no papilledema, vision WNL, no visual field defects
Ears: B/L Canals w/o abn, TM clear
Nose: No congestion/discharge
Throat: No erythema/exudate/vesicles/ulcers/tonsillar enlargement
Dentition: WNL
Neck: Supple, no thyromegaly, no LAD

Complete Resp. :
No cyanosis/clubbing
Chest appears NL
No chest wall tenderness, TVF WNL
CTA & P (or clear to A&P) B/L
No Rales/rhonchi/wheezes
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”

Last edited by Novobiocin; 05-05-2013 at 06:38 PM.
Reply With Quote Quick reply to this message
The above post was thanked by:
Dr. Mexito (06-02-2013), sudha1985 (05-06-2013), usmlenj (05-05-2013)
  #10  
Old 05-07-2013
Banned
 
Steps History: 1 + CK
Posts: 751
Threads: 133
Thanked 306 Times in 192 Posts
Reputation: 316
Default

U can say oropharynx normal.
But like Novobiocin mentioned,
for HEENT just write everything.
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (06-16-2013)
  #11  
Old 06-25-2013
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 44
Threads: 3
Thanked 26 Times in 16 Posts
Reputation: 36
Default

wouldn´t ABD examination be relevant in this case?? you mentioned: incomplete bladder emptying. probably should have palpated the abd to assess for bladder distension. just a thought.
Reply With Quote Quick reply to this message



Reply

Tags
Patient-Note

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
back pain aknz USMLE Step 2 CK Forum 3 01-23-2013 05:20 AM
Back Pain and Hematuria! tyagee USMLE Step 2 CK Forum 11 04-15-2012 12:20 PM
back pain! salz USMLE Step 1 Forum 2 08-05-2011 03:50 AM
old man with back pain. dr_lizard USMLE Step 1 Forum 7 08-04-2011 07:36 PM
Old man with lower back pain rasheed USMLE Step 1 Classic Clues 0 08-21-2009 11:25 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)