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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 06-18-2013
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Wink My notes

HISTORY:
60 yo M c/o cough since 4 days,intermittent,progressive,worse in the evening,sometimes have to wake up at night to coughwith yellowish sputum 1 tea spoon full,no blood.Feeling warm ,no chills or night sweats,has muscle aches and pains,lost 10 Lb weight in 6 months,unintyentional,appetite decreased,SOB on walking 20 - 30 steps.No runny nose,watery eyes or any recent infection,no known illcontact or T.B exposure.Taken tylenol ,no relief of symptoms ROS: Negative except above PMH: HTN 5 years, taking HCTZ ,compliant PSH: appendectomy - 10 years ago ALLERGIES: none Medication: given above FH: Mother - DM SH: smoke 2 PPD/10 years, no ETOH,no illicit drugs,active with wife
PHYSICAL EXAMINATION:
Patient is anxious. BP : 130/90, P : 90/min, T : 99 F ,R : 20/min HEENT:AT/NC, NT,no nasal congestion,no tonsillar erythema Neck: no LAD CHEST: CTA,NT,normal tactile fremitus,normal precussion CVS: RRR,S1 + 0 + S2 EXT: no cynosis, Pulses intact
DATA INTERPRETATION:
Diagnosis #1
URI
History Finding(s) Physical Exam Finding(s)
Cough with sputum
Fever
Diagnosis #2
COPD
History Finding(s) Physical Exam Finding(s)
Cough with sputum
Fever
Smoker
Diagnosis #3
Lung ca
History Finding(s) Physical Exam Finding(s)
Cough with sputum
Fever
Smoker
Diagnostic Study/Studies
CBC with differentials ,ESR
CXR
CT chest
Bronchoscopy with biopsy
Sputum culture ,gram stain ,smear for AFB
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  #2  
Old 06-18-2013
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-even if the pt is smoker, i would not put COPD after a h/o 4 days and nothing in the past
-i would put Ca Lung as first diagnosis as it's the biggest killer in this country....also smoking plus unintentional wt loss
- u need to do PFTs in this case
-no need to write INTERMITTENT cough. also just tsf is fine instead of Tea Spoon Ful
-need to write recent travel history and occupation in this case
-need to mention abt neck vessels
-i don't think u can write in CVS- S1 + or S2 + as they are never -ve as long as pt is alive.
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  #3  
Old 06-18-2013
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agree with kdm0101 in all points
except pfts whicH is used mainly in asthma, obstructive or restrictive lung disease and there is no indication if any of these diseases in this patient.
aslo i want to add allergy : NKDA better than you put no medication.
so according to this case;
ddx
1- CA lung
2- URI DISEASE
3- PNEUMONIA
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  #4  
Old 06-18-2013
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Quote:
Originally Posted by usramt View Post
agree with kdm0101 in all points
except pfts whicH is used mainly in asthma, obstructive or restrictive lung disease and there is no indication if any of these diseases in this patient.
aslo i want to add allergy : NKDA better than you put no medication.
so according to this case;
ddx
1- CA lung
2- URI DISEASE
3- PNEUMONIA

people is been 4 days... you diagnose cancer
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  #5  
Old 06-18-2013
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Quote:
Originally Posted by shima View Post
people is been 4 days... you diagnose cancer

1- loss appetite
2- loss 10 pounds in few months
3- sob on walking 20-30 steps
4- smoke 2 ppd/10 years
5- 60 yrs old ( not 20's or 30's)
+ 4 days productive cough
all these make
1st choice ddx ca lung
remember in cs there is no stright forward case with all s/s .
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  #6  
Old 06-19-2013
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You are not diagnosing it. You keep it in in DD so that the pt didn't die because you didn't investigate for it early enough.
Quote:
Originally Posted by shima View Post
people is been 4 days... you diagnose cancer
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  #7  
Old 06-19-2013
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Thanks for telling me my mistakes,next time I will keep in my mind these things.But are my notes enough to pass ??
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  #8  
Old 06-19-2013
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Quote:
Originally Posted by aknz View Post
CC:60 yo M c/o cough
HISTORY:

since 4 days (4 d),intermittent,progressive,worse in the evening,sometimes have to wake up at night to cough (night-time awakening+) with yellowish sputum 1 tea spoon full,no blood.Feeling warm ,no chills or night sweats,has muscle aches and pains,lost 10 Lb weight in 6 months,unintyentional,appetite decreased,SOB on walking 20 - 30 steps.No runny nose,watery eyes or any recent infection,no known illcontact or T.B exposure.Taken tylenol ,no relief of symptoms ROS: Negative except above PMH: HTN 5 years, taking HCTZ ,compliant PSH: appendectomy - 10 years ago ALLERGIES: none Medication: given above FH: Mother - DM SH: smoke 2 PPD/10 years, no ETOH,no illicit drugs, sexually active with wife (or SxHx:active with wife)
PHYSICAL EXAMINATION:
Patient is anxious. BP : 130/90, P : 90/min, T : 99 F ,R : 20/min
GPE:Pulses intact (pulses 3+ B/L), no cynosis,
HEENT:AT/NC, NT,no nasal congestion,no tonsillar erythema Neck: no LAD CHEST: CTA,NT,normal tactile fremitus,normal precussion (CTA&P, TVF-WNL)
CVS: RRR,S1 + 0 + S2 (S1S2 WNL, RRR,No M/R/G)
DATA INTERPRETATION:
Diagnosis #1
URI
History Finding(s) Physical Exam Finding(s)
Cough with sputum
Fever
Diagnosis #2
COPD
History Finding(s) Physical Exam Finding(s)
Cough with sputum
Fever
Smoker
Diagnosis #3
Lung ca
History Finding(s) Physical Exam Finding(s)
Cough with sputum
Fever
Smoker
Diagnostic Study/Studies
CBC with differentials ,ESR
CXR
CT chest
Bronchoscopy with biopsy
Sputum culture ,gram stain ,smear for AFB
You need to learn to use abbreviations -not only it saves time but also make PNs look more professional. I have shown some examples in history (not all) and also you must improve you PE notes. Look here for how to write perfect PE notes.
These will make your PNs perfect but what you have written are sufficient to pass (but remember that in the real test due to stress and time constraints you may not be able to write like that and you should practice writing perfect notes in less amount of time)
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Last edited by Novobiocin; 06-19-2013 at 07:39 AM.
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  #9  
Old 06-19-2013
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Thanks Novo.

What CTA&P, TVF-WNL stands for ?
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  #10  
Old 06-19-2013
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Quote:
Originally Posted by aknz View Post
Thanks Novo.

What CTA&P, TVF-WNL stands for ?
CTA&P-clear to auscultation and percussion

TVF-WNL- Tactile Vocal Fremitus-Within Normal Limits
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  #11  
Old 06-20-2013
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Quote:
Originally Posted by shima View Post
people is been 4 days... you diagnose cancer
wht abt wt loss?that cud explain lung ca.
+ cough may not have been an initial presentation
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