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Old 06-20-2013
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Question Physical Finding, Type None or Leave it Blank!

should I put none when there is nothing, or just leave it blank
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Old 06-20-2013
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i would not put anything down.

like for your previous post about LOC being due to cardiac arrhythmia. literally there is nothing you can put. i know people that didn't put anything in that part for most of the cases and passed.
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Originally Posted by shima View Post
should I put none when there is nothing, or just leave it blank
If you mean if PE cannot be done as in a phone case or peds case then just leave it blank.
If there is no PE findings in all other patients then you must write normal findings of the system you examined. NEVER leave it blank or write none.
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Old 06-20-2013
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@novobiocin I'm sorry to disagree with you but I know plenty of people who left it blank and passed the PN with flying colors.
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I think novobiocin was referring to write normal findings in the PE section of the PN, not in the differential section.
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Old 06-20-2013
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please can anyone tell me clearly what to write exactly in differential PE

@ novobiocin and @skyline24----->normal findings in PE or leave blank if we get only normal findings

thank you
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Originally Posted by venky2600 View Post
please can anyone tell me clearly what to write exactly in differential PE

@ novobiocin and @skyline24----->normal findings in PE or leave blank if we get only normal findings

thank you
Must write pertinent positive or negative findings for your differential.

Also, do not leave any blanks on PNs unless not indicated (i.e. PE in Peds /phone case)

For example, in an LOC case where your differential is Cardiac Arrhythmia you would write (pertinent negatives) like
1. S1S2 wnl
2. RRR
3. No m/r/g
4. A&O X 3

There is an excellent thread about all aspects of CS . A MUST read for everyone: Random Tips for the CS exam: Q & A
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Originally Posted by skyline24 View Post
@novobiocin I'm sorry to disagree with you but I know plenty of people who left it blank and passed the PN with flying colors.
That's because you only need over 65% in PNs to pass BUT do you want to take a chance?
So, why not do your best on the test & forget the "rest"
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Quote:
Originally Posted by Novobiocin View Post
If you mean if PE cannot be done as in a phone case or peds case then just leave it blank.
If there is no PE findings in all other patients then you must write normal findings of the system you examined. NEVER leave it blank or write none.

I left everything blank where I did not find anything (lots of PEs were blank) and got a high pass in ICE so I am pretty sure it is ok to leave fields blank!!
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Old 06-21-2013
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so what I mean by I did not put anything for PE is I did not put anything in the PE section for the supporting findings in multiple cases.
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Originally Posted by val7 View Post
I left everything blank where I did not find anything (lots of PEs were blank) and got a high pass in ICE so I am pretty sure it is ok to leave fields blank!!
I almost never left anything blank and also had a high performance in ICE by a wide margin.. so I think there is no actual consensus about this.. however I heard while I was in the U.S that it is better to write pertinent negatives
Dont risk it.. unless you are a slow typer, freak out or dont have enough time.. then you can write pertinent negatives (as long as you did them) and feel confident
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Originally Posted by XpaezX View Post
I almost never left anything blank and also had a high performance in ICE by a wide margin.. so I think there is no actual consensus about this.. however I heard while I was in the U.S that it is better to write pertinent negatives
Dont risk it.. unless you are a slow typer, freak out or dont have enough time.. then you can write pertinent negatives (as long as you did them) and feel confident
I agree, there is no consensus, but you certainly don't have to fill in something if you don't find anything/don't have time!
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I think most people are not used to the concept of pertinent negatives.
For example, normal PE findings are pertinent negative findings. In other words if you do not find any abnormality on PE (majority of pts) then put down those normal findings which you would expect to be positive under that differential (this is called pertinent negatives) as explained in my earlier post above..
So, again, you didn't find anything on PE = pertinent negatives

During Kaplan CS course we were very clearly told NOT to leave any spaces blank. So, there is no question of having a consensus based on anecdotal evidence.
Moreover, why take a chance when you can do better and have a margin of error to cover any serious mistakes/computer freezes etc etc during your remaining encounters?
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Last edited by Novobiocin; 06-21-2013 at 10:39 AM.
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Originally Posted by val7 View Post
I left everything blank where I did not find anything (lots of PEs were blank) and got a high pass in ICE so I am pretty sure it is ok to leave fields blank!!
It turned out OK for you to leave the spaces blank as you most likely did everything else perfectly but think about someone who didn't do the rest of ICE components well and read here that it is OK to leave the spaces blank. What do you think their result might be?
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Originally Posted by Novobiocin View Post
I think most people are not used to the concept of pertinent negatives.
For example, a normal PE findings are pertinent negative findings. In other words if you do not find any abnormality on PE (majority of pts) then put down those normal findings which you would expect to be positive under that differential (this is called pertinent negatives) as explained in my earlier post above..
So, again, you didn't find anything on PE = pertinent negatives

During Kaplan CS course we were very clearly told NOT to leave any spaces blank. So, there is no question of having a consensus based on anecdotal evidence.
Moreover, why take a chance when you can do better and have a margin of error to cover any serious mistakes/computer freezes etc etc during your remaining encounters?
I was also told while in the U.S not to leave anything blank, the issue of pertinent negatives has been explained numerous times and people still dont understand, the recommendation has been given, let them decide what technique and method to use.
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Old 06-21-2013
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I'm not sure if everyone here is arguing about the same thing…

There are two places to put detail about physical exam findings. First, right after the history there is a box for physical exam findings. Here it is suggested that you write the pertinent negative exam findings in an orderly fashion. Second, when you list each diagnosis there are spots to add supporting physical exam findings. This part is more difficult because there aren’t many positive findings. I don’t think there will be to many instances when a negative finding should be added here.

Is this correct?
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Originally Posted by Vurtil View Post
I'm not sure if everyone here is arguing about the same thing…

There are two places to put detail about physical exam findings. First, right after the history there is a box for physical exam findings. Here it is suggested that you write the pertinent negative exam findings in an orderly fashion. Second, when you list each diagnosis there are spots to add supporting physical exam findings. This part is more difficult because there aren’t many positive findings. I don’t think there will be to many instances when a negative finding should be added here.

Is this correct?
I think we are all discussing (not arguing) about the PE findings to support the diagnosis. As I have explained above that since there aren't many positive findings to support a particular differential but you can put plenty of pertinent negatives for a particular differential.
For example, if your diagnosis is Pulmonary embolism then you can put a pulse rate of 80/min as a pertinent negative since you expect to find tachycardia in a pt with pulmonary embolism.
It is very difficult concept to grasp and it took me a while to understand it myself.
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Old 06-22-2013
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I understand the significance of a pertinent negative finding... i.e. the patient may have pulmonary embolism, but his normal breathing rate argues against it.

On the exam, however, I thought that you were only supposed to write supporting findings for each diagnosis. At least that's all that I've seen on USMLE world and on the Sample note provided by ECFMG.
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Old 06-22-2013
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I understand the significance of a pertinent negative finding... i.e. the patient may have pulmonary embolism, but his normal breathing rate argues against it.

On the exam, however, I thought that you were only supposed to write supporting findings for each diagnosis. At least that's all that I've seen on USMLE world and on the Sample note provided by ECFMG.

Nope, look guys.. We didnt just got this out of our arse and started telling people about pertinent negatives... It is there in the USMLE bulletin and the videos I posted here.. from youtube.

Remember that to diagnose whatever disease you need to have positive and negative findings that either support of go against that diagnosis.

The example you gave it goes against a diagnosis but i will tell you a pertinent negative that favors a diagnosis.

IN Pulmonary embolism; CLEAR LUNGS is a pertinent negative.. why? because the patient presents with dyspnea, tachypnea, chest pain and a fever.. just with that you would think in a shitload of stuff including pneumonia... but hey you find clear LUNGS SO THAT WILL narrow your diagnosis so much is not even funny.. THIS IS AN EXAMPLE of a PERTINENT NEGATIVE THAT FAVORS A DIAGNOSIS.

So now you know they exist and that YOU HAVE TO use them.

No more I didnt know and stuff.. now everyone knows
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Old 06-22-2013
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i dont want to push the issue, but just for the sake of clarity i want to ask a couple more things. remember, im not arguing that pertinent negative findings are not important.

1. isnt it more common that there are few or no positive nor pertinent negative findings. so if someone leaves it blank it probably would be better than if they add something for no reason.

2. off the top of my head i cant think of many pertinent negative findings, maybe it wouldnt be a bad idea to make a list. one that i could think of that favors the diagnosis of a simple case of cystitis is negative costovertebral angle tenderness. absence of cough in strep throat would be another.

Last edited by Vurtil; 06-22-2013 at 08:20 AM.
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Old 06-22-2013
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Originally Posted by Vurtil View Post
i dont want to push the issue, but just for the sake of clarity i want to ask a couple more things. remember, im not arguing that pertinent negative findings are not important.

1. isnt it more common that there are few or no positive nor pertinent negative findings. so if someone leaves it blank it probably would be better than if they add something for no reason.

2. off the top of my head i cant think of many pertinent negative findings, maybe it wouldnt be a bad idea to make a list. one that i could think of that favors the diagnosis of a simple case of cystitis is negative costovertebral angle tenderness. absence of cough in strep throat would be another.
Almost every diagnosis known to mankind has pertinent negatives, the issue here is that we are used since medical school to only look at positive findings; that is why is really hard to get a good grasp about this.

Regarding your first point, yess.. in the exam only few things will be positive findings... but if you do a maneuver you have to write it, dont leave anything blank.

Regarding your second point, you are missing the most important negative finding; the absence of FEVER.

Neither me nor Novobiocin are here to teach the concept of negative findings, we already explained it as well as we could; it is up to you guys to use it or not, we already passed our exams so... We only want to help but not to force anything on you guys.. if you feel more comfortable not using negative findings then dont use them.. it is your exam and your issue not ours .
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Old 06-22-2013
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gotcha... so here’s my summary of what’s posted here…

Supporting physical exam findings for USMLE Step 2 CS
  1. Positive finding – should be at least one, and probably heavily simulated to make it obvious (e.g., pain on palpation, yellow makeup for jaundice).
  2. Absence of fever – relevant almost every time. its abscence would probably already be noted under review of systems though.
  3. Other pertinent negative finding – add whenever applicable.
all in all, nobody who takes this exam should stress over this issue. as posted by others, ppl who have left it blank got a high performance rating. and i am sure that there are times that no finding will be applicable nor should be mentioned. medicine isnt a three blank filling contest... do whats applicable and necessary.
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Old 06-22-2013
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Quote:
Originally Posted by Vurtil View Post
gotcha... so here’s my summary of what’s posted here…

Supporting physical exam findings for USMLE Step 2 CS
  1. Positive finding – should be at least one, and probably heavily simulated to make it obvious (e.g., pain on palpation, yellow makeup for jaundice).
  2. Absence of fever – relevant almost every time. its abscence would probably already be noted under review of systems though.
  3. Other pertinent negative finding – add whenever applicable.
all in all, nobody who takes this exam should stress over this issue. as posted by others, ppl who have left it blank got a high performance rating. and i am sure that there are times that no finding will be applicable nor should be mentioned. medicine isnt a three blank filling contest... do whats applicable and necessary.
Perfectly summarized , you will do fine in your exam
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Old 06-26-2013
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Originally Posted by XpaezX View Post
Perfectly summarized , you will do fine in your exam
TOTALLY CONFUSED
PLZ DO ME A FAVOUR

SELECT A SIMPLE CASE FROM F.A
CONSIDER THE SAME HX AND P/E AND THEN ADVISE ME WHAT TO WRITE IN BOTH HX AND P/E OF D/D SECTION ONLY

I LL REQUEST CASE 10 OF F.A THAT IS PERSISTENT COUGH
YOUR RESPONSES LL BE HIGHLY APPRECIATED THANKS
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