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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 08-03-2013
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Question Review of Symptoms Specific for each complaint

Looking at the blueprints guide, I messed up in a major way with my questions about provocative/palliative factors. In all my cases, I just threw out the broad/vague "does anything make it better or worse?" I think that the SPs wont give you credit for that, you have to ask SPECIFIC THINGS. For example, suppose a pt comes in with dizziness. You have to ask them specifically whether its made worse by standing up, or by reaching overhead, or by turning their head, etc. They wont give you credit if you just ask what makes it better or worse.

Another example in blueprints was a lady with chronic abd pain and diarrhea. One of the suggested questions was "do you consume large amounts of diet soda or sorbitol." I never woulda thought to ask that in a million years. I dont think a general question about diet woulda got you those points either.

Also, on the PMH part I'm wondering how specific you have to be. In Blueprints, for a guy with chest pain they want you to ask SPECIFICALLY if the pt has a history of DM or HTN, not just a vague "do you have any other medical problems" question.

Next time I'm going to use PAMHUGSFOSS, LIQORAAA, and TOADDES as a base of questioning, but I'm also going to memorize the specific ROS questions associated with each complaint.


So are u saying that for cs ur not supposed
to ask 'what makes it better? what makes it worse?
any medical problems in the past?'
i dont get it. i thought we were supposed to ask these questions.
this post was written by someone on sdn.
is it true????
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Old 08-03-2013
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I think you are right. Just, in order to do it we must keep our attention to the problem in particular patient with association of a particular diagnosis. Than, I guess mnemonics will be not so much helpful.
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Old 08-03-2013
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If we do everything that sounds more perfect or ask very detailed questions, is 15-minute going to be enough?

ROS is going to take some time to finish. How will you choose which ones to ask in specific cases? Besides a complete HPI and PMH?
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Old 08-03-2013
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For eg
Chest pain After asking details of chest pain in HPI you would ask for other symptoms in ROS
Joint pain or stiffness or rashes Dysuria, oliguria/anuria, hematuria etc
Insomnia or sleep disturbances Constitutional symptoms including
appetite and weight, fatigue, night sweats
Ask about travel or TB exposure (dont forget pericarditis and pleuritis in autoimmune conditions malignancies tb uremia etc )
MI is only most common!
ie one must not assume that chest pain = heart attack ie
dig deep in history
Actually i think one should ask the routine questions and SP will answer ques's and u will put the pieces together.
but im not sure.
because u need to ask about past medical always.
So just say Any medical problems in the past? He will answer and u will connect the dots.
Anyone else have any thoughts regarding this issue?
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Old 08-03-2013
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I don't see why you cannot ask open questions like "Anything makes it better?". All books support those questions as the perfect start, and then according to the answers you get more and more specific in your questions.

The HPI should give you at least a couple of differentials, and you have to adapt your PAM... and specially the ROS to those differentials, looking for clues that help you confirm or reject your clinical suspicion. There isn't time to cover the full differential diagnosis list for fatigue, abdominal pain, or a chest pain, etc. Don't even try it.

To ask for a complete PAM and ROS just makes sense if the HPI gives you no clue about what's going on, or maybe it's a systemic and complex disease, and they aren't supposed to throw at us those cases which would need way more than 15 minutes; all the cases have been carefully designed to last approximately 15 min.
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Old 08-03-2013
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so basically
is it ok to ask what makes it better?
have people failed for asking
what makes it better?
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Old 08-03-2013
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I guess this post below was never really finished. The focus in ROS may also be the focus of PE.

Which organ system to examine first based on Chief complaint?

Which organ system to examine first based on Cheif complaint?

On a related question, how to make sure that we are not just following the mnemonics like a robot? I mean, reading one question after another will NOT make the SP feel that you are behaving naturally?
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Old 08-06-2013
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Quote:
Originally Posted by add1 View Post
so basically
is it ok to ask what makes it better?
have people failed for asking
what makes it better?

LOL. Seriously? I don't think anyone has failed for asking if there is anything that makes it better, if everything else they did was great.
I think it is fine to ask what makes it better. Just remember patients don't always tell you everything, so if they say there is nothing, ask them about a few things you have in mind.
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Old 08-07-2013
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that's ridiculous. these SP's are supposed to answer your questions regardless. @ least from my experience. if u ask " does anything make it better or worse" they definitely tell you or do you have any medical conditions ? if they have at that moment they will tell you.. if they say no. then they don't have anything. don't even bother ..just move on to your next question or you will be wasting your time.

the only dangerous question is "does anything else happen or occur along with this?" in this case they may not tell you anything or they will simply say " not that i can remember?" so then you have to dig deep.
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