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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 08-23-2013
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Unhappy I am having PTSD Flashbacks!

I finished my CS 3 days ago.... and feel so awful....
I think I missed 2 diagnosis..... and a little bit of stuff, either HPI questions or PE, on every single patient......
and also..... there is 1 thing.....
In order to protect the modesty of my SPs, I untied their gown, but I didn't lower all the way, i just reveal the upper chest above the breast, and reached inside, so technically they were still mostly cover, but I DID NOT listen through the gown...... Are they gonna take points off of that?

Please help this poor little worrier.... I can't eat, sleep, study, or do anything useful.... I just constantly having PTSD flashbacks
Thank you...
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  #2  
Old 08-23-2013
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about the 2 dx I think it's ok to miss some dx. And they said that they will only take 10 cases out of the 12...

About the chest auscultation... I can't understand why do you think they will take off point of that. For me you were correct.


it those are your mistake you will pass.. I passed and I did a way more mistakes than that.
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  #3  
Old 08-23-2013
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Thanks for the reply.
But they are not necessarily taking out your 2 worst......
and some of my closure were vague even though I tried to be as empathetic as I possibly could....
also I think I missed more than I can remember
This is so nerve wracking..... I hate my life
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  #4  
Old 08-23-2013
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Quote:
Originally Posted by AiLSP View Post
Thanks for the reply.
But they are not necessarily taking out your 2 worst......
and some of my closure were vague even though I tried to be as empathetic as I possibly could....
also I think I missed more than I can remember
This is so nerve wracking..... I hate my life
are you kidding me,,c'mon ask about real mistakes,,you will pass dont worry,its just a matter of time before you see your score report
what about your patient notes? these are the most important
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  #5  
Old 08-23-2013
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Quote:
Originally Posted by h007 View Post
are you kidding me,,c'mon ask about real mistakes,,you will pass dont worry,its just a matter of time before you see your score report
what about your patient notes? these are the most important
I mean I don't really know.....
I usually used up >80% of the allotted space for the history section because just by putting PMH/PSH/MED/Allergies/FH/Social used up so many space. I am worry about my HPI because i forgot to ask some questions for each patient so the HPI are usually just 3-4 lines long, and I put ROS on every note. I didn't do ObHx and sexual Hx on every pt, just when I thought was pertinent, like I didn't ask in chest pain and cough encounter.

Physical Exam section.... oh dear...... i never used more than 50% of the space since i only do FOCUSED physicals..... and not to mention sometimes i even forgot to do the required PE maneuvers and sometimes I did it but forgot to write it down (like i check thyroid for most patients, but since they are all normal I tend to forget to put them on the note)

And for DDX, i know i missed 2, but the rest... who knows
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  #6  
Old 08-23-2013
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Well first of all physicians will review your notes and i am not one of them, but out of experience i did the same thing like you in addition to spelling mistakes, writing it all in small letters, improper punctuation, and i passed,,, i guess hou already passed your exam
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  #7  
Old 08-23-2013
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thank you 007, that makes me feel better....!
just 1 more questions.
for encounters where i was sure it was 1 thing, i didn't explain the differential, even though multiple study aids said you should.... I just said "Mr/s xxx, i think you have abc, but i will do xyz to confirm it and rule out other causes" without actually explaining what "other causes" were. is that acceptable?
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  #8  
Old 08-23-2013
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You shouldnt explain your diagnosis to the patient, he/she didnt go to medical school to interpret history and physical exam into a disease, mr. X from what you have told me and my physical exam i think hou have a/b/c and we have to draw some blood, do imaging tests... Etc

As for explaining, you should have done that in the patient note under each diagnosis yiu have 3 blank spaces for history findings and 3 for physical exam that support your diagnosis

I hope i answered your question
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  #9  
Old 08-23-2013
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sorry I didn't mean explain, i mean to "mention" about other possible differentials.
just for example: this pt i thought has classic hypothyroidism for her fatigue, i just said, i think you have hypothyroidism and i am going to draw your blood to test. I didn't say any other "possible" causes of fatigue like anemia blah blah blah.... so the "explain differential" on the checklist is what i didn't do on some of the cases where i couldn't think of any other ddx..... Is that Ok? and is that CIS or ICE?
Thank you so much 007 for willing to share your input.
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  #10  
Old 08-23-2013
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well,if you said I THINK YOU HAVE "X" AND I SHOULD DO SOME TESTS TO EXCLUDE OTHER "CAUSES OF YOUR SYMPTOMS", i think you will be fine,but on the patient notes,you should mention 3 ddx,and at least one item under each dd,even if it is a normal finding,but i think you should write something,i really dont know if that goes under ice or cis,,

although i know some ppl who left these justification spaces empty,and they passed but that was before january 2013,
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  #11  
Old 08-23-2013
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Quote:
Originally Posted by AiLSP View Post
sorry I didn't mean explain, i mean to "mention" about other possible differentials.
just for example: this pt i thought has classic hypothyroidism for her fatigue, i just said, i think you have hypothyroidism and i am going to draw your blood to test. I didn't say any other "possible" causes of fatigue like anemia blah blah blah.... so the "explain differential" on the checklist is what i didn't do on some of the cases where i couldn't think of any other ddx..... Is that Ok? and is that CIS or ICE?
Thank you so much 007 for willing to share your input.

if leaving those spaces empty in just some of the cases and for some of the ddx not all of them,,,i think you will be ready to get your pass very soon
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  #12  
Old 08-23-2013
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for each pt note, i didn't really force myself to come up with 3 ddx. If I only think of 1, i just put that 1. With each ddx i put down, i at least put down a history or PE finding, though most of the time PE findings are empty because..... i couldn't find anything lol..... so each ddx is with at least 1 finding (history or physical)
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  #13  
Old 08-23-2013
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i hope that would be fine,even if you knew now that this wasnt the right thing to do ,it wont help you,,you cant retake it,

i really dont know but i think you are fine if you didnt do that in all of your cases,but i still dont know

may be someone might tell you its wrong but who know may be the physician will be impressed by your PN and gets satisfied with your single ddx,,,who knows,,there are rules but who knows if any examiner follow any of them,,,

just relax,get something to drink,,,and dont worry
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  #14  
Old 08-23-2013
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Quote:
Originally Posted by h007 View Post
i hope that would be fine,even if you knew now that this wasnt the right thing to do ,it wont help you,,you cant retake it,

i really dont know but i think you are fine if you didnt do that in all of your cases,but i still dont know

may be someone might tell you its wrong but who know may be the physician will be impressed by your PN and gets satisfied with your single ddx,,,who knows,,there are rules but who knows if any examiner follow any of them,,,

just relax,get something to drink,,,and dont worry
Thank you so much!
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  #15  
Old 08-26-2013
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Quote:
Originally Posted by AiLSP View Post
for each pt note, i didn't really force myself to come up with 3 ddx. If I only think of 1, i just put that 1. With each ddx i put down, i at least put down a history or PE finding, though most of the time PE findings are empty because..... i couldn't find anything lol..... so each ddx is with at least 1 finding (history or physical)
U should write down at least 2 ddx if possible 3rd which is least possible. even if no PE, u should try to fill up the spaces for supportive findings. Never leave it blank.
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  #16  
Old 08-26-2013
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Quote:
Originally Posted by AiLSP View Post
I finished my CS 3 days ago.... and feel so awful....
I think I missed 2 diagnosis..... and a little bit of stuff, either HPI questions or PE, on every single patient......
and also..... there is 1 thing.....
In order to protect the modesty of my SPs, I untied their gown, but I didn't lower all the way, i just reveal the upper chest above the breast, and reached inside, so technically they were still mostly cover, but I DID NOT listen through the gown...... Are they gonna take points off of that?

Please help this poor little worrier.... I can't eat, sleep, study, or do anything useful.... I just constantly having PTSD flashbacks
Thank you...
Which portions u failed?
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  #17  
Old 08-26-2013
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He/she didnt fail,took the exam just 3 days ago, he is asking wether they are going to take off points for that.... Still awaiting the results
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  #18  
Old 08-26-2013
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Default same here

I feel bad also about my exam which I took 10 days ago.. ..I understand your worries ...but it's done now all we have to do is to pray
may I know where did you take your exam please??
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  #19  
Old 08-26-2013
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I took it at Houston
and regarding the ddx...... like i said before
unless it's totally obvious that there were 3 ddx, i just did as much as i can (usually 2, i have 2 cases i just put 1 diagnoses) and usually with 1~2 supporting history findings...... I hope that's fine....
but I am really worried that I failed :sorry:
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  #20  
Old 08-26-2013
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I am really sorry about wrong comments in your thread. :sorry:
Regarding the test, everybody worried about the result after finished the test. I scarce everyday until got the result. I made so many mistakes during the test: some arguments with pt bc of wrong diagnosis - pt did not accept my dx, skip some PE when I dont have time to finish, some pt cannot understand me and need to explain again in other ways, sometimes I cannot understand what the pt was talking..etc.
Its normal phenomenon about having the flashback.
You did ur best at the test.
Wish you guys good luck with the exam!
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  #21  
Old 08-26-2013
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Thank you!

Did you pass?
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  #22  
Old 08-26-2013
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Quote:
Originally Posted by AiLSP View Post
Thank you!

Did you pass?
Y------
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  #23  
Old 08-26-2013
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Quote:
Originally Posted by medhelp View Post
Y------
haha Congrats
I hope I pass ^.^
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  #24  
Old 08-26-2013
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Quote:
Originally Posted by medhelp View Post
I am really sorry about wrong comments in your thread. :sorry:
Regarding the test, everybody worried about the result after finished the test. I scarce everyday until got the result. I made so many mistakes during the test: some arguments with pt bc of wrong diagnosis - pt did not accept my dx, skip some PE when I dont have time to finish, some pt cannot understand me and need to explain again in other ways, sometimes I cannot understand what the pt was talking..etc.
Its normal phenomenon about having the flashback.
You did ur best at the test.
Wish you guys good luck with the exam!
so you are not even a licensed doctor ins USA and your trying to sell off your business.
Nice thinking. Let me guess your next project is to create a CS course.
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  #25  
Old 08-27-2013
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Quote:
Originally Posted by medhelp View Post
U should write down at least 2 ddx if possible 3rd which is least possible. even if no PE, u should try to fill up the spaces for supportive findings. Never leave it blank.
That is not true. Don't know where you got it from, but definitely not from the official information.
They say "list up to three diagnoses". This means one, two or three.
I listed one or two for most of them and passed with a high pass in all three subcomponents.
So don't tell me you cannot leave stuff blank.
Fill in the important things!
If you had clinical experience you will know what the important things are!
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