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  #1  
Old 12-17-2013
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Experiences How I Passed Step 2 CS

Hey guys,
I wanted to share with you on how I got through Step 2 CS. I passed all portions with high marks.
I'm sure I left stuff out in this write up, so I'll keep updating as questions come up.
First off -- I'm a native English speaker and have always been strong in terms of communicating with people from all walks of life. I've been in the business world as well as taught college classes while I was a grad student so I'm familiar with public speaking and being able to connect with people. So I wasn't nervous about the SEP, CIS but I was very NERVOUS about ICE. This seems to be the worst section for native speakers.

1. Nothing substitutes being in current rotations -- my advice is to squeeze in a family med or emergency med rotation right before you take CS. EM is quite good because you have a ton of patients and you have to do a quick focused H&P which is what CS is all about.

2. If you aren't in rotations -- no sweat -- but get a partner and work out First Aid or usmleworld. If you don't have a partner then make sure you are talking out loud and going through every motion as you practice -- don't just sit there.

3. Create a template for the H & P and stick to it. On exam day you need to be on auto pilot. It flies by. That means get your dialogue down pat.*

4. What helped me the most actually was studying for CK prior to taking CS. The reason being that I have no issues with spoken English nor the empathy/compassion portion -- but was nervous with coming up with differentials and supporting them from my H&P and then the diagnostic w/u.

5. So the mnemonics I used:*

FOR HPI: For PAIN the standard LIQQORAAA (location, intensity, quality/quantity, onset, radiation, aggravating/alleviating/associated) For everything else: DOCFP (duration, onset, course, frequency, precipitation factors).*

FOR HX: PAMHUGSExFOSS (previous, allergies, medications, hospitalizations (past medical/surgery/illnessnes/etc), urinary sx, GI sx, sleep, exercise, family hx, obgyn hx, sexual hx, social hx -- for social this includes occupation/tobacco/EtOH (CAGE)/rec drugs/other stressors/living conditions/etc

Now this is a very loose skeleton -- I included extra ROS as needed -- for instance appetite, travel hx, diarrhea/constipation/nausea/vomiting in the GI sx -- obviously CP/SOB/orthopnea/etc for chest/breathing cases -- you'll have to fill in the details.

Also before OBGYN & SEXUAL/SOCIAL hx I always said "Thank you for answering my questions. Now the next set of questions are a bit personal but I wanted to remind you and assure you that everything we talk about is confidential and that these are standard questions that I ask all my patients in order to get a complete history so I can provide the best possible care.

6. For PE: I was very conflicted. On one hand I had everyone telling me to be very focused and do relevant organ system and I had other buddies do more. What I did was I came up with a template from head to toe. I touched a bit on everything from HEENT -- NECK (including thyroid) -- CHEST -- LUNGS -- ABD -- EXTREMITIES. I could do this in about a 1 minute. The reason being was it allowed me time to think about what my focused exam would be without looking like I have no idea what to do. Once I figured out what I wanted to do I would do a more focused exam on the relevant organ system.

Now of course if it is a NEURO or MUSCULOSKELETAL case I would just dive right into that exam because they were lengthy and there is no time to do other stuff. If I had extra time I'd jump back into my 1 minute template.

Now USMLE makes it clear that you will not be graded on irrelevant exams and some people think my method is a waste of time -- but it worked for me. Now from my general template I could come up with a template patient note for a benign/normal exam.

GEN: AAOx3; NAD
HEENT: EOMI; PERRLA; moist mucus membrances; -ve scleral icterus; -ve conjunctival pallor; -ve tonsillar erythema, enlargements, exudates
NECK: supple; -ve LAD
CVS: RRR; normal S1 S2; no M/R/G
LUNGS: CTA B/L; no W/C/R
ABD: + BS in all 4 Qs; tympanic to percussion; soft/NT/ND/-ve HSM/no palpable masses
EXTREMITIES: 2+ pulses throughout; no edema; no cyanosis, clubbing

Now I wouldn't use all of this -- only relevant ones but I wanted to have them in my toolbox to throw out there if I needed them. Of course neuro I used Mini Mental -- Cranial Nerves -- MRS (motor strength, reflexes, sensations) -- as well as RAM; heel to shin; gait; romberg.

Musculoskeletal I used "I PROM MRSP" (inspection, palpation, ROM, MRS, pulses). Always beginning with the unaffected side then moving to the affected side. Starting with distal joints moving towards affected joint as well as proximal joint moving towards affected joint.

7. Now on my sheet before going in the room I wrote down my mnemonics, studied the doorway info, as well as added the words 'SUMMARIZE' and 'COUNSEL' to remind myself of these 2 tasks for every encounter.

8. So here is a sample encounter: Write my mnemonics. Knock on door. Hi Mr/Ms Smith -- I'm Dr. Jones and I'll be taking care of you today. So what brings you in?*

USE MY LIQQORAAA, PAMHUGSExFOSS -- Finish history.

Well thank you Mr/Ms Smith for answering my questions. Do you mind if we begin the physical exam? Please excuse me while I wash my hands.

GO INTO MY TEMPLATE -- Finish PE

Then I usually sat down and said "Ok Mr/Ms Smith. I just wanted to SUMMARIZE everything you told me -- this allows you to get the history organized as well as have the patient correct any parts that you've blanked out on.

Then I said something like this: "So Mr/Ms Smith I wanted to let you know what I'm thinking so far from what you told me as well as from the PE….."
At this point give some kind of differential along with some back up. If you're clueless -- keep it vague and remind them that you'll need to run some tests to really get a handle on what is going on. Keep stressing the fact that without labs/imaging you can't give a definitive diagnosis.

Now at this point I would say something like this: "Besides starting on your lab work there are some things that I'd like to discuss with you -- have you thought about quitting smoking/etc…" COUNSEL!!!!!

So for every patient I had this template during the close.
1. Do you understand my diagnosis?
2. Do you agree with my treatment plan?
3. Do you have any questions for me? ANSWER challenge question
4. Well Mr/Ms Smith, regardless of the final diagnosis I just want to make sure you know that I am here for you and that we will work together as a team to figure out what's going on with you and how we can make you feeling better. It was an absolute pleasure meeting you and I'll call in the nurse to begin the lab work up.

I always left the room with 2 minutes to spare. This allowed me extra time for my patient note.
Now make sure you fill out the whole PATIENT NOTE. The very first encounter that I had since the computer screen doesn't show the whole length of the note, I filled everything out perfectly and sat there with extra 2 minutes and when they said to submit I realized I had forgotten to write down any diagnostic w/u. I guess it was my nerves or whatever but I didn't realize I left it blank until I scrolled the computer down and to submit. So please practice on the usmle website and use their patient note to practice typing and such.
So for one of my notes I had left out the whole diagnostic w/u, but I still scored high marks on ICE because the rest of my notes were good (I'm assuming).
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  #2  
Old 12-23-2013
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Great post! Very helpful. I just a couple questions. Where did you take your exam? And what was the book that you used mostly for this exam? Thankyou.
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Old 12-31-2013
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Quote:
Originally Posted by exudate View Post
Great post! Very helpful. I just a couple questions. Where did you take your exam? And what was the book that you used mostly for this exam? Thankyou.
Philly & First Aid
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  #4  
Old 01-02-2014
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ROM, MRS, what is meant by these abbreviations? you used in musculoskeletal system abbreviation.

and abbreviations you used in describing PE. like EOMI in HEENT examination.

Thank you.
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  #5  
Old 01-03-2014
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Quote:
Originally Posted by Nini View Post
ROM, MRS, what is meant by these abbreviations? you used in musculoskeletal system abbreviation.

and abbreviations you used in describing PE. like EOMI in HEENT examination.

Thank you.
ROM = range of motion
MRS = motor, reflexes, sensations
EOMI = extra-ocular muscles intact
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  #6  
Old 01-03-2014
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Thank you so much.
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Old 01-03-2014
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Default Help for CS

hi....congratulations for your great performance....my cs on 7th march..will start reading FA minicases from today....How do I plan my study and what all things I need to read apart from FA?....what to read first?....when to read UW?....which videos to watch?....can u give me any link to good videos?
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Old 01-17-2014
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Default thanks, doubts

Thanks a lot. Your post is really helpful. And congrats on passing this exam. They way you you wrote makes it look pretty easy. Cold you please expand the short forms in your general template. Cannot make them all out. Thank you
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Old 01-17-2014
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AAOx3 Alert, oriented to to time place person; NAD no acute distress
HEENT: EOMI; PERRLA pupils equal, round reactive to light and accomodation; moist mucus membrances; -ve scleral icterus; -ve conjunctival pallor; -ve tonsillar erythema, enlargements, exudates
NECK: supple; -ve LAD lymadenopathy
CVS: RRR rate rhythm regular; normal S1 S2; no M/R/G murmur, rub, gallop
LUNGS: CTA B/L clear to auscultation bilaterally; no W/C/R wheeze, crepitations, ronchi
ABD: + BS in all 4 Qs; tympanic to percussion; soft/NT/ND/ non tender, non distended -ve HSM hepatosplenomegaly/no palpable masses
EXTREMITIES: 2+ pulses throughout; no edema; no cyanosis, clubbing
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Old 01-19-2014
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what was your template for the physical examination? do you mind telling me what you exactly you went through in that 1 minute mini-exam you did? thanks
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Old 01-24-2014
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can you plz email me a copy of ur patient note along with PE, differentials and Diagnostic studies...i mean any case....i would like to compare it with mine...and i would really appretiate that
my email: naveed733@yahoo.com

thanks
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Old 01-25-2014
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Quote:
Originally Posted by Nini View Post
AAOx3 Alert, oriented to to time place person; NAD no acute distress
HEENT: EOMI; PERRLA pupils equal, round reactive to light and accomodation; moist mucus membrances; -ve scleral icterus; -ve conjunctival pallor; -ve tonsillar erythema, enlargements, exudates
NECK: supple; -ve LAD lymadenopathy
CVS: RRR rate rhythm regular; normal S1 S2; no M/R/G murmur, rub, gallop
LUNGS: CTA B/L clear to auscultation bilaterally; no W/C/R wheeze, crepitations, ronchi
ABD: + BS in all 4 Qs; tympanic to percussion; soft/NT/ND/ non tender, non distended -ve HSM hepatosplenomegaly/no palpable masses
EXTREMITIES: 2+ pulses throughout; no edema; no cyanosis, clubbing
Are all of these abbreviations acceptable for the exam? In the general information booklet, abbreviations like AAOx3 or NAD are not mentioned...
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  #13  
Old 01-28-2014
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can you use NC/AT for normocephalic atraumatic?

also for ROS, i was told to just write negative except as above, is that ok?
I usually just write down the negatives..... but now i have incorporated the pertinent negatives in the HPI, which left ROS blank
what is a better way of doing it?
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Old 02-12-2014
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Quote:
Originally Posted by mpnyc View Post
Hey guys,
I wanted to share with you on how I got through Step 2 CS. I passed all portions with high marks.
I'm sure I left stuff out in this write up, so I'll keep updating as questions come up.
First off -- I'm a native English speaker and have always been strong in terms of communicating with people from all walks of life. I've been in the business world as well as taught college classes while I was a grad student so I'm familiar with public speaking and being able to connect with people. So I wasn't nervous about the SEP, CIS but I was very NERVOUS about ICE. This seems to be the worst section for native speakers.

1. Nothing substitutes being in current rotations -- my advice is to squeeze in a family med or emergency med rotation right before you take CS. EM is quite good because you have a ton of patients and you have to do a quick focused H&P which is what CS is all about.

2. If you aren't in rotations -- no sweat -- but get a partner and work out First Aid or usmleworld. If you don't have a partner then make sure you are talking out loud and going through every motion as you practice -- don't just sit there.

3. Create a template for the H & P and stick to it. On exam day you need to be on auto pilot. It flies by. That means get your dialogue down pat.*

4. What helped me the most actually was studying for CK prior to taking CS. The reason being that I have no issues with spoken English nor the empathy/compassion portion -- but was nervous with coming up with differentials and supporting them from my H&P and then the diagnostic w/u.

5. So the mnemonics I used:*

FOR HPI: For PAIN the standard LIQQORAAA (location, intensity, quality/quantity, onset, radiation, aggravating/alleviating/associated) For everything else: DOCFP (duration, onset, course, frequency, precipitation factors).*

FOR HX: PAMHUGSExFOSS (previous, allergies, medications, hospitalizations (past medical/surgery/illnessnes/etc), urinary sx, GI sx, sleep, exercise, family hx, obgyn hx, sexual hx, social hx -- for social this includes occupation/tobacco/EtOH (CAGE)/rec drugs/other stressors/living conditions/etc

Now this is a very loose skeleton -- I included extra ROS as needed -- for instance appetite, travel hx, diarrhea/constipation/nausea/vomiting in the GI sx -- obviously CP/SOB/orthopnea/etc for chest/breathing cases -- you'll have to fill in the details.

Also before OBGYN & SEXUAL/SOCIAL hx I always said "Thank you for answering my questions. Now the next set of questions are a bit personal but I wanted to remind you and assure you that everything we talk about is confidential and that these are standard questions that I ask all my patients in order to get a complete history so I can provide the best possible care.

6. For PE: I was very conflicted. On one hand I had everyone telling me to be very focused and do relevant organ system and I had other buddies do more. What I did was I came up with a template from head to toe. I touched a bit on everything from HEENT -- NECK (including thyroid) -- CHEST -- LUNGS -- ABD -- EXTREMITIES. I could do this in about a 1 minute. The reason being was it allowed me time to think about what my focused exam would be without looking like I have no idea what to do. Once I figured out what I wanted to do I would do a more focused exam on the relevant organ system.

Now of course if it is a NEURO or MUSCULOSKELETAL case I would just dive right into that exam because they were lengthy and there is no time to do other stuff. If I had extra time I'd jump back into my 1 minute template.

Now USMLE makes it clear that you will not be graded on irrelevant exams and some people think my method is a waste of time -- but it worked for me. Now from my general template I could come up with a template patient note for a benign/normal exam.

GEN: AAOx3; NAD
HEENT: EOMI; PERRLA; moist mucus membrances; -ve scleral icterus; -ve conjunctival pallor; -ve tonsillar erythema, enlargements, exudates
NECK: supple; -ve LAD
CVS: RRR; normal S1 S2; no M/R/G
LUNGS: CTA B/L; no W/C/R
ABD: + BS in all 4 Qs; tympanic to percussion; soft/NT/ND/-ve HSM/no palpable masses
EXTREMITIES: 2+ pulses throughout; no edema; no cyanosis, clubbing

Now I wouldn't use all of this -- only relevant ones but I wanted to have them in my toolbox to throw out there if I needed them. Of course neuro I used Mini Mental -- Cranial Nerves -- MRS (motor strength, reflexes, sensations) -- as well as RAM; heel to shin; gait; romberg.

Musculoskeletal I used "I PROM MRSP" (inspection, palpation, ROM, MRS, pulses). Always beginning with the unaffected side then moving to the affected side. Starting with distal joints moving towards affected joint as well as proximal joint moving towards affected joint.

7. Now on my sheet before going in the room I wrote down my mnemonics, studied the doorway info, as well as added the words 'SUMMARIZE' and 'COUNSEL' to remind myself of these 2 tasks for every encounter.

8. So here is a sample encounter: Write my mnemonics. Knock on door. Hi Mr/Ms Smith -- I'm Dr. Jones and I'll be taking care of you today. So what brings you in?*

USE MY LIQQORAAA, PAMHUGSExFOSS -- Finish history.

Well thank you Mr/Ms Smith for answering my questions. Do you mind if we begin the physical exam? Please excuse me while I wash my hands.

GO INTO MY TEMPLATE -- Finish PE

Then I usually sat down and said "Ok Mr/Ms Smith. I just wanted to SUMMARIZE everything you told me -- this allows you to get the history organized as well as have the patient correct any parts that you've blanked out on.

Then I said something like this: "So Mr/Ms Smith I wanted to let you know what I'm thinking so far from what you told me as well as from the PE….."
At this point give some kind of differential along with some back up. If you're clueless -- keep it vague and remind them that you'll need to run some tests to really get a handle on what is going on. Keep stressing the fact that without labs/imaging you can't give a definitive diagnosis.

Now at this point I would say something like this: "Besides starting on your lab work there are some things that I'd like to discuss with you -- have you thought about quitting smoking/etc…" COUNSEL!!!!!

So for every patient I had this template during the close.
1. Do you understand my diagnosis?
2. Do you agree with my treatment plan?
3. Do you have any questions for me? ANSWER challenge question
4. Well Mr/Ms Smith, regardless of the final diagnosis I just want to make sure you know that I am here for you and that we will work together as a team to figure out what's going on with you and how we can make you feeling better. It was an absolute pleasure meeting you and I'll call in the nurse to begin the lab work up.

I always left the room with 2 minutes to spare. This allowed me extra time for my patient note.
Now make sure you fill out the whole PATIENT NOTE. The very first encounter that I had since the computer screen doesn't show the whole length of the note, I filled everything out perfectly and sat there with extra 2 minutes and when they said to submit I realized I had forgotten to write down any diagnostic w/u. I guess it was my nerves or whatever but I didn't realize I left it blank until I scrolled the computer down and to submit. So please practice on the usmle website and use their patient note to practice typing and such.
So for one of my notes I had left out the whole diagnostic w/u, but I still scored high marks on ICE because the rest of my notes were good (I'm assuming).
Please tell me what you exactly you went through in an 1 minute mini-exam you did? That is very interesting. Thank you so much and congrats on your passingh
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Old 02-12-2014
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thank you! It was really helpful....
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Old 03-02-2014
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Very helpful post....Thank you for sharing your experience
I have question about abbreviations you used in P/E , Are all of these acceptable in real exam? I would be really grateful if get answer of my query...
Thanks in advance.
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  #17  
Old 06-07-2014
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Superb post!!!!!!!!!

can u plz tel me how did u learn the physical exam practically? did u follow any videos?

Thanks...a great post indeed!!!!
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  #18  
Old 06-30-2015
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Listening thank you

quick question....did you use a mnemonic for special conditions....

syncope "6 ps"
preprodrome activities
prodrome (aura, palpit, vision loss, weakness etc)
Predisposing factors (age, epilepsy, insuline overdose, etc)
Precipitating factors
passersby witness (what did they see)
Postictal state (yes or no)

this next mnemonic is useful for hispanic IMGs
for chronic illness like Diabetes...
"Yo Te Dare Muchos Regalos Caros Dulce Enamorada" (it means i will buy you many expensive gifts my sweet lover)... try to make one mnemonic for you w/those letters if you think it will help you.

Years w/ disease i.e. DM 15 years
Treatment Insulin, sulphonylureas, TZDs etc...and if Insuline Technique
Dose
Monitoring (how often... twice a week, a day, post prandial)
Readings (125-145 mg/dl)
Last Hba1c (6.9 %)
Compliance (Adherence to treatment regimen)
Diet
Exercise
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Old 07-20-2015
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thank you so much for posting this , gives a good background to build on . !!!
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Old 07-21-2015
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Quote:
Originally Posted by Short View Post
hi....congratulations for your great performance....my cs on 7th march..will start reading FA minicases from today....How do I plan my study and what all things I need to read apart from FA?....what to read first?....when to read UW?....which videos to watch?....can u give me any link to good videos?
csevideo the new ones 2015 with the new fa csevideo.com and you will surely pass its just like the exam gl
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  #21  
Old 07-21-2015
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Originally Posted by MEDICINE DOC View Post
Superb post!!!!!!!!!

can u plz tel me how did u learn the physical exam practically? did u follow any videos?

Thanks...a great post indeed!!!!
I passed the cs recently and was suppose to put up my post but have not had the time. My recommendation is csevideo and you will learn the pe for the cs use the fa and sp and you will do fine
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Old 07-21-2015
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Hello mpnyc your experience is really impressive. I like your process and style. I quite sure you are so confident. This is your key to success. Also you are a native speaker where more than 50% job has done beforehand. And I must do respect you as ideal. Congrats for your massive performance and achievement. Thanks
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