April-May 2014 Step 2 CS Exam Takers Thread - Page 2 - USMLE Forums
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  #101  
Old 03-14-2014
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Quote:
Originally Posted by Dr Pepper View Post
Does the examination room contain neuro hammers and a tuning fork?

PS. Congratulations to this thread for its 100th post.

yes everything is in there and they let you check everything before exam.
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  #102  
Old 03-15-2014
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Hello guys,
My exam is in April too. I have just started my prep. I hope that we all will pass the exam.
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  #103  
Old 03-15-2014
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Quick question for who took the exam: is it possible to use the copy/paste command in the pn?
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  #104  
Old 03-15-2014
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Quote:
Originally Posted by Kawthar View Post
I havd a question?
If we have a minor ( i.e.<18 yo)and they don't refer to the parent consent on the door way information, then how to ask the pt about the p consent?
I mean what exactly should We say?
well as a Physician we can say-

"Mr/ Miss __( the name ) , it seems that you are __( the age / <18) years old, do you have the permission to be here? Is that allowed from your parents?

(The SP will have some kind of note or a written consent )
May I see the note please ?

( After you receive the note )
Thank you."
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  #105  
Old 03-15-2014
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Are we supposed to counsel on cancer screening for ALL demographics where they're recommended regardless of the case?

Colonoscopy > 50 y/o, every 10 years
Mammography > 40 y/o, every 1-2 years (although there's a recent study saying it doesn't affect mortality rates)
Pap smear > 21 y/o or 3 years after first sexual activity, every 1-2 years


Suppose I have a 51 y/o woman complaining of heel pain who haven't had any of these yet. Do they expect us to counsel her on all three?
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  #106  
Old 03-15-2014
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Quote:
Originally Posted by Dr Pepper View Post
Are we supposed to counsel on cancer screening for ALL demographics where they're recommended regardless of the case?

Colonoscopy > 50 y/o, every 10 years
Mammography > 40 y/o, every 1-2 years (although there's a recent study saying it doesn't affect mortality rates)
Pap smear > 21 y/o or 3 years after first sexual activity, every 1-2 years


Suppose I have a 51 y/o woman complaining of heel pain who haven't had any of these yet. Do they expect us to counsel her on all three?
I guess in such case u should counsel her on osteoporosis due to menaupause , so u counsel on exercise and ca++ , vit d intake?
Fof colonoscopy I guess h leave it for related cases and high risk pts.
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  #107  
Old 03-15-2014
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Quote:
Originally Posted by Dr Pepper View Post
Does the examination room contain neuro hammers and a tuning fork?

PS. Congratulations to this thread for its 100th post.
anyone has a pnemonic for child with jaundice case?
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  #108  
Old 03-15-2014
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I have a q?
When we do Romberg sign ,and if positive what is its indication?
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  #109  
Old 03-15-2014
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rombergs i guess you will do in case of dizziness and vertigo cases
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  #110  
Old 03-15-2014
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rhomberg is positive in case of cerebellum pathology. ok i m taking the test in atlanta centre on april 8th. i have a study partner through skype but i was wondering if i should get cse videos too? also i wanted to know anyone else taking the test around the same date as i m? hows your prep so far? i m doing fa practice cases alongwith pertinent mini cases daily. i have already done about 16 practice cases plus relevant mini cases. my weak point is typing patient note fast enough but i m practicing. any suggestions? thanks!
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  #111  
Old 03-15-2014
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Quote:
Originally Posted by Nixy View Post
rhomberg is positive in case of cerebellum pathology. ok i m taking the test in atlanta centre on april 8th. i have a study partner through skype but i was wondering if i should get cse videos too? also i wanted to know anyone else taking the test around the same date as i m? hows your prep so far? i m doing fa practice cases alongwith pertinent mini cases daily. i have already done about 16 practice cases plus relevant mini cases. my weak point is typing patient note fast enough but i m practicing. any suggestions? thanks!
I think Romberg is not for cerebellar pathology
It is for proprioception and inner ear pathologies
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  #112  
Old 03-15-2014
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Sorry my bad. Yes if positive then it rules out cerebellar ataxia. We check Romberg sign to determine if its cerebellar or sensory ataxia.
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  #113  
Old 03-16-2014
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Quote:
Originally Posted by Nixy View Post
rhomberg is positive in case of cerebellum pathology. ok i m taking the test in atlanta centre on april 8th. i have a study partner through skype but i was wondering if i should get cse videos too? also i wanted to know anyone else taking the test around the same date as i m? hows your prep so far? i m doing fa practice cases alongwith pertinent mini cases daily. i have already done about 16 practice cases plus relevant mini cases. my weak point is typing patient note fast enough but i m practicing. any suggestions? thanks!
are you using the practice patient note on usmle.org? Ive used that to time myself and its faster if the blue sheet has the relevant info you have to type instead of from memory... that will help save about 2 mins...Eg. if you write the ddx on the blue sheet you wont waste time thinking about it
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  #114  
Old 03-16-2014
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How do we check for orthostatic signs?
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  #115  
Old 03-16-2014
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Originally Posted by KovachMarina View Post
How do we check for orthostatic signs?
In FA, they just put the orthostatic vital signs in the work-up. I'm not sure if we can really do the same.

But this is how it's done: have the patient lie down for at least 3mins, then get the BP, HR, and ask for any symptoms of hypotension (pallor, diaphoresis, faintness). Then ask patient to stand for at least a minute, then take again the same information.


So you see, it's really time consuming. I don't know if we should really do this.
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  #116  
Old 03-16-2014
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Quote:
Originally Posted by Dr Pepper View Post
In FA, they just put the orthostatic vital signs in the work-up. I'm not sure if we can really do the same.

But this is how it's done: have the patient lie down for at least 3mins, then get the BP, HR, and ask for any symptoms of hypotension (pallor, diaphoresis, faintness). Then ask patient to stand for at least a minute, then take again the same information.


So you see, it's really time consuming. I don't know if we should really do this.
I've been over more than 30 cases now, and haven't seen that they put orthostatic changes anywhere, and they actually put that we should check for orthostatic changes in that exam component part. And considering we don't have watches, I suppose we should check only by changes in BP.
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  #117  
Old 03-16-2014
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Quote:
Originally Posted by KovachMarina View Post
I've been over more than 30 cases now, and haven't seen that they put orthostatic changes anywhere, and they actually put that we should check for orthostatic changes in that exam component part. And considering we don't have watches, I suppose we should check only by changes in BP.
its really simple ... with patient lying down take the BP and make the patient stand/situp with legs hanging down and take BP... if drop in SBP>20/DBP>10.
Incase you think its Autonomic Neuropathy check HR also
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  #118  
Old 03-16-2014
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And what do you write in the dif. dx, in that physical exam findings part, when you don't have contributory findings? WNL?
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  #119  
Old 03-16-2014
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Quote:
Originally Posted by KovachMarina View Post
I've been over more than 30 cases now, and haven't seen that they put orthostatic changes anywhere, and they actually put that we should check for orthostatic changes in that exam component part. And considering we don't have watches, I suppose we should check only by changes in BP.
It's in the mini cases, loss of consciousness. I'm using the 3rd ed. They have wall clocks on each room.
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  #120  
Old 03-16-2014
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Guys! i asked the same question at Kaplan..The doc said that if we run out of time, we could put it in the work up, but if you have time, you could do the orthostatic vitals...I know that im not going to do it..will just write it in the work up.
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  #121  
Old 03-16-2014
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wil be giving step 2 CS on 16th april in atlanta
need a LIVE study partner from 12th april onwards
will be staying at country inn and suites hotel atlanta south.
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  #122  
Old 03-18-2014
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Default skype/live SP

Really need skype SP from now till may, and live SP in May.
Exam in Atlanta by May 13th.
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  #123  
Old 03-20-2014
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hi , my exam is in the 2nd week of APril and im thinking to go for a review course
Can anyone suggest any ?? or if u have taken one ? or even if it would be helpful ? ?

Im just worried about focused examination plus how to manage time with it, so was thinking to get a course

Ive heard about target usmle and gold usmle ??

Please suggest

Thanks
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  #124  
Old 03-21-2014
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hi guys ive just started another thread for PN writing and questions regarding DDX and PE feel free to join and give your input and discuss.

DATA intepretation. What to/not to write? And case discussion
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  #125  
Old 03-21-2014
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Guys i am into study. Exam is may 5 atlanta. I may not make it by that time and need to change date. My friends wil be in atlanta for those lookingdor SPs and i mag also need SP if i change the date. So everybody keep in touch here. I dint believe philly is a bad place for IMGs but even americans have scared me. So hopefully i make it on may 5 atlanta
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  #126  
Old 03-21-2014
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Quote:
Originally Posted by Neuron View Post
Hi guys!
Just starting to prepare the exam that will be at the end of April in Philly.
I was wondering if fa is exactly what i need or if there is something else in the real exam that is not covered in fa?

Guys this thread is really nice. didnot have oportunity to follow it through. I am in now. Cheking thyroid from the back.
Neuron I need your feedback about Philly my friend. cause i may need to change date. again what about videos i havenot watched any subscriptions yet, rockstar whatabout Kaplan 4-5 day course. drsrb what about NY course. and thanks for onderfull PE videos.
Tom thanks for neuro videos. Im in guys. Love this thread. Let's keep it up....I have two wonderfull live partners for couple hours every day.. and anna make exam with them praying for circumstances to coincide...
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  #127  
Old 03-21-2014
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Quote:
Originally Posted by mlecs View Post
well as a Physician we can say-

"Mr/ Miss __( the name ) , it seems that you are __( the age / <18) years old, do you have the permission to be here? Is that allowed from your parents?

(The SP will have some kind of note or a written consent )
May I see the note please ?

( After you receive the note )
Thank you."

I have read somewhere when you are in there you have consent on examination already is it minor or Major. we dont bother with consent for adult so don't we for minor. correct me anyone if i am wrong. we are just verbally comunication and asking personal agreement and using empathy for any physical exam or any our question etc.
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  #128  
Old 03-22-2014
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i have a doubt with regards to a pediatric case.
PE on Pt note will be blank but what about the workup. Do we leave that blank too or write "physical exam"
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  #129  
Old 03-22-2014
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I am really scared about Philly. I heard very bad things about them. But, unfortunatly, It is the nearest place from nyc and thus the cheapest one for me.
It is supposed that we do not perform the pe only if the patient is dressed but what about drug refill, psychiatric cases and alcohol/smoke/weight/drug advise? Do we have to perform the pe in those cases even if the sp is drapped?
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  #130  
Old 03-22-2014
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Quote:
Originally Posted by aman_j View Post
i have a doubt with regards to a pediatric case.
PE on Pt note will be blank but what about the workup. Do we leave that blank too or write "physical exam"
I do not think so. We advise the mother to bring the child to the hospital during the encounter. Then, in the workup I will write down only particular procedures such as rectal exam in a constipated neonate but not an entire physical exam.. It is not specific and probably not what they require from us. Just my opinion.
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  #131  
Old 03-22-2014
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Originally Posted by Neuron View Post
I do not think so. We advise the mother to bring the child to the hospital during the encounter. Then, in the workup I will write down only particular procedures such as rectal exam in a constipated neonate but not an entire physical exam.. It is not specific and probably not what they require from us. Just my opinion.
No, the 1st diagnostic work up will be Physical exam...bcz no matter what the case is, you have to do a PE..Then, you write down whatever the work up is (if the case is cough, then, cxr and whatever your differentials are).
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  #132  
Old 03-22-2014
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Quote:
Originally Posted by Neuron View Post
I am really scared about Philly. I heard very bad things about them. But, unfortunatly, It is the nearest place from nyc and thus the cheapest one for me.
It is supposed that we do not perform the pe only if the patient is dressed but what about drug refill, psychiatric cases and alcohol/smoke/weight/drug advise? Do we have to perform the pe in those cases even if the sp is drapped?
Anytime the patient is draped (or in a gown), it means you have to do a PE..Drug refill is going to be a phone case.
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  #133  
Old 03-22-2014
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Quote:
Originally Posted by tamta View Post
Guys this thread is really nice. didnot have oportunity to follow it through. I am in now. Cheking thyroid from the back.
Neuron I need your feedback about Philly my friend. cause i may need to change date. again what about videos i havenot watched any subscriptions yet, rockstar whatabout Kaplan 4-5 day course. drsrb what about NY course. and thanks for onderfull PE videos.
Tom thanks for neuro videos. Im in guys. Love this thread. Let's keep it up....I have two wonderfull live partners for couple hours every day.. and anna make exam with them praying for circumstances to coincide...
Hey Tamta! I wrote a detailed experience about Kaplan in another post.
Kaplan live course experience
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  #134  
Old 03-22-2014
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Quote:
Originally Posted by rockstar88 View Post
No, the 1st diagnostic work up will be Physical exam...bcz no matter what the case is, you have to do a PE..Then, you write down whatever the work up is (if the case is cough, then, cxr and whatever your differentials are).
Are you sure about it? I looked at every pediatric cases in fa. In workup the pe is never mentioned. Neither in neeraj's note is mentioned in the workup.
Who told you that?
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  #135  
Old 03-22-2014
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Quote:
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Are you sure about it? I looked at every pediatric cases in fa. In workup the pe is never mentioned. Neither in neeraj's note is mentioned in the workup.
Who told you that?
Kaplan!!
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  #136  
Old 03-22-2014
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Kaplan!!
i agree with kaplan and rockstar
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  #137  
Old 03-22-2014
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i keep forgeting to check gait, ask the three words after some time, which i asked pt to remember. in counseling and workup to mention pelvi rectal etc.. also Last PAP
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  #138  
Old 03-22-2014
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Quote:
Originally Posted by tamta View Post
i keep forgeting to check gait, ask the three words after some time, which i asked pt to remember. in counseling and workup to mention pelvi rectal etc.. also Last PAP
These are classic for everyone...everyone seems to forget the same set of things.
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  #139  
Old 03-22-2014
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1 more thing kaplan recommends is to summarize while taking history...Personally, i think its great bcz when you dunno what questions to ask next, you can buy some time and summarize what the SP said so far and think what you want to ask next..I also like to counsel the patient on smoking/alcohol/drugs right after the social history bcz i forget by the time im done with the PE.
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  #140  
Old 03-22-2014
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Quote:
Originally Posted by rockstar88 View Post
1 more thing kaplan recommends is to summarize while taking history...Personally, i think its great bcz when you dunno what questions to ask next, you can buy some time and summarize what the SP said so far and think what you want to ask next..I also like to counsel the patient on smoking/alcohol/drugs right after the social history bcz i forget by the time im done with the PE.
yeap same here.i prefer counseling right away. on second hand we use arrows for tobacco alcohol etc if it needs counseling but anyways i dont know i am very badly using mnemonics.. especially that docfpaa thing is killing me i have hard times using them..
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  #141  
Old 03-22-2014
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i would love to do at least kaplan simulation exam only..
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  #142  
Old 03-22-2014
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Quote:
Originally Posted by tamta View Post
yeap same here.i prefer counseling right away. on second hand we use arrows for tobacco alcohol etc if it needs counseling but anyways i dont know i am very badly using mnemonics.. especially that docfpaa thing is killing me i have hard times using them..
What is docfpaa?? I only mnemonics i know are SIQORAAA & PAMHRFOSS
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  #143  
Old 03-22-2014
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Originally Posted by Neuron View Post
I am really scared about Philly. I heard very bad things about them. But, unfortunatly, It is the nearest place from nyc and thus the cheapest one for me.
It is supposed that we do not perform the pe only if the patient is dressed but what about drug refill, psychiatric cases and alcohol/smoke/weight/drug advise? Do we have to perform the pe in those cases even if the sp is drapped?
If it's a psych case, we do neuro exam and MMSE, right?

I have another question. What if the patient denies recreational drug use? Do we still ask for urine toxicology and solicit the patient's consent for it? how do we inform the patient of this?
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Old 03-22-2014
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What is docfpaa?? I only mnemonics i know are SIQORAAA & PAMHRFOSS
duration, onset, consistency, freqency, aggravating factors, alleviating factors, and associated factors
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  #145  
Old 03-22-2014
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and p is progression only part of mnemonic that i use well asking: does your chief complain become worse, or is it getting worse during the day.

this docfpaa is used when chief complain iz not Pain rockstar. but i dont like it.
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  #146  
Old 03-23-2014
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hey guys,
Its a really great thread , went thru it just now. And its good to see a lot of familiar names around.( tamta ; aman_J ; rockstar88 ; kovachmarina ...
Im having my exam on may 2nd @ houston. Hoping to keep myself motivated and updated thru this forum.

Does anyone know if there r CS encounter vids on youtube? apart from the usual physical exam part??
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hey guys,
Its a really great thread , went thru it just now. And its good to see a lot of familiar names around.( tamta ; aman_J ; rockstar88 ; kovachmarina ...
Im having my exam on may 2nd @ houston. Hoping to keep myself motivated and updated thru this forum.

Does anyone know if there r CS encounter vids on youtube? apart from the usual physical exam part??
Welcome friend. Just made 4-5 case timed with my friends and feel great. Im going through kaplan core cases. My exam is in same time or further.
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Old 03-23-2014
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I see that you, dear people, have been active and I suppose it's time for me to ask my question again So, in the part for the physical exam findings of the differential diagnosis, what should we put if there's no finding that supports our dx ( in the pediatric case, or when everything is normal)? None? WNL?
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Quote:
Originally Posted by asam87 View Post
hey guys,
Its a really great thread , went thru it just now. And its good to see a lot of familiar names around.( tamta ; aman_J ; rockstar88 ; kovachmarina ...
Im having my exam on may 2nd @ houston. Hoping to keep myself motivated and updated thru this forum.

Does anyone know if there r CS encounter vids on youtube? apart from the usual physical exam part??
Welcome ! Im taking mine on 5th may chicago..
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Old 03-23-2014
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I see that you, dear people, have been active and I suppose it's time for me to ask my question again So, in the part for the physical exam findings of the differential diagnosis, what should we put if there's no finding that supports our dx ( in the pediatric case, or when everything is normal)? None? WNL?
I think we can leave it blank if we have nothing..For diagnostic work up, if you have nothing to do, you can write "no diagnostic studies indiacated"..But for PE, we can leave it blank i guess.
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Im doing kaplan core cases because of paitent note mostly. and diffs and how to write history findings and what goes into PE. usually not always there are blank PE findigs cause there is none. so doing same way. generally i strongly recommend to do COre cases at least once. im on 14 th case with my friends and today feeling much confident. with PN writting we did timed and it went pretty well. First aid also needs to be done for sure. it is good in matter of what to ask and what you miss to ask.
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And what should we do in a case that patient has a bandage on the leg? Remove it and check what's below or just write that the bandage is there?
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Originally Posted by KovachMarina View Post
And what should we do in a case that patient has a bandage on the leg? Remove it and check what's below or just write that the bandage is there?

IN kaplan case of noseblood guy has tissue in his left nare and it tells us to remove and inspect the nose. so i would also remove bandage and inspect at least
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  #154  
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Kaplan!!
Thank you for the information!! Kaplan is absolutely the best source!!
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Old 03-24-2014
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how do u close a psych case?
if ur thinking schizophrenia as d dx?
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Old 03-25-2014
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Today I'm going with drug refill!
Quick question: as first qst, do you think that it is better "When were you diagnosed with ...?" or "when were you diagnosed for the first time?" I think that there is a slighlty difference but I can not appreciate it.
How do you start a drug refill case? Thank you!!
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Quote:
Originally Posted by Neuron View Post
Today I'm going with drug refill!
Quick question: as first qst, do you think that it is better "When were you diagnosed with ...?" or "when were you diagnosed for the first time?" I think that there is a slighlty difference but I can not appreciate it.
How do you start a drug refill case? Thank you!!

i have 2 more weeks for my exam, i havent come across any such case in FA
now reading ur post im getting anxious .. am i missing on something here ???
Can we get cases as such ? out of FA ???
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Old 03-25-2014
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Originally Posted by mom260 View Post
i have 2 more weeks for my exam, i havent come across any such case in FA
now reading ur post im getting anxious .. am i missing on something here ???
Can we get cases as such ? out of FA ???
Do not be anxious. I am sure that you are extremely prepared and you will do absolutely great!
There are few cases that are not mentioned on fa. Look at kaplan core or search on this forum. However it is almost impossible knowing all the twelve cases that will be in the real exam. If you have something that u did not prepare before, just stay calm, do not panic and know the basic mnemonics. They are testing us much on our interpersonal skills then our medical knowledge that is widely tested on 2ck. Good luck!
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i would say for any case follow the general pattern..what brings u to the hospital today?
the guy will say drug refill and then u proceed--what are u taking this for?say ace- for htn,when were u dx with this condition?and den when was this med started?also ask about what other meds he is taking?
and then u proceed with side effects ,compliance of drugs etc.
the effects of disease and go for ros .
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Default painful joint

guys just want to discuss a few pointers:
1) always examine the normal joint first
2)All ROM are passive movements
3)donot perform passive movements on painful joints ask patient to move his joints


anything else to keep in mind
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  #161  
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Quote:
Originally Posted by aman_j View Post
guys just want to discuss a few pointers:
1) always examine the normal joint first
2)All ROM are passive movements
3)donot perform passive movements on painful joints ask patient to move his joints


anything else to keep in mind
It's not necessary to do normal joint first. Some doctors prefer that, but it's not the rule of thumb. I also think that we need to perform both passive and active ROM as they help to differentiate intra- from extra-articular joint damage.
How do we check for spinous processus tenderness?
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Old 03-25-2014
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Originally Posted by KovachMarina View Post
It's not necessary to do normal joint first. Some doctors prefer that, but it's not the rule of thumb. I also think that we need to perform both passive and active ROM as they help to differentiate intra- from extra-articular joint damage.
How do we check for spinous processus tenderness?
I think its nice to start with the normal joint first..Bcz, the patient becomes a lil more comfortable and when we are nervous, we may forget the normal joint if we start with the abnormal joint..If that happens, we don't get any credit at all..Happened to me on the Kaplan practice test (was my 1st case)...In kaplan, they say its enough to do the active ROM..Don't have to do passive if active ROM is done.
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Quote:
Originally Posted by Neuron View Post
Do not be anxious. I am sure that you are extremely prepared and you will do absolutely great!
There are few cases that are not mentioned on fa. Look at kaplan core or search on this forum. However it is almost impossible knowing all the twelve cases that will be in the real exam. If you have something that u did not prepare before, just stay calm, do not panic and know the basic mnemonics. They are testing us much on our interpersonal skills then our medical knowledge that is widely tested on 2ck. Good luck!
thanks alot, im not sure if i have enough time to look for extra cases right now, im gona start practicing examination and mini cases now
Do u recommend any videos on youtube ?? im just seeing random videos :|
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Quote:
Originally Posted by drsrb View Post
i would say for any case follow the general pattern..what brings u to the hospital today?
the guy will say drug refill and then u proceed--what are u taking this for?say ace- for htn,when were u dx with this condition?and den when was this med started?also ask about what other meds he is taking?
and then u proceed with side effects ,compliance of drugs etc.
the effects of disease and go for ros .
Thanks this is helpful
And what about DD in such a case ? ?
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  #165  
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If the joint is painful on active ROM, we might still have to do a passive ROM to see if the damage is articular or non articular. Non articular damage tends to be painful only in active motion, not in passive motion. But I guess we must explain that we have to do it.

Quote:
Originally Posted by mom260 View Post
thanks alot, im not sure if i have enough time to look for extra cases right now, im gona start practicing examination and mini cases now
Do u recommend any videos on youtube ?? im just seeing random videos :|
There's a link in the first page of this thread to a website compiling the PE videos.

-----


I have a question on hematuria. I remember in usmle world, they differentiate between hematuria during the start of urination vs end of urination. Can anyone remind me again of its significance?
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  #166  
Old 03-26-2014
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Urinary questions mnemonic FINISHED PUB CS

F requency how frequently do you urinate
IInitiation/ INcointinence (do you have problem holding urine until u get to bathroom?)
Nocturia- do you have to wake up at night to get to bathroom?
Incomplete emptying- do you feel fullness even after urinating?
Stream- How is your urine flow? Is it constant or is there any dribbling?
HEmaturia and HESistancy (do you have to wait before strating urination?)
E
Dysuria/ Dribbling

Pyuria
Urgency
Burning with urination
C- olor
Straining/ Stone have you passed stone in the past?
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  #167  
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Phrases we need to have in our mind and on our tongue all the time.
except Tell me more i would strongly recommend everyone especially in atypical case to have as 2nd or 3rd question after introduction: How is this (complaint or problem) AFFECTING YOUR LIFE? (Job performance..) this is very important open ended question which could let us suck out some info from patient.

other phrases these are from kaplan:

That sounds very frustrating..
I noticed that you seem to be feeling..
I want to understand what happened.. I want to get to the root of problem..
I want to understand your feelings
What you seem to be saying is... Is that correct?
Can i help you put your feelings in words (this one sounds to romantic to me
Some people feel.. How do you feel..
Am I hearing you right?
It must be difficult for you to cope with this..
I recognize that this is difficult time for you
I can understand how that could be upsetting
It sound like you have been through a lot lately. I can understand how you would be upset..

Let me make sure I understand your concerns
You seem angry, sad..etc
You seem to be having trouble telling me about..
It must be terrible feeling tired all the time, everything is an effort tell me how it affects you..
What do you think might be going on..
How does that affect you
What do you fear most about...

What about drug refill cases they can be telephone ones.. we should for sure ask dosage, route of administration, how long has she been taking it, compliance and depending on whats the med for.. side effects and the disease symtpoms they are taking it for and associated symptoms for that disease etc.. also LAST READING of glucose or BP if med is for that..

we should htink broadly and it is hard.
I am stargin mini cases now never done them to create my own ability of DIFFERENTIAL DIAGNOSES i am so bad i cant even think of things sometimes simplest ones.. but with time it is getting better after each and every new case. and kaplan core cases are good. harder to practice than FIRST AID but it helps me think and helps me find out thing I would never think of..and again its newest uptodate with notes and additional 40 different cases.. to first aid.
Good luck guys. I like this thread we are all doing good.
Keep in mind i may need to exchange may 5 ATLANTA for whatever I dont know date yet if anyone needs it..
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Default Apendicitis signs to check

Obturator sign: i am going to uncover your leg and bend it.
Pain in RLQ with flexion of hip to 90 degrees and rotation of hip

Psoas: Please bring up your leg. do you have pain?
pain in RLQ with flexion of right hip against resistance

Rovsing's: Any tenderness (while palpating LLQ)
if it hurts: Where dies it hurt?

CVA tenderness: I am going to tap on your back. please let me know if it hurts.

Murphy's" Place your hand gently under right costal margin and ask patient to take a deep breath. " take a deep breath" positive sign is pain with deep breathing.

When using stethoscope: I will warm this up for you. next Im going to listen to your..
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  #169  
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Do you guys think that we should measure BP in the room, on both hands, in a case of chest pain? Or write it as a part of a work-up?
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i dont think there is any point of measuring bp coz ur gng to take the vitals provided to u as correct and final vitals and u cant write the bp u measured ..i dont think there is any need to waste time if ur not even gonna get credit for it.
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Quote:
Originally Posted by drsrb View Post
i dont think there is any point of measuring bp coz ur gng to take the vitals provided to u as correct and final vitals and u cant write the bp u measured ..i dont think there is any need to waste time if ur not even gonna get credit for it.

agree. thesea are one of those time wasting things. together with SChnellen's chart. maximum if it is obvious eye problem I would simply tell to cover one eye and read the smallest line he can see on the chart on both sides and thats it
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im so freaked out. all the dates untill JULY are already gone here and there some available dates. but they show up generally. now even houston is available some late May sessions but PM ones. its so bad i have to make blind decisions. issue is i probably will not make it by my exam date in early may which was so convenient for me.

again is Houston so much better than ATLANTA ? okay i stopped thinkign about Philly which is most convenient for me. although i still think this is relative thing.. and individual. Chicago atlanta or houston? i need help
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I'm asking about this BP checking on both hands because in the FA mini cases stands that we should check it in pt with chest pain in order to exclude dissection. And I don't know what to do. It's definitely time consuming.
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im so freaked out. all the dates untill JULY are already gone here and there some available dates. but they show up generally. now even houston is available some late May sessions but PM ones. its so bad i have to make blind decisions. issue is i probably will not make it by my exam date in early may which was so convenient for me.

again is Houston so much better than ATLANTA ? okay i stopped thinkign about Philly which is most convenient for me. although i still think this is relative thing.. and individual. Chicago atlanta or houston? i need help
Like i said earlier, dates open up closer to the desired date as a lot of people get cold feet and cancel their test..I have been told by someone that Chicago is a good place to take the test..So is Houston, but I can just drive to Chicago..So taking it there..Recently, one of my friends took the test in Atlanta and said there were a lot of AMGs there..So, I dunno how good it is to take in Atlanta..I'm kinda happy i canceled it in Atlanta.
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Quote:
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Like i said earlier, dates open up closer to the desired date as a lot of people get cold feet and cancel their test..I have been told by someone that Chicago is a good place to take the test..So is Houston, but I can just drive to Chicago..So taking it there..Recently, one of my friends took the test in Atlanta and said there were a lot of AMGs there..So, I dunno how good it is to take in Atlanta..I'm kinda happy i canceled it in Atlanta.
im taking in chicago too, and what u just said up there about canceling the test! my god im feeling the same pressure now !
2 more weeks to go woooooohooooo
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Quote:
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I'm asking about this BP checking on both hands because in the FA mini cases stands that we should check it in pt with chest pain in order to exclude dissection. And I don't know what to do. It's definitely time consuming.
"Exclude" is such a strong word! You cannot possibly EXCLUDE dissesction just because the BP is equal in both hands! But if the chest pain is indicative of dissection I think it would be wrong not to take the time and check BP on both arms. This measurement might not have a high sensibility, but it definitely has a high specificity.
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"Exclude" is such a strong word! You cannot possibly EXCLUDE dissesction just because the BP is equal in both hands! But if the chest pain is indicative of dissection I think it would be wrong not to take the time and check BP on both arms. This measurement might not have a high sensibility, but it definitely has a high specificity.
You've opened my eyes! Thanks
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Like i said earlier, dates open up closer to the desired date as a lot of people get cold feet and cancel their test..I have been told by someone that Chicago is a good place to take the test..So is Houston, but I can just drive to Chicago..So taking it there..Recently, one of my friends took the test in Atlanta and said there were a lot of AMGs there..So, I dunno how good it is to take in Atlanta..I'm kinda happy i canceled it in Atlanta.

yeah I agree everyone agrees with that and i see now april is all opened up with dates. so i hope for the same. i am preparing well with my partners and as soon as i get visa in my hands than i will probably find out which is the best date for me. My friends took exam in Atlanta 3 of them passed, 3 failed. Everyone scares me to death about taking exam in philly or that would be most convenient for me. so anyways good thing is i am doing second part of Kaplan cases and one two cases from first aid for the first time around 5 cases each day with complete Patient note and differentials writing. after doing kaplan core cases doing first aid NOTE AND DIFFERENTIAL DIAGNOSES PART seems like a hell loss of time. so keep it up guys. now i need to do the reading of case discussion and agani move over doing basic part of the book.
lot of Practice + some additional reading and overview of what i have practiced.. is the key
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im taking in chicago too, and what u just said up there about canceling the test! my god im feeling the same pressure now !
2 more weeks to go woooooohooooo
Yeah..I did the same..Canceled my test in Atlanta..I have my test coming up on Monday..Hope i do well, i just don't want to delay it anymore..I don't think i will improve if i postpone it anymore..So, I'm just going for it!!
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yeah I agree everyone agrees with that and i see now april is all opened up with dates. so i hope for the same. i am preparing well with my partners and as soon as i get visa in my hands than i will probably find out which is the best date for me. My friends took exam in Atlanta 3 of them passed, 3 failed. Everyone scares me to death about taking exam in philly or that would be most convenient for me. so anyways good thing is i am doing second part of Kaplan cases and one two cases from first aid for the first time around 5 cases each day with complete Patient note and differentials writing. after doing kaplan core cases doing first aid NOTE AND DIFFERENTIAL DIAGNOSES PART seems like a hell loss of time. so keep it up guys. now i need to do the reading of case discussion and agani move over doing basic part of the book.
lot of Practice + some additional reading and overview of what i have practiced.. is the key
I dunno how the test centers make a difference, but i definitely know that for IMGs, Chicago and Houston are the preferred centers..For some reason, IMGs hate Philly..I don't want to take any chances, so not taking the test in Philly.
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Old 03-28-2014
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I dunno how the test centers make a difference, but i definitely know that for IMGs, Chicago and Houston are the preferred centers..For some reason, IMGs hate Philly..I don't want to take any chances, so not taking the test in Philly.
Good luck rockstar! we believe you will do well. Just stay focused and calm and take it as one of the practise sessions
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  #182  
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Yeah..I did the same..Canceled my test in Atlanta..I have my test coming up on Monday..Hope i do well, i just don't want to delay it anymore..I don't think i will improve if i postpone it anymore..So, I'm just going for it!!
ull do great rockstar
Gooooodluck to you ... im thinking to push it off for a week.. not sure though if ill practice more
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  #183  
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Good luck rockstar! we believe you will do well. Just stay focused and calm and take it as one of the practise sessions
Thank you!!
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  #184  
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ull do great rockstar
Gooooodluck to you ... im thinking to push it off for a week.. not sure though if ill practice more
Thank you..When is your test?
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when we examine the anterior chest/ CVS how do we drape the posterior chest? or do we leave the posterior chest open till exam is finished and then tie the gown.
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Thank you..When is your test?
april 14
im still so confused about examinations
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Can someone please tell me when exactly are we doing the EYE EXAM ??
like the snellen chart and all that

my plan is to be very focussed in the examinations so im not sure .... Now are we going to get a case of vision impairment or follow up on vision ...
i know DM and HTN we're checking eyes but how does this snellen chart come into picture

Please help me understand this
thanks
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  #188  
Old 03-28-2014
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when we examine the anterior chest/ CVS how do we drape the posterior chest? or do we leave the posterior chest open till exam is finished and then tie the gown.
When you are examining anterior chest, the posterior chest has to be exposed..There's not much you can do about it..Except don't leave the chest exposed too long..As soon as you are done examining the anterior chest, you can loosely tie the gown.
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Can someone please tell me when exactly are we doing the EYE EXAM ??
like the snellen chart and all that

my plan is to be very focussed in the examinations so im not sure .... Now are we going to get a case of vision impairment or follow up on vision ...
i know DM and HTN we're checking eyes but how does this snellen chart come into picture

Please help me understand this
thanks
Same question. Also, do we do a confrontation visual field test for patients suspected of pituitary adenoma?
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Yeah..I did the same..Canceled my test in Atlanta..I have my test coming up on Monday..Hope i do well, i just don't want to delay it anymore..I don't think i will improve if i postpone it anymore..So, I'm just going for it!!
Good luck rockstar! We know you'll ace the test!
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Same question. Also, do we do a confrontation visual field test for patients suspected of pituitary adenoma?
yea in case ur suspecting pit adenoma in amenorrhea case u will do the confrontation visual field but even that 2 times on each side..dont hv time for whole thing...i did talk to a couple of amgs..all they did was d examination of d system involved nothing other than that!!
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  #192  
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Good luck rockstar! We know you'll ace the test!
Thank you!!
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yea in case ur suspecting pit adenoma in amenorrhea case u will do the confrontation visual field but even that 2 times on each side..dont hv time for whole thing...i did talk to a couple of amgs..all they did was d examination of d system involved nothing other than that!!
Thats what im thinking if we r going focused ... we dont need the snellen chart until n unless we get a case of impaired vision or vision followup or somethhing rite ?

Please somebody help me understand this
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I m taking cs on April 8. Wanted to know if anyone else taking it close to the date I m taking. I have been practicing the fa cases with an sp and practicing patient note. I m so nervous about the whole thing, I m able to complete the encounters within time but then sometimes I have forgotten one thing or two and I get so upset thinking I m still not ready may be. I can't postpone exam at all and not that I want to. Any suggestions to what else should I practice/learn?
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rockstar good luck girl!!!! wish you all the best. you are very lively, focused and im sure you will do your best!!
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I m taking cs on April 8. Wanted to know if anyone else taking it close to the date I m taking. I have been practicing the fa cases with an sp and practicing patient note. I m so nervous about the whole thing, I m able to complete the encounters within time but then sometimes I have forgotten one thing or two and I get so upset thinking I m still not ready may be. I can't postpone exam at all and not that I want to. Any suggestions to what else should I practice/learn?
Hey you need to relax . Everyone makes a few mistakes cause no one is perfect. Just to quote kaplan core cases"take a deep breath , smile and enter the room" cause your going to be fine
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rockstar good luck girl!!!! wish you all the best. you are very lively, focused and im sure you will do your best!!
Thanks a lot Tamta!!
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Originally Posted by Nixy View Post
I m taking cs on April 8. Wanted to know if anyone else taking it close to the date I m taking. I have been practicing the fa cases with an sp and practicing patient note. I m so nervous about the whole thing, I m able to complete the encounters within time but then sometimes I have forgotten one thing or two and I get so upset thinking I m still not ready may be. I can't postpone exam at all and not that I want to. Any suggestions to what else should I practice/learn?
even i go thru this anxiety every now and then coz no matter what u miss out on a few things,to calm myself i go thru various experiences on this forum or any other forum as a matter of fact..these help..
i hv my exam on the 1st and that is how i am kinda keeping it together..
funny how this is said to be the easiest exam in usmle steps
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I think they say its easy bcz you don't have time to sit there are brood..you just have to move to the next case and not think about the previous case..Where as, that's not really possible with step 1 and CK..and the exam gets done soon, that's how Kaplan practice test was.
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yea i guess so..i was talking to a couple of friends who recently took the exam and they were like u dont know how time flies in there..its like ur in a different dimension inside the room where time runs at twice the speed...
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