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  #1  
Old 06-03-2014
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Default How woukd I keep an eye contact

Hi Guys ,
I just wonder how can I keep eye contact with the patient while I'm writing down the history and that stuff in the blue sheet ?
I really find it difficult to to both at the same time , and if so , my hand writing is very weird to me , i couldn't read it again to write the patient note !!

Any advice about this ??1!
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  #2  
Old 06-03-2014
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Hi there,

I had the same concerns with you before i took my exam. When is your exam? If you still have a week or so you can try this:

1. Make abbreviations of common sx. You have to use this as much as you can so you would not get confused when reading it during exam and it will be like 2nd nature. Here's couple that i used:
- Headache = H, L/R (side), pul (pusatile), etc
- Cold intolerance = CI
- CHest pain = CP. well you get the point.

2. Group the sx of common DDx. So it will come to you automatically in exam right when you consider the dd.

Eg: instead of asking signs of hypothyroid scatteredly over the Hx, like this: do you have any day time sleepiness? what about cold intolerance? feeling depresses? problem with sleeping? irritability? caffeine use? constipation. Notice that the hypothy qs are interspersed in other ddx.

==> this will be problematic when you want to quickly summarize everything in PN. Also you might get confused have you covered all the q for hypothy, ask some q multple times and lose points for not listening well.

Here's what I did:
hypothy: CI -, DS (dry skin) -, C- (constipation), WG (weight gain) -
Insomnia: sleep prob: if yes +, initiate, 4 hrs/d, caff (caffeine) 6x/d, hyg (sleep hygiene)+.
Dep (depression): S-, I-, G-, E-, C-, A-, P-, S-

I tried it for 1-2 weeks until it is a second nature to me. So I only took min time to write and I didn't get confused when reread it.

You can do whatever abbrev you want as long as you're comfortable w that.

GL!
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  #3  
Old 06-03-2014
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Default Thank you much

Thank you much IMLover , this sounds great actually .
I'll try to do it . my exam is on June 28 , Houston .
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Old 06-03-2014
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Glad to be able to help! Practice it everytime, until you dont even have to write the mnemonic for each diff. and you just need to write the DD on top of your blue sheet.

Ask the qs in organized fashion. Also do the same when write PN. It will be a neat PN and easy for the scorer to follow your thoughts.

All the best for you!
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Old 06-03-2014
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Thank you very much for you help ,
I really appreciate your reply ,

I think I have enough time to practice this .
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  #6  
Old 06-07-2014
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how many cases did u make mnemonics for,,like hypo thryroid,insomnia etc...are those cases there in FA?
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Old 06-07-2014
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for me I don't memorize mnemonics for every case like hypothyroid for example , but of course you know its symptoms so you ain't gonna miss it .
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Old 06-07-2014
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I only use mnemonic for non HPI. Like PMH, FH, PSH, SxH, Obgyn.
I tried using mnemonic but didn't like it and in the end I was lost in the mnemonic.

What I did was practicing, rewriting the common sx for common ddx. So that it will come in cluster whenever I remember the ddx.
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  #9  
Old 06-07-2014
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How did u both learn/practice physical exam. I mean we can refer FA,but how to get an idea practically?
Thanks
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Old 06-08-2014
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you can use FA as a guidance on PE. But you also have to critically appraise it, meaning try to think and prioritize of the PE listed in a case in FA. If you only have very limited time, which one will you ditch.

eg: in DM; funduscopy, sensation, motor, reflex esp on acrals are indispensable. if you have time you can add cardio if sx +.

in low back pain case, you can skip lung, cardio exam and focus right on MSK, CVA tenderness, tenderness on spine, paraspinal, SLR.

in swollen knee w/o any traumatic hx or twisting injury I wouldn't do anterior drawer sign or posterior drawer.

Please read the CS bulletin. That's is your only valid, reliable source. Others will be urban legend or what other people understand (which may or may not be correct). The bulletin also address this PE question thing.

GL for both of you!
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