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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 06-22-2014
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Default Passed Step 2 CS- here's what I did

Hi everyone, thought I'd pay it forward and help out even just one student who seeks out this forum. Hopefully this is good karma too haha. I took my CS in LA in March and got my score report just recently. I passed with a * in SEP, higher performance in interpersonal skills and the "xxxxxxxxxxx" bar was right in middle between borderline and high performance.

This is what I did day of the exam:

Patient Encounter

I left every pt encounter 2-3 mins early and entered the room probably 1 min after time was called to begin. This is because in the 1 min after they said to begin, I would write out my mneumonic and differentials based on the CC.

Ex: 25 y/o F VS unstable, acute abdomen

I used these mneumonics:

LIQORAAA (location, intensity, quality, onset, radiation, alleviating, aggrevating, associated factors)

PAMHITSFOSS-SADTOES (PMH, allergies, medications, hospitalizations, illness/comorbidities, trauma, surgery, family hx, OBGYN, sexual hx, social hx (smoking, ,alcohol, drugs, travel, O-i forgot, energy, stress level),

THEN FR CS PUBSAWED (temperature sensitivity, headache, edema, nausa/vom, F-i forgot, Racing heart/ rashes, chestpain, SOB, pain in joints, urinary changes, bowel changes, sleeping, appetite, weight, energy, diet) , SIGECAPS for depression, DIGFAST for mania. I would also ask about SAFETY in the house/etc looked for abuse/neglect, Activities of daily living, etc etc here.

So for every pt I knew exactly how to ask every question to get the answer I want. This just takes practice. Get a partner.

After I'd take the interview, I would wash my hands. During hand washing I would small talk the pt. "The weather is so nice here today..." something silly. Or "is there anything I can do to make you feel more comfortable?" Also, while I practiced washing my hands (sounds silly but do it) the test center offered hand sanitizer. I thought that was quicker.

Then the Physical:

FOCUSSED PHYSICAL!!! So before I'd go into the room, I'd draw a little stick figure and circle the body parts that needed to be checked. Ex: for acute abdomen, I checked abdomen, heart and lungs.

Be sure to CLOSE EVERY ENCOUNTER!!! Be ready for questions. My standard response to everything they'd say was this:
"Ms. Jones, I can see you're concerned about X. I am also concerned about X. Let me finish this interview with you, run some tests, and I'll be better equipped to answer your concerns about X. Is this alright with you?"

That was GOLD. Because the patients couldn't really say anything to me after such a diplomatic answer
Be compassionate though. Never seem like a know-it-all. Be super nice.

CSE videos helped me with the physical exam. They're really abrupt and precise but they do work! And the methods just make you feel more confident.


Then the patient note:
I told you that I was leaving pts room 2-3 mins early every time. This helped tremendously for pt note. I was able to just take a breather and really convey all the info that I gathered.

I would always start out with
"25 yo F G0P0 presenting today due to "crampy" pain in her RLQ, 7/10 that has been gradual in onset since yesterday"....Describe the pain more and it's always good to quote the patient. LIQRAAA.
Then I'd do:
PMH: negative
Allergies:
Meds: OCP
ROS: positive for n/v, slight headache which she attributes to not being able to sleep, negative for weight loss, SOB, chest pain,

Physical
VS: list exaclty what was on the door/ say WNL
Cardio S1 S2 WNL, no murmurs rubs or gallops
Lungs: clear bilaterally, no wheezes, rales, ronchi
Abdomen: + obturator sign, +rebound tenderness


DDX: Appendicitis, Ovarian torsion, Ectopic Pregnancy and you have to list reasons for each differentia.
1) physical findings and hx findings
2) physical &hx
3) physical &hx

Next step management: stable vs. unstable patient
So because she's more stable, we can run some tests
order the cheapest first
CBC with differential, Chem 7, UA, urine beta HCG and confirm blood HCG
Rectal exam Pelvic exam
LFT Lipase,
USG to r/o gynecologic problem, CT abdomen


I hope this helps someone out there!! Remember not to take this test lightly. But if you put in about a few weeks (for me, 4) of reading and studying with a partner, there's no reason for you not to pass.

My mistakes on the exam: the speculum from the otoscope got stuck in one lady's ear. Oops. I didn't put the wrap around a girls ankle after I took it off. Oops. I forgot to ask the pediatrics questions for a girl who was 16. Yes, you should ask about immunizations, etc.

I have a good impression of the LA testing center. El Segundo is basically California's asshole but the center itself had a very kind staff and they made the test day more pleasant-- if that's even possible.

Remember, focus on completeness. Not perfection!

Good luck!!!
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  #2  
Old 06-22-2014
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Default Resources

I used Step 2 CS First Aid, CSE videos, and the Laura Miranda lady on youtube. She's great.

Also!!! Don't forget to counsel patients. When a patient would tell me what his or her bad habits were, I would counsel them on the spot because I have amnesia and would end up forgetting to tell them at the end. So I would say something like
"Oh Ms. Jones, I know how hard it can be but I would like to encourage you to stop smoking. Smoking is linked to a variety of different cancers and chronic diseases like hypertension. Prevention is always better than treatment. If you'd like to quit today, I have the resources available for you and I'll help you in any way I can."
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  #3  
Old 06-22-2014
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congrats on passing ...!! awesome news ...thanks for the advice .. really helps ... i have cs in 18 days .. clueless as to what i should practice . i read the 40~ cases twice ...dont know wht to do now . i was wondering where did u find the cse videos ??
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  #4  
Old 06-22-2014
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Quote:
Originally Posted by dr adi View Post
congrats on passing ...!! awesome news ...thanks for the advice .. really helps ... i have cs in 18 days .. clueless as to what i should practice . i read the 40~ cases twice ...dont know wht to do now . i was wondering where did u find the cse videos ??
You definitely need to find a partner and practice, practice, practice. Go on youtube to get the CS timer and practice doing the cases on someone from start to finish. including the history, physical, handwashing and counseling...etc. You think it's easy until you do it and then you see how easy it is to get tongue-tied, and flustered. Do NOT walk into that exam without practicing. The patietns on the test are going to try to throw you off so the more practice you get the better!!

As for the CSE vids, there was a course offered at my school so we watched it then.
Have you tried pirate bay? or something like that?
Worst case scenario I think the cost is about 100bucks?? which compared to all of the other expensive things we have to buy as med students...isn't so bad.


Good luck on your exam!!
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  #5  
Old 06-22-2014
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hey thanks for the reply !! .. yeh gonna start practicing on someone soon ... ws a bit confused on which areas to conc. more on as well .. history taking , conversing witht the patient , examination ???? ..and in exmination like do they check what u do or how u do it or how u approach the pt while doin it ???...

and what'd u mean by cs timer in youtube

sorry for the trouble and thanks alot again for the advice
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Old 06-22-2014
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Default Mini Cases

Hey I agree with the above post, practice practice practice. I passed on my first time, took it in April. I practiced with a friend on weekends, I took my CS during one of my core rotations. I watched CS videos on YouTube. Go over the mini cases in First Aid. They help with differential diagnosis in case you get stuck. I can honestly say there were 5 CS cases very similar to the ones in FA.

I felt a bit nervous at first during test day but after the 3rd case I started to get into the groove. The thing that stooped me were the lunch and snack break. I feel like I got into a routine and then break time.

The order went 5 cases, break, 4 cases, break and 3 cases, done.
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Old 06-26-2014
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congrats on your exam what do you mean you did not put the wrap back on the the girls ankle?
thanks
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  #8  
Old 06-26-2014
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Default

Quote:
Originally Posted by bootsnpants View Post
congrats on your exam what do you mean you did not put the wrap back on the the girls ankle?
thanks

The girl had an issue with her ankle and was wearing a cast/wrap/bandage around her ankle. I took it off to look at the joint and forgot to put it back on. Not sure if it mattered...?
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