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Author69 Posts
  #1

I started reviewing slightly in the past 2 weeks. My practice pt is my spouse, who has taken the exam b4, and is a hard critic (If I can get through him, ANY SP will be a piece of cake), which helps, though due to busy schedule, can only practice on him on prob 5-10 cases, which is fine. This is someone who did a full neuro on everyone who showed up LOL. No I dont plan to do the same (haha), just a full heart and lung, also abdominal (if needed), and neuro for patients with headaches, fatigue, dizziness, memory loss/confusion. I also practicing on my imaginary patients LOL, as well as real pts in clinic (usually sore throat, diabetes, chest pain...).

 

I'm American, so no problem speaking english, and I also get to work with real patients, so can practice with them in the clinic a few times a week.

 

 

Resources

 

1) FA (2nd and 3rd editions)

2) Clinical skills videos

3) CSE videos

4) light review of kaplan complex cases 

 

KEY: Treat patients the way I'd like my spouse, parents and siblings treated. Ask questions based on my DD and also what I would want my doctor asking me as a patient, given how scary it can be coming to the clinic.

 

 

So far reviewed

Diabetes followup (practiced in clinic)

Sore throat (practiced on spouse)

Chest pain

female with headache.

 

My timing appears to be fine. I plan on reviewing 40+ FA cases, all CSE video cases, and the Kaplan ones. 

I can probably study about 3hrs a day. So far I feel good, confidence is good, God is in control. Looking forward to updating this journal and doing well.


Edited by DrOO4 on Mar 31, 2012 - 6:34 AM



  #2

Will redo headache case, and type up PN tonight

Will also do 2 cases of abdominal pain b4 tonight is over, one in young female, another in middle age female.I'll also try to do 1 of those PNs as well.

 

 

Common Workups (when in doubt put CBC at least) from memory

Headache: CBC, CT head, MRI brain, Electrolytes, LP

Abdominal pain: Rectal exam, Abdominal ultrasound, pelvic exam, UA, b-hcG levels

Chest pain: CXR, CPK-MB, troponin, EKG, Echo, ABG, CBC

Diabetes: HbA1c, UA, CBC, renal ultrasound, 

Sore throat: CXR, CBC, Monospot, rapid strep antigen, throat culture

 

Goal is to get through all cases at least 2x before end of March (I make sure that by 2nd time, I cover all the key stuff, b4 moving on to next pt) and spend the 3wks in April practicing them over and over.

 

As I practice, I cant imagine what it must be like for those who speak English as a 2nd language, wow much props to all who do, and are prepping for CS. For the person who speaks English as a 1st language, I believe CS prep can be done in 2wks (if schedule isnt crazy) to 1mth.

From others who have passed, I believe the key is to appear comfortable, to spend more time on history, and conclusion, offer much empathy, make SPs comfortable and practice PNs. I believe knowing key PE steps are good, but just the basics should be fine


  #3

Remember CS is an exam of showmanship, the SPs are acting, and its your job to show them you can act too. Even when inspecting, make sure they can see that it is obvious that you are examining for abnormalities, scars, bruises and all! Definitely overdo it!


  #4

Need to remember to ask woman with Abdominal pain always about nausea and vomiting.

 

Also need to remember to ask for Allergies, sometimes I remember, sometimes I dont, should ask that after Medications.

 

Completed sudden Abdominal pain case in Kaplan complex cases book.

Now to watch quick video of abdominal pain case and do 1 PN before I call it a night for CS, so I can finish reviewing some UW CK answers. 

 

Anyone else enjoy studying for CS? I actually love it, cause this is what medicine is about, get to act like a doctor. Maybe I love the acting a bit much too :-) Its definitely showing me that primary care is the best fit for me. 


Edited by DrOO4 on Mar 13, 2012 - 12:13 AM

  #5

Practiced pediatrics case with fever today and did PN. I love peds, easiest, no PE.

Case 7

Also review phone pediatrics case (All same questions, and same DD and workup)

Under 1 mth left!

Free next few days, straight CS review. I'll review all cases I've covered in the past week. Goal by friday is to have reviewed 15-20 total cases. Need to practice PN's too. 

For kids, figured out my way of remembering what to ask. I have image of a snotty kid crying on floor (think of image of your child, cousin, friend's kid etc)

If its not mother/father, if grandmother or other relative, ask if they are the legal guardian.

Ask mother: So what brings you here today /How may I help you today (phone)

Mother: My child has fever/diarrhea/is crying

Me: I am so sorry to hear that, that must be quite frustrating (Empathy 1). When did it start

Mother: says when

Me (image of baby): RunCENVDS

Runny nose

Cough

Ear discharge/pulling

Nausea/Vomiting

Difficulty breathing

Problems swallowing

**Opportunity to give empathy here 1-2x)

Instead of PAMHUGFOSS, do PAMHUGFILD

I-Immunizations

L-Last checkup

D-daycare question

 

Use open ended question to ask "Can you tell me how child's name looks", "Can you tell me more about child's name's eating habits/sleeping habits"

 

All the while, keep the image of the baby in your head, how you would examine the baby, it makes the questions flow. Dont forget to ask for rash!


  #6

Case 8 done, another peds with fever and rash. Mastered Peds PN and questions.


  #7

Reviewed Chest pain again, Case 6

Reviewed Cough again, Case 9

Practiced PN

Read some History Tips from Kaplan Complex cases

Watched CSE videos on Chest pain and Cough grin

Tomorrow: Need to do some cases on memory loss (case 12), dizziness (case 14), fatigue (case 15, 16, 17), htn(case 20), knee pain (case 21)

Also go through DD. Hoping for 6hours of CS study at minimum tomorrow. 




Edited by DrOO4 on Mar 30, 2012 - 7:18 PM

  #8

So far today

 

Did mini cases on headache

Watched CSEvideo, mystery case (medication refill menopausal woman) and took notes, finished PN in 8mins. I graded myself with a 7/10. 

Going to watch and read 3+ more cases tonight. 


Edited by DrOO4 on Mar 31, 2012 - 6:30 AM

  #9

Watched CSE video on headache, practiced headache case on my own, recorded my audio, so I can review and see what question I missed, did PN, compared it to CSEvideo one and that of FA.


  #10

 

Random PN I did on headache pasted below. I know any case that involves Neuro takes me longer,so I was happy to be able to do this in 15mins on 1st try. I can speed up questions though, and a bit of PE and get it to 14mins. I recorded myself by audio for this case. 

I get mine done in 8:30, have to cut down on HPI, I realize I ask all the questions and with 950 characters not enough space to put it all. I will suggest people try using the usmle practice on website so you get used to it, same exact one that we'll use on real cs. New version after june 20 has a diff format (for those taking that one).

www.usmle.org/Orientation/2...PatientNote/EntryFrame.htm

ORIGINAL HPI one I did (via csevideo website, wrote this in 8mins, 30secs-I'm a fast typer)

HPI: 23 yo F c/o headaches for 2 weeks. The headaches occur 1-2 times a day and last about 30 mins. The pain is sharp and pounding and located on the right temporal side. It radiates to the left temporal side and left auricle. Patient reports halos and bright lights before the headache comes and occasional joint pains and aches. Patient denies nausea/vomiting, weight loss, fever, dizziness, numbness, and weakness. Patient experiences some fatigue after the headache.Headaches are alleviated by Excedrin and worsened by bright lights and noise. Patient is a nurse and states that the headaches are affecting her performance at work.

ROS: Negative except as above

PMH: None

Medications: Excedrin po 2 times daily

Allergies: NKDA

FH: Mother suffers from migraine.

SH: Denies EtOH, smoking, drug use. Patient is sexually active with boyfriend and uses condom

OB/GYN: Mernache at age 13, LMP 2 weeks ago, LPS 1 year ago Normal. Patient uses birth control pills.

 

EDITED HPI and rest of PN (so can fit number of characters needed, HPI-950characters)

 

HPI: 23 yo F c/o headaches for 2 weeks. Headaches occur 1-2 times a day and last 30 mins. Sharp and pounding pain 8/10 in severity, located on the R. temporal hemisphere, radiating to the L. side. No nausea/vomiting or numbness. Excedrin helps headaches, bright light and noise makes it worse.
ROS: some joint pains and aches.
PMH: None 
Medications: Excedrin
Allergies: NKDA
FH: Mother has migraines.
SH: No EtOH, no smoking, no drug use. 
OB/Gyn: Mernache at 13, LMP 2 weeks ago, Uses OCP
 
PHYSICAL EXAMINATION
GA: Patient is in distress 
VS: WNL
HEENT: PERRLA, EOMI, Right temporal region tender on palpation, no nasal congestion, no pharyngeal erythema or exudates, good dentition.
Neck: Supple, No LAD 
Chest: clear breath sounds bilaterally 
Heart: Normal S1/s2, no murmurs, rubs or gallops 
Neuro: DTRs: 2+ symmetric reflexes bilaterally. Motor: 5/5 in all extremities. CN 2-4,6-12 intact, Patient has difficulty with CN 5 on the right side.

 


DD
1.:Migraine

2.:Cluster headache

3.:Sinusitis

4.:Intracranial hemorrhage

5.:Intracranial neoplasm

:

Workup
1.:CBC

2.:CT head

3.:MRI brain

4.:LP-CSF

5.:CT sinus

 

I give my PN an 8/10 grin, feel free to grade though. Didnt put NC, AT in HEENT

One thing is for sure, doing nothing the day b4 CS and getting rest, in clinic after 3 patients  back to back, I get tired. At least there is lunch and the breaks. I give props to anyone taking this who isnt a native speaker of english, I'd need months to prepare for this in a foreign language. Its one thing to be able to speak basic english, CS teaches how to express yourself in English, and not just that, but the American way. I'd encourage anyone who can to at least spend a week or more in a US FM clinic prior to taking CS. Whenever I blank out, I remember my FM preceptor, and I can quickly come up with some question based on that image. 




Edited by DrOO4 on Mar 31, 2012 - 6:37 AM

  #11

Stuff for today (for now) Think I've covered about 13-14 cases or so btw FA and CSEvideo
  1. Review audio headache, and see what I did wrong, and can improve on
  2. Today review Pediatric PN
  3. do mini cases for memory loss
  4. watch csevideo memory loss and practice, record audio
  5. do mini cases for fatigue
  6. watch csevideo fatigue, practice and record.
  7. Same for weight loss
  8. same for numbness/weakness
  9. Do a csevideo mystery case

 

 




  #12

My wonderful hubby went thru my 2 PNs from yesterday and gave some useful criticism that I missed. In the one I posted above, he noted I didnt that Trigeminal neuralgia should be on DD above the Intracranial stuff. I missed that. But overall he is giving my PNs a pass, and he's a tough doctor!nod

 

Just reviewing some MTB for CK actually for under an hr, havent done all week, and cant neglect that completely. After that its CS for at least 6hrs, and my so called list above.


  #13

Well this is what I was able to get done today, not all I wanted but its something. 3 weeks to go! Start a BUSY rotation Monday too!!!

 

For dizziness, 1st review, I didnt ask about "positions" that help or worsen, I just said does anything make it better, or does anything make it worse. I didnt ask about fever, headache, fullness in ear, ear discharge, didnt ask about ringing in the ear or Abdominal pain.

Went over by a min, cause I was talking so slow and its so late in the night, ready to sleep! Church in a few hours!

Entering into a sacred week, Passover! Holy Week! So Happy! God is AWESOME! smiling face

 

 

 

  • Review audio headache, and see what I did wrong, and can improve on

     

     

    • Today review Pediatric PN
    • do mini cases for memory loss
    • watch csevideo memory loss and practice, record audio 
    • Cant find memory loss one, so did mini cases for dizziness
    • did csevideo dizziness and record audio.
    • do mini cases for fatigue
    • watch csevideo fatigue, practice and record.
    • Same for weight loss
    • same for numbness/weakness
    • Do a csevideo mystery case

     




    Edited by DrOO4 on Apr 01, 2012 - 2:50 AM

  •   #14

    Ideally these common cases are what I'd love for my CS grin
    1. Diabetes followup
    2. Chest pain
    3. Sore throat
    4. mother whose child has a fever
    5. back pain
    6. medication refills
    7. STD
    8. cough
    9. headache
    10. fatigue
    11. HTN followup
    12. knee pain

     


      #15

     

    Review audio headache, and see what I did wrong, and can improve on


     

     
    • Today review Pediatric PN
    • do mini cases for memory loss
    • watch csevideo memory loss and practice, record audio 
    • Cant find memory loss one, so did mini cases for dizziness
    • did csevideo dizziness and record audio.
    • do mini cases for fatigue
    • watch csevideo fatigue, practice and record.
    • Same for weight loss
    • same for numbness/weakness
    • Do a csevideo mystery case

     

    Did a case on Smoking cessation and Loved it, did PN, think I'd love to see that one on my exam. Pretty much same format as person with chronic cough.

    So far in FA, covered Cases 1, 2, 4, 6,7, 8, 9, 13, 14, 18, and the rest

    So havent done: 3,5,10,11,13,15,16,17

    Covered outside FA: Medication refill (menopause), Smoking cessation, Phone pediatrics case

     

    3 weeks left! Not in OR tomorrow, just clinic, hoping they'll let me out early, so I can try to get at least 4 hrs of studying done!


      #16

    Busy day, love my rotation though, helping me for CK but no real time, I only get 2 hrs of CS studying tonight. At least tomorrow looks like an easier day.

    Covered Back pain and ankle pain in Kaplan book (did on the go), while in the hosp today

    Covered back pain in CSEvideo, and then did quick practice and PN. Thats case 27 in FA too

    Things I missed in my back pain practice

    1) didnt ask about quality of pain

    2) didnt ask about fever, night sweats and wt loss

    3) didnt ask about family history

    4) didnt check gait, have him walk

     

    What I'll do better

    1) Do Neuro immediately after checking back

    2) Try to cut down on questions 

    3) not check eye nerves and upper body neuro (can save for the end if I have some time and 2mins mark hasnt been called)

    I did heart and lungs before neuro, that was a mistake.

     


     


    Edited by DrOO4 on Apr 03, 2012 - 1:35 AM

      #17

    My doc hubby reviewed my previous PN, said it was ok'ish but suggested I ask for fever, PPD (Potts-TB), better walking up or down, any changes in morning vs evening, ankylosis spondylitis, of cause Ab exam cos of AAA and pancreatitis (I ran out of time), among other things. 

     

    Tonight, I prob spent an hr+ on CS, Covered FA Cases 31 (MVA) and 33 (PPT)

    Watched CSE video for and PPT on my own, and did PN. Didnt get to do MVA one, I'll do it wed, if I'm not exhausted by 12 hrs in OR...

    Also reviewed those similar topics in kaplan, got some tid bits (did this while running on the treadmill LOL)

    off to sleep, under 4hrs sleep and I'm in the OR all day

     

    So up next MVA, fatigue, memory loss...

    This weekend, I get to practice with someone, I'll pick the complex cases,  and practice 2 of those.

    Hoping by the end of next weekend, to have gone through all cases at least 1x, and spend the last week reviewing errors, PNs and memorizing DDs. 


      #18

    It was a long day in the OR.

    Watched CSE video on MVA and did a PN on it. Also practiced it (recorded)

    Read FA cases 15, 16  on fatigue.

    For thursday

    I'll watch cse video on fatigue, do PN. Also will review domestic violence in Kaplan cases, elevated BP, and breaking bad news. 


      #19

    Some downtime on my rotation, reading cases on my phone. Just did one on breaking bad news. This one had no hpi, pe or pn


      #20

    just read one on htn, pretty standard, same pe as pt with hd or dm, will practice it later





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