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 Exam 3rd wk April, lets go  
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  #41

Did FA case 32 alongside csevideo. I practiced and did mine in 13mins, which is great cause I'll have soooo much extra time for more empathy.

 

Did PN with csevideo case, and typed mine on the usmle.org website

 

Now going on to do sleeping problems, breaking bad news and then mental stuff


  #42

FA case 34 (insomnia) done, with corresponding csevideo

PN completed in 9 mins. 

 


  #43

Practiced case on tremors, case 22.

Did 1x by myself, and then over the phone with my hubby (according to him, the history was fine and passable)

For this, full Neuro is needed, also TPR. Tone, Power and Reflexes.

Tone you check by checking both arms and legs for rigidity, move them around.

Power, have them kick out.

Reflexes, you check with Reflex hammer.

Also Gait, should be small shuffling steps, bradykinetic.

 

Reviewing picky eater telephone case now, and after that I'll go ahead and do kid with tantrums


  #44

Yipee took this opportunity to review more pediatric cases, going to do another pediatric PN. 

My hubby flipped the switch on me with picky eater case, and turned it from a 4yr old to a 12 yr old. So that allowed me to think outside the box last min.


  #45

Did FA case 40 (peds stridor), and peds tantrum (kaplan case 35)

 

 


  #46

Schizophrenia FA case 35

Practiced patient in street clothes vs Patient that needs PE. I can do it quickly in about 13-14mins, so thats good.

For Psychiatric history (esp when pt is in street clothes and no PE)

Alert and Oriented, Speech, Memory (Recent and Remote, remembering 3 things), Attention and Cooperation (Spell WORLD backwords)Mood (elated/expansive or euthymic, dysphoric), Affect -person's emotion as you see it (agitated, jittery, flat, blunted...)Thought process (delusional, loose associations, flight of ideas...), Suicidal Illusions

For Speech, you write what you observe.

For Mood, ask patient "How do you feel?"

For Affect, that is emotional state that you observe.

For Hallucinations, ask "Sometimes people see or hear things that others dont see or hear, does that happen to you?"

For Insight, ask "what do you think about your symptoms?"

 


Edited by DrOO4 on Apr 16, 2012 - 12:02 AM

  #47

A week from now, I'll be fast asleep, getting ready for my exam!! I cant wait to take it, kinda tired of going through the cases. I am so ready though to PASS and so ready to PASS with HIGH PERFORMANCE in ALL Categories!! Its so doable!! Best wishes to all studying for CS, and feel free to ask questions. Once I take the exam, I'll at least be able to go into my details about my strategy and how it worked for me.


  #48

This week, I'll try and go through all of the CSEVIDEOS and I'll look through FA's mini cases for DD.

CSEVIDEO has 36 videos, plus 12 mystery cases. I'll go over PN for each set (menstrual, cough, chest, dizziness, memory loss, joints etc but not all PNs).

Thats 12 hrs of cases, since I have rotations, I'll aim for about 3hrs of videos a day, so that I'll be done by Friday. Saturday will be practicing about 5 cases live, maybe more if we can, but definitely 5 major ones, Sunday will be just reviewing DDs and Workups and rest.


  #49

Updated FA cases I've covered, so far, added 12, 22, 25, 32, 34, 22, 40, 35, 

 




So far in FA, covered Cases 1, 2, 4, 6,7, 8, 9, 10,11, 12, 13, 14, 15 (depression, still need to practice more), 16 (domestic violence), 18, 20, 21, 22 23, 24, 25, 26, 27, 28, 29, 30 (enuresis), 31 (MVA), 32, 33, 34, 35, 39, 40, 41

 

So whats left are FA Cases 3, 5, 17, 19, 36, 37, 38 (To Practice, they are similar to others, so writing my thoughts on them below by scanning 1st page of case) Hoping to Practice them all Monday when I get off clinic. Hopefully its an early day. Still need to do breaking bad news review again too.

case 3-right arm pain (Mnemonic DEFORMS comes to mind, Dislocation, elder abuse, fracture, osteoporosis, osteomyelitis, rotator cuff tear, myositis, sprain/strain)  JOINT CASE (XR, MRI, Bone scan)

case 5-blood in stool (what I see all the time in this current rotation) DD that come to mind are Colon CA, Diverticulosis, Diverticulitis, Ulcerative Colitis, crohn's, hemorrhoids, etc), You Scope (Endoscopy, Abdomen-CT, U/A, Stool culture, stool for occult blood, CBC, Rectal Exam)

case 17-fatigue in 61 yo M, DD that comes to mind Anemia, Depression, Malignancy, Pancreatic CA, Pancreatitis). Workup: AST/ALT/Bili/Alk Phosp, CBC, Rectal exam, Abdominal U/S, U/A

case 19-bloody urine in 57 yo M, DD that comes to mind Nephrolithiasis, Bladder CA, Vasculitis, Prostate CA, BPH, Renal CA. Workup include CBC, U/A, Abdomen-XR, Abdominal CT, PSA, Rectal exam, Genital exam)

case 36-diabetes in a 10yo F, DD that comes to mind type I, type II, hemochromatosis, 

Workup include BUN/Cr, CBC, glucose, LDL, HDL, U/A, albumin levels, AST/ALT, HbA1c

case 37-right calf pain 35 yo F, DD that comes to mind Ruptured Baker's cyst, myositis, muscle sprain/strain, cellulitis, DVT. Workup includes Doppler U/S, D-dimer levels, CBC, XR-calf, U/A, CPK, bone scan    JOINT case (A MUST PRACTICE for Joint PE and PN)

case 38-heel pain in a 31 yo M, DD that comes to mind: Plantar fasciitis, muscle sprain/strain, tendonitis, osteomyelitis, myositis, splinter. Workup includes CBC, XR-heel, XR-foot, CPK, myoglobin, U/A, bone scan  JOINT case (A MUST Practice for Joint PE and PN)

 

So at least that tells me, if I had any of these cases, can get through them, as always the goal is to be extremely comfortable and ace it. God is always in control!


  #50

From the newest FA that just came out, which I dont have, here are cases 41-44, I'll try and write DD and Workup below. 

42. 62 yr old man with Hoarsness
43.67 yr old women with Neckpain
44. 11 month old girl with seizures

42) DD: Cancer of the larynx, Inflammation of the larynx, GERD, foreign object obstruction, allergies, URI

Workup: CT-neck, CXR, CBC, MRI-neck, barium swallow, upper endoscopy, manometry, CPK

43) DD: Muscle sprain/strain, osteoporosis/osteomyelitis, myositis, osteoarthritis (cervical spondylosis)

Workup: CT-neck, MRI-neck, CBC, CPK, bone scan

44) DD: Febrile seizures from high fevers, Absent seizures, Brain tumor, severe dehydration, hypoglycemia

Workup: EEG, MRI-brain, CT w/o contrast-head, CBC, Electrolytes, serum glucose




  #51

Monday wasnt great. Just covered 2 cases, Shoulder pain, and heel pain/ankle pain. Funny enough I covered case 5 with my preceptor during our daily lecture

Need to cover at least 5 cases today, so that it will be all review from here.


  #52

So far (still at least 3hrs left for me tonight), covered Cases 38 and 40.

Covered Case 40 1x, it was ok, can do better, so I'll come back to it.

Covered case 38 2x, 1st time, did too much on physical exam, and just finished on time, read it, and realized mistake, so did it a 2x, and finished with 13-14mins.

Time for dinner, then continue. Plus watch corresponding csevideos and go over some DDs in FA. 6 days till show time!


Edited by DrOO4 on Apr 17, 2012 - 10:27 PM

  #53

I'm a visual learner, hard for me to learn by reading,

Watched a csevideo on wt gain, did PN in 9 mins. DD: Hypothyroidism, Lithium-related obesity, smoking cessation, familial obesity, pregnancy

Workup: TSH, U/A, CBC, Urine hcG,, Electrolytes, cholesterol, triglycerides


Edited by DrOO4 on Apr 17, 2012 - 10:18 PM

  #54

Did cases 5 (hematochezia)and 19 (watched the videos and practiced on my own.

Case 19--bloody urine, I got most of the FA check boxes, except for asking about renal stones, and STD infections. It felt easy, and I got done in 13mins.

Case 5--hematochezia, I forgot to ask about mucus in stool, travel, sick ppl contact who have diarrhea, and exercise. I was able to get done in 12mins.

I have to say these are the cases I feel the most comfortable about. I am praying I get 1 bloody stool case, 1 ab pain case, 1 PPT case, 1 sore throat, 1 back pain, 1 basic peds case, diabetes followup, a OSA case, among others.

Did PN for case 5. So that leaves 3, 17, 36 and 37. Plus I need to practice my weak ones (hearing loss/dizziness) and also breaking bad news.  I'll definitely be practicing those ones as well with my hubby on friday, as well as several others, so for a total of maybe 10 cases, one from each section. Sunday after church, will just be for skimming thru FA mini cases multiple times, and watch maybe 5 videos, sleep early, by 9pm. 

In OR Wed, I pray we get done early afternoon, so I can have time to review.  Time for sleep, 4hrs till alarm goes off shaking head

 


  #55

Came back from the OR real tired, and ended up taking a 4 hr nap! Good thing is I can still get about 5+ hrs of CS review tonight before crashing, lets go!

 


  #56

Read some Minicases, all the head stuff, from headache to insomnia, and then joint/limb pain. I didnt get through the Throat/GI and urinary sections

 

1) watched csevideo hip pain video

2) did FA 37 (calf pain). Practiced in 13mins, which puts me at a safe side to leave room for questions and all. 

3) watched csevideo on dizziness (I'll be practicing this over weekend)

4) did FA 3 (arm pain)

5) did FA case 17 (fatigue)

6) watched csevideo on middle age fatigue

So all that is left out of my FA is case 36 about new diabetes in 10 yo, I'll practice that Thursday, and finish up rest of mini cases review, and go over that again. I'll also be watching videos, and do PNs for half as many videos that I cover. 

4 hrs sleep for me tonight.


  #57

Got outfit ready to go!

Picked up a case and practiced with my outfit , FA Case 10--persistent cough. I forgot to ask some key stuff which I never forget to ask, nausea/vomiting, constipation/diarrhea, fatigue, SOB, wheezing. I also knew I was running out of time so just skipped Abdominal. 

I started with Extremities inspection, Chest, Lungs. I wasted time checking for pulse and reflexes, I shouldnt, that time would be best spent doing the Abdominal exam. I also realized I waste time initially, so I really should do a better job. I'm going to do this one again before I sleep, and see how much better I do with it.

Now to finish up the FA 36 case, and do some pediatric cases. Goal for tonight is to cover about 6 or 7 cases and do 2 PNs. 


  #58

FA case 36 done!! Yipeee!!! Practiced and did it in 13mins, but I didnt really like my performance. Though I asked all the questions, except for compliance. I need to practice it again. Now going to read through some DDs and then 2 hrs or so of csevideos, 


  #59

Ok practiced FA case 36 again, and I did it in 11mins, and I was a lot more sharper with my questions. Didnt miss any this time around. Can probably spend more time counseling, and the importance of the family helping the young newly-diagnosed diabetic.


  #60

Finished all the minicases Friday!

Listened to all csevideo audio while on a long drive, it went through H&P questions, I covered LOC, Tremors, Chest Pain, Peds with Vomiting/Diarrhea, Blood in stool, Ab pain, fatigue, diabetes followup and knee pain. Wouldnt that be amazing if the majority of my cases end up being from this set :-)

I just reviewed breaking bad news from kaplan. Want to watch a csevideo on dyspareunia, do that PN and practice 1 random case. Sat is the big day to at least practice 5+ cases live! I'm ready for Monday and ready to get this bad boy done!





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