2bmd
Forum Senior
Topics: 8
Posts: 100
|
Hello all,
I didnt want to post anything without knowing how I had done on the CS. Now that I have passed, by the grace of God.....if anyone has any questions I'll be more than happy to answer them.
I took my exam on Oct 18 in Philly. Didnt really study much, as I had gotten the test date about a week before I was scheduled. I bought the First Aid for CS, and read it about 4 days before my exam. I practiced with my sister...more so with history and timing rather than the PE. I found that I was spending way too much time interviewing so I decided on keeping the interview problem focused while making sure to ask PAM HUG FOSS. My biggest problems were coming up with a work up. I spent most of my time writing practice notes and reviewing the practice notes in the FA.
During my exam, I had 11 pt encounters, some of which were almost exactly out of FA. My first one I froze on... pt had belly pain and I did an ophthalmic exam...AGH!! The rest of my rooms went great. I kept the questions problem focused like I mentioned, tried to hit everything and get done before the encounter time was up so I would have more time to write my note. There were some cases where I couldnt come up wiith more than 4 tests or 3 dif dx. But they say that you wont have 5 for all cases, so I didnt worry too much about it. As I left the testing center, I realized that more than half my pts were smokers, and not ONE did I counsel on to quit smoking. But I think that happens, you blank and forget to ask the obvious. Thats why I think your hx, and pt note are most important. PE I think is a formality in the sense that they just wanna make sure you dont hurt the pt or do things to make them uncomfortable....I dont think they really grade you on if you did EVERYTHING during the PE. Counselling, I would just tell the pt what was in my head...if I thought there was a chance of cancer, I told them....while also saying...."I would like to run some tests which included a, b, c, to see if it is or is not cancer, but based on what yorue telling me, cancer may be a suspicion along with some other possiblities. Id like to get the results back before I say anything further."
Score reporting...as I said I took my exam Oct 18th, OASIS was updated on Jan 12th. I took my exam in Philly.
If anyone has any questions, I'd be more than happy to help.
Good Luck,
-2bmd
|
| sar
Forum Guru
Topics: 22
Posts: 639
|
Congratulations to you 2bmd! =D>
Glad to hear a good news after a long time on this forum!
You have given good details of your experience. Although i have many questions in my mind but for today i am asking you some. Please dont go from this forum so that you can answer our questions. I am going to take my exam on 10th feb.
Are you an img or an american grad?
What do you think, how much english fluency will count towards the result. Do fluency important or the correct english imp??
I am practicing cases, and having problem with timings and to remember PE to be completed and specific.
How do we tell SP about different d/ds in laymans lang, eg Pseudogout, PID, many other diseases??
we dont have to do a complete exam for all systems. Like if we have pt with cns problem, we dont have to do complete exam of lungs and heart, just auscultation would be ok?
Can we stop for a some time during history taking to remind questions or to remind d/ds? How difficult the questions that SPs ask?
Ok 2bmd
Good luck to you for a good residency program!
Hang in here please for some days to answer more questions 
Sar.
|
| BC
Forum Newbie
Topics: 3
Posts: 36
|
hello. congratulations to us! i just found out today through the oasis trick that i passed my step 2 cs. I took it in LA, end of august. i have a question though, do we have to apply for the ecfmg certification or will it be sent to us automatically after 2 weeks?
thank you and congrats again.
___________________
The threshold between right and wrong is pain.
|
| 2bmd
Forum Senior
Topics: 8
Posts: 100
| | 01/14/05 - 02:22 PM
1 of 1 forum leaders found this post helpful
| #4 |
Thanks alot sar!
I am actually an American IMG. As far as proficiency in English goes, I really dont see it having too much of weight. I mean yes of course it is a factor, but I think they would want to see if you can communicate in English enough to gather information from the pt, analyze it, and then be able to explain it back to them. From your posts, it doesnt seem like you would have a problem with that. Although I can speak other languages, English is my first language, and I found myself stubling a few times just out of sheer nervousness. Just know that its not the most important part of the exam, cause if you concentrate too hard on that, you may make more mistakes.
Yeah, I know time is a killer. I found an old post of mine where I was answering someone about timing...maybe it'll help you.
-------
Yes its true, you do want to ask as many relevant questions as possible, however your history also has to be as complete as possible. Having taken the exam and asking myself what the point was...if I were an examineR I would want to know if the examineEs are able to think of the body as a whole....for example, if your patient has a cough, you arent JUST focusing on the lungs, as Im sure you know there are many reasons for a cough not related to the lungs. So your history has to make sure youve asked the questions to rule out other possible reasons.
I stuck with the LIQ... just because I found that it kept me organized. Once I read the doorway information, I wrote a few differentials I could think of just based on that info, and the patient interview was just a matter of ruling in, or ruling out that condition. So direct your questioning towards just that. If you think your patient gallstones, you dont need to ask EVERY question about that. You just need to ask enough to have it as a differential...then move on. This will help you save time!
Regarding your other question....actually no, I rarely had positive findings...even when I EXPECTED to find them. Just goes to show that the history is where you are going to find what you need....the PE is just matter of going through the motions, making sure you know how to interact with the patient (dont hurt them, tell them when your about to do something, etc).
------
Sar, remember that you will be given cases that are either initial visits in a clinic or ER. You wont have something as complex as pseudogout (would need an inflammed joint..thats hard to standardize). SP may present with joint pain.
I didnt discuss ALL my dx with the SPs, I discussed the ones that were highest on my list (1 or 2) or ones that were most serious (ie cancer...even if it wasnt high on my list).
They test you on VERY common things. HTN, headache, syncope, GB dz, 1-2 peds cases, CP, cough, Abd pain, muskl pain, depression, fatigue. And the cases are simple enough to where you dont need to use medical jargon.
No you dont have to do a complete PE...just relavent things. As a standard though I did auscultate heart, lungs and abd (palpated too), just cause it makes your note look more complete.
SPs will ask common pt questions, "so doc, what do you think it is? Do you think its serious? My sister had cancer, do you think this could be cancer too?" Mostly they just ask what you think is going on. Just speak your mind...."well, pain in your arm could be many things. It could be something as simple as a muscle strain, or sometimes it can be a sign for something more serious like a heart attack. Or maybe you hurt yourself a while back. So before I can tell you something definitively, I'd like to run some tests. What Id like to start with is a simple Xray just to see if there was any trauma to the area. I'd also like to get an EKG to see how your heart is doing. When I get the results back it'll give us a better idea of whats going on. Does that sound like a plan to you? Is there anything else I can answer for you?" I asked all my pts that closing question and they all said NO...so dont be afraid to ask it. It'll just show more confidence.
If you search for my posts on the CS forum, it may give you more info.
Lemme know if you have anymore questions.
Good Luck,
-2bmd
|
| 2bmd
Forum Senior
Topics: 8
Posts: 100
|
Congrats!!
Im afraid I cant answer that though, Im still in school, so my school takes care of all that.
|
| bugsbunny
Forum Junior
Topics: 14
Posts: 54
|
Hi 2bmd...congrats..i wish i can do as well as u did in ur exam too..so wat ur plans for now?...good luck for residency
|
| sar
Forum Guru
Topics: 22
Posts: 639
|
Hello 2bmd,
Thank you soooooooooooo much for replying me in detail. Thanks for clearing many points and taking time from your happy moments. I am little relax now.
If you have time do tell us about the telephone encounter, Gynae/obs cases and paeds case.
I am preparing from uw and osce, I dont have first aid, what do you think should i get it or not? Osce doesnt have pt notes in it. uw has some.
How detailed should we write the pt notes?
Sorry to bother you again,
Have a great day!
Sar.
|
| sar
Forum Guru
Topics: 22
Posts: 639
|
Hi 2bmd,
If you are still here, please answer my questions if you can!
A friend of mine who took CSA 4 years ago says you have to wash your hands immediately after entering the exam room, not after history taking and before physical exam and then just before leaving the room (not just after completing PE and before giving the last words)
So can you please tell me the correct timings of washing hands??
Good luck!
Sar.
|
| 2bmd
Forum Senior
Topics: 8
Posts: 100
|
Hi Sar,
Sorry for the delay...
When I got into the room, I shook hands, and after the history, Id ask, "i'd like to do a quick physical exam if thats ok with you..." once I got the answer, I would say, ok lemme just wash my hands. This was just to kinda cover all bases. If I washed my hands when I walked in, they may forget, b/c they are looking for did the examinee was hands BEFORE the PE. I verbalize in case they forget or are busy fixing their gown or something while Im washing my hands and dont actually SEE me doing it.
I actually didnt have a phone case, it was a concerned parent that came in to discuss an issue with his child. VERY simple case. Just dont forget to tell the parent why the child might be experiencing what he is. There arent really any fullon OB/GYN cases. The SP may present with something that may have an OB/GYN issue as a differential, but not the main focus. For example...your SP could have fatigue...well you know in a woman of child bearing age, pregnancy is always a dif dx....so order a HCG...other dif dx hypothyroidism, depression etc, and order accordingly. Same thing with abd pain...you could have PID or an ovarian cyst or something in a female along with NON-ob/gyn causes...so you would order a pelvic exam, GC culture, US, etc....and that is your OB/GYN aspect of the SP. You wont have a straight up OB/GYN case. So thats less to worry about
I would HIGHLY recommend First Aid. My husband read the OSCE the night before his exam and LOVES the book, but he took his CSA 3-4 yrs ago. I couldnt find the OSCE, and I like the fact that FA has 15-20 notes, a list of differentials for each presenting symptom, and a work-up list of things to order. So, again I would recommend the FA, but I have lots of friends in my class that used the OSCE for their CS. Choice is yours. Im sure you'll do well either way.
If you have more questions, please ask away!
-2bmd
|
| sar
Forum Guru
Topics: 22
Posts: 639
|
Dear 2bmd,
Thank you so much! ....but sorry to bother you again and again.
<:help:> I have some more questions ( :roll: ):
Which abbreviations u used in exam. usmle Cd has one page of abbreviations( short list) but uw has 10 pg of abb, can we use uw abbreviations, like for abd exam: s/nt/nd BS +ve.
There is another way in Kaplans book eg: (-) tenderness or (-) swelling etc. What did you do?
If I choose to type one pts note, then I have to write all pts notes, or if i type one pts notes i have to type all pts notes, it it correct? as my writing is not good. so i want to type, although i dont have a very good typing speed. What do you suggest?
Should we have to write vitals (that would be listed on the door sheet) at the top of PE notes. and also the general condition??
How many d/ds did you explain to the pt. If a pt has complaint that is not an emergency we can explain him that lets meet again after i get the results of your tests, and i will go over them with you, and will tell you about the rx plan. but if he has a complaint which is acute or a complaint like hemetemsis etc, what should we tell him?
I have a doctors coat on which there is some mongram stiched. Can I use that coat? I heard they will put some thing on the mongram.
When the encounter time begins, at the door what should we do, reading the door sheet, and write PAMHUGFOSS, LIQOR AAA, and possible D/Ds on scratch paper. Is there a time to write em on paper?? suggest me what should i write? what did you do?
Thanks 2bmd for clearing my confusion about various issues.
Good luck!
Sar.
|
| 2bmd
Forum Senior
Topics: 8
Posts: 100
|
Hey Sar,
I just got back from giving my CK...whew..its all over! Thank GOD!!
Anyhow, I tried not to abbreviate as they discourage it. At each station, they have a list of abbreviations you can use. So instead of losing time on constantly check the list, I just didnt use them. I did use +, and a circle with a line through it for negative, and BS for bowels sounds..for everything else though, I wrote it all out.
You have to committ to how you do your pt notes...once you type you type for ALL of them...same goes for writing. I wrote just cause Im used to writing my notes as opposed to typing them. My handwriting isnt great, but I tried to make it legible. I would suggest doing whatever youre already used to.
In half my notes I forgot to write the VS, but I guess you should for completeness sake...and yes a one line general statement.
I discussed at least two dif dx that werent related by systems and/or the most serious, even if it wasnt highly likely. And yes, thats exactly what you can say...you want to have the results from some tests back before you can tell them anything further, so you'll have them follow up when the results come back. Same thing with acute pts....you need to figure out what exactly is going on before you can tell them anything for sure.
The proctors will put tape over anything on the coat, to standardize everything.
When they annouced examinees you may begin your pt encounter...i read the doorway info, wrote down PAMHUGFOSS, LIQ... and every differential that came to mind. Whether I used PAM...or the differentials didnt matter...at least it was on paper so I wouldnt blank out when I was with the pt. You have as much time as you need...you just have to make sure you budget it...I mean you can spend 5 mins at the door, but you shouldnt.
Like I said, when I read the doorway info, I thought of things that I should ask as well as differentials I am thinking of, even before speaking with the pt...this should NOT take more than 20 secs. It doesnt sound like alot of time...but trust me. When youre there and there are other examinees around you that are knocking on doors and already going in, you arent going to stay outside the door for long.
Just practice, get good with knowing what tests to run for certain complaints, and what questions to ask. If you get a system for yourself that makes everything FLOW, the exam will be a BREEZE for you. Practice enough to where it become systematic and you arent really thinking about it. Sounds harder than it really is...trust me.
Dont feel bad about asking questions...this forum is a resource...use it! :wink:
Good Luck,
-2bmd
|
| sar
Forum Guru
Topics: 22
Posts: 639
|
Hello 2bmd
Congratulations on finishing STEPS! I dint know that you had to take CK after CS. I am sooooooooooooooooooooooo thankful to you that you answered me despite your exam. So how was your CK?? I am sure you will get good score in CK too!
Keep visiting this place to help us. I might bother you again 
Best wishes,
Sar.
|
| sar
Forum Guru
Topics: 22
Posts: 639
|
Hello 2bmd here i am again! to bother you.
Can you explain the draping technique for a woman, to check PMI and to examine lungs and heart?
Should we have to lower her gown and cover with drapes the rest of body or do we have to raise her gown from below upwards with out taking it off??
For shoulder exam in male as well as in female, do we have to take off their gown as shown in uw shoulder exam?? and cover the rest of body with drapes??
Please let me know what is the correct tech.
Thanks a lot in advance.
Best of luck 2bmd,
Sar.
|
| 2bmd
Forum Senior
Topics: 8
Posts: 100
|
Hey Sar,
Thanks alot...its kinda weird though, now that Im done....I dont know what to do....I just sit here worrying about my answers. Oh well...whats done is done.
Drapping...well as the CD that they give out tells you, theres a sheet in the room that youre supposed to give to the pt. I gave them that sheet no matter what...even if you werent going to lift their gown. Sometimes I gave it to them before I washed my hands, and sometimes after...right b4 the PE, just depending on when I actually remembered. I would undo the top string of the gown, and bring it down almost hanging off the right shoulder...or if I needed, I would bring it down half way down the upper arm and keep a hand there. I didnt ever drop the gown off their shoulders, just cause *I* would feel uncomfortable if I was a pt and that happened. But I did have a couple of pts who, after I brought it to their shoulder, they themselves took it down...so I guess as long as you try to keep pt comfort in mind. I made sure I had enough space for my hand to go in without rubbing against the pt. Through the neck of the gown, I examined the heart and the left lung...for the right lung, you can just slip your hand around the back since its already kinda open. For abd exams, I pulled the sheet up and lifted the gown....constantly verbalizing what Im doing...."Im going to place this here, Im gonna lift up your gown, etc." Just so they know whats going on, and so its not dead silent in the room.
For shoulder exams....theyre snap buttons on the side of the gown you can undo and expose the arm while still leaving the pts torso covered. If there arent, take out the arm but still try and cover the pt with the gown as much as you can...dont make a conscious effort to where you look awkward, just enough to where the pt knows you arent trying to get a nice look at them or something. I didnt use UW so I dont know how they explain drapping. The way I like to think about it is, pretend the room is 2 degrees. You wanna try and keep the pt was warm as possible....by warm I mean minimize exposed skin.
After I was done with the exam, I would tie up their gown...whether or not I was supposed to I have no clue, I just know that the SPs were very grateful when I did. Nice note to end on with a pt.
Im not sure if that helps you at all since drapping is something that needs to be seen....just remember how you would like to be covered if you were the pt and if it was really cold in the room... 8)
And of course its no prob at all.
-2bmd
|
| sar
Forum Guru
Topics: 22
Posts: 639
|
Thanks 2bmd again. You are right that draping is something that i need to see it, but you have explained it very well so that i can imagine you doing exam of the pt. I just want to describe you what i understand from your explanation, you said that you examined the left side of the chest from the neck of the gown, you lowered the gown enough so that you can do the exam from the neck in sitting position. Is that right?
You examined left chest from posterior only, is that right?
How would I inspect the chest without exposing it? or Is inspection not necessary??
Do we need to wash hands before leaving the room too (ie washing hands two times, one before PE and one other time after that)?? If yes what would be the correct time? Just after PE or after finishing the encounter or ?????
Ok friend, its really so nice of you that you are replying all of my messages.
Thank you very much!
Sar.
|
| 2bmd
Forum Senior
Topics: 8
Posts: 100
|
Ok...lets see if I can put you in my head
I always stand on the right of the pt...
So now i have undone the gown and lowered it to the end of the shoulder/axilla. My left hand is holding the gown there. With my right hand, I go through the neck of the gown auscl the heart. Now since Im already there....near the mitral valve, I reposition to hear the left lower lung....under the breast, midclavicular line. Then I come out.
The second tie of the gown is at the level of the mid-lower back...so the only thing holding the gown on are the sleeves. You have alot of room to slide your hand around the right side of the back towards the chest (like you were wrapping your arms around someone from behind)....at this point youre kinda standing behind the pt....your left shoulder behind the pts right shoulder. Same point...midclavicular line below the breast, the ausc a second point...anterior axillary line, now reach across, and ausc the same ant axillary line...at this point your perpendicular to the pt (looking in their ear...if you want ) Come out, listen to the post lungs from the exposed back. This sounds MUCH MUCH more complicated than it really is.
If you wanna make it easier....just do the whole thing from the neck of the gown....if the pt is thin it shouldnt be a prob. Im not very tall so I found that I would be at awkward angels trying to hear the sides that were closer to me from the neck of the gown.
I dont remember if I inspected or not, but if I were to, I wouldnt inspect unless there was need...ie trauma or something. And even then, I would do it when they were lying down.
No you dont need to wash your hands twice...just before the PE.
It is no prob at all, Im just afraid that I may have confused you more than acutally help you. if I have confused you....my apologies! 
-2bmd
|
| rhonda
Forum Senior
Topics: 9
Posts: 122
|
Hi 2bmd! It's no wonder why you passed this exam judging from your posts alone. You did absolutely great! :P Congratulations! I'll try to remember all these in my exam. I'm sure you'll also do well in your CK.
|
| monica76
Forum Senior
Topics: 13
Posts: 151
|
ur posts are gonna help people for a looong time to come
|
| sar
Forum Guru
Topics: 22
Posts: 639
|
Hi 2bmd,
Check your pm, i replied your message!
I agree with rhonda, your posts show how well you did in your exam.
How many days did you practice?
Thanks a lot again. I understand now, the correct method!
Please keep visiting here to answer our questions!
Best wishes,
Sar.
|
| FAT_GOITER
Forum Senior
Topics: 18
Posts: 110
|
Congratulations 2bmd !
I remember you were feeling very confident after taking the exam. I wish you good luck with your step 2 ck and the residency this year.
Fat Goiter
|
| bugsbunny
Forum Junior
Topics: 14
Posts: 54
|
Hi 2bmd...i have a question for u..plss do reply....were u able to counsel every pt. during ur CS?..i mean were u able to tell them ..that u r thinking that it could b so n so disease n u need to run tests to find out..how much does it matter if u run outta time in few cases n r not able to counsel.....n plss one more thing..wat would u tell SP if u were gonna listen for carotid bruit?.,.i know it might sound stupid but i m just too tense right now regarding my exam next week............thanx a million in advance.
|
| 2bmd
Forum Senior
Topics: 8
Posts: 100
|
Hi Bugsbunny,
I know its very stressful, but part of doing well is to stay calm...cause you'll forget things you already know. I know its easier said than done, but if you can try, please do.
There are three important parts of your encounter with the SP. 1) history, 2) PE, 3) counselling, so YES you should definitely counsel EVERY SP. I ran through 2-3 dif dx with them...I should have also counselling on preventative medicine, but I TOTALLY BLANKED. I didnt tell a single pt to stop smoking (so you really do need to relax ). Counselling shouldnt take you more than 2 minutes MAX....so if you practice, get your Hx and PE done in 12-13 minutes. When you hear the 5 minute warning, you should be at least half way done with your PE, this will also make sure you have enough time to counsel. DOnt worry about what will happen if you dont counsel...try to work it in. If time is an issue for you, I would work on your history taking. Try to make it problem focused. Ask the LIQ... PAM... if you get a positive, ask one or two questions more to either rule your dx in or rule it out, and MOVE ON. Maybe you should pratice with only 10 minutes for your history and PE.
Listening for bruits....tell the SP, "Im going to listen to some vessels in your neck, can you please look towards the door." Palpate the carotid, put your scope there, then ask the pt to hold their breath. Listen for not more than 3 beats, then make sure you tell the SP, "ok you can breath now." Then for the other side, "Now please look here (opposite side)", and say the same thing.
If your exam is next week, you still have enough time to practice, and hopefully you'll become less tense when things start flowing.
Good luck,
-2bmd
|
| bugsbunny
Forum Junior
Topics: 14
Posts: 54
|
Hi 2bmd
thanx a lot for ur help...well im doing practice but i will have to take 2 days off for my interview..so i'll try to take some notes with me to read during my flight..well one more question..does it matter if we forget to write down carotid bruit not heard..or pallor not noted..i mean wat if we check that stuff on physical but somehow forget to write it..u know wat i mean..coz sometimes im doing everything during PE but once a while i forget to write that i checked for carotid bruit..i dont know y but i m sure practicing more will take care of that but still one can forget these things...
n how do we write for pallor in pt. note ..eg in case of palpitations we look for pallor in eyes,,where should we write ..pallor not noted on pt. note,, n also how to write it too...thanx a million in advance.
|
| 2bmd
Forum Senior
Topics: 8
Posts: 100
|
I know EXACTLY what you mean, cause I did exactly just that. I examined a whole system and totally forgot to write it in my note...and it was pretty relavent to the SPs Sx as well. I dunno what to tell you though, cause if you forget you forget ....one thing to remember is that you WILL forget things, so work on knowing enough things where you dont have to consciously think about it. That way, if you DO forget things, at least youve done other things that may off set what you forgot.
HEENT: + conjunctival pallor
if its negative, dont mention it. Only mention a negative if its supposed to be there and its not....ie (-) bowel sounds.
Good Luck with your interviews!
-2bmd
|
| bugsbunny
Forum Junior
Topics: 14
Posts: 54
|
thanx 2bmd..
u know....u r a very nice person...u will become a very good doctor too....i appreciate the way u explaiin things too..coz very few people can do that..u know wat i mean...well if i have any questions i 'll bother u again...i know i wanted to ask u some questions..but forgot them in euphoria..lol
good luck
|
|
| |
| | | | | | | | | | | | | | | | | | | | | | | | | |
