FAT_GOITER
Forum Senior
Topics: 18
Posts: 110
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Well, I agree with you buggsbunny for what you said for 2bmd. 2bmd is indeed very nice and helpful. 2bmd has helped me on more than one occassions too. God bless you 2bmd ..
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| sar
Forum Guru
Topics: 22
Posts: 639
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Hello 2bmd,
Its me again ::very_confused::
I take hx and take notes on scratch paper under LIQORAAA and PAMHUGSFOSS. When i write pt notes should i also write it like that ie:
cc:..........
HPI:....................write whatever under LIQORAAA ( without heading of location, intensity etc., but in bullet form), then
ROS:
PH:.........
All:............
Meds:..................
H: .............
U:.............
G:.................
S:...............
FH:............
O:.........
SH:.............
S:................
(or only those out of them which are necessary for the given complaint)
How much space is provided, is it equal to the one that is given is usmle cd.
Please give some suggestions about writing notes. Do i need to write everyhting i ask?
like above.
Now PE:
V: WNL except....(is it ok? or should write all hr, rr, temp, BP?)
GA:
Abd:
HEENT:
Abd:
Heart:
Lungs:
CNS:
only the relvant exams, but suppose i get + finding of rt hand decreased pain sensation, can i write " Decreased sensations in rt hand, rest of the CNS is normal" or should i write all motor, reflexes etc
I know I have asked you a lengthy question, but please <:help:> if you have time.
Do you have kaps cs book. If yes, how are its pt notes??
Thanks 2bmd,
Have a good weekend,
Sar.
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| 2bmd
Forum Senior
Topics: 8
Posts: 100
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Thanks alot guys for your kind words.
Sar...Im stuck inside for two days...we're expecting 12-14 inches of snow, so this is ALL I have to do. Well, this and 5 movies we rented 
Anywho...I wrote out LIQ...etc just to remind me to ask of that, there are some cases of course where you wont use it, so dont be dependent on it.
I dont really remember what the USMLE CD said as far as the paper goes, but to tell you what I had....It was a normal sized paper divided into thirds. The first 3rd was for Hx, the second for PE, and last part was split in two (L and R), on the left, there were 5 lines to list dif dx and on the right 5 lines to list tests to order. You may have more than 5 or less than 5, but dont worry about it.
The note format...
cc:
HPI:
PMH: which should include medical hx, surgical hx, and any
hospitalizations (so this knocks off the H in the 'HUGS')
All:
Meds:
FHx:
SHx: this includes sexual hx
ObHx: you can have a separate section if its relavanet to the SP, like if
you think shes pregnant or something.
ROS: should include the U, G, S, and everything else (I start from the
skin, wt changes, energy level, head and go down)
PE
VS: WNL, BP 140/96 (so I wrote wnl unless something was not, then I
just wrote it next to wnl)
GA:
HEENT:
CVS:
Lungs:
Abd:
Ext:
CNS:
At minimum I did VS, GA,CVS, Lungs, and Abd (though like I told you before I forgot to write anything about the VS in HALF my notes).
You should try and write as much as you do, though you may forget. I didnt write during my PE cause it takes too much time and I DID forget things I examined. Just try and think about what the pt is complaining of and what is relavant and make sure you include that as a priority. Everything else, though should be there, is only a matter of completeness, and to make sure you are thinking on a multi-system level. If you do examine the extremities, you should put it in your note....if you did motor, pain and reflexes...write them all. If you dont do all of them, then dont worry about it. I dont know if I addressed eveything, if I didnt, pls let me know and I'll try to. I dont have kaplans CS, so I cant comment...sorry.
And again, its no problem at all 
-2bmd
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| sar
Forum Guru
Topics: 22
Posts: 639
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Thanks a lot 2bmd!
I will keep on bothering you till my exam.  and will ask you more questions, as i know you are so kind to answer me everytime i ask you.
Best wishes,
Sar.
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| sar
Forum Guru
Topics: 22
Posts: 639
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Hi 2bmd,
How are you? I have another question :?:
:arrow: case of Abd pain: I will examine abd for sup, deep palp, rebound tenderness, Psoas and obturator sign, CVA tenderness. How would I explain psoas and obturators signs to the SP.
:arrow: Do I need to explain +ve findings in history (that he told during history taking) and +ve findings in physical exam to the SP at the end of encounter during councelling.
Please keep visiting this page, till my exam!
Sar.
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| 2bmd
Forum Senior
Topics: 8
Posts: 100
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Hey Sar,
snow snow and more snow...I live 10 minutes from the hospital and it took me an hour and a half to get home. :cry: How are things in your neck of the woods?
For time sake, dont bother with superficial palpation separately. When you put your hand on the abd, just say lemme know if you have any pain, so this kinda prepares them, and just go in deep. with psoas or obturator.... do the tests and tell them that this is just an exam to see if there are any troubling issues with your abd.
I just said, based on what youve told me and as well as the physical exam, this is what I am thinking, and would like to run such and such tests. No need to go into specifics.
Im glad your preparing is going well.
I'll be here, dont worry.
-2bmd
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| sar
Forum Guru
Topics: 22
Posts: 639
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Hello 2bmd,
Thanks again! You make things so easy!
Its not snowing here in Virginia, but it is still cold.
I am satisfied now that you will be here for some days! You are such a great help.
When are you expecting your ck score??
Best of luck,
Sar.
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| 2bmd
Forum Senior
Topics: 8
Posts: 100
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Hey Sar,
Always a pleasure. CK scores....no idea....I think I would be unusually hopeful if I expect OASIS to be updated next Thursday. Afterall, they say the third thursday after your exam...but I took it on MLK day so I dont know if that would push my score release back. Not to mention the program director of where Im trying to match already asked for my scores....so :cry: IM SOO SCARED!! Oh well...what ever is meant to be, will. [-o<
-2bmd
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| sar
Forum Guru
Topics: 22
Posts: 639
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Dont worry our prayers are with you too! [-o< [-o< [-o< [-o<
You have helped many, and many prayers are for your excellent score!
Dont worry!
Bye bye,
Sar.
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| sar
Forum Guru
Topics: 22
Posts: 639
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Hi 2bmd,
Are you still here???
Can you please tell me, are liver, spleen, kidneys, and other organ names lay man's language, i mean can I use them with SP. When i will palpate these organ do i need to say "now i am going to palpate your liver, now spleen and now kidneys etc etc." If not then what should i say while palpating these organs????
How should i ask for past illness and Family illness. If i want to ask about osteoporosis, etc can i ask like this " Do any of your family members have osteoporosis?" or in a case of diarrhea how would i ask about IgA deficiency disease in family?? and for past med history, can i ask like this "Do you have any othe med prob?" and if he asks "like what" can I tell him the names of diseases " like , inflammatory bowel didease, osteoporosis" etc
If not then how should i ask them??
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| 2bmd
Forum Senior
Topics: 8
Posts: 100
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Hi Sar,
Yessss, I am here...and thank you for your kind words
Yes, they are lay man terms but you kind of want to soften them up. You could say "I'd like to feel around your belly to check the rest of your organs....like your liver, spleen etc.
When you ask for family history, they should give you all the Fhx, cause remember they are actors, and are supposed to give the answers when prompted.
IgA def for diarrhea?? Sar...RELAX. The cases are VERY SIMPLE and VERY STRAIGHT FWD. They arent trying to misguide you and there isnt a definite right answer. For diarrhea, your top 5 choices should NOT include IgA def. If I were to come up with Dif Dx for diarrhea, 1)gastritis, 2) food poisoning, 3) lactose intolerance, 4) IBS, 5) IBD, 6) Celiac dz, 7) Ca, etc. Think SIMPLE.
For fam Hx of these dz, you can ask them the using the name...if a family member as been dx, then they should know the name.
Dont pick your brain for this stuff...remember its very common things persented in the most common way. If you get TOO specific, you may get yourself backed into a corner..keep it broad.
It'll be over soon and you will have done marvelously!
-2bmd
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| sar
Forum Guru
Topics: 22
Posts: 639
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Thanks 2bmd,
You are right i make things complexed but it is due to getting bad news from everywhere.
You always make all my concerns very simple and easy. Thanks!
Do you know in which cases do we need to check BP, or if i get a case in which i should check the BP, can I just say to the SP that "I will check your BP after the PE" ???
In a telephone encounter case, would they give us a number to dial, when enter the room, or it will be dialed, we just need to get it and start talking??
Thanks 2bmd,
sar.
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| dacis
Forum Junior
Topics: 1
Posts: 75
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Before the test they will show you instructional video and tell what to do in telephone encounter case . You will not have to dial a number . There will be a speaker . When you are finished press one button ( sorry, don't remember which one - but proctors at the test center will tell you ) to finish . You will have a sheet with basic Pt. information and what they want you to do at the door before you enter the Pt room . There will be instructions what to do and which button to press and when .
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| sar
Forum Guru
Topics: 22
Posts: 639
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Thanks Dacis! for answering me. I am really anxious, scared confused etc etc!
When did you take CS and where?
May you pass this exam,
Best of luck
Sar.
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| dacis
Forum Junior
Topics: 1
Posts: 75
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Took my exam on November 2nd in Chicago - still waiting for the results .
Getting more and more nervous .
Good luck to you .
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| sar
Forum Guru
Topics: 22
Posts: 639
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It means you will get your result with in few days. I think you will pass your exam!
Good luck to you too!
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| dacis
Forum Junior
Topics: 1
Posts: 75
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Today I found out that I have passed CS test .
Now I am ready to answer all the questions and give my Step 2CS books away - for free .
Good luck to you Sar , I am sure you will pass .
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| sar
Forum Guru
Topics: 22
Posts: 639
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Many many congrats to you Dacis,
I knew you will pass. Thanks for wishing me!
I will ask you many questions. Now i am going to start studying, and i usually put questions while i am studying, so i will post questions any time from now . Stay tuned!
Thanks for offering yourself for questions.
I am very happy that all good peoples have passed!
Best wishes,
Sar.
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| sar
Forum Guru
Topics: 22
Posts: 639
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Here i am with a question Dacis,
30 yr old woman with abd pain for 12 hrs. Invs: can we put both x-ray abd and u/s abd for this case along with other tests or just an u/s??
For another case, can we put CBC and LFT on one line?
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| dacis
Forum Junior
Topics: 1
Posts: 75
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You can order both - Abd. x-ray and US for the same Pt . . In the case you have described- Pt. is a 30 years old woman - so before ordering the abdominal x-ray make sure that she is not pregnant - order pregnancy test .
In exam I did write CBC and LFT on the same line . Please remember that you can not write "LFT " in exam - insted you should write : " AST , ALT , bilirubin , alkaline phospatase " etc .
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| sar
Forum Guru
Topics: 22
Posts: 639
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Thanks Dacis,
But how about CBC, i think we can write that.
or like this WBC, Hematocrit, Hb ?
What are you doing these days, any job, externship??
Enjoy exam free days,
Sar.
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| dacis
Forum Junior
Topics: 1
Posts: 75
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You can write CBC .
I am doing observership in Neurology and now that I have all my exam results I will try to get a few months of externship in Internal medicine since before the Neurology residency I have to do an Internship and I have not been in touch with internal medicine stuff for many , many years .
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| sar
Forum Guru
Topics: 22
Posts: 639
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Neurology, thats great!
Good luck for your residency!
Thanks for all your help,
sar.
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| 2bmd
Forum Senior
Topics: 8
Posts: 100
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Hey Sar,
Long time no hear...just wondering how the preparations are going. Your exam is sometime this week right? Well, Im sure youve already mastered everything. Just take some time to relax also
Lots of prayers and well wishes.
-2bmd
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| sar
Forum Guru
Topics: 22
Posts: 639
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Hi 2bmd,
Thanks for your prayers and best wishes! I have a question:
I have some minor cuts on my hands, my exam is on 10th, should i wear gloves for PE or not. If i use gloves would it effect my score??? do you have any idea??
Pray for me!
Sar.
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