docmama
Forum Senior
Topics: 3
Posts: 83
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HEY! I just found out i passed and thought i could help.
I did it in Houston on June 21st. There everyone is really nice and helpful. The proctors are great. The SP's are nice...not so helpful if ur stuck. But some will even give u some clues to help u out. Dont worry about the place. I am not sure about accents and all b/c i am an American IMG so i cant comment on how hard. Actually 3 of them asked me to repeat (AND I WAS BORN AND BROUGHT UP HERE!! WITH A TEXAS ACCENT!!) so dont worry about that. Be confident and look smart-wear comfortable clothing, cologne/perfume, makeup, and comb hair well (if ur a girl, its better to tie it back so it doesnt get in ur way...or at least have a small band with u in case u need it). U will get through. Actually i saw a few posts from this site which helped me. I used only USMLEWorld.com...and i practiced about 2-3 hours on the phone. A couple of days b/f the exam, i practiced on my husband (an IM resident) and we discussed the last few days.
I could say that the main thing to do is know what all cases (chief complaints) could come, and discuss the Differential Diagnosis-everythign is in usmleworld.com...but i've heard first aid is also very good...once u get that down, everything else is easy. I have a baby and had only studied a few hours a day before i discussed on the phone with my friend. -i did this for two weeks, no actually 2 1/2 wks. One of us would be the patient and the other the doctor. We would then discuss our mistakes and differential diagnosis....what would be the 5 we would write and the 5 relevant investigations.
Make sure u know how to do CNS examination fast b/c u may also have to do other examinations also. also dont forget those tests like murphys, moses, and homans, straight leg raising tests, neck rigidity, etc. If u came straight out of med school u need not worry...but for me its been 2 yrs since i've been out of med shcool so i forgot a lot of the manuevers.
Main things to remember: Before i walked in i would take a minute to look at the chief complaint on the door and think of differentials...also i would write them down as well as write down the two mneumonics i use (LIQORAAA and PAMHUGSFOSS). I would write it up to down so i can write anything next to it if i need to. Make sure u look at the name of the patient and the age. I actually forgot one of the names...but there is the same paper inside on the desk in case u do forget. (Its better to remember b/c its rude to forget people's names), and i asked a lady about her period when she told me she had been on menopause for 20 yrs!! OOPS!
Walk in smiling, introduce urself,"Hello Mr. XOXO, I'm DR. ABCD, how are u doing today?" shake hands. " So what brings you here today?"
Start ur History, I asked LIQORAA for all pains, and I asked All of PAMHUGFOSS-except didnt go into sexual history unless i thought it was relevant. If there was anything relevant, i would write it next to the letter...like if the SP's mother had cancer i would write cancer next to the F in PAMHUGFOSS. THink of any other differential diagnosis that u could have missed (from head to toe)...but dont take too long thinking...during ur examination u could always ask more if u need to.
After that i would tell them "Ok, well do u have anything else to add to this before i examine u?" Most of the time they would say no.
I would go wash my hands-i would ask them what they do for a living so to not have any silence. I would take the sheet and drape the patient while we were talking.
I would do a quick general examination from head to toe (anemia, jaundice,ophthalmoscope, ears, mouth, thyroid, neck lymph node, clubbing, koilonychia (forgive my spelling), pitting pedal edema) I did this for all patients, just to be on the safe side. I always forget things like this when i am under stress so i just made a point to do that-that's why i ask all of PAMHUGFOSS also...knowing that i could have forgotten something ). Make sure u explain when u r touching them...like "oknow i'm going to press ur belly, let meknow if u have any pain."..MAKE SURE U LOOK AT THE PATIENTS FACE NOT THEIR ABDOMEN.
I then proceeded to examination of relevant systems. MAKE SURE U PULL OUT THE Extension to the table...i forgot that twice. AND MAKE SURE U EXAMINE UNDER THE GOWN NOT THROUGH THE GOWN...I FORGOt that once also.
After u r done, just sit down with ur clipboard and summarize the chief complaint and presenting illness ONLY...do not do any negative history or unrelevant history unless u want to clear anything that u didnt understand. Like i would say " ok,u told me that u had BLAH BLAH BLAH, what did u mean by that?" ... THEN i would say "On examination, i didnt find anything significant...but i do want to rule out X, Y, and Z. So lets do a couple investigations. I would like to do a complete blood count, an xray, and a sonogram of ur (system in question).
"is that ok? Do u have any questions?" Amajority of them will have a question...most lkely to do with ur diagnosis. All of the questions are simple and can be found on usmleworld.com. But lets say ur not sure what the actual diagnosis is...(which happened to me 2 times). I would tell them that " i honestly do not know what exactly is going on, so lets do a couple of lab works to figure this out, then we will sit and discuss the possiblitiies, is that alright?"
Many of them would be having unprotected sex, or would be a smoker, alcoholic, not exercising...i would make it a point to discuss at least one of these things with them-like the importance of quitting and what all u can get from not quitting alcohol, smoking, promiscuity...etc.
When I was finished i would say "ok Mr. XOXO, thank you for your time, I will get a nurse to help u and get u some medication for the pain and as soon as the lab results come back, we will sit down together and think of the next treatment plan."
Now, everything i have said here, my friend and i said onthe phone for EACH AND EVERY CAse we discussed. So i didnt need to think much of how to word my phrases. I already knew them at the tip of my tongue.
I hope this wasnt too long but rather, it helps u. I had so much help from this forum so i dont mind taking the time to write these things down...If u have any questions i wil try to answer...please ask relevant questions that have not already been asked...as i am preparing for my step...and need all the time i can get. But like i said, i will try to answer any questions i can. Oh also, the phone cases are very similar to the ones in usmleworld.com....so like i said, just know what all they have in there and u will do fine.
No need to take any snacks with u unless ur diet is a restricted one, or if u dont like american food like sandwiches, chips, cookies, all that much. I dont know who all were there and what they were doing, just because i have heard that many would say they took all sorts of courses and studied all sorts of books, so i knew i could get nervous and it would affect my performance. But go ahead and talk to a couple people also taking it with u...where they are from, how long they have been here, who are in their families...it will help u relieve ur tension. Good luck.
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| Hamidi
Forum Guru
Topics: 46
Posts: 471
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Thanks docmama, that was avery comprehensive review of te prep and exam.Good luck for the rest
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| thambha
Forum Newbie
Topics: 2
Posts: 3
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hi this is chenna,this is my first message.im gonna do my step2 cs on aug 19thin philadelphia.
docmama,that was a verey useful tip that u gave.thax a lot hope that will help me do my exam well.i have signed up for cs course wat should i be studying before i go to the course?
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| IL12
Forum Junior
Topics: 11
Posts: 30
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congratulations thank u very much for ur advice , really was a lot of help good luck on ur match.
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| docmama
Forum Senior
Topics: 3
Posts: 83
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Thambha,
I think the courses actually help u with physical examination...but i'm not really sure since i had never taken or known anyone that has taken the courses. Probably the best thing to do is go through the theory part...meaning go through the different cases that u could get (i think there is a file that u can download off of this forum website called 40 csa cases...most people say that is all that comes. So go through those chief complaints and write differential diagnosis and investigations u would do for each of them. EXAMPLE: A 40 yr old lady comes with chest pain. What all would u think of? MI, Angina, Pulm Embolism, Gastric Ulcer, Lung Abcess, Pneumonia, etc...As you can see, these are all basic basic diagnosis...that is all they expect. So now what would u ask for each of these? What examinations would u do for each of them? And What investigations would you do?
See, its just like what you learned in med school and while practicing medicine. For the most part, relax, learn ur english, learn to communicate with confidence...u have almost 3 weeks. Talk to people around you...wherever u go! Even while grocery shopping, at the check out counter talk to the lady/man. "So how are u doing, it must have been a long day!" That's all u have to say, and the person behind the counter will be so happy and converse with u. (This is only if u r not an American-only if u r new to the country). Learn to listen. Now all u have to do is learn the physical examination and how to go about that. I think at the courses they will teach u those things. So ur pretty lucky that u probably dont have to focus on that right now. Like i said, my husband was my mentor...and for 2 1/2 days (we have been livng apart so that i can get help from my parents with my baby). I'm sure the course would be much better help!
Oh, in these courses one thing u can do is find a good study partner to practice with u...i wish i had more time to practice with somebody, but my situation didnt allow me. I mean go through each and every system until u r thorough...
But maybe u should ask someone that had already taken a course similar to urs...for assurance. Take care and good luck!!
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