LisaM
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I have maintained prep journals in this forum for step one and CK prep and it helped me atleast in reminding me that I had to make some goal oriented progress each day. I am feeling a little lost with the CS prep, so decided to start a journal here for this and am hoping this helps.
SO FAR:
I completed my Step one in August last year (got 212/86) and CK on 24th Feb. Yet to get my results for CK. Am about to appear for CS in the middle of April 2006 in Chicago. Still searching for a suitable study partner. Planning to use FA and UW. Read most of the tips and tricks posted by digitaldoc and found them very useful. Trying to apply the principles to UW as I go through the CS sample cases there.
Today, I am about to complete review of the first 10 sample cases in UW. I look at the topic and take a moment to think about the differential diagnoses and formulate questions to rule them out. Also learning to apply the many mnemonics- PAM HUGS FOS, SODA, LIQOR AAA, PICKLE, SIG E CAPS, CAGE, VASES, DEATH, SHAFT, FROM HIS JFK CASE- wonder how much I will actually remember and use in the exam itself.
Tomorrow, I think I will review 10 more cases and view some of the physical examination videos in UW. I am also watching quite a bit of TV, doing some recreational reading and spending time with my family.  
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lisa
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| lancer
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hello
I am done with step 1 and planning to give my cs in april first week at atlanta.
Started reading kaplan notes but found FA to be better, especially initial pages with good orientation of exams and how to tackle the challenging questions of patient.
I am doing systemwise........
neurology - headache, seizure, stroke, dementia, ataxia,
gone through D/D and investigations and some theory as I still have to give my step 2 ck, CNS examination part is quite lenght with time constrain in exam.
now going through abdominal and urinary symptoms.
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| prep4usmle
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A new forum was born for CS Prep Journals, thanks LisaM !
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| machmach
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Hi LisaM,
I know the mnemonics "PAM HUGS FOS, LIQOR AAA, SIG E CAPS, CAGE, "
What are the other mnemonic "VASES, DEATH, SHAFT, FROM HIS JFK CASE-SODA, PICKLE" which you mentioned?
 
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| LisaM
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Thank you prep4usmle
machmach, I dont know how useful the mnemonics are, but they stand for:
SODA: Social history. Smoking, Occupation, Drugs, Alcohol
PICKLE: General examination. Pallor, Icterus, Cyanosis/ Clubbing, Koilonychia, Lymphadenopathy, Edema.
VASES: In domestic abuse. Violence, Afraid, Safe, Emergency plan, Support system
DEATH & SHAFT: Activities of daily living. Dressing, Eating, Ambulating, Toiletting, Hygeine.
Shopping, Housekeeping, Accounting, Food preparation, Transportation.
FROM HIS JFK CASE: Mental state exam (overlaps with SIG E CAPS actually)
Funtionality
Reasoning
Orientation/ Outlook
Memory/ Mood
Hallucinations/ delusions
Insight
Speech/ Sleep
Judgement
Feelings
Knowledge
Concentration
Attention/ appearance
Suicidality
Energy
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lisa
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| lancer
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hi guys,
whats SIG E CAPS?
for depression - FACE SIPS
F - feeling - shame guilt, sadness, anger
A - appetite
C - concentration, memory
E - eneregy level
S - sleep pattern
I - interest in normal activites , hobbies
P - pscyhomotor retardation
S - sucidial ideation/intent
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| machmach
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Hi LisaM and Lancer,
Thanks for your help!! I find the mnemonics helpful!
Thanks!
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| LisaM
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I have gone through most of the sample cases in UW though really unsure of what I remember. Hope to finish reading it all and also complete watching the video clips by Monday. Waiting for the short video clips to download is so annoying, but atleast they are all mercifully short if I need to review any later.
I am planning to write down and learn the differntial diagnoses and investigations to be ordered by system. There seem to be only a limited number of cases and learning the DDs must help in both history taking and in writing the patient note. I am looking forward to practising with my potential study partners as practising with them in real time will be the true reflection of time management, fluency, my comfort level and confidence in asking the questions, making the transition from history to examination to counselling etc.
How is it going, Lancer and machmach?
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lisa
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| lancer
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hi lisa and machmach,
Two weeks are left for exams, well I have gone through examination videos, and started practising on cases with my partner, but I forget few things to ask and time is also big factor.
Now I am trying to work on patient notes with abbreviation and within 10 mins.
There are many cases in which you have to do multiple system examination, so in that you need to be focus also.
yeh lisa, I think DD are important from the point you know the chief complain, at door, so you history can go in right direction.
query -
In female patient how we asculated the heart and lung? Do we need to undress the patient?
How to do examination of prenatal case?
I think practice, practice and that make you perfect.
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| antigen
Forum Newbie
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hi all, i am really stressed out , plz i need an answer , i have to take my step2 CK (most probably in May) & my CS eligibility ends on sep8th. Should i schedule a date for CS in June or late August . (i wont be here from 21st june till end of july) . What i really want to know is.....is one month enough for CS prep? & i also want to apply for 2007 match.
I think i confused you all, but i am stressed out , really , have been postponing Ck for last 3 months, plz help me!!
thanks & best of luck.
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| lancer
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hi antigen,
Dont worry, one month is more than enough, normally 15-20 days are required.
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| LisaM
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Hello, I was not able to post daily in the journal because I am not able to sign onto the forum website from home! I am typing this from the library. My preparation is coming along fine (I think!). I am discussing with someone on a regular basis over telephone. We try to find challenging cases for each other and it is even fun at times. I also have a friend who has completed CS succesfully and has kindly offered her help in evaluating me and getting me more comfortable with talking.
Lancer, we need to expose the area of examination. So if you are about to auscultate the chest, then ask the permission of the patient to untie the gown, bring it upto abdomen level and finish examining CVS and RS. Then thank the patient and tie back the gown. To examine abdomen, request the patient to lie down (remember to pull down the leg extension piece of the table while doing so and also describe what you are doing and why), then ask the patient's permission to expose abdomen. Make sure the drape covers the area from hip down and the gown covers upto epigastrium and then examine the abdomen. I am not sure if we will have a pregnant woman in the exam, but most examination must be preliminary like fundal height, palpation of head and spine and we may have to tell about need for gynecological exam.
I tend to forget to use transition sentences!  I counted that we need to use trasition sentences atlest 6 times- before Past Medical History, before family history, social history, sexual history (also assurance of confidentiality here) Physical Exam, summary and counselling.
Also I keep forgetting to mention need for genital exam.  Yesterday we discussed a case of joint pain in 35 year old and I also forgot to ask about genital ulcers though my SP gave history suggestive of STD. Hopefully, I wont make the same mistakes in exam!
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lisa
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| lancer
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hi LisaM,
heh thanks for sharing this with me.
well I am also trying to practice how to present the cases with study partner.
well but I usually take 8-9 min for history, 5 min for examination so only few time remains for closing. well I am thinking down to cut a history bit and can ask some during washing hands and examination. hope that works
well can we do cvs and rs examination in sitting position , I means just ascultation
Can you tell me how to do tilt test?
orthostatic vitals - jst BP in sitting and supine?
well PN is not a problem with 10 mins, but doing FA sometimes they have long list of DD and investigation, and sometimes the chronological order doesnot match.
me too forgetting genital, pelvic, rectal, breast examination
and I feel most cases needs - thyroid and ophthalmoscopy - so jst do it in all.
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| LisaM
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Hi Lancer, I think except for CVS cases where we may have to examine patient in sitting and lying postures, I think it is enough if we auscultate with patient sitting alone. My history taking is far from perfect. One thing I do is also start discussing with study partner some points during history itself. Like "how else could I ask this" or "what else I need to ask". I must take care to practice strictly so I will be comfortable on exam day. Also, since I am discussing on the phone I am not really going through the maneuvers of physical examination. I must practice that too. I am planning to write a few patient notes in the FA column format. Apparently we only get one sheet of paper with our name, number, case encounter number etc and no additional paper. A friend who has already completed CS suggested that I practice by writing atleast 5 to 10 PNs so that I will be comfortable during exam. Maybe I will start that today. I too feel that the chronological order of the differntial diagnoses is not right in FA as well as UW and some of the DDs dont seem relevant to me. I am not sure if we need to do tilt test. I dont remember seeing that demonstrated in the video clips from UW. I will check that too.
Have a nice day!
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lisa
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| LisaM
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I have been thinking about the questions in the PMH (PAM HUGS FOSS) that we can afford to skip if we have a case that takes up too much of our time like CNS cases or in case of patient presenting with severe pain. I think we can skip sexual history (just asking for history of being diagnosed with Syphilis if there is a possibility of neurosyphilis), Gynecological history, and ask a shortened verion of social history. Also, I thought about asking about Weight, Appetite, Diet, Stress, Exercise and Travel (WAD SET) only in GI, depression or possible endocrine (Thyroid, Cushings, PCOS) cases. Any suggestions?
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lisa
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| LisaM
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Spring break is over- Thank God. So many distractions. I have been discussing about two cases daily with my study partners and also some possible difficult questions and best answers to them. Yet to start practising writing the patient note and also actually doing the physical examination.Will start those today.
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lisa
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| LisaM
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My husband is helping me by being the SP after my daughter goes to sleep and I have been practising physical examination maneuvers. I am getting more comfortable with explaining, talking through and performing various system examinations. I still get nervous when I start the examinations though. Also, I get silly doubts like where exactly to hold the tuning fork, which end of the reflex hammer to use etc. So, I am really glad for the opportunity to try out these and highly recommend actual practice for learning and perfecting the techniques before exam.
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lisa
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| LisaM
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Completed CS on April 11th in Chicago. I used UW, FA and Kaplan texts. Found something useful from every source. Loved the first few pages of FA- I made a gist by writing the possible DD and Investigations for each symptom system wise. Not really needed, but it was a good exercise for me to get familiar with writing too. I practiced over phone with two other exam candidates and I think the phone conversations gave me the confidence to get comfortable with talking. In the last week before my exam, I also enlisted my husband's help and practised examining the different major systems along with history to give me an idea of the time I actually take to perform the exams. The UW videos were great to teach physical examination techniques esepcially for someone out of touch like me. I think my exam went quite well. One thing I would recommend is writing the name of the patient on the clipboard as I tend to forget or mixup names and that helped.
All the best to everyone! Hopefully, now I can move onto step 3.
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lisa
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| nithu
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Dear LISAM ,
You are great, i am sure u will come out in flying colours.
I will always pray for u.
Good luck for ur step 3 prep.
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| LisaM
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 Thank you Nithu.
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lisa
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| sarika
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lisaM it was really fun reading your prep journel. Though i am months away from my CS (havent even scheduled it yet) i am still paranoid about this part of exam. Can you please list all possible material and sources for this exam including the most important ones. And i am not sure which DVD's you guys are talking about. Thanks again And goodluck
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| LisaM
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Hi Sarika, Thanks. If you are fluent in English and have recently completed CK/ are a new graduate/ practiced medicine recently, you truly need only 15 days to prepare for CS. Having a study partner helps too. I used First Aid text book, Kaplan text book, USMLE world online and also benefitted from reading the exam experiences here as well as the CS tips and tricks blogspot. The link to that is found after "digital doc"s posts. The UW online course has short video clips demonstrating physical examination techniques that you can save to your computer. It is important to learn to elicit pertinent history and the correct technique to do the differnt maneuvers confidently and quickly.
All the best to you!
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lisa
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| Isther
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Dear LisaM:
Just checked your thread and is amazingly helpful. I'm scheduled for may 8th, and just started to practice cases (spend the first weeks with DD, and general tips). As you mentioned, it is difficult to perform the whole PAM HUGS etc etc, since 15 min for history, exam and counseling is really a challenge. A friend told me to "select" systems and specific data during the 1-min doorway phase and go straight to those, but even though I'm still forgetting a lot of things to ask. Do you have any advice?
All the best with your scores, I'm sure you'll end up with awsome credentials.
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| LisaM
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Hi Isther, Thank you. Yes, it is helpful to have system based that you can modify for specific symptoms. I had written down "extra" questions that I would ask for specific symptoms like weight loss, palpitaions, memory loss/ depression/ psychiatry, OBG and Peds (AN & PN history, immunization, milestones) etc. I had practiced with these well enough beforehand that in front of the door, I only took enough time to note down the name of the SP in my notepad, check if any of the vital signs were abnormal and think of atleast 2 DDs. There really is no time to think of what questions you would ask outside the SP's room. During my practice with study partners, after the first two times for each system, I noticed that the questions flowed without much conscious thought. I tired to follow the tip to be half way through physical examination with 5 minutes to go and that was a pretty helpful one.
I really found some helpful counselling tips too that made counselling quick, easy and positive. For instance, if I were to counsel about smoking, I would do it right after I asked "have you ever smoked"? If the patient is a current smoker, next question would be "have you ever tried to quit smoking"? If yes, I would just counsel about how to improve his chances of quitting. If never tired to quit, then the next question is "are you aware of the harmful effects of smoking"? Then I had a little 3 sentence speech about how smoking causes cancers, stroke etc, how quitting reduces those risks, how the person could get help with quitting smoking. I had these little speeches prepared for counselling for STD, Alcoholism, and ofcourse, standard ones like how to convince mom to bring child to ER etc.
All the best to you!
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lisa
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| Isther
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Thank you very much!!! You are really a helpful guide.
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