wamba
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I have my CS the 28th of june and I'm just at the beginning of ma prep. I have read from many people that 15 days are enough. Some other people need more than one month to get ready. Anyway, I cannot postpone the exam because I'm going through a big time of work during this summer and I won't be able to travel to the states. (unless I fail  ).
I have been told that english will not be a problem, but I don't know why I just can't avoid to make an issue of it. I'm really concerned about my english proficiency, for one good reason: I live in Italy and I almost never speak. maybe I shouldn't worry but I need to be more confident with the language. Because the first step for the succes is confidence.
Yesterday I took a private SP from england. She will be my english teacher and my personnal SP. 20 hours for 200 euro in 3 weeks. We will do this cinema together. She will be the polite SP, the impolite SP, the one in extreme pain, etc. We start on wednesday. I think this will help me a lot to get confidence with the language. The visit will be completed in 12 minutes. Then she will help me with data gathering, which, according to usmleworld, accounts for 80% of failure in this exam.
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| wamba
Forum Guru
Topics: 149
Posts: 664
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Now I have to follow two road maps:
1. On the road to the test center
2. In the test center
1. ON THE ROAD TO THE CENTER
the FIRST POINT is what to study and how to study. I registered to usmleworld two days ago and checked it out. it sounds good. I'm still a little bit confused about how to organize all the info they provide but It's normal coz I'm only at the beginning. I bought FA 4 CS one month ago but I haven't received it yet. I'm starting to worrying about that. Anyway I will go through these two sources: FIRST AID FOR CS AND USMLEWORLD. Then CRAZY PRACTICE on my wife and my personal SP.
I took this month off so I can study 8-10 hours a day.
SECOND POINT: the visa. I have my appointment on Thursday. B1/B2 visa, tourism and business. This is an insidious hurdle. AN EXAM BEFORE THE EXAM. I know so many people who have been refused this B1/B2 visa that I would crazy to disregard this issue. It would be like "drowning in a glass of water" as we say here in Italy.
The issue here, is not demonstrate that you have an appointment for an exam. even if ECFMG sent me a nice letter, even if I have already completed step 1 and 2, I think in the embassy they don't care about that. The real issue, is providing a proof that YOU WILL TURN BACK TO YOUR COUNTRY OF RESIDENCE AFTER THE EXAM. A friend of mine was refused the visa for the US even though he has an american child. He was so angry and upset for that but I think he didn't undertand well the sense of B1/B2 visa. If you have family, a girl or a boyfriend in the states, or if you want to study or work DON'T APPLY TO B1/B2 VISA. You will certainly go through a "NIET, NADA, NIENTE, NON!!! The more people you know in the states the more negative it is for you because it only provides evidence that you will not go back. This is what I think. Am I wrong? We'll see on thursday. I will do my part providing the proof that I will come back to Italy after my exam and we'll see.
THIRD POINT: plane ticket OK. Arrival the 25 of june, three days prior to the exam. I think it will be good to get used to the local accent. I have to talk a lot with people these three days, and keep practising. If I find a study partner who will also take the exam it will be really great.
FOURTH POINT: Hotel reservation. I haven't made my mind yet. I'm looking for a place which is
1. close to the test center; 2. with internet; 3. honnest price; 4. fairly comfortable.
I have to choose between Ramada Inn, Days Inn, Best Western, Country Inn, Wingate Inn and Econo Lodge. I will wait 24 hrs for a feed back from someone in this forum. if no suggestions will come up I'll go for one of them.
FIFTH POINT: I know they give us the lab coat and the stetoscope but I will bring mines. because everybody feels more comfortable with its own material. it will be like having old partners accompanying you in a hard time setting. I have mine, I use mine.
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| wamba
Forum Guru
Topics: 149
Posts: 664
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1.ON THE ROAD TO THE TEST CENTER
The day before my departure, the 24 of june, I have to check through:
1. my scheduling permit and the address of the test center;
2. my IDs;
3. my lab coat and stetos;
4. my laptop;
5. FA and studying material;
6. my alarm clock;
7. and of course my plane ticket.
have I forgot anything?
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| wamba
Forum Guru
Topics: 149
Posts: 664
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Got ma visa yesterday
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| doctor81
Forum Elite
Topics: 34
Posts: 240
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congrats on getting the visa
all the best for ur exam
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| wamba
Forum Guru
Topics: 149
Posts: 664
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I found http://csprotocol.blogspot.com extremly useful.
Mnemonics for psychiatrics SP.
3 mnemonics goes for it.
1. O.P.C.
Onset: when did your fatigue start? there can b 2 kinds of answers to this Qs.
group A: "2 months ago" for SP with PTSD, adjustment dis, malingering, cancer or other illness, etc.
group B: I've been tired all my life or it comes and goes for SP with major depressive dis, cyclotimia, etc.
Previous: have you ever had it b4? this Qs applies only to group A bcos group B already answers to it. Most of the answer group A will give will b a NO
Cause: it is now the case, to ask to both groups a nice open ended Qs: what do you think is the cause of your problem? group A would give the important clue. MVA in case of PTSD, separation in case of adjustment dis, abdominal pain in case of possible pancreatic cancer. etc. if group A does not give the answer SPECIFICALLY ASK what happened 2 months ago?
most of group B SP will say I don't know doc. cos they have felt like this all life. (but even group A SP could answer that)).
NOW WE GO TO THE 2 MNEMONICS
2. FACE SLIPS
3. then I finish with PAM HUGS FOSSODA
If SP has any other complaint, like pain, I have to investigate it through LIQORAAA and introduce it in my D/Ds and work up.
I tried this system with all the psychiatrics chief complaints and it works.
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| wamba
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Topics: 149
Posts: 664
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There are some fews differences betw psy cases.
In case of fatigue, I have to ask: do you feel it all day long or you feel better in some particular moments? if yes, I investigate which moments. I put this Qs at O (onset), after asking when the fatigue started.
In case of depression or feeling low, I have to ask if he generally looks at things in a positive or a negative frame of mind. I put this Qs in F (feelings), after asking If he has feelings of worthlessness.
In case of PTSD, I have to ask about nightmare related to traumatic event. Even in this case I put the Qs in feelings, after asking about feelings of guiltyness
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| wamba
Forum Guru
Topics: 149
Posts: 664
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History taking for any kind of pain is
1. LIQORAAA
and then
2. PAM HUGS FOSSODA
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| wamba
Forum Guru
Topics: 149
Posts: 664
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About MMSE I don't know if to do it to all SP with psy chief complaint. According to Usmleworld I should but FA does not state that. Furthermore It would be more time consuming. We'll see.
I must always consider hypothyroidism as a D/Ds. also, I must always ask about delusion and hallucinations. But where to insert these Qs? maybe I should modify the Mnemonic from FACE SLIPS to FACE SLIPSO, with O being Others (actually 2 Qs: do you feel cold when other don't? do you hear or see what other people don't?)
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| wamba
Forum Guru
Topics: 149
Posts: 664
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For the chief complaints which are neither Psychiatrics nor pain, I will use the following 2 Mnemonics.
OAAA, where O is the onset the same from psychiatric history and AAA is (associated, aggravating and alleviating factors) taken for pain history.
then I will continue with PAM HUGS FOSSODA.
As a general rule, I will use this for all symptoms which are not psy (fatigue, depression, feeling low) or pain related (cefalea, sore throat, knee pain, etc. where LIQORAAA will be fine)
The problem of these mnemonics is that if I want to make the history as much complete as possible, I often need to apply more than one Qs to some letters.
Let's consider a chief complaint of knee pain for exemple. To perform a proper interview I have to apply more than one Qs to the letter O.
Location: Could u plz tell me exactl where you feel the pain?
Intensity: on a scale... howould u rate?
Quality: how would u describe the pain? (important open ended Qs)
Onset: here, I have verified that asking only when the pain starts makes the interview incomplete. So the Qs will b:
1. when did it first start? point X
2. have you ever had it before? before X
3. do have everyday? and all day long? if it is not all day long ask how long it lasts. after X
4. Is it worsening days after day or it is the same? progression
Applying this Qs to Onset makes the History more complete.
Radiation: does the pain move?
Associated Symptoms: Do you have other problem other than this, for exemple fever, nausea, vomiting, diarrhea (it is important to give exemples and went the SP is done I ask anything else?)
Aggravating factors: Do you know something that makes is worsen?
Alleviating factors: ... that makes you feel better?
Let's then return to the top. For all complaints that will not be psy or pain, I will use OAAA and then PAM HUGS FOSSODA. But in this case, I would apply to O the same 4 questions as above.
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| wamba
Forum Guru
Topics: 149
Posts: 664
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According to many sources I have to make a transition sentence before starting with LIQUORAA or OAAA, and then between PAM and HUGS, between HUGS and F, between F and O, between O and S, etc, etc.
For one who have been practising medecine like me this sounds really weird. Even my personal SP (which happens to be from the US) told me that all that transition sentences make the interview weird. keeping saying always "Now I need to ask some Qs about past medical history, is it ok? now I need to ask you about your family is it fine? I need to know more about your personal life is it okay with you? now I need to know about you social life is it fine? now I need to examine your chest? now it is the turn of your head, I need to palpate your belly. I need to check your pulse is it fine? is it fine? is it fine? is it fine? is it okay? is it ok? ok?ok?ok?ok?ok?ok?ok? COMEON!!!!!!!!!!!
Maybe I do not do my transitions properly. But according to usmleworld I have to do these transitions.
Now here is the deal: I know they want me to show professionality, compassion and respect. I do have a great deal of it. But I know I will not feel comfortable during the exam if I say it as it is described in usmleworld. So the deal is ask permission and describe what you are going to do in the same sentence.
before going through the LIQORAAA I will say:
I have been informed that you came in today because of abdominal pain. Could you pls tell me more about it? (I will not say what brings you in today? because I have read of one who recieved in response by the bus. In the same way, I will not ask why are you here today? because we are in a hospital and when we visit a patient we are supposed to know the chief complaint. In order to avoid any pb at the beginning of the interview, I think it would be better to start with a "closed ended Qs" I know that you are here because of abdominal pain, could you please tell me more about it? I think this gives an idea of professionality because it means that you get informations about the patient before seeing him.
After the patient answer, I will say: I'm sorry to here that (only if it is the case). I need to ask you some questions about your problem, just to have a good view of it. Is it ok with you miss jones? yes. thank you very much. Then I will procede with the LIQORAAA
then before going to PAM HUGS FOSSODA I'll say
Now miss Jones, I will ask you some few Qs about your personal health, your personal life and your family. ok? okay! pls don't be embarrassed by my Qs because everything we'll talk about in this conversation will remain absolutely confidential. Then I'll go on.
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| wamba
Forum Guru
Topics: 149
Posts: 664
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Let's then summarize the history taking.
1. In case of pain:
LIQORAAA where O is related to 4 Qs and then
PAM HUGS FOSSODA
2. In case of psy complaint
OC (P is inside O)
FACE SLIPSO
PAM HUGS FOSSODA
3. In case of a complaint that is neither psy nor painful
OAAA
PAM HUGS FOSSODA
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| amygdalaa
Forum Guru
Topics: 24
Posts: 399
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Have a safe trip and good luck in your CS!
___________________
"If at any point you feel you cant..... then you MUST"
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| waqastariq
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| maylea
Forum Elite
Topics: 4
Posts: 86
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Hi Wamba...your journal is very helpful. How was your CSE?
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| wamba
Forum Guru
Topics: 149
Posts: 664
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I sent it in the experience forum...
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