zerocool79
Forum Junior
Topics: 8
Posts: 75
| | 06/18/07 - 07:19 PM
5 of 5 forum leaders found this post helpful
| #1 |
Hey guys, so i just took the exam about 2 hours ago. Overall, there were no surprises i'd say.
I'm having some post-exam jitters (not to say that i didn't have pre-exam jitters too, i definitely did). I want to talk about my insecurities and things that I think i did wrong.. so I can get some feedback to see how serious my mistakes were.
1. I forgot to test visual fields on a girl with amenorrhea.
2. I forgot to ask about suicide on a pt who seemed to be depressed.
3. I examined the abdomen by pulling the gown down, instead of lifting their gown up and only exposing their stomach.. it just seemed practical to do a quick abdomenal exam after listening to their heart lying down. Is that a bad mistake?
4. I think i accidentally put "EOMI" on the physical exam, on a pt where i didn't examine the eye movements. Is that horrible? i feel like it is really bad.
5. I put R-sided tactile fremitus increased on a pt., and slight wheezes on R-lobe... is that unlikely? given, that most pts are suppose to be healthy? it's not likely that a pt can have increased tactile fremitus and still be healthy enough to be an SP every day right? Is this a serious mistake?
6. I finished most encounters really early... some like barely after the 5 minute warning... does that look bad?
Other than that, i think i was overall ok with the exam. I think my weakest part was my physical exam. I hadn't had much practice, and i don't think i'm as fluent at it as other medical students. I always feel a little flustered on the spot, when i'm trying to interview the pt, and formulate a differential at the same time.. and then seemlessly flow into a physical exam and examine the right systems, and do it as if you had planned to do it before you walked into the room.
I think what got me is that the pts often say that they don't have any associated symptoms that would suggest possible diagnoses.. but in my case, i think i still should have done a visual field test for amenorrhea case even if she didn't state any neurological changes.
ok, so let me run through things, starting from the top:::::::
I got there at 7:40, really nervous that I was late.. the traffic around the LA center is a nightmare.. if you are driving, i'd recommend leaving unusually earlier than you'd think. I left from the 710/10 freeways, and it took me about 1.25 hours to get there. The offramps are confusing too, and it is right near the airport, for added fun, so if you are not familiar with the area, i would recommend looking into the transportation issue before the day of.
Anyway, i got there at 7:40, and apparently they only open at 7:30, and i was the 5th person there, so I wasn't late. phew.
We got there, all sat in a nice lobby area, and chatted anxiously in nervous tension amongst ourselves.
Then we go put our stuff in a locker, we're only allowed our coat and stethoscope--without an attached light i might add. no pens or anything else other than ID and cash, no credit cards allowed.
We watched the video, and then tested the equippment on our own.. sort of like a freetime for about 10 minutes. Then you line up and go into the hallway, and the proctors place you at your station.. and then it's just how you've seen in the videos. (that USMLE mails you)
The patients in general were very nice, and polite. I only had trouble with one who was not very responsive, and wouldn't elaborate on my questions much.. and wasn't making much eye contact. It felt a little uncomfortable, but then that's how it's suppose to be I think.
So you do 5 cases, then break for 30 minutes.. and they provided us with some nice sandwiches, gourmet style, turkey, veggie, tuna, ham, etc, your choice.. and a salad and 2 different fruit bowls to serve from. They had sodas and water, coffee and tea available too.
Then you line up again and do 4 cases, then 15 break, then last 3 cases.. then a survey.
It's pretty straight forward.
Now.. my study regime::::::
I just got back from a trip in Europe on June 2, so I haven't had too much time, with jetlag and all, to prepare for my CS. I'm an IMG, and I think my PE skills were a bit weak.. as well as my history taking skills... I talked to the guy next to me who is a med student here at USC and he said that his school gave him mock simulated exams just like the CS, and that they even timed him, and evaluated him, to make sure they are prepared for the CS. .. i didn't have that same training.
So i just went through the FA book, and took some notes, made some highlights. And got a feel for the exam. I was probably putting in about 2 hours max per day into the exam.
When I entered the room, basically i repeated the same thing to every pt... "hello mr/ms. blah, i'm dr. blah and i'd like to ask you a few questions and examine you today. is that ok with you? But before we get started, i'd like to make sure you're comfortable at all points during the exam, so if there is anything that you can think of that would make you more comfortable, please let me know..." I said all this as I was reaching for the drape.. then i would say, "these hospital gowns can be a bit draft huh? maybe this drape can help you be more comfortable" (then drape it over their legs)
I made up my LIQOR AAA (then a little break to sum up the cc, and ask if they have questions or left anything out), then i gave a transition statement like "now i'd like to ask you some general questions to get a broader picture so we can put the pieces together to learn more about your main problem), and then i went through PAM HUGS FOSS, and tried to throw out some random other questions that might be associated with any findings that they respond to.
I was fairly quick in my questions. and usually was well into my physical by the time they gave the 5 minute warning.
Usually, at that point, i was pretty nervous about what to do next in my PE, and i didn't want to look like I was stalling, so I just gave them a closure, and as many differentials as I could think of, and what tests I'd like to do.. and then gave a generic closure statement like "OK, well when these tests get back this afternoon, I'll meet with you again and we can figure out the diagnosis and try to get you fixed up in no time. Do you have any questions for me? ok, well then it was great meeting you, have a nice day."
During my handwashings i always kept the conversation going and asked "So, how has this problem affected your life? How do you feel about it in general.. that way they can talk a bit, while I wash my hands.. then my next question was Do you have a social network--family/friends?" and then they would say something insignificant.. and I would blindly comment back.. "i think social networks are always a good idea to have because they help to reduce your stress and anxiety during difficult times. Stress tends to make many medical problems worse, so reducing stress is a good idea I think." they usually smiled, and i hope it grabbed me another check.. since it plainly states in the USMLE CS criteria that you should demonstrate interest in their feelings/concerns about their problem, and inquire about social networks etc. .. so i figured hand washing was a good time to be "human" and stop asking clinical questions.
My pt notes went by pretty easily, since i always seemed to get out rather early, i had a lot of time. Some histories fly by.. especially when they don't really have any pain.. then my "LIQORAAA" pretty much went out the window, since i didn't have to ask about radiation or intensity, etc.
I had one peds case.. and it was super easy, since basically you just have to convince the parents to bring their kid in, because infants can't talk, and you never know what's wrong with them, and with infants any little thing can always be an indication for something very serious like meningitis. not to mention that kid differentials are always really easy.. you just have to rule out meningitis, RTI, UTI, gastroenteritis, pneumonia, and that's 5 there already. and you have a LOT of extra time because there is no physical. The one thing about kids though is to inquire about the BINDdER birth history, immunizations, nutrition, development, daycare?, eating habits, rash.. and don't forget about wet diapers to rule out dehydration, and fever, chills, nausea/vomiting/diarrhea/constipation etc.. the standard other questions you should be asking every pt.
Other than that... i would say that if you review the differentials in FA, and just run through LIQORAAA and PAM HUGS FOSS, you'll pretty much have a lot of time for your physical.. and pretty much I just ran through a really quick heart/lung, most of the time Abd exam on everone.. unless they had a sore shoulder or aching calves.. then i just focused on the muscular/skeletal or neuro exam on their affected limbs only.
Does anyone have any questions for me? please ask me while it's all still fresh in my mind.
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| dncosta
Licensed, finally
Topics: 19
Posts: 604
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Congratulations and thanks for sharing the nice experience 
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| zerocool79
Forum Junior
Topics: 8
Posts: 75
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yeah.. i think i'll write more when i get rid of this headache that i have right now. haha. The memories keep coming back to.. so i'll definitely help you guys out as I remember things... i hope i passed this thing!
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| vradojc1
Forum Elite
Topics: 21
Posts: 309
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It seems you did great job! Good luck!
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| zerocool79
Forum Junior
Topics: 8
Posts: 75
|
well thank you vradojc1...
let's hope for the best. i don't know how strict their grading is.. but i'm a little nervous. .. naturally
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| vanshita
Forum Guru
Topics: 22
Posts: 821
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thanks for sharing with us
GOOD LUCK
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| zerocool79
Forum Junior
Topics: 8
Posts: 75
|
:::::::::::::::::::::COUNSELLING::::::::::::::::::::::::::::::::::::
ok.. so these are points to remember to counsel... and when i sketched out my mneumonic for interviewing questions on the blue sheet of paper they give you.. i drew a small little box in my lower right corner, and whenever one of these topics came up, i'd just jot it down in my "counseling box" so i'd remember what to counsel on.
1. Menopausal - risk of osteoporosis, importance of Calcium supplementation and weight bearing exercises
2. HTN/MI/high cholesterol/Diabetes - importance of low salt diet, and exercising to keep heart in good shape, and keep good circulation, and keep cholesterol down also, and blood pressure down.
3. older than 40, or 10 years earlier in cases of FHx of coloncancer - regular colonoscopies and high fiber diet.
4. Mononucleosis risk - no sports activities for risk of spleen rupture
5. sickle cell disease - dehydration or hypoxia can exacerbate sickling.. avoid these triggering factors
6. smoking/marijuana - risk of lung cancer, chronic bronchitis, emphysema, the longer you smoke, the higher the risk, so if you stop now, the lower the risk you'll have.
7. alcoholism - risk of early dementia(wernicke's dementia i think?) and hepatitis, liver failure, portal hypertension, not to mention other social/family problems associated with it.
8. cocaine - risk of MI due to increased heart rate and vasoconstriction, and raises blood pressure.. basically puts extra strain on your heart
9. heroin - respiratory failure, HIV and other IV-associated infections
10. unprotected sex - HIV, hepatitis, gonorrhea, chlamydia, not to mention unwanted pregnancies
11. muscle strains - maybe refer them to physical therapy so they can learn proper ways of lifting things, so that the can prevent injuries
12. Depression - offer them pamphlets about psychotherapy or suggest possibly seening a therapist to help them cope with their life stresses and deal with psychiatric abnormalities.
13. peds - always bring kid in for PE, because any illness could potentially be life threatening, since you can't tell what it is without a full examination since they can't explain their symptoms to you.
if you keep these things in mind, then you won't forget anything.
When I did it.. i usually counselled them right after my interview was over. I was nervous about counseling with my closure in case it goot to long.. so as soon as I was done with my interview questions (LIQORAAA -PAM HUGS FOSS), i just said "i noticed that you mentioned that you blah blah blah.. and then just counseled them right then to get it out of the way.. and then proceed to the PE. that way I only had to think about DDx and W/U plans for closure, as usual.
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| smal
Forum Guru
Topics: 140
Posts: 727
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exellently wrinten experience,
thanks.my CS is in LA on 14th july too
good luck for results
___________________
remedy for weakness is not brooding over it ,but thinking of strength.
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| zerocool79
Forum Junior
Topics: 8
Posts: 75
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best of luck Smal. it's a pretty straight forward exam if you go through FA, you won't have any surprises i think. i didn't.
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| kavi
Forum Newbie
Topics: 4
Posts: 18
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Wow..that was such a great post!
Thanks for counselling tips..that was so helpful!!
You seem to have done a really good job..Good Luck for your results..tho i'm sure its a PASS!!!
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| zerocool79
Forum Junior
Topics: 8
Posts: 75
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thank you. i'm still a little worried about those mistakes i mentioned in the first post
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| paviraj
Forum Senior
Topics: 1
Posts: 59
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Hi i have my exam in aug in LA. How is the center ? any problem with sps?
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| virgola82
Forum Guru
Topics: 85
Posts: 348
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Thanks a lot and good luck for your score. Your post has been really helpful! Thanks!
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| njemt369
Forum Junior
Topics: 8
Posts: 48
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Hey Zerocool79, Best of luck on the PASS!!!
I am very interested to hear how you do because it sounds to me like I made some similar mistakes on my exam that I gave on August 4th. I am about to pull my hair out in suspense as to weather I Pass or Fail.
I hope you post when you get your results.
Thanks for your post!!!
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| zerocool79
Forum Junior
Topics: 8
Posts: 75
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hoorah hoorah hoorah!! i passed.. oh and sorry for not posting this way earlier.
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| sachagro
Forum Newbie
Topics: 4
Posts: 15
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THIS IS THE BEST CS EXPERIENCE I HAVE EVER READ!
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