grechita12
Forum Senior
Topics: 7
Posts: 229
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OMG Grazie you're my hero!!!!!!!
take care of the baby!!!!!! i don't know how you can, i cuoldn't do anything during my pregnancy (except throw up everything......for the entire 39 weeks)....... good luck on your prep.
for me the most imp are : LIQORAAA & PAMHUGSFOSS for everything......then DEATH SHAFT for dementia
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Case:
Abdominal Pain
Opening Scenario
24 yo, Female, college student c/o right lower abdominal pain.
Vital Signs:
BP: 110/80 HR: 96x' RR: 16x' T: 100.1 F
------------------------------------------------------------ -------------------------
On Blue Sheet:
For Abdominal Pain (CC): Mnemonic: LIQOR AAA
then > PAM Hits Rugs FOSS
Probably DDx: Appendicitis, Diverticulitis, Pelvis abcess, PID, Ectopic pregnancy, Renal colic.
Female patient > consider Ob/Gyn causes.
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PE:
Detailed Abdominal exam. Heart and Lung Exam.
--------------------------------------------------------------------------- ---------------
Workup Plan:
Rectal & Pelvic examination
Urine hCG
CBC with differential
Urinalysis including C/S
U/S - abdomen/pelvis
___________________
"We aim above the mark to hit the mark."
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Grechita,
Thanks. I know it's tough, feel like I have a hangover everyday  jeje, but even feeling sick, I have to do something these months, I am hoping to pass this test asap, but I am taking it slow. Please if you still need somebody to practice in chicago, please let me know ok?
I am trying to cover all the cases but haven't practiced PN yet, as I said, I am going slow 
See ya buddy 
___________________
"We aim above the mark to hit the mark."
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Repertory for Abdominal Case
Doc: Good morning Miss Tammy .......... SP: Good morning
Doc: I’m Dr. House, I am the physician on duty here today
(shake hands) Nice to meet you! ........ SP: nice to meet you too
Do you feel comfortable in the room? ....... SP: yes
LOOK INTO THE EYES
Let me make you more comfortable (Put drape)
I hope you don’t mind if I sit while I ask you some questions? (Chair at 1 meter) (Sit down if pt is not in distress) (Stay standing if an emg)
“So tell me how can I help you?” .... SP: I have abdominal pain that is killing me!
"I can see you are under a lot of pain, but I will try my best to help you" (empathy)
HPI about the CC: ABD PAIN
L : Could you pls show me where is exactly the pain?
I : On a scale from 0 to 10, being 10 the worst the pain you've ever had, how would you grade your pain?
Q : How would you describe the pain? burning, cramping, stabbing....?
O : Onset: When did the pain first start? .... P: Progression: Did it get better or worse? .... D: Duration: How long have you been having this problem? .... S: Setting: What were you doing when it started? ..... F: Frequency: How often does it occur? C: Constant/Intermittent: Is the pain constant or does it come and go?
R : Does the pain move anywhere?
A : Does anything improves the pain?
A : Does anything makes it worse?
A : Any other associated problems? like diarrhea/constipation?.... Weightloss?..... nauseas/vomits? Fever? ... How is your appetite?
TRANSITION SENTENCE!
PMH: Did you have any similar episodes in the past?
P: Any other medical conditions?
A: Allergies?
M: Medications?
H: Hospitalizations, traumas, Surgeries
U: Urinary symptoms?
G: Bowel movements changes?
S: Sleep pattern?
TRANSITION SENTENCE!
F: Family's health history, important pathologies running in the family related or no to CC.
TRANSITION SENTENCE!
O: Ob-Gyn history
TRANSITION SENTENCE!
S: Sexual history
TRANSITION SENTENCE!
S: Social habits
--------------------------------------------------------- --------------------------
I think that covering HPI or Chief Complaint's Details needs more time and concentration  , because then PAM HUGS FOSS is more mechanic, that's why I want to have mnemonics ready and known by heart for every different CC we might see in the exam. 
Edited by Grazie on 05/24/08 - 12:46 PM
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"We aim above the mark to hit the mark."
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Social History
“Now let me ask you some qs about your social life and lifestyle ok?”
L SODA WET
L “Who do you Live with?”
S “Do you Smoke?”
O OH- “Do you drink AlcOHol?
D “Do you use any recreational Drugs?
A “How is your Appetite? Nutrition, Diet? Changes in Weight? # Pounds? Over what period of time?
W: “What kind of Work do you do?”
E: “How often do you Exercise?”
T: “Have you recently Traveled?”
___________________
"We aim above the mark to hit the mark."
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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MY TEST IS IN JULY 3 
Alcoholism
CAGE is considered a validated screening technique, with one study determining that it CAGE test scores >=2 had a sensitivity of 93% and a specificity of 76% for the identification of problem drinkers.
1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticising your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)?
Edited by Grazie on 06/06/08 - 09:44 AM
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"We aim above the mark to hit the mark."
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| grechita12
Forum Senior
Topics: 7
Posts: 229
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Hi grazie!!!!!
I'm in chicago.i'm taking the kaplan's course starting today and staying close to the center (downtown) .......
i'm here.take care
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Grechita
Good luck in your kaplan course, it's a great experience to deal with those SP  I sent you a pm, please check it out  and if you could please share some tips with your pals it would be greatly appreciated 
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"We aim above the mark to hit the mark."
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Depression
Mnemonic for Depression
"SIGECAPS"
SIGECAPS= SIG + Energy + CAPSules
S leep disorder (either increased or decreased sleep)*
I nterest deficit (anhedonia)
G uilt (worthlessness,* hopelessness,* regret)
E nergy deficit*
C oncentration deficit*
A ppetite disorder (either decreased or increased)*
P sychomotor retardation or agitation
S uicidality
NOTE: To meet the diagnosis of Major Depression, a patient must have 4 of the symptoms plus Depressed Mood or Anhedonia, for at least 2 weeks. To meet the diagnosis of dysthymic disorder, a patient must have two of the six symptoms marked with an asterisk, plus depression, for at least two years
There is also this alternative mnemonic from CSprotocol
"FACE SLIPS"
F: Feelings of guilt, anger or worthlessness
A: Appetite, diet, weight history
C: Concentration levels
E: Energy levels in daily activities
S: Sleep disturbances
L: Libido level, loneliness
I: Interests, hobbies
P: Psychomotor symptoms, pleasure levels
S: Suicidal ideation, any plans for suicidal
Make your choice
Edited by Grazie on 05/26/08 - 12:20 PM
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"We aim above the mark to hit the mark."
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| angel23
Forum Guru
Topics: 42
Posts: 980
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hey grazie...
can u plz chek out this post...post number 27
http://www.prep4usmle.com/forum/thread/70916/2/
does closure carry 6 marks out of 23?
this person says kaplan people tell u this in 5day course
can u through some light on it
plzz...actually i dnt do closure in 3 cases but i did counselling in all three
cud not complete my cases on time so i m asking
thanks
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God please help me....Haribol!
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| paheli
It'sAllAboutGoodKarma
Topics: 197
Posts: 2,712
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Hey, Grazie. I'm very impressed by your journal. The way you are systematic will stand you in very good stead indeed, for CS, and more! 
I plan to be a regular visitor here!
All the best! 
___________________
Prepare as if you're the worst, Perform as if you're the best! As you dream, so you manifest. So, DREAM BIG!! When you face hardship, remember, God never gives you more than you can handle. Keep your face to the sunshine and you cannot see the shadows. Internship, Here I come!!
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Angel,
I checked the post from roentgenindia...
"...as far as I know there are about 23 points of CIS nad you need to score 20
1)examinee knocked before entering
2)apeared professional in dress/hygiene
3)introduced self by name
4)comfortable eye contact
5)used patient name
6)Focused attention on patient
7)expressed empathy( reflected pt feeling)
8)conveyed nonjudgmental attitude ( avoid words like good, great,excellent)instead say allright, okay, thank you
9)used appropriate draping techniqe
10)used few open ended questions
11)used non leading quaestions
12)asked one question at a time
13)answered without interrupting the patient
14)paraphrased
15)used lay language ( imaging studies instead of CT MRI, Electrical study instead of ecg
16)used transitional phrases
17)gave explantion during physical
18)appropriate reassurence
19)summerized significant hx
20)diagnostic impression in lay term
21)discussed diagnostic test
22)asked if pt had any questions or concerns
23)paient educations/suggestion
If you see point 18-23 are generally discussed in counseling.
So it means just by doing proper wrap up you secure 6 points out of 20 which you need to pass CIS-The most dreaded component for IMG's! "
I remember the doctors giving the lectures at Kaplan used to say, if you have to choose between a great PE and a lousy Closure or the opposite; pick the lousy PE and a great Closure.
But I think nothing is written by blood. If you took your test Angel, don't get stressed over it, what is done is done, I hope your results come back soon and you PASS! because I know how painful is to be waiting for the results when we are not completely sure about how we did.
Best of luck Buddy
___________________
"We aim above the mark to hit the mark."
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Hey Paheli,
Thanks for your words , I actually am taking this slow but it's getting better, I was reading your post about breaks it was so funny 
Hang in there 
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"We aim above the mark to hit the mark."
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| milee99
Forum Guru
Topics: 54
Posts: 1,281
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hey grazie
thank you so much for dropping at my jounal
your journal is one place which makes cs look so enjoyable
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If you really want something, you will find a way. If you don't, you will find an excuse.
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Milee, Keep working hard, the day is coming, Good Luck,
Now, back to business 
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"We aim above the mark to hit the mark."
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| milee99
Forum Guru
Topics: 54
Posts: 1,281
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hey!
those smilies bring a smile on my face!
___________________
If you really want something, you will find a way. If you don't, you will find an excuse.
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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DOMESTIC VIOLENCE
Establish Confidentiality, ask qs about physical, sexual or emotional abuse.
First ask about the injuries and get details from the bruises and wounds.
Mnemonic: SAFE
STRESS/SAFETY
Do you have any kind of Stress in your relationship?
Should I be concerned about your safety?
Is there any alcohol or drugs involved?
AFRAID/ABUSE
Are there situations with your partner where you feel afraid?
Has your partner ever physically abused you or your children?
FRIENDS/FAMILY/FIREARMS
Is your family or friends aware of this? Can you tell them? Do you think they can give you support?
Is there any Firearms at home?
EMERGENCY
Do you have an emergency plan? a place to go?
Would you like me to help finding you a shelter so you can be safe?
Would you like to talk to a social worker to develop an emergency plan?
After SAFE go to PAM HUGS FOSS.
___________________
"We aim above the mark to hit the mark."
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Pediatric History
Mnemonic: BINDERS
BIRTH:
Pre Natal info: Mom smoked? Drugs? Drunk OH? Prenatal checkup?
Full term? Premature?
Type of delivery? Any complications at birth? Infections?
INMUNIZATIONS:
Are his/her vaccines up to date?
NUTRITION:
Breastfeed? Bottle?
When the baby started eating?
Recent changes in his/her nutrition? (for constipation or diarrhea)
DEVELOPMENT:
Compare to your other kids?
Ask for some milestones qs?
EXPOSURE:
Daycare? Routine care.
Smoking at home?
RASH:
Any kind of rash?
SYMPTOMS:
Any other symptom than what the caregiver have told you already.
Fever? Cough? Fuzzy? ...
Then continue with PAM HUGS FOSS, what applies.
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"We aim above the mark to hit the mark."
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Sex Assault Case
Any help to build the questions of the HPI for this kind of cases?, I heard this kind of cases are coming in some centers
Edited by Grazie on 06/03/08 - 11:12 AM
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"We aim above the mark to hit the mark."
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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CS in July
June 3rd 2008
Ok, time to get serious , no, I mean it I have been postponing my CS date but I gotta take it the latest in July so that's most likely to be my last chance before baby comes 
I have been studying in a not so organized way, so I better start from scratch again; master DDs and Questions to ask for each symptom, I gotta know those qs by heart , have them at the tip of my tongue 
Today I will go through FA
Common Questions to Ask for the different Symptoms:
Pain
Nausea
Vomiting
Cough
Headache
Fever
Shortness of Breath
Urinary symptoms
Bowel symptoms
Weight
Appetite
Diet
Sleep
Dizziness
Joint pain
Travel history
PMH
FH
SH
SxH
Alcohol History
Ob/Gyn H
Pediatric H
Growth and Development
Feeding History
Routine Care
Psychiatric H
Daily activities (for dementia)
Abuse
I should go through all these items today and would also like to start with kapl audios, let's see how far I go
Edited by Grazie on 06/05/08 - 05:04 PM
___________________
"We aim above the mark to hit the mark."
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