milee99
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hi
how do u do tilt test
and do u do it??
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| Grazie
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Hey Guys 
Milee, I had the same question before but first you need a tilt bed and second even if you try to do it on your own, I have seen some docs doing it, the patient feels so sick afterwards that I think the SP will fail me just for disturbing him/her; so I think I would just order it in the workup plan. But maybe somebody else would like to talk about it. Keep studying hard sweetie, you will do great! 
Carlitos, thanks for your words, we can gather here and solve our doubts, welcome aboard. 
Snowdrops: about your question, the blue sheet I pasted in the 1st page of this journal was intended to help us to organize ourselves better in the real exam, and since all information will be organized we will be able to do a good PN also. About the red alerts and counseling section, for ex. if your pt says he smokes or had multiple sexual partners in the last year or drinks a lot, a personal suggestion is just write it down and wait for the end to do the counseling specially in this kind of situations otherwise, when counseling right away the patient can feel judged and wont help us, we goota be nice and do the counseling for the end, at least that's what Kpln lady says; for situations like nutrition or exercise, like this: just make a circle while taking the history on things I know have to counsel like: Smoke - S , alcohol - OH , Drugs- D , etc. 
About the red alerts, it's supossed to be for the alarm signs like Fever, High BP, just things you can't miss.
Need to catch up my reading, see you around guys. 
Edited by Grazie on 06/10/08 - 09:50 AM
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| snowdrops
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I don't think we should do this test for CS.
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| snowdrops
Forum Senior
Topics: 6
Posts: 149
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Hi, Grazie:
You explained so well for Counseling and Red Alert. Now I know how to use it. It is like a reminder.
I also like all mnemonics you posted in here. Actually, I write down all of them. I find they are very helpful. With those mnemonics, I don't think we will miss any thing during the test.
For PE, we only need do one focused exam and two other general exams. Don't go to too detailed.
Tomorrow, I will start practice FA cases.
Thank you for your information.
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| paheli
It'sAllAboutGoodKarma
Topics: 197
Posts: 2,712
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Grazie, I'm so glad that you're doing so much of this before my test. I'm getting to revise so much of what I already know, and I also learn some new things as well.
This journal is invaluable, Keep it up! 
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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
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Sick, SIck  yesterday I woke up sick and went to be sicker  , I hate days like this one, I will try to overcome those days though, I need to be tougher if I want to accomplish something, well, let's see.
Snowdrops, I am glad the mnemos are helping you, and about the Physical Exam, it was just like a whole review, but for every case we have to do it focusing on ths system of course, I am looking forward to practice with you from monday.
Paheli, I know your test is coming soon, sure you will nail it cause you have been working hard and you are such a nice girl, you deserve it, all the best for you buddy!
See you around...
Edited by Grazie on 06/11/08 - 08:28 AM
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"We aim above the mark to hit the mark."
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| paheli
It'sAllAboutGoodKarma
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Grazie, I can finally offer you a tip on something! Confirm the gender of the patient before you begin.
It's Paheli, mid-20s, Female, c/o encephalitis, Step 2 CS-type.
___________________
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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| snowdrops
Forum Senior
Topics: 6
Posts: 149
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Hi, Grazie:
I understand how uncomfortable you feel now because I have been like this before. I kept cleaning up my washroom when I was pregnant, because I felt a strong odor coming from sink. Actually nobody else in the house felt that way.
Any way, this is a special time for a woman. Maybe your review study for CS can bring your attention away from the unpleasant feeling. Plus, it is good fetal education for your baby because he/she get a good study habit from so early day. When I was pregnant, I thought: I feel so uncomfortable and I can not concentrate. So, just watch TV. Now, what I got?! My son watches too much TV in spite of the fact that I don't watch much TV before and after my pregnancy. I mean, mom's behavior during pregnancy is really important for the baby. Therefore, you just schedule your CS review, step by step. You will be there and you may also train another person becoming a doctor. I am not kidding you.
OK, back to our review. One more question for you. I am not very sure how to ask questions on RUGS of PAM HITS RUGS FOSS. The rest part of this mnemonic is fine for me because I learned how to approach those questions from Kaplan lecture, but not RUGS. Could you please give me your example questions for this part?
Looking forward to practicing with you on Monday!
Thank you!
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| Grazie
Forum Senior
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Paheli: I already corrected the mistake, I am sorry about it  but maybe the picture of the good looking guy gave me a clue that you were a guy,  jeje
Snowdrops, about the PAM HITS RUGS FOSS
P : PMH, related to HPI and then other medical conditions
A : Allergies
M : Medication
That's easy right?, then comes:
H : Hospitalizations, Inujries, Traumatisms, Surgeries ( HITS)
U : Urinary symptoms
G : Bowel movements, other GI symptoms
S : Sleep pattern
RUGS, because ROS (Review of Systems, as you write it in the PN), "R" is just to remind you that now you are going over ROS, so be aware, something else may come as a new info about the patient.
Before I learned it like everybody else, PAM HUGS FOSS but then I thought about memorizing like HITS RUGS because it can also give me more possible answers and new info I might miss, just a thought.
Thank You for the advice about the pregnancy, it is funny though  well, with my current "puking habits" I hope baby doesn't become bulimic in the future  I am just kidding I will try to be stronger and do what I have to do.
Anyway Father's Day is coming and my in_laws are coming over, what means I really have to polish my house not that I don't clean often but when "they" come everything has to shine, I will get some decoration also, so I wont be around as much as I would like, but don't worry Snowdrops I will be punctual on monday for our study session, send me a pm to set the date
Now I gotta go...see u around guys...
Edited by Grazie on 06/11/08 - 08:57 AM
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| snowdrops
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I got it now. Before, I wasn't sure that it is review of past history of different systems or review of different systems associated to the present illness. It is the first one, not the second one, right?
Can I ask like this?
"Did you have urinary tract infection? Any other problem from kidney?"
"Did you have diarrhea before? Is there any change in your appetite?"
"How about your sleep?"
Is this OK?
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| Grazie
Forum Senior
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Hey Snowdrops,
About the first question, in PAM , P is for PMH , first related to the current problem "Have you ever had a similar problem before?" and then you ask about any other medical conditions, in this same page I put another review of that, after you are done with other medical conditions, go ask for ROS which includes Urinary, Gastro, Sleep, don't forget the HITS also.
Now, about the questions you formulated about U-G-S i think they are right, everyone has its way to ask questions but one think they say at Kpln is not to be so fancy with words since english is not our first language so I will use just simple words in my questions so patients can't miss them , you gotta have your questions ready though.
You are doing a great job Snowdrops, I will be with you from monday yayyy!
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| snowdrops
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Hi, Grazie:
Did you do dementia case yet? For those 'Pain' cases, we can use 'LIQOR AAA', but if it is dementia or depression case, how do you prepare?
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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Hi Snowdrops,
For Dementia, I found this example of interview...
Ask these questions about the memory
Hello, Mrs. Lake, I am Dr. House. Nice to meet you. (Smile and shake hands)
How may I help you today? SP ("I am here because my husband says I am forgetting things" ) Since how long have you noticed that you are having trouble remembering things? ("about a year")
What kind of things are you having difficulty remembering? (" I am having difficulty remembering dates, family birthdays and appointments")
Are you having difficulty with recent events or remote events? ("mostly recent events")
Do you have any history of head trauma? ("No") Did you notice any changes in your weight? ("No")
Are you having any neurological symptoms such as weakness, dizziness, gate problems or incontinence? ("No")
Have you noticed any cold or heat intolerance? ("No")
Inquire about Activities of daily living (ADL)
Do you have any problems eating or cooking your meals? ("some times")
Do you have difficulty walking? ("No")
Do you have any trouble with your toiletry habits? ("No")
Inquire about ADL's
Do have any problems getting your shopping and housekeeping done? ("Yes, I let my neighbors do the shopping")
Are you able to find your way through your house? ("A few times, I took the wrong bus, but I eventually made it home!")
Do you have any problem driving to the grocery store? ("I stopped driving since it was difficult to find my way")
Do you have any difficulty managing your bank accounts or paying bills? ("I sometimes forget to pay bills")
Inquire about depression/loneliness
Do you feel lonely or sad? ("some times I feel lonely")
Do you have any thoughts to kill yourself ("No") Inquire about safety/support systems?
Do you have somebody to take care of you, in case of an emergency? ("Yes, I have my daughter")
If not, make sure to offer social services to help with finding some help!
Now, complete rest of the questions like in any other case excluding those that you already asked. Use mnemonic: PAM HUGS FOSS
Past Medical History: Do you have any other medical problems ? ("High blood pressure") Allergies: Do you have allergies to drugs or foods? (No)
Medications: Are you taking any prescription medications? ("Yes I am taking Aspirin, Norvasc and vitamins")
Gastrointestinal Symptoms: Do you have any problems with Bowel Movements? ("No")
Family History: Do any of your family members with Dementia? ("No")
Social History: Do you drink alcohol? ("No") Do you smoke? ("No")
Physical Examination:
Wash your hands
Mrs. Brown, can you tell me your age? What is the date today?
Can you tell me where we are now?
Can you spell the word "WORLD" backward for me?
Do you know the name of the President?
I am going to give you three objects for you to remember: Tree, Pencil and Apple Ask the patient to begin with 100 and count backwards by 7. Stop after 5 subtractions.
Can you close your eyes put your hands together and bring them on to your belly and back?
Do a funduscopic exam
Check the thyroid
Listen to the heart and lungs
Check for reflexes and strength in muscles
Do a get up and go test If you have time,
Do a full minimental test as below
Mini-Mental State Examination (MMSE)
Orientation in time: what is the year, month, date, season, day of the week?(1 point each, total 5)
Orientation in place: in which state, county, town/city, hospital/street, floor/number are you now? (1 point each, total 5)
Registration: repeat these three words: e.g. car, ball, key (1 point for each, total 3)
Arithmetic: take 100 and subtract 7 in 5 iterations: 100, 93, 86, 79, 72, 65, 58 (1 point for each, total 5)
Recall/memory: repeat the three words from before (1 point each, total 3)
Language: (total 8)
name these objects: e.g. key, watch (1 point for each, maximum 2)
repeat "NO IFS, ANDS OR BUTS" (1 point for correctly repeating)
follow a three-stage instruction: take this sheet of paper, fold it over once, and put it on your lap (1 point each, total 3)
read and obey "CLOSE YOUR EYES" (1 point for closing eyes)
write a sentence (1 point for a grammatically correct sentence)
Spatial insight: copy out a drawing of two interlocking pentagons (1 point for correct drawing)
You can just do 3 of the above, usually orientation, recall/memory and serial sevens or world spelled backwards. If you do the full, any score over 24 is effectively normal on mini-mental.
Differential Diagnosis
- Alzheimer's Dementia
- Vascular dementia
- Vitamin B12 deficiency
- Normal pressure hydrocephalus
- Hypothyroidism
- Depression
Diagnostic Work up
- CBC
- BMP
- TSH
- B12, folate
- MRI brain
Edited by Grazie on 06/16/08 - 01:41 AM
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| Grazie
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For Depression, example of interview.
Questions to ask in HPI
1. How is your mood?
2. Do you have any difficulty sleeping?
3. How is your appetite?
4. How is your concentration?
5. Did you notice any lack o energy to do things that you normally do?
6. Do you have any possible stressors in your life?
7. What kind of support systems do you have?
8. Do you have any thoughts about ending your life?
9. Do you hear voices that are not there?
10. Do you have frequent crying spells with little or no provocation?
11. Do you have feelings of depression that disrupt work, school, or family life?
12. (Inquire about drug and alcohol use, and about the medications patient is currently taking in the history sections below)
Then do a quick PAM HUGS FOSS
Past medical history
Allergies: any allergies?
Medications: any medications that you take?
Hospitalizations: any history of hospitalizations?
Urinary tract: any urinary symptoms?
Gastrointestinal Tract: any gastrointestinal symptoms? (N/V, diarrhea...)
Sleep pattern: any problems with sleep?
Family history: any family history of significant health problems?
Social history: any smoking, drinking or recreational drugs? What is your occupation?
Sexual history: any problems with sexual activity? (use transition sentences)
Physical Exam
23. Wash your hands (a must in CS) before examining the patient
24. Check the thyroid
25. Auscultate heart
26. Auscultate lungs
27. Palpate abdomen
28. Do a focused neurological examination
29. Drape appropriately, and pull out leg support
30. Do a quick Mini-mental test:
Orientation in time: what is the year, month, date, season, day of the week?(1 point each, total 5) 31. Orientation in place: in which state, county, town/city, hospital/street, floor/number are you now? (1 point each, total 5)
32. Registration: repeat these three words: e.g. car, ball, key (1 point for each, total 3)
33. Arithmetic: take 100 and subtract 7 in 5 iterations: 100, 93, 86, 79, 72, 65, 58 (1 point for each, total 5)
34. Recall/memory: repeat the three words from before (1 point each, total 3)
35. Language: (total 8)
36. Name these objects: e.g. key, watch (1 point for each, maximum 2).
37. repeat "NO IFS, ANDS OR BUTS" (1 point for correctly repeating)
38. Follow a three-stage instruction: take this sheet of paper, fold it over once, and put it on your lap (1 point each, total 3)
read and obey "CLOSE YOUR EYES" (1 point for closing eyes)
39. write a sentence (1 point for a grammatically correct sentence)
40. Spatial insight: copy out a drawing of two interlocking pentagons (1 point for correct drawing)
41. You may just do 3 of the above, usually orientation, recall/memory and serial sevens or world spelled backwards.
Any score over 24 is normal.
Differential diagnosis:
Major Depression
Alcohol Dependence
Dysthymic Disorder
Adjustment Disorder
Dependent Personality Disorder
Diagnostic Workup:
TSH
CBC
urine toxicology
Hospitalization: Suicide precautions
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| Ivonne
Find a way or make one
Topics: 58
Posts: 1,654
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OMG, this is like a book for CS!
Just wanted to drop a line in your journal and remind you that time management is also the key for this exam and the only way to master time management is by practicing. Practice makes perfect!!!
Hard work always pay off, keep it up san fernandina!
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| snowdrops
Forum Senior
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Thank you for your information, Grazie. It is very useful. I am going to make Q cards from your notes.
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| snowdrops
Forum Senior
Topics: 6
Posts: 149
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Hi, Grazie:
What is BMP standing for?
Thank you!
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| Grazie
Forum Senior
Topics: 13
Posts: 207
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BMP.- Stands for basic Metabolic Profile or panel
The BMP includes:
Glucose
Calcium
Electrolytes
Sodium
Potassium
CO2
Chloride
Kidney Tests
BUN
Creatinine
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"We aim above the mark to hit the mark."
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| snowdrops
Forum Senior
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I didn't see this acronym on FA index, so we better write down whole names.
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| snowdrops
Forum Senior
Topics: 6
Posts: 149
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Hi, Grazie:
How are you feeling nowaday? Hope you don't feel too sick.
Take care.
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