truedoc
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love what've done Grazie! your journal is awesome.Take it slow and you'll soon be seeing PASS in your CS exam very soon! All the best! 
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| Grazie
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Thank you Truedoc ,
This past week I have been so sick, I have already passed 1st trimester many weeks ago but it's still hitting me so badly  it's tough to focus when you just want to through up, but I gotta be strong I know 
Snowdrop,
Sorry for my absence, as I explained to you I have not been feeling well at all; anyway, my good friend Ivonne was cheering me up and encouraging me to come back, so I am planning to definitely start with cases from this monday, I was checking some new cases that may come, like the sex assault or elderly abuse, etc, we will see, I need to get my hands on even virtual SP and practice asap, theory is over I hope  , now is time to practice Case by Case, master them all, master Patient Notes and time my performance, I am definitely taking my exam by the end of July otherwise contractions are going to hit me right there at the exam and I will end up being the patient  jeje
Ok Guys, Thanks for your support, I am coming back, being a woman can be hard sometimes but that can't stop us from reaching our dreams, so let's get this done 
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| Ivonne
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Grazie wrote: Ok Guys, Thanks for your support, I am coming back, being a woman can be hard sometimes but that can't stop us from reaching our dreams
That's what I am talking about! Grazie is back!
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| Grazie
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Hi Ivonne Bombom
I have to do some cleanup after hubby's bday, but yes definitely today I am going to review at least 5 cases.
Thanks for your support amiga (friend) 
Grazie.
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| snowdrops
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Hi, Grazie:
Welcome back to our business from a few days' absence.
I have only one week left before my CS test. I read through all cases in FA and UW. Now need lots of practice. If you want to practice with you, give me a call or go to Skype.
Talk to you later.
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| Grazie
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Snowdrops,
Sweetie, I would love to practice cases with u , I will skype you tomorrow, please be online so we can arrange times.
Grazie.
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| smalley
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hi grazie ..ur journal is amazing ..gl for ur exam.....
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But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint-Isaiah 40:31
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| snowdrops
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OK then. See you on Skype. If you start to puke, I probably ask you questions for pregnancy. 
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| Grazie
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Thank you Smalley, good luck to you too 
Hey snowdrops, I will send you a pm ok?
Edited by Grazie on 06/25/08 - 02:28 AM
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| Grazie
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CASES' REPERTORIES
I am going to start with repertories for the cases, I decided to group the cases by organ system or something like that , let's see how it goes, for today it will be: GI Cases.
GI Symptoms (CC) :
Abdominal Pain
Nausea/Vomiting
Bloody Stools
Jaundice
Diarrhea, etc.
HISTORY OF PRESENT ILLNESS (HPI)
OSCD PQRST UVW + AAA
ONSET: “How did it start? >> Was it all of a sudden or gradually?”
SETTING: “What were you doing when it started?”
COURSE: “Is it getting worse, better or just the same?”
DURATION: “You said it started … ago, does it come and go?” … If Yes >> “How often/ frequent does it come?” … “For how long does it stay each time?”
PLACE: “Show me exactly where is it on your body, point where with one finger”
QUALITY: “Tell me, how does it feel like?” … >> Clarify one at a time: Is it sharp? Stabbing? Dull? Tight? Cramps? Squeezing? Burning?
RADIATION: “Does it go/ shoot anywhere?”
SEVERITY: “How bad is it, on a scale from 1 to 10, with 1 is the mildest, and 10 is the worst pain? … Does it interfere with your daily activities?”
TIMING: “Is it worst in a particular time of the day?”
U (You) YOUR DAILY ACTIVITIES: “Does it change with your daily activities like postures, exertion, rest, sleeping, eating, hunger?”
V (déjà vu): “Has it happened before?” If Yes >> When? .. How did you handle it? … What happened to it? .. Which doctor? .. What medication? .. etc explore.
WHAT: “What has worked for you so far? … What hasn’t? … What do you think is causing it? …”
AGGRAVATING FACTORS: “What brings it on?” .. What makes it worse?”
ALLEVIATING FACTORS: “What makes it better?”
ASSOCIATED SYMPTOMS: “Have you noticed anything else that occurs with it?” “If the patient ask “What do you mean/ …such us What?”
“Any thing that you may recall?”
Edited by Grazie on 06/29/08 - 03:30 AM
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| Grazie
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Gastrointestinal Questions:
PAN HSBG JBO + Risk
A.- Pain: "Any stomach pain?"
Place: "Where do you feel it, point with one finger please?" (Localized or generalized)?
Quality: "How does it feel like? .. Is it colicky/... diffuese/ ... sharp/... stabbing/... dull/... tight/... cramps/... squeezing? ... Burning?
B.- Appetite: "Any change in your appetite recently?"
Yes >> "Is it more or less than usual?"
C.- Nausea/Vomiting: Do you feel sick?" (Nausea); "Did you throw up?" (vomiting)
Yes >> Explore OSCD PQRST UVW + AAA
Quality: "Was it digested or undigested food?" ... What color was it? (dark green: Bile) ... Any blood? .. Yes >> mixed with vomitus or streak?...
How does it smell?"
Severity: "How much?" ... How frequent?" ... How much blood? .. A cup?" "Is it forceful (projectile) or with retching?"
Timing: "Is it worse in particular time of the day?" (Morning: ICP)
AAA: "any headache? .. Stiff neck? .. Weakness? (CNS causes)
Females: "Ms..., as feeling sick and throwing up may occur with pregnancy and menses, I need to ask you, is it possible that you are pregnant? ... when was the first day of your last period?"
D.- HEARTBURN: "Do you have water brush?" ... Any burning sensation in the middle of your chest that radiates to your mouth?"
E.- SWALLOWING: "What about your swallowing, any difficulty?"
Yes >> Explores OSCD PQRST UVW + AAA
Course: "Is it getting worse?" (Progressive)
Duration: "Does it come and go?" (Intermittent)
Quality: "Is it difficult to swallow liquids (Neuromuscular & mechanical) or SOlids (mechanical)? ... Do you feel a lump in your throat?"
Timing: "Do you feel the difficulty immediately at the beginning of swallowing (oropharyngeal) or does food stop in yoour chest a few seconds later (esophageal)? ... Is it followed by vomiting? ... Choking or cough?"
AAA: Screen for:
Thyroid: "Does the heat or cold bother you more than you think it bothers other people? ... How?"
Scleroderma: "Any skin tightness on your face or hands?"
CNS: "Do you have headache?" "Do you feel lightheadedness?"
"Do you feel any pins and needless sensation?" ... Where? ...
"Any muscle weakness? ... Where?"
F.- BLOATTING: "Any gases?"
Yes >> Does the gas escape upwards or downwards? ... Does it smell?"
G.- GIRTH: "What about your stomach girth? ... Is it bigger? ... DO you feel any lumps or bumps?"
Yes >>> Where do you feel the lump?"
H.- JAUNDICE: "Did your skin or the eyes' whute areas turn yellos or red? ... Any change in your urine color? ... Is it dark like tea or cola? ... Is your skin itchy? .. Any bad mouth smell?"
I.- BOWEL HABITS: FP LTCS "Any change in your bowel habits recently?"
Yes >> Explore OSCD PQRST UVW + AAA
Frequency: "Any change in your bowel motion frequency?"
Yes >> "In what way? ... How often do you pass your bowel? ... Is it more or less frequent recently?" (Diarrhea: >3/day unformed/ Constipation: < 3/week hard stool with stainning & sense of incomplete evacuation or blockade)
Pain: "Any pain with passing bowel motion?" ... Any pain in your bottom? Yes>> When does it occur?"
Lesions: "Any lumps, ulcers or fissures in your bottom?"
Tenesmus: "Any urgency to pass bowel motion but then little to pass?"
Control: "Do you control your bowel or your soil yourself?"
Stool: "Does your stool look as it was before or different?" ... No >> Explore:
- Shape: "Is it wider, more bulky or narrower? ... Softer or harder?"
- Content: "Is it greasy?... Does it stick to the bowell or float? ... Any mucus? ... Pus?... Undigested food?..."
- Colour: "What colour is it? : Pale? (fat) ? Black? (malena) / Green? (Pus)"
- Blood: "Any blood?" ... Yes>> Is it fresh bright blood (after splenic flexure) or altered or clots (before)? .. How much blood? .. A cup? .. Is it gross or only streaks on the stool surface? ... Does it appear at the beginning, at the end, all through the motion, or only on the toilet tissue?"
- Smell: How does it smell?"
* DIARRHEA:
- Onset: "How did it start? .. Was it all of a sudden or gradually?"
- Duration: "When did it start? (>2 weeks: chronic), So it is less/ more than two weeks?
Does it come and go?" ... Yes >> How frequent does it come? .. For how long does it stay each time .. How does it alternate with periods of constipation?"
- Quality: "Is it loose or watery? ... Is it bluky shapeless?"
- Timing: "Is it worst in a particular time of the day?"
J. ORTHOSTATIC ASSESSMENT: Only if bleeding, diarrhea or vomiting (DTHU):
" Do you get lightheadedness? .. What about when you stand up or get out of bed in the morning?" (pre-syncope/Anemia), Do you feel thirsty and your mouth dry? .... Have you ever felt your heart racing? .. Do you void less?"
K. RISK FACTORS:
* Recent travel ... * Contact with sick yellow looking person ... *Sea food
* IV (Drugs, blood, piercing) ... * Unprotected sex/ oral/ anal) ... * Smoking
* Alcohol ... * Occupation: Blood exposure.
Edited by Grazie on 06/28/08 - 12:21 PM
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| snowdrops
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Hi, Grazie:
For GI cases, after you ask all those GI questions. You can collect a few question from your DDs. This is the way I am doing for history of present illness.
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| smalley
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hi grazie...am starting my cs prep now...now my question is basically whats ur prep material..fa or fa +uw or fa+uw+kaplan?
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But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint-Isaiah 40:31
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| Grazie
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Hey Snowdrops, yes I think that's the way to go  , the DDx will guide us to do the right questions and then get our most likely 1st Dx, remember if we get the 1st DDx right we get 2 points for this one and the rest is just 1 point each.
Smalley, my preparation for CS have been so irregular, this pregnancy knocks me out somedays  I wish I was stronger but well this week has been a little bit better. I like FA 1st, then UW and I also got some cases from Usmlesource (only the ones that are not in FA or UW) I have heard some weird cases coming in the real exam but definitely the common cases are the most we are going to get, so FA is a great source to stick to.  Kaplan 5d handout it's ok just for the introductory part and the red book has some cases, but what we need to do is "practice", case after case; I am nothing like an actress and really I feel a little uncomfortable acting , but for this exam we have to take out that "actor" we have inside, mine must be really deep somewhere in there Good luck smalley, make the best of your CS Prep.
Grazie.
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| angel23
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hey grazie
this is so sweet....mommy dear!!
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| snowdrops
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Action is the hard part for me as well. As an Asian woman, it is difficult to say all your feeling in words. In real life, we just keep quiet for many emotional situations. I don't get used to say 'I am sorry to hear that...' But for the test, I have to say. Any way, acting skill is very bad.
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| smalley
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thanks grazie for ur info..i will stick to fa and uw mainly.....yes grazie ur rt..for this exam we have to let out the actor inside us yes sometimes as kid and even now after seeing some good flicks i had always dreamed of me acting the same way..and knocking the bad guys out ..so in this exam my acting skills will come to the forefront...but omg i gotta be careful..these are SPS'
i wish u good health and a very healthy baby..
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But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint-Isaiah 40:31
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| hiren
Forum Newbie
Topics: 2
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hi
my cs exam is on 29 july in chicago.
at present, i live in hanover park area of chicago.
i heard that practicing cs cases face to face is the key to pass exam.
if you are interested in practicing with me contact me on 630 213 6748 or at drhiren83@yahoo.com
thanks,
- hiren
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| Grazie
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Hi hiren,
I will send you a pm.
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| Grazie
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Hi CS Fighters 
Today is sunday but I will review and practice 2 cases on my own, after that I will start with my sunday's schedule  : church, family.
Don't you guys feel that until we don't get our MD we wont have normal lifes? I do So, the best thing is to hurry and get our lifes back, but also obtaining good results, as IMG we have to otherwise chances are lower for us, this is a very competitive environment.
Enough of reflections of life , it's very early but I will start with my 2 cases for today:
1) Diarrhea
2) Nose Bleeding
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