Sunday, April 10, 2016

Step 2 CS: Blue sheet

What's a blue sheet? A blue colored paper given to you during the step 2 CS exam.

I finally figured out what my blue sheet will be like before entering the room and maybe it will be helpful for you guys too!

I tailored it from existing mnemonics and things I used to forget. You should make a personalized blue sheet according to your need too.

This is what my sheet would look like before I enter the room:

Step 2 CS blue sheet
First box: Doorway info. I would write the name of the patient so that I can refer to it even if I forget.

Second box: "OPDFCS LIQRAAA" (From Neeraj notes)
Onset, Progression, Duration, Frequency, Constant or intermittent, Setting.
Location, Intensity, Quality, Radiation, Alleviating, Aggravating, Associated symptoms.

Third box: Review Of Systems
I also write "WAD FUGT" sometimes to make sure I am asking for Weight, Appetite, Diet, Fever, Urinary and Gastrointestinal complaints (Nausea, vomiting, diarrhea, constipation) and Thyroid symptoms (Skin changes, hair changes, cold or heat intolerance). (Here are a list of ROS that I would usually ask)

Fourth box: "PAM FOS"
PAMHUGSFOSSWA was a very scattered mnemonic for me. So I changed it to "PAM FOS"

Past medical / Past surgical
Family history
Social history:
Smoking, Alcohol, Drugs, Travel, Occupation, Exercise, Sexual
(I didn't ask Travel, Exercise and Sexual to every patient. Only if I felt it was relevant, I asked.)

Fifth box: "STIECQ"
This was a very important box for me because I used to forget maximum things from this box.
Summarize, Thank the patient, Initial management, Examination, Counsel, Questions

I would summarize before the physical exam: "So you are having fever, cough and sore throat. Is there any thing else that I am missing out?
Once I was done summarizing, I would strike out S.

After examination: "Thank you for letting me examine you and for being so co-operative."
(Strike out T)

"Your cough would be caused due to a number of reasons but most likely it is due to tuberculosis. Tb is an infection of your lungs. I would like to do some blood work and imaging to diagnose it."
(Strike out I)

(Updated: I write an E next to I for examination like pelvic exam, rectal exam that you can not do in the encounter and would like to do later.)

While taking the history, I write down what I want to counsel about.
"I would also like to advise you to quit smoking since it is injurious to your health. Have you considered quitting smoking? I understand it's very hard but we have excellent programs that can help you quit."
(Strike out C)

"Do you have any questions or concerns?"
(Strike out Q)

Sixth box: Things I have to examine.
For a heart case, I would forget to check extremities for edema, neck for JVD & carotid bruits. So I wrote it down on the doorway itself.

Seventh box: Differentials. Just so I know what to ask.
If it was a follow up case, I would write - Ask medications, compliance, complications.

Here's how it would look like after I was done:

Step 2 CS blue sheet
Here's a sample blue sheet. The case is the first case from First Aid.

Blue sheet before I enter the room. First Aid case with chest pain,
Blue sheet after I am done.
That's all!

Hope that helped!


Updated on 12th April, 2016: STIECQ & WADFUGT mnemonic.

Click here to read related posts on Step 2 CS


  1. Diseases with Fibrinoid Necrosis :
    Mr & Mrs SPARsHH

    Malignant HTN
    Polyarteritis Nodosa
    Acute Rheumatic Fever{Aschoff's nodule}
    Rheumatoid Arthritis

    Henoch-Schonlen Purpura

  2. Nice post bro /sis.. thank you very much

    1. XX chromosomes here ^__^
      Thanks! <3


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