Saturday, April 9, 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

  3. How long should you spend outside the room scribbling your mnemonics and patient doorway information on your blue sheet? Is it awkward to be outside for 1 minute when every other candidate has already knocked the door and stepped in 50 seconds ago?

    1. No, it's not awkward. You can stay outside and prepare yourself for as long as you want but once you enter, you should know what you're doing!


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