Step 2 CS: Transition phrases

Once you are done with History, do a Review Of Systems:

Transition phrase: "Just for the sake of completion, I would like to ask you a few more questions - You can answer these questions with a 'Yes' or a 'No'."

These are the questions I would usually ask:
"WAD FUG"
Any changes in your Weight?
Any Appetite changes?
Any changes in your Diet?

Do you have any Fever? (Night sweats / Chills)
Any changes in your Urinary habits?

Gastrointestinal complaints:
Any abdominal pain?
Any diarrhea or constipation?
Any nausea?
Vomiting?

Step 2 CS: Child with diarrhea mnemonic

For a child with diarrhea, make sure you ask these things (D's).

Diarrhea characteristics - Amount, Blood, Color, Consistency, Duration, Frequency, Odor,
Dehydration features - Dry mouth, sunken spot on forehead, Drowsy
Diet - Any new foods introduced that may have caused the diarrhea?

Step 2 CS: How to introduce yourself

"Mr. XXX?"

"Hi. I am Dr. _______. I am the attending physician today and I am here to take care of you."

"Are you comfortable in the room?"

"Let me put this drape on you to make you more comfortable."

"Is it okay with you that I take some notes while interviewing you just so I don't miss out on any important points?"

"So tell me, what brought you to the clinic?"

Dr. Thinker: USMLE STEP 2 CS

When to give it? 

1.      Ideally give it after your clerkship or observership, as you will get to know how to talk to patients in the USA.

2.      It can be given before step 1 or after. It doesn’t matter. I gave it before step 1.

Step 2 CS: Writing examination in patient note

Hello! In this post, I'll be noting some points how to write a patient note for step 2 CS. Especially, focusing on short forms that can be used in the exam.

I have noticed that writing the note in ALL CAPS is better and it does save a lot of time. Similarly, instead of using the "colon : " you could use the "dash - " and it'll make life simpler.

Step 2 CS: Loss of consciousness

Differentials:

Seizure - Ask for shaking, tongue biting, rolling of eyes, incontinence

Hypoglycemia - Sweating, fatigue, excessive hunger

Orthostatic hypotension - Ask for palpitations, positional syncope or hypotension associated with large meals. Medications can cause this. Counsel this patient properly by warning them and ask them to get up slowly, etc.

Vasovagal syncope: What were you doing when you lost consciousness?

Step 2 CS: Amenorrhea

I am just trying to set a sequence of questions to ask in the exam, tests to order and examination to do so that I am not all over the place in the exam.

So here's what I am going to do if a case of amenorrhea shows up - Ask about general menstrual history and then go to symptoms specific for differentials:

Step 2 CS: Noisy breathing

I think mnemonics aren't required for every case if you have the correct thought process, you will ask the right questions.

Step 2 CS: Writing patient note

Patient note tips:

1. Write the chief complaint in brilliant detail
2. Write findings consistent with diagnosis #1
3. Write findings consistent with diagnosis #2
4. Write "denies" (Negative findings associated with particular dx)

Step 2 CS: Do you think I have cancer?

Counselling a patient who says, "My father died of lung cancer 10 years ago. Do you think I have cancer?"

Step 2 CS: Upper limb neurological examination

So I am practicing for my CS exam. I am memorizing what I will tell my patient and writing them down for my reference. Uploading it on the blog for whoever finds it helpful.

I recommend watching videos and making your own "Set of dialogues" and practicing over and over again. Here are mine for upper limb neurological examination: