Step 2 CS: Musculoskeletal patient note

IPROM MRSP is a brilliant mnemonic
You can use it for patient notes as well!

For shoulder pain:
Inspection - R arm is closely held to the chest wall. R shoulder appears red compared to the L.
Palpation - Non localized tenderness on palpation of R shoulder, arm and clavicle.
ROM - Pain and restricted flexion, extension, abduction, adduction, internal rotation and external rotation.
Motor - Unable to assess strength due to pain.
DTR's - 2+ intact, symmetric (If time, mention - Biceps, triceps and supinator)
Sensations - Intact to pin prick and light touch
Pulses - 2+ in brachial and radial arteries

For wrist pain:
Palpation - Non tender to palpation
ROM - Flexion, extension, abduction, adduction are WNL
Motor - 5/5 strength in shoulder, elbow and wrist
DTR's - 2+ intact, symmetric
Sensations - Intact to pin prick and light touch except decreased sensation in the palmar aspect of right arm
Pulse - 2+ in brachial and radial arteries
Tinels, Phalens test +ve. Finkelsteins test -ve.

Step 2 CS: Memory loss / confusion

Soo.. I wanted to remember "medical terms" to report my findings in my patient note. I made a mnemonic for remembering "findings in Alzheimer's disease:

AC MI EF

- Decline in Activities of daily living
- Cognitive decline
- Memory Impairment
- Executive Functioning

For activities of daily living, DEATH SHAFT is a tedious mnemonic. Keep it simple -ABCD
Ask for ABCD - accounts, bathing, cooking, dressing and transport - Can you walk in the house / drive a car?

Other diagnoses:

Normal Pressure Hydrocephalus - Ask for urinary incontinence, gait disturbance

Syphilis / AIDS - Have you ever been diagnosed with a STD in the past?

Major depressive disorder (Psuedodementia) - SIGECAPS

Hypothyroidism - Cold intolerance, constipation, slowing of movement, etc

Step 2 CS: Writing a psychiatry note and mini mental status

Mnemonic: ABC MATTS

Appearance - Well groomed / Dishevealed
Behaviour - Appropritate / Inappropriate
Co-operation - Cooperative / Non-cooperative

Mood - Euphoric / Depressed
Affect - Normal / Blunt affect with poor eye contact
Thought Process- Direct / Disorganized
Thought Content - Normal / Delusional
Speech - Fluent speech / Slow speech

"Now I am going to ask you a few questions that may seem odd, but these are just to assess your mental status."

"What is your name?"
"Do you know where we are?"
"Do you know what time is it?"
AAOx 3

"I will name three objects for you, can you repeat them after me? I will ask you to repeat the same objects after a while."
3/3 registration, 3/3 recall at 3 minutes

Step 2 CS: Headache / photophobia

When dealing with a patient with severe photophobia, you might want to dim the light out for the patient just to make the patient comfortable. Say, "I see that the light is making you uncomfortable, let me dim the lights out for you to make you feel more comfortable."

Then you start taking history.

Think of differentials, then ask  about -

Migraine - Ask about aura, catamenial migraine

Cluster headache - Ask about tearing of eyes, rhinorrhea

Tension headache - Ask about stresses in life

Meningitis - Ask for neck stiffness, fever

Excess use of antibiotics can cause Diabetes

New research has pointed out that excess of antibiotics in children can increase there risk of getting diabetes in future.

Why?

Step 2 CS: Hoarseness

This is a very easy case because there are limited number of  things that can cause hoarseness of voice.

Step 2 CS: What to ask in cases involving joint

Any case of joint pain, ask OPDFCS LIQRAA first.

Then, ask - Calor, dolor, rubor, tumor, functio laesa (Mnemonic: CRaFTeD)

Calor - Is the joint warm?
Dolor - Is it painful on movement?
Rubor - Does it look red to you?
Tumor - Does the joint look swollen to you?
Functio laesa - How has this affected your day to day activities?

Blast cells - Acute or chronic leukemia? Mnemonic!

Hope you are having a good day so far! :D

Acute leukemias are characterized by a predominance of blasts. Chronic leukemias are characterized by proliferation of lymphoid or hematopoietic cells that are more mature than those of acute leukemias.

Opportunity for Medical students to be part of a research study!

Hello!

We are doing a study on internet addiction among medical students in south east Asia ( Mainly 4 countries: India, Pakistan, Bangladesh and Nepal).

Step 2 CS: What to ask a patient with positive pregnancy test

What to ask if a patient comes in with a positive pregnancy test:

Step 2 CS: Back pain causes mnemonic

Back pain mnemonic: D(i)SSCC

Step 2 CS: Hearing loss mnemonic

Hearing loss mnemonic:

EBOLA
MBOLA

It’s a desi (Indian) Medico’s thing! Part 2

Neighbours/Relatives: (Knowing that I am taking up internal medicine) So, you want to become a cardiologist later?

Me: Yes, it’s a possibility.

N/R: Nice. So, how long before you start performing surgeries?

Me: Never

N/R: WHAT?!?! Why?

It's a desi (Indian) Medico's thing!

Neighbours/Relatives: What specialization are you taking?

Me: Internal Medicine/General Medicine

N/R: You mean general physician?

Me: Yes

N/R: Chi, Yuck, Thuuu, Ayyoo (disgusted)

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

Step 2 CS: Asking for sexual history

Sexual history is always a dilemma for step 2 Cs exam takers. Here's a simplification.

Are you sexually active?
Patient will answer either "Yes" or "No"

If no: Don't ask why and make it awkward. If the patient has problems, he will tell you.

If yes: How many sexual partners have you had in the past one year?

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?

Dr. Thinker: Personal Statement

-          Some say it is very important and some say they only read it after you are offered an interview.

-          Either way, I would say not to take it easy. Just think it as one of those minimum things which we can do to secure our future.

1.      When to start writing?

-          Start writing it as early possible. Don’t delay. The correct time to start writing or think about it is NOW.

-          You will end up making many drafts and corrections.  You would want to make changes even few seconds before applying. You would literally cry if you keep it for the end.

Dr. Thinker: FAQs asked by the members of the USMLE page

1.      Second match guys did you tell the program its your second match and did they ask u?

A.      I mentioned it in my PS that I didn’t match last year. The interviewers mentioned that they noticed it.  At a couple of places where the interviewer didn’t read the PS, they asked me whether I applied for last match.

2.      IM LOR for neuro advisable?

A.      Only, if you don’t have enough LORs from Neuro.

3.      Please mention what extracurricular activities we could add on to our CV and if it is really necessary?

Dr. Thinker: What to expect during the interview season?

-          Accept the fact asap that the whole process is UNCERTAIN.

-          Be ready to face many depressive circumstances.

-          On the good side, you will see new places, meet many people and some of them become your support for the rest of the season and friends for life.