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.

Dr. Thinker: SOAP

-          Everyone who doesn’t match will be automatically eligible for SOAP.

-          Everyone gets an email regarding SOAP 2-3 days before the match results are out. This is a common email for everyone. It doesn’t mean that you will go unmatched.

-          There is a very common saying – “ SOAP is a LOST Cause”.

-          It is very difficult for an IMG to match in soap as they usually take unmatched AMGs in Soap. But, don’t give up. Try till the end. You could be an exception.

Dr. Thinker: Rank order list (ROL)

-          You can start making the list from mid Jan until the last Wednesday of Feruary.

-          The deadline for ROL submission would be on the last Wednesday of Feb. The programs have the same deadline as you.

-          You can create a list and keep changing it until the deadline. But, everytime you edit the list make sure to certify it. You will get an email notification saying your ROL has been submitted succefully.

-          Start working on your list as soon as possible so that you can do enough research about the programs where you had an interivew.

Misconceptions and the way to rank:

Dr. Thinker: Contacts in the USA

When you say you don’t have any contacts in the USA, if you give up because of it or if you blame everything on this factor, then you are only ridiculing yourself.

-          Yes, having contacts will help in a big way.

-          With a proper strong contact it can be a cake to matching. And, yes you will come across such people. Don’t be jealous of them. Remember, you would have done the same thing if you had such contacts.

-          But, you will also many people reaching the end without any contacts, without even a family member to support in the USA.

-          So, don’t worry about something which you can do nothing about.

CONTACTS don’t just happen for everyone, you have to make them!

Dr. Thinker: Factors related to the MATCH

What are the factors that go into one’s match?

-          It is a mixture of various things.

a.      Contacts

b.      A word from your attending – if they personally email or call

Dr. Thinker: Post interview communication with the programs

1.      Whom should you send you a thank you note?

-          You can email

A.      Program director

B.      Program coordinators – they are important

C.      Your interviewers

D.     The residents you met on the iv day

2.      Should you email or send a hand written thank you letter?

Dr. Thinker: Phone interview

-          Some programs might do a phone pre-interview first before they select you for an actual in person interview.

-          Otherwise, phone interview is common during SOAP.

-          It’s just like a regular interview. It’s a little easier as you don’t have to dress up, don’t have to worry about your expressions.

-          But, you have to take care about the length of your answers and your tone.

Dr. Thinker: Interview season and FAQs related to interviews

1.      When should you be in the USA?

-          I would advise you to be in the USA, at least from the 1st of Oct until end of Feb (Rand order list submission) or Match day ( if things doesn’t go as planned, it’s better to be in the USA for SOAP).

-          If you are in the USA, you can contact programs by telling that you are in the vicinity and so can make it to the interview at a moment’s notice.

-          Even in February there are chances to get an interview due to last minute cancellation by others.

Dr. Thinker: Contacting the programs after Sep 15th

1.      Can you contact the programs to review your application? If so, when is the right time?

-          Of course, you can contact the program coordinators to review your application.

-          One of the biggest misconceptions during the interview season is to NOT contact the program early (like until end of October).

-          You will see a lot of people especially on facebook pages and usmle forums strongly advising you not to contact them. Don’t believe them. Most of those, especially the ones with fake identities would be just trying to screw with you. They would mislead you to cut down their competition.

-          You can start emailing program coordinators from the end of September or preferably

first weeks of October.

-          The tone of your email should be in a requesting manner.

-          You can even call the program coordinators. But, before you rub your information on them, first enquire if they are free and comfortable to talk about your application. Proceed only if they say yes.

-          I just stated this from my own experience. I am just clearing the misconceptions. I am in no way forcing you to do it.

Dr. Thinker: NRMP registration

-          Register as soon as possible, before the end of November to avoid late fee.

-          NRMP registration is a must to be able to participate in the MATCH.