I can see that you are distressed about an event that occurred in your life. We have some medical therapy available that can help you with this. Medicines take time to work, in the mean while I can get you in touch with some support groups and social help organizations that have patients who have witnessed similar traumatic events in their life.
Monday, April 25, 2016
Saturday, April 23, 2016
Step 2 CS: Physical exam findings in a patient with calf pain
We were practicing a case of calf pain (DVT / cellulitis) today and my friends told me that I documented the physical examination findings well, which is why I posted the note on the blog :)
Things in brackets are for reference only and I didn't type those in my 10 minutes encounter.
Things in brackets are for reference only and I didn't type those in my 10 minutes encounter.
Thursday, April 21, 2016
Step 2 CS: Headache LOC tip
In a case of headache or loss of consciousness, any weakness or numbness is the first question you ask - because if there is anything suggestive of stroke or transient ischemic attack, you can time yourself to do a neuro exam which includes cranial nerves and strength, reflexes and sensations.
Sunday, April 17, 2016
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.
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.
Thursday, April 14, 2016
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
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
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
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?
Wednesday, April 13, 2016
Step 2 CS: Hoarseness
This is a very easy case because there are limited number of things that can cause hoarseness of voice.
Tuesday, April 12, 2016
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?
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.
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).
We are doing a study on internet addiction among medical students in south east Asia ( Mainly 4 countries: India, Pakistan, Bangladesh and Nepal).
Monday, April 11, 2016
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:
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?
Sunday, April 10, 2016
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)
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:
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?
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?
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?
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?
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