Give me tips on the CS

Blesbok said:

This think is really freaking me out. CK, not so much, but CS is just scaring the crap out of me.

I haven't done tactile fremitus since 2nd year standardized patients. Do you really do stuff like this?

For those that took it, lets say you have someone come in with some pleuritic chest pain, take me through what you would do as far as ROS and PE.

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First Aid for Step 2 CS is very helpful. It walks you through lots of common scenarios, like pleuritic CP.

I really don't think the physical exam portion is that detailed as people probably had to do at their schools. From what I understand, as long as you listen to the lungs in a few areas, that's good enough. But I guess I won't find out for sure until my own score comes back later this month (only been 7.5 weeks now).

tacrum43 said:

First Aid for Step 2 CS is very helpful. It walks you through lots of common scenarios, like pleuritic CP.

I really don't think the physical exam portion is that detailed as people probably had to do at their schools. From what I understand, as long as you listen to the lungs in a few areas, that's good enough. But I guess I won't find out for sure until my own score comes back later this month (only been 7.5 weeks now).

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Absolutely read FA for CS cover to cover -- it will tell you most of what you need to know. I also found it helpful to glance through Bates to remind myself the components of a couple of the exams. While I disagree with tacrum and think you need to do a bit more than just auscultate to get full credit, you certainly get more "points" making sure you do all the niceties like asking before you undo gowns, draping the patient, washing hands, narrating your way through the exam, and handling all their questions and doing counseling on all their vices. Not really an exam to stress over if you've had a family med, community med or ED rotation where you saw lots of patients in short time intervals, and jotted down a note to present to an attending/resident. If you haven't had such a rotation, or never took an OSCE, you may need to find a study partner to practice with. But generally, FA is right on the money, so get through it at least once cover to cover.

Blesbok said:

Does ROS count for anything or is it mainly to fish out the symptoms they may not be mentioning?

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Do whatever they say to do in FA. I don't think they focus on this that much.

Definitely first aid for CS.

Definately read First Aid. It will calm you down.

1. ROS matters a lot, and it needs to be specifically focused on the differential, not wide.

2. Exams are focused on the area of complaint, plus one level above and below. Very brief. Pleuritic chest pain... an acutely focused history, shorter ROS, very short family hx, ask about travel (PE), you know the drill....double check vitals for fever, RR, examine the chest throughly, the belly some, probably ankles for edema, JVP, focused, not everything, you are only expected to what's most pertinent while being thoroug, but not comprehensive. Just think of being practical, and problem/area focused, and any system directly connected to the problem.

2. READ FIRST AID STEP2 CS.... it tells you crucial things like what it means when a patients says shh, shh, shh when you are auscultating, or wears a mexican hat (travel exposures), to never forget to introduce yourself or drape (each one gets a point), to always auscultate and examine on bare skin (which we rarely did in hospital rounds). It's a good read, and really covers DDX ideas thoroughly, and the most common presentations.

3. CS is NOT HARD AT ALL....Time management, as First Aid says is the main thing that trips most people up. Practice your flow 4 or 5 times with a friend or at home, you'll probably feel much calmer.

4. Be really courteous to the patient. They will actually help you.

(Dont' be afraid to say, if you are blanking, "So, is there anything else you haven't told me that you feel I should know?"... they will remind you of things... just like in real life)

5. Dont' forget to ALWAYS reccomend protection for sexually active individuals, and council on smoking cessation, as needed.

Visualizing, and practicing the 15 minute encounter will probably remove your fear.