Another Step II CS panic thread

[RedRaider2014]

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So, I realize that multiple people have posted over the last year fearing that they failed Step II CS. It seems like the majority of them ended up doing just fine. I felt pretty good about the test right after finishing it, but am now panicking that I may have really messed up.

Some things I'm really concerned about:
- I was pretty confident that most of my differential diagnoses were well within reason, but I would say that I only listed 1-2 supporting details from the history on ~ 70% of my differential diagnoses. I didn't list supporting details on the rest of my diagnoses. I either didn't have enough time, or just thought that there wasn't much more detail I could include.
- Looking back at my cases, I'm pretty confident in most of work-up orders. Reviewing first aid got me geared towards ordering more follow-up studies than I would have originally been comfortable doing. I have now learned that they dock for "extraneous" tests
- Physical exam - I only listened to 4 places on the lung exam (but inspected, percussed and evaluated for fremitus when indicated); I rushed my abdominal exam and didn't spend "3 seconds" palpating or auscultating
- I ran out of time and couldn't list Social History, Allergies and Meds in one case
- May have accidentally documented a couple things I didn't ask about

Things I did well
- Alway knocked, shook hands, said patient's name, started with open ended questions, washed hands, summarized, expressed empathy, counseled when appropriate, debriefed patients
- HPIs were accurate and thorough
- Always asked about PMH, PSH, Social, Meds, Allergies, OB/GYN, Family history, Growth/Development and documented appropriately
- Did heart/lungs on every patient with additional physical exam components as needed
- Physical exam was documented well
- Was confident with most of my differential diagnoses
- Ordered appropriate tests (and a couple I maybe shouldn't have)

Mainly, I'm worried about me not having enough "supporting details" for my differential. Looking back, I probably should have included more. Anyone else have a similar experience and is willing to share their result?

 

[doopdidoop]

you did way more than me...consistently and I comfortably passed. stay off SDN and try and put it out of your mind!

 

[hoopie]

You passed

 

[thecalccobra]

You passed with high performance

 

[sakata8242]

As long as you didn't take it in Philly you're probably fine.

 

[darkpassenger17]

I know there is almost nothing anyone can tell you that will prevent you from reading every thread and freaking out until you get your score and I feel your pain. I felt terrible after the exam and was sure I failed and I passed with nothing even close to borderline. I took it in Chicago.

"Physical exam - I only listened to 4 places on the lung exam (but inspected, percussed and evaluated for fremitus when indicated); I rushed my abdominal exam and didn't spend "3 seconds" palpating or auscultating"

Physical exam was the thing I worried about the most and thought I was going to fail solely because I did such half-assed exams. I had 3 MSK cases and NEVER did more than inspection, palpation, and ROM. I never did a "special maneuver". Mostly because they were always in pain and I was under the impression that we weren't supposed to do anything that would put them in more pain. Except of course when a patient told me she couldn't bear weight on her ankle and I made her walk across the room and back. I don't know what I was thinking, and I was seriously worried that would be an automatic fail. I only did heart and lungs if I thought it was necessary and I never did more than inspect and auscultate. You may have rushed a single abdominal exam but I pretty much rushed every part of mostly every exam.

This is all in addition to 3 cases where I had no idea what they were trying to get at with a super vague CC and suspiciously zero other complaints, associated symptoms, or any other history that might provide some clue.

I wish you luck getting through the time left until you get your score back. This test is ridiculous, but based on what you said I agree you very likely passed by a high margin, its just so hard to realize that before you get the official score.

 

[RedRaider2014]

Thanks for the info guys. It's gonna be a long two months before I get my results back, but I take some solace in knowing that other people seemed to have done less or were less confident after leaving the test and did just fine. I just keep thinking about not really strongly justifying my differentials and hope that it doesn't hurt me too much. I usually justified my first and maybe second with 1-2 details, then often left the 3rd diagnosis unsupported. I really didn't think it was all that important and focused more on the work-up with time constraints. Hoping the next couple months go by fast. (Btw, didn't take it in Philly)

 

[hoopie]

Thanks for the info guys. It's gonna be a long two months before I get my results back, but I take some solace in knowing that other people seemed to have done less or were less confident after leaving the test and did just fine. I just keep thinking about not really strongly justifying my differentials and hope that it doesn't hurt me too much. I usually justified my first and maybe second with 1-2 details, then often left the 3rd diagnosis unsupported. I really didn't think it was all that important and focused more on the work-up with time constraints. Hoping the next couple months go by fast. (Btw, didn't take it in Philly)

No seriously, you passed. We've all been in your position, I know how easy it is to fixate on what you think are big mistakes. But based on what you wrote, you don't have anything to worry about. Don't torture yourself for months. Relax and enjoy life. If you spend the next few months worrying you're going to feel silly when you see that you passed easily. Relax and most importantly avoid reading message boards like this, it'll only start freaking you out. I'm telling you!

 

[HarryPlopper]

You did fine. The only thing you mentioned that could haunt you is the erroneous documentation. However it seems much more likely you're being paranoid than any significant problem. It's done now focus on rotations.

 

[Salt and Lime]

It's a horrible feeling, waiting for the results. I, too, felt like I had very little supporting evidence for my differentials and was worried I would fail based on that. I also couldn't always think of 3 that fit the HPI and had some really ridiculous diagnoses thrown in at times. I passed comfortably and I'm certain that you did, too. I also know that nothing I or anyone else says will make you feel better until you open that score report and see "Pass." I almost cried when that happened; I was more nervous about passing Step 2 CS than I was about the match.

 

[Good Samaritan2]

sorry to add onto this 'panic thread' but just wanted to put down my experience from the step 2 cs in chicago today. I am freaking out like crazy going over the things i did wrong/missed.

For one of the cases, i forgot to do an snellen eye chart for vision for a htn pt as well as forgetting to check her pulses. I did check eyes tho. dammit, now that i think of it, I forgot to do an entire neuro exam on her due to her lightheadness. forgot to order a cholesterol panel for her high cholesterol. forgot to order a test despite me telling her I was gonna order one for her and didn't do an entire cardio exam. fml.

For another case, i totally forgot to do a particular test for a pt (i knew my diag though) but also forgot to order a couple of necessary tests for my diagnosis. (i learned from my mistake and put those tests in a diff case as it was my number 2 diag for that pt)

Another case I didn't order a for a particular test which i feel was needed.

For another two cases, i had absolutely NO CLUE WHAT THOSE PTS HAD. I had to put down something and did best I could then.

For another case I forgot to order a test for aftereffects of his diag. (but got everything else). Didn't fully counsel him about his alcohol.

For another case I just did not put down the right diagnosis down which was so beyond stupid as I had other differential that could have worked and my diagnostic workup was also pertinent for the diag. i forgot to put down

Another case, I forgot to to order a diag. test for his foot and didn't get the correct diagnosis down and the 2nd ddx i had i didn't order the necessary tests for.

For another case, my correct diagnosis (which I realized later was correct) was number 2 on my ddx.

I wasn't able to fully close like 3 cases as well as time was running out.

I gowned and checked heart/lungs for every single pt. I also did abdominal exams as needed as well as neuro exams and special tests as needed. I always asked for permission to do a physical exam on a pt and always gowned them back up as well as draped them when needed. Answered any questions they had. Outside of the mess up of forgetting to put down my correct diagnosis and the other two cases which I had no clue on, I feel the correct diagnosis is on the list with the necessary workup. I washed my hands before any PE as well and gloved as needed for most part. I also did retie their gowns as needed. Was polite and summarized for most part for most of the cases. I also did the CAGE questions for the alcoholics tho.

But I didn't get a whole lot of feedback by the SPs hence I'm freaking out more cuz i'm worried they didn't like me even though I tried to show empathy (for past losses in family etc.) and tried to explain what I was going to do for a workup.

this is going to suck.

 

[Good Samaritan2]

also forgot to add, I think I messed up another case, diag. wise. fml. Any kind of feedback would be greatly appreciated. Thanks. I'm so beyond worried.

 

[RedRaider2014]

Just wanted to update that I passed the exam. Thanks for the posters who offered words of encouragement. It was a long wait.

 

[Bronchiectasis]

sorry to add onto this 'panic thread' but just wanted to put down my experience from the step 2 cs in chicago today. I am freaking out like crazy going over the things i did wrong/missed.

For one of the cases, i forgot to do an snellen eye chart for vision for a htn pt as well as forgetting to check her pulses. I did check eyes tho. dammit, now that i think of it, I forgot to do an entire neuro exam on her due to her lightheadness. forgot to order a cholesterol panel for her high cholesterol. forgot to order a test despite me telling her I was gonna order one for her and didn't do an entire cardio exam. fml.

For another case, i totally forgot to do a particular test for a pt (i knew my diag though) but also forgot to order a couple of necessary tests for my diagnosis. (i learned from my mistake and put those tests in a diff case as it was my number 2 diag for that pt)

Another case I didn't order a for a particular test which i feel was needed.

For another two cases, i had absolutely NO CLUE WHAT THOSE PTS HAD. I had to put down something and did best I could then.

For another case I forgot to order a test for aftereffects of his diag. (but got everything else). Didn't fully counsel him about his alcohol.

For another case I just did not put down the right diagnosis down which was so beyond stupid as I had other differential that could have worked and my diagnostic workup was also pertinent for the diag. i forgot to put down

Another case, I forgot to to order a diag. test for his foot and didn't get the correct diagnosis down and the 2nd ddx i had i didn't order the necessary tests for.

For another case, my correct diagnosis (which I realized later was correct) was number 2 on my ddx.

I wasn't able to fully close like 3 cases as well as time was running out.

I gowned and checked heart/lungs for every single pt. I also did abdominal exams as needed as well as neuro exams and special tests as needed. I always asked for permission to do a physical exam on a pt and always gowned them back up as well as draped them when needed. Answered any questions they had. Outside of the mess up of forgetting to put down my correct diagnosis and the other two cases which I had no clue on, I feel the correct diagnosis is on the list with the necessary workup. I washed my hands before any PE as well and gloved as needed for most part. I also did retie their gowns as needed. Was polite and summarized for most part for most of the cases. I also did the CAGE questions for the alcoholics tho.

But I didn't get a whole lot of feedback by the SPs hence I'm freaking out more cuz i'm worried they didn't like me even though I tried to show empathy (for past losses in family etc.) and tried to explain what I was going to do for a workup.

this is going to suck.

Hey man did you pass? I know this thread was a while ago but I feel like I had a similar experience.