Pox in a box

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Let me get this straight...is it necessary to ask EVERY single patient you encounter of Step 2 CS their sexual history, drug history, and alcohol history? It makes for an odd transition and will consume an awful lot of time, especially if you have a neuro complaint. It seems irrelevant in many scenarios to go into such an "H&P" mode.
 
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deleted113029

Let me get this straight...is it necessary to ask EVERY single patient you encounter of Step 2 CS their sexual history, drug history, and alcohol history? It makes for an odd transition and will consume an awful lot of time, especially if you have a neuro complaint. It seems irrelevant in many scenarios to go into such an "H&P" mode.

Well, you bring up a good point. it may seem like wasting a lot of time, but i had no time issues. by looking at the initial patient info, ask pertinent questions and just fire the rest of the questions quickly. I did that for EVERY patient and passed...but that's just how i did it.

I transitioned from the CC&HPI by saying, "now i'll be asking about your past medical history and your lifestyle." If they said they smoked or drank a lot, i just asked if they thought about quitting and that i would be there to help in whatever way possible.

i know it seems like a lot to ask but the key is to have no pauses in questioning the patient. First Aid CS is a good book to review the week before the exam. (i spent 5 days studying from FA.)
 
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deleted113029

How do you study for CS in the first place?

i 'studied' by practicing my physical exam on my wife so that it would be complete and efficient. the history part, i just reviewed pertinent questions to ask depending on the system in question. Differential Dx and Work-up are areas that one can review also...helpful if you want more than just 2-3 DDx on a patient who seems to have a 'no-brainer' Dx.
 
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Pox in a box

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Well, you bring up a good point. it may seem like wasting a lot of time, but i had no time issues. by looking at the initial patient info, ask pertinent questions and just fire the rest of the questions quickly. I did that for EVERY patient and passed...but that's just how i did it.

I transitioned from the CC&HPI by saying, "now i'll be asking about your past medical history and your lifestyle." If they said they smoked or drank a lot, i just asked if they thought about quitting and that i would be there to help in whatever way possible.

i know it seems like a lot to ask but the key is to have no pauses in questioning the patient. First Aid CS is a good book to review the week before the exam. (i spent 5 days studying from FA.)

So even though it sounds strange, you would ask a patient with (a) an acute cough, (b) forgetfulness, (c) insomnia, (d) hemoptysis, and (e) chronic diarrhea about their sexual history (activity, # of partners, condoms, etc.)? I assume you can just one-line it and get credit...just brisk the surface on these scenarios where sexual history just seems like a check box for the SP.
 
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deleted113029

So even though it sounds strange, you would ask a patient with (a) an acute cough, (b) forgetfulness, (c) insomnia, (d) hemoptysis, and (e) chronic diarrhea about their sexual history (activity, # of partners, condoms, etc.)? I assume you can just one-line it and get credit...just brisk the surface on these scenarios where sexual history just seems like a check box for the SP.

strange as it sounds, yes. sexual Hx is kinda important (not trying to be a smartass): syphilis-related dementia, chronic diarrhea with immunocompromised patients, etc.

your approach is good and the one i used. didn't go into to much detail except when a female has pain/discomfort below the umbilicus. the one-line approach took all but 20 seconds or so.
 

JCserver3

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You don't have to get every "check box" to pass so make sure you are not skimping on any part of the history. Always ask smoking/alcohol/drugs/occupation. Always get full PMH including meds/allergies.
 

pillowhead

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You don't have to get every "check box" to pass so make sure you are not skimping on any part of the history. Always ask smoking/alcohol/drugs/occupation. Always get full PMH including meds/allergies.

i agree. i only once asked a sexual hx (in a patient with a gyn complaint). always asked "do you smoke cigarettes? do you drink any alcohol--beer wine or liquor? the smoking question is good because it gives you a chance to do some quick counseling. the meds is important because of side effects like with NSAIDS for example--they cause a ton of stuff.

oh, and i passed.
 

IFNgamma

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yes, you should ask sexual hx, drug hx, alcohol hx on EVERY single patient. You need to do that not only cuz u will gets points for asking them, u need to find out those things in order to counsel the patient, which is important for your CIS score.

Just use this mnemonic and it should be very easy: PAMHUGSFOSS

P = PMH
A = allergies
M = meds
H = hospitalizations
U = urinary complaints
G = GI complaints
S = Sleep problems
F = Fam Hx
O = OB/GYN Hx
S = sexual Hx
S = Social Hx

for Social Hx, u can use SODA

S = smoking
O = occupation
D = Drugs
A = alcohol (ask CAGE if necessary)
 

doc901333

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I failed the first time b/c I didn't ask every irrelevant question mentioned above. Just remember that this is a game. You can ask all of this sh!t if you practice. Don't end up taking it twice. It was hard coughing up the money the first time, much less the second.
 

Pox in a box

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If you forget to do a physical exam maneuver (for example, forgot to check for CVA tenderness, do the psoas sign, or do the obturator sign in an abdominal pain case), should you still include this in your patient note? Are the SP and the physician scorer of the PN in communication with one another?
 
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deleted113029

If you forget to do a physical exam maneuver (for example, forgot to check for CVA tenderness, do the psoas sign, or do the obturator sign in an abdominal pain case), should you still include this in your patient note? Are the SP and the physician scorer of the PN in communication with one another?

don't risk it! i had that happen several times and still passed.
 

megsMS

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One of our top administrators just went to a conference where they interacted with SPs and they said that it doesn't add points if you ask every patients about their sexual history...it's only needed if it's pertinent; i.e. if someone has chest pain you don't need to do it

yes, you should ask sexual hx, drug hx, alcohol hx on EVERY single patient. You need to do that not only cuz u will gets points for asking them, u need to find out those things in order to counsel the patient, which is important for your CIS score.

Just use this mnemonic and it should be very easy: PAMHUGSFOSS

P = PMH
A = allergies
M = meds
H = hospitalizations
U = urinary complaints
G = GI complaints
S = Sleep problems
F = Fam Hx
O = OB/GYN Hx
S = sexual Hx
S = Social Hx

for Social Hx, u can use SODA

S = smoking
O = occupation
D = Drugs
A = alcohol (ask CAGE if necessary)
 

Pox in a box

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One of our top administrators just went to a conference where they interacted with SPs and they said that it doesn't add points if you ask every patients about their sexual history...it's only needed if it's pertinent; i.e. if someone has chest pain you don't need to do it

I'm not going to risk it. If they say, "No, I longer have sex with my wife because it hurts my chest too much" I'm going to be thankful I still asked.
 

IFNgamma

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One of our top administrators just went to a conference where they interacted with SPs and they said that it doesn't add points if you ask every patients about their sexual history...it's only needed if it's pertinent; i.e. if someone has chest pain you don't need to do it

No you still need to ask it, and why not? it will be quick.

You don't know which case requires it and which one doesn't.
 

pillowhead

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So you left it out of your note even though you KNEW it should be there?

I did not include stuff on my note that i did not do in the exam even though i knew i should have done it in the exam. better to leave it out than to have a discrepancy between what the SP says you did and wha you said you did. besides, what are you going to write on your note? say you forgot the obturator exam in a patietn with abd pain? it could have been neg or pos.

and just to reiterate, i only asked one of my patients sexual hx and passed. i think people get a little too paranoid about this exam.
 
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