Feel like you bombed CS?

[Skills of House]

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I must really suck at the "search" engine on here because I did a search for others view points on this and got the big goose egg! Anywayz, seriously, I am freaking out a little bit over CS. I took it last week, and there are literally dozens of things that I know that I left out. I generally take a pretty good hx so that part came easy, but most of my PEs were shoddy (sp?) at best. Of course I would listen to the heart and lungs and make the occasional attempt at an abdominal exam. But NONE of my exams were complete AND I walked out realizing that I completely f-ked up one of the diagnosis (and of course in retrospect the diagnosis is just mind-numbingly obvious!!!) I even forgot to ask a parent if a sick kid was in day care or had sick contacts! I am seriously worried. And none to VERY few of my cases were obvious in my opinion. And I was extremely surprised by this because all I kept hearing from people was how straight forward the dx was and how well the sp's played the part. Don't get me wrong, some played the role to perfection and a few times I almost forgot that it was even an exam, but several of the others, I was just like wtf is wrong with you?! For example, I palpated one guy's abdomen and he shows no sign of discomfort whatsoever, so I just ask nonchalantly "did you have any pain or tenderness" expecting the answer to of course be "No" and he's like "yeah, actually I felt soreness in every place you touched!!" And I specifically said before hand as well "let me know if you feel any pain or tenderness." I was so pissed at that guy I didn't know what to do! If anyone else had disastrous experiences and later remembered that you forgot 1001 things but still managed to pass, PLEASE share your story and provide hope!!!!!

 

[Biscuit799]

Don't worry about it. When I took it, I went to the hotel bar the night before, and completely botched one of the rooms (as in did the completely wrong physical exam), and in a couple other rooms had no idea what to do. I left thinking that I had failed, and ended up doing fine. The moral of the story is that with CS, don't worry about it as you probably passed. Best of luck!

 

[gonogo]

I honnestly wouldn't worry at all. I felt exactly that way. I made so many mistakes in that test, forgot to do so many things, missed a couple of differentials, etc... when I left the exam I was almost sure I had failed it and in the end I passed.

 

[Dr McSteamy]

while you do have a 95% chance of passing,.......

yeah, some cases aren't so straightforward.
on my test day, i had 4 CC's of fatigue in a row. they were all different ages, and you had to try to figure out the cause. could be pregnancy, anemia, depression....... etc. i went with more common differentials, since this test is supposed to test the common.

 

[Skills of House]

Thanks my fellow SDN'ers for the replies, I feel a little better knowing that at least I'm not the only one who walked out feeling absolutely positive that a "mulligan" was going to be necessary! No sense stressin over it anyway I suppose seeing as according to the USMLE site results don't come back til mid October...and that's if they're on time!

 

[radiomedicine]

well i posted my experience under another topic ..
but please let me know if there are any hopes for me..

seems like i made the biggest blunders ever ;;
1. had many cases which needed counselling for alcohol or smoking or diabetes care but. . counselled only two. .

2. had 3 social cases which warranted asking about abuse or depression due to stress or adjustment problems. . completely missed out on those 3 cases. . another gross mistake. . HUGE

3. didnt tell anyone about any specific diagnosis. . just said it could be this system problem. . we will do tests and find out and tll you. .

4 came out 6 minutes early in most cases. . and at least 2 mins before in others. . couldnt finish neuro exam or do counselling in one. .

5. badly screwed a paediatric case. . didnt ask ANY history related to paeds case.. that was the worst case i guess..

6. pt coughed but absolutely ignored it..

 

[Dr McSteamy]

3. didnt tell anyone about any specific diagnosis. . just said it could be this system problem. . we will do tests and find out and tll you. .


6. pt coughed but absolutely ignored it..

3. that's fine, i think. you're not supposed to tell them a specific diagnosis. only differentials.

6. one of my pts was a smoker, and was coughing. cough was also the CC. So when she coughed while I was doing the resp exam, I also ignored it.

 

[Babycatcher2B]

3. that's fine, i think. you're not supposed to tell them a specific diagnosis. only differentials.

6. one of my pts was a smoker, and was coughing. cough was also the CC. So when she coughed while I was doing the resp exam, I also ignored it.

I asked two of my patients who were coughing if they needed tissue, both of them refused. I forgot about water, LOL. 😛

 

[Dr McSteamy]

I asked two of my patients who were coughing if they needed tissue, both of them refused. I forgot about water, LOL. 😛

i didn't even think about that stuff on test day. but now that you remind me, i read it in FA.

when i was a kid, none of my dr's ever offered anything when i was coughing.

I'd naturally offer tissue if they had profuse snot. but not a regular cough.


anyhow, the pt was only coughing during the resp exam. not throughout the interview. so i thought nothing of it. hope they didn't minus too many points

 

[Skills of House]

i didn't even think about that stuff on test day. but now that you remind me, i read it in FA.

when i was a kid, none of my dr's ever offered anything when i was coughing.

I'd naturally offer tissue if they had profuse snot. but not a regular cough.


anyhow, the pt was only coughing during the resp exam. not throughout the interview. so i thought nothing of it. hope they didn't minus too many points

I checked peripheral pulses on a girl with suspected HOCM and realized later (long after I'm out of the room of course) that I never even checked the carotid ... DOH!😱
I also did a thyroid check on a pt and didn't offer water, I just said "swallow"
And I never left the room early, I always stayed and pretended to adjust my clipboard paper or jot down notes (in reality I was scribbling) just in case stg else popped in my head. And most of my cases I finished pretty early though not so much due to efficiency as a completely half-*****ed PE!

 

[Dr McSteamy]

I checked peripheral pulses on a girl with suspected HOCM and realized later (long after I'm out of the room of course) that I never even checked the carotid ... DOH!😱
I also did a thyroid check on a pt and didn't offer water, I just said "swallow"
And I never left the room early, I always stayed and pretended to adjust my clipboard paper or jot down notes (in reality I was scribbling) just in case stg else popped in my head. And most of my cases I finished pretty early though not so much due to efficiency as a completely half-*****ed PE!

swallowing without water is fine. that's how i learned it. it's clumsy and inefficient to give water, as they have to hold the water in their mouth until you are ready. stupid technique IMO.

I'm sure most people do a semi crappy PE. there's just no time.
I tried to do a full neuro exam. fuggedabout that!

 

[Ypo.]

A couple of my cases were like WTF??

My PE skills were lacking for sure.

Still waiting to hear if i passed (took it end of July).

 

[smq123]

anyhow, the pt was only coughing during the resp exam. not throughout the interview. so i thought nothing of it. hope they didn't minus too many points

I think that, if they cough during the lung exam, that's supposed to be your cue to stop the exam and ask them questions. "How long have you had that cough? Do you have that cough while you sleep at night? Ever bring up any blood or dark green mucus with that cough?"

Like I said, all the SPs have a hidden "agenda." If you uncover that agenda, you should be okay.

swallowing without water is fine. that's how i learned it. it's clumsy and inefficient to give water, as they have to hold the water in their mouth until you are ready. stupid technique IMO.

In the rooms (at least in Philadelphia), there were small paper cups available. I used those to give the patients water to help them swallow. Those cups were on the shelf in the room, I think.

 

[Dr McSteamy]

I think that, if they cough during the lung exam, that's supposed to be your cue to stop the exam and ask them questions. "How long have you had that cough? Do you have that cough while you sleep at night? Ever bring up any blood or dark green mucus with that cough?"

nope. I got all that info from the thorough history I took BEFORE starting the PE. cough was her CC, i think.
i just thought it was natural for her to cough, so i didn't say anything.