USMLE Freaking out over the patient note

[Volkmann]

Hi guys. I would love some input regarding whether I'll fail the ICE portion. I did my exam in Houston last month and I felt ok coming out. Since then I've found the following mistakes in my patient note.
What I didn't do
Did not include pertinent negatives in the physical exam under support for my DDs. I only included the pertinent positives. Only 4 patients actually had any simulated findings. So all the other sections under PE supporting diagnosis I left blank. I thought this was fine since I had plenty to write under support for DD from the history. I did include all the negatives in the physical exam proper

What I did do
Completed all my notes including workup. Included pertinent negatives under HPI and physical examination. Most if not all my DDs were acceptable.

Not writing pertinent negatives and leaving it blank really seems like a fatal mistake. Please provide some feedback and input. Thanks in advance.

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[Phloston]

Hi guys. I would love some input regarding whether I'll fail the ICE portion. I did my exam in Houston last month and I felt ok coming out. Since then I've found the following mistakes in my patient note.
What I didn't do
Did not include pertinent negatives in the physical exam under support for my DDs. I only included the pertinent positives. Only 4 patients actually had any simulated findings. So all the other sections under PE supporting diagnosis I left blank. I thought this was fine since I had plenty to write under support for DD from the history. I did include all the negatives in the physical exam proper

What I did do
Completed all my notes including workup. Included pertinent negatives under HPI and physical examination. Most if not all my DDs were acceptable.

Not writing pertinent negatives and leaving it blank really seems like a fatal mistake. Please provide some feedback and input. Thanks in advance.

It's a good question but I think you're probably fine. If you look at the two sample notes on the USMLE website, the examination findings have essentially nothing written in them. All of the notes are a point system, so you'd be talking a couple points here and there if that. If you feel you did everything else well, on average, then you passed.

 

[Volkmann]

It's a good question but I think you're probably fine. If you look at the two sample notes on the USMLE website, the examination findings have essentially nothing written in them. All of the notes are a point system, so you'd be talking a couple points here and there if that. If you feel you did everything else well, on average, then you passed.

Thanks for the reply Phloston. I actually did write a detailed physical examination for everyone. I just didn't include anything under exam findings for the differential diagnoses. For example people are telling me I should've put stuff like NO CVA TENDERNESS for physical examination points supporting a diagnosis of bladder carcinoma. FA pretty much has NO examination findings supporting the differentials, so I'm hopeful. The wait is agonizing though. Failing this means years of studying for step 1 & step 2CK are down the drain.

 

[palakas]

My understanding is that only including the pertinent negatives in the PE notes is sufficient as per the FA cases PNs.

 

[Phloston]

Thanks for the reply Phloston. I actually did write a detailed physical examination for everyone. I just didn't include anything under exam findings for the differential diagnoses. For example people are telling me I should've put stuff like NO CVA TENDERNESS for physical examination points supporting a diagnosis of bladder carcinoma. FA pretty much has NO examination findings supporting the differentials, so I'm hopeful. The wait is agonizing though. Failing this means years of studying for step 1 & step 2CK are down the drain.

I have to admit that FA isn't bad - it's terrible - when it comes to the DDx, Hx/PE findings because its format doesn't match the USMLE at all, and that's not even taking into account DDx/Ix they have are superfluous.

 

[Volkmann]

I have to admit that FA isn't bad - it's terrible - when it comes to the DDx, Hx/PE findings because its format doesn't match the USMLE at all, and that's not even taking into account DDx/Ix they have are superfluous.

Are you looking at the two patient note examples given under practice material in the usmle step 2CS Web page?? They say that those aren't ideal. I believe one of them doesn't even have family history etc. In the HPI section. I don't know what to follow to be honest. If I fail at least I'll know what to do differently.

 

[Phloston]

Are you looking at the two patient note examples given under practice material in the usmle step 2CS Web page?? They say that those aren't ideal. I believe one of them doesn't even have family history etc. In the HPI section. I don't know what to follow to be honest. If I fail at least I'll know what to do differently.

Those notes on the website are what is to be expected.