I have a few questions about Step 2 CS

[PowerDan]

1) Is it absolutely necessary to do Heart, Lung and Abdominal examination for every case? Like even for a case of migraine or tension headaches?
I ask because I am seeing people (on older posts of forums) who passed and said they did CVS, Respi and Abd examination for every case regardless.

2) Is it necessary to ask Ob-Gyn history for every female patient regardless of their presentation?

3) Is it necessary to make small talk with the SPs? (mild jokes, talk about the weather, etc). I am seeing people who seem to have done everything else right and didn't make small talk, and they failed.

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[shouldigomd]

1) Is it absolutely necessary to do Heart, Lung and Abdominal examination for every case? Like even for a case of migraine or tension headaches?
I ask because I am seeing people (on older posts of forums) who passed and said they did CVS, Respi and Abd examination for every case regardless.

2) Is it necessary to ask Ob-Gyn history for every female patient regardless of their presentation?

3) Is it necessary to make small talk with the SPs? (mild jokes, talk about the weather, etc). I am seeing people who seem to have done everything else right and didn't make small talk, and they failed.

I have never heard of small talk lol... Bottom line is just be logical. Patient says he drinks a glass of wine with dinner 1x/wk ... not necessary to CAGE him...

1) Most people do at least basic cardio / lung for every patient just like in real life. Time permitting I would add 1-2 extra tests depending on the patient. Back pain / Diabetes you can do patellar reflex and sensation. Pneumonia you do a more extensive pulm like fremitus / ergophany. Cardio a more extensive cardio like JVD / heave. Also you can pick something that applies to most systems and do it quickly for every patient. I chose peripheral pulses which I did for every patient because it was so fast and easy. Honestly you can probably do basic cardio/pulm/peripheral pulses for every patient and be fine ...

2) Nobody knows what is necessary but think about it logically. I only asked OBGYN questions if it was relevant. 56 year old female having headaches ... maybe relevant to ask when menopause was. Vaginal bleeding ... obviously. But if she is coming in for DM follow up not necessary to ask about how many pregnancies, abortions, normal cycle, etc. But do ask sexually active / STI's / last pap for every relevant patient as part of normal screening. I wouldn't really ask a 85 year old woman with COPD if she was using condoms.

3) I don't know what you mean by small talk but I never asked how the weather / etc. I was just genuinely nice and non awkward. Show a little bit of natural empathy which is where that component of your score comes from ... not asking about the mets game last night. They cough, offer a tissue. They are angry ... ask them why and say is there anything you can do. Introduction is the most important thing imo. Hi good morning my name is dr. John are you Bill? Hi Bill its nice to meet you, how are you feeling today? Oh I am sorry to hear that I hope we can get to the bottom if it and have you feeling better soon. Anything I can do to make you more comfortable? Is it ok if I address you as bill? Ok, great, I would like to ask you some questions and perhaps a physical exam if thats ok with you? Awesome, lets rock...

 

[Leafcolonel]

1) No it's not necessary unless you have extra time, do a focused examination on whatever the chief complaint and the differentials indicate. And if necessary go into more detailed system exams for those systems. I did not do CVS/Resp for half the cases and had higher performance in ICE.
2) I think it's safer to go through the motions than be sorry, especially with females below 50 where it's essential to r/o any pregnancy, sometimes you need to counsel patients regarding the sexual history too.
3) Nope. Like the above poster said, be professional and be empathetic and use basic communication skills and you should be fine.

 

[Snowdon48]

Just remember that nobody really knows exactly what is required. So all answers you get on this forum will just be educated opinions.

1) In MY opinion the answer is no, you don't need to do heart, lung, abd unless the case specifically calls for it. This was my strategy and I passed easily.

2) If they are the right age, you should at least ask if they could be pregnant and the LMP. If further history or counseling is warranted, do it.

3) I made 0 attempts at small talk and all my stars were well above the borderline zone. I was empathetic and respectful but didn't try to be their buddy. I think that's too much.


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[Melatonin87]

There are only 3 things you need to pass this exam.....1) Show up 2) Make eye contact 3)Speak English! Honestly, I have no Idea how people fail this exam. I not only passed, I passed with a star in ICE and SPE with high marks in CIS. I messed up so much I was sure that I failed. So after receiving my results, I came to the conclusion that you must be pretty arrogant or just straight up incompetent to fail this exam. Don't read all the blogs saying, "I just failed CS I don't know what to do???? (((" These are all fear mongers who were probably the last in their classes, and just won't get the hint that medicine is not for them. Keep confident they like confidence.

 

[PowerDan]

Thank you so much for your replies, guys. That was really helpful. I have one more query - it is regarding the list of permissible abbreviations.

What abbreviations - other than those listed in the official manual are safe to use (or the ones that you used personally while typing the patient note)?

Would writing the PE portion of the patient note like this be OK?

GEN: AAOx3; NAD
HEENT: EOMI; PERRLA; moist mucus membrances; -ve scleral icterus; -ve conjunctival pallor; -ve tonsillar erythema, enlargements, exudates
NECK: supple; -ve LAD
CVS: RRR; normal S1 S2; no M/R/G
LUNGS: CTA B/L; no W/C/R
ABD: + BS in all 4 Qs; tympanic to percussion; soft/NT/ND/-ve HSM/no palpable masses
EXTREMITIES: 2+ pulses throughout; no edema; no cyanosis, clubbing

 

[PowerDan]

Anyone please?

 

[PowerDan]

I also have one other query.

I keep running out of lines while practicing the PN on the official website.

Is it okay to write different subheadings in the same line to save space?

For example, write the history portion of PN as :

"HPI : .....
ROS : As in HPI, Allergies : NKDA, PMH : None, PSH : None, FH :..."

Instead of

"HPI :....
ROS : As in HPI
Allergies : NKDA
PMH : None
PSH : None
FH : ...."

I know the second way looks nicer, but I keep running out of lines if I do it that way :/

Anyone else faced the same problem?

Any input at all...please?