Aug 13, 2015
8
4
So took my CS today.

Freakin out.

Thats what i did in all cases:
1) knocked on the door
2) COnfirm patients name
3) introduced myself and my name and hand shake
4) asked can i do anything to make you feel more comfortable
5) asked, if i can ask few questions?
6) Asked HPI using LIQOPraaa or Docfapaa
7) Summarized and asked if thats accurate and if want to add anything?
8) Asked ROS using THEN FR CS PUB SAW ID
9) Now, i would like to ask some questions about your past history. is that okay?
10) did PAM HITs Foss
11) Before asking obgyn question and before sexual hx: Said, i would like to ask some personal questions but want to assure you that they are absolutely confidential. Is that okay?
12) Asked the rest
13) Now i would like to do a quick PE. is that okay?
14) Put on gloves and while putting on gloves, i was facing directly them and asked, in the mean time, do you have any questions? then made sure they were draped
15) Did the focused PE. if cardio then PMI, carotid, JVD (45 degree angle), Inspect, palpate then ausculate.
16) If resp, then inspect, palpate (TVF, chest rise etc), then listened for entire inspiratory and expiratory cycle...
17) Before doing anything, told them what i am gonna do and if you feel pain please let me know.
18) before un tying their gown, asked them and then tied it back and thanks..
19) only exposed small area to be examined and made sure they were draped.
20) abd did: inspect, ausculate for 2-3 seconds at each spot, then purcuss and then palpate. Started away from the area of pain..
21) Done. Then said, Thank you for letting me examine you. So based on your cc and what you told me, you could have this or this and thats why and thats what i would like to do..and once the results are back, ill be in touch and we'll go from there. Qs? concerns? no. okay. So now nurse will come in and will start the process and she will give you something for your pain or cough. Just wanted to make sure their cc is being addressed while i wait for the results..and then asked any qs? and then said. okay, if you have any other questions later on, feel free to call and i will be more than happy to answer your questions..THanks, shook hands and peace out..



Now where i screwed up:
1) First case didn't close. i was just dehydrated, just nervous. So i wrote the hpi but only listed 1 ddx with supporting info and 2 ddx just the name without any history. Did the workup..


Overall, I closed all cases except the first one..6-7 cases had 3 ddx with history and PE findings (if warranted) and then the workup...2-3 cases. Just had 2 DDX with the workup..and perhaps 1-3 causes had 1 ddx with hx and or with 2ddx without history due to perhaps writing too much in PE and HPI. or just blanked out...

Really pissed about the last case...i had 1 ddx with hx etc and other 2 ddx i had written on my blue sheet but just blanked out and couldn't think to look at my sheet and bam time...did the work up tho...

So how screwed am i?

Thanks for reading!!!
 
Last edited:
Mar 9, 2015
1
0
Status
Medical Student
lol. If you think you're screwed then there's definitely no hope for a lot of others. You're fine. Pass for sure.
 
OP
H
Aug 13, 2015
8
4
lol. If you think you're screwed then there's definitely no hope for a lot of others. You're fine. Pass for sure.
I sure hope so. I wasn't trying to "show off" or have false freak out or anything. Im waiting for my CK scores (sept 16, i believe) and now CS scores on oct 7th. Don't wanna submit ERAS without everything. Just way too much riding on this stupid test which is just way too $$$$$$...
 
Feb 21, 2014
34
9
Status
Medical Student
I hope you are right. I don't want to pass with flying colors because i just want to pass. lol!
A lot of ppl were in your shoes before. It seems like you did enough to pass and i wouldn't worry about it. I made a lot more mistakes.

But then again, a lot of people ignore peoples reassurance so chances are you will still freak out after all these reassuring posts. Just get off this Site and keep yourself busy. You will start forgetting about it after a couple weeks. Just try not to have too many nightmares until then.
 
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OP
H
Aug 13, 2015
8
4
A lot of ppl were in your shoes before. It seems like you did enough to pass and i wouldn't worry about it. I made a lot more mistakes.

But then again, a lot of people ignore peoples reassurance so chances are you will still freak out after all these reassuring posts. Just get off this Site and keep yourself busy. You will start forgetting about it after a couple weeks. Just try not to have too many nightmares until then.
You are right. I just need to get back to working on stupid ERAS
 

J ROD

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I took my CS 2 weeks ago and feel the exact same way; this was my second go around so hopefully I am ok. I made allot of corrections and also ran into many pits. I used the exact same mnemonics and I counsel every patient but one because of time; I had a uncooperative patient who I believe was suffering from anxiety disorder do to palpitations who was pissed with my performance because she really made me uncomfortable. Lastly I had a patient who suffered from diarrhea but responded negative to pain/fever/chills/travel/pallor/joint pain/oral ulcers/multiple sexual partners/blood in stool/recent party causing food posion/changes in stool color/recent sick contacts he only reported 3 week history of watery diarrhea that was not associated with anything and denies any aggreviating factors ie food/bread/wheat products I was completely lost for this guy. I put DD Lactose intolerance, Celiac disease, and gastro however I didnt or stool parasite/ova and IGA stool antibodies. I put stool culture, stool leukocytes, CBC, Na/K; I was just lost and it was last case. However my presentation was

Mr.X is XX y/o male who presents with 3wk history of diarrhea. Patient unsure of any triggers or causes of diarrhea. Symptoms are daily and happens 5-6x each day. Patient reports watery stool; 2 day history of cramping however resolved; denies any prior episdose and denies progression. Patient denies aggreviated factors and reports Imdium and Pepto Bismuth to be uneffective. Patient denies any associate pain/fevers/chills/hematochazia/abd pain/heartburn/joint soreness/pallor of skin/sick contacts/recent travel/oral ulcers/recent parties. In addition patient unsure if food is a primary factor for diarrhea

ROS: negative unless otherwise stated above
PMH: denies
ALL: denies
Meds: Imdium and Bismuth
FHx: denies
SurHx: denies
SocHx: denies alcohol/tobacco/drugs; patient married and sexual active with wife
OccHx: work history

General: cooperative, normal judgement, NAD
Vitals: stable and afebrile
HEENT: forgot to inspect mucos membranse; normcephalic
CV: RRR. S1S2, negative murmurs/rales/gallops
Resp: CTAB, nonlabored, negative chest wall tenderness
GI: normal bowel sounds, nondistended/nontender; negative hepatosplenomegaly;
Skin: warm, dry intact; negative pallor


DD:
1) Lactose intolerance:
- watery stool for 3wks; 5-6 episodes each day; reports food "runs through him"
- reported water stool not releived by imdium; denies travel/fevers/fevers/heartburn, blood in stool; or abd pain
- unsure if food is possible cause

2) Celiac Disease
- reported water stool not releived by imdium; denies travel/fevers/fevers
- unsure if food is possible cause

3) Projectile Diarrhea: I should have put gastro I was rushing here
- water stool; history of cramping that has resolved

Orders: CBC,Na/K, stool culture/ stool antigens/leukocytes; rectal exam

Informed patient of my thougts for his diarrhea and the 3 possible causes above;
I told patient during exam that I was unsure of his possible causes, however I am going to get blood work; check stool for bacterial and start fluids; I also informed him that when the results of the test are confirmed that I will personally return and provide him with the details in addition make any corrects at that time.

I feel I did bad for this case
Recent antibiotics? C. diff ?
 
Sep 3, 2015
6
1
Status
Dental Student, Medical Student
I asked all those questions, no weight loss on antibiotic use
 
Sep 3, 2015
6
1
Status
Dental Student, Medical Student
I was thinking travel's diarrhea, gastro, food posion, c diff, anxiety disorder, etc...I couldnt thinnk of anything to fit the case
 

VCorp

5+ Year Member
Jun 17, 2013
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I'm worried that I may not have passed, would you guys be willing to critique what I had done, please?