My CS mistakes

[Smashingdude]

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Just took the exam yesterday. Gosh, what a day, and what an exam. I want to post a full experience, but I am too tired to write now. All my thoughts are currently floating in 'red bull' tarnished haze, so it will be a few days till I post my full experience/study plan for it.

I am just worried on 'some' of the mistakes I did. 'Some' is too generous a word for it. These are the ones I recall:

1. In one patient, I told him I was about to examine his feet, and I did the babinski on him, and he immediately felt ticklish and moved his foot and felt irritated. I asked him, and he says its not pain but discomfort. I apologized immediately, and 2 times later, and explained to him it may tickle a bit.

2. One patient was standing, and was not draped. When I did examine him, I didn't put the drape on till I examined his abdomen. I mean, I examined just his back, and at this time I forgot to drape him. But when I made him lie down, I draped him appropriately to examine his belly.

3. I did ophathlmoscopy in a case of headache, even though patient had photophobia, but I thought it was necessary

4. 3-4 cases, I finished just at announcement. And at that time, I just shook hands, smiled, and left.

5. 1 case, I couldn't close properly

6. One patient felt kinda insulted when I asked his activities of daily living, in a memory problem patient. But I apologized, and told him its necessary for the history.

7. Forgot to counsel on alcohol in one case

8. I felt some of my counselling/answers to challenging questions were too 'diplomatic', with no clear cut answer. I didn't say a yes or a no, but 'maybe'. The patient's seemed somewhat satisfied, but not like I expected them to be. It seemed I could have given a better answer.

9. In 2-3 cases, I wasn't sure about the diagnosis, but tried to make it as close as I can, and tried to list at least 7-8 workup in all cases

10. One patient, I messed her name 2-3 times.

Things I did right are:
Knock, Introduce myself/position, explain the plan, smiling, permission before any maneuver, tieing the gown back, washing hands, addressing patient by their last names, counsel on STD/Smoking/Marijuana/Alcohol etc,showing empathy, asking permission to take notes, trying to maintain eye contact, using a lot of facial/hand expressions, helping patient lying down or sitting, warming hands/strethoscope before touching patient, telling at least 1-2 diagnosis and a few workup in layman terms, asking if they understood the plan, using transition sentences, using confidentiality statements.

Anyone to shed some light on these? I'll be very grateful to you. I hope I pass. Now when I look back, many more mistakes are just coming to my mind and I am just scared....😕

 

[IJL]

Are you a FMG?

 

[ajs321]

Relax. No one can actually do each case perfect.

Yes you made mistakes. But so did everyone else that day you took the test.

You have me at a loss with the Babinski ticklish thing though. I guess maybe you should warn the patient?

 

[link2swim06]

Relax. No one can actually do each case perfect.

Yes you made mistakes. But so did everyone else that day you took the test.

You have me at a loss with the Babinski ticklish thing though. I guess maybe you should warn the patient?

Similar think happened to me...I did the heel jar as part of my acute abdomen physical....he didn't seem very happy I did it.

 

[coxsackie]

For #3 case...if the patient had photophobia- he might have had meningitis. Did you do a kerngi's or brudzinski on him?

 

[Smashingdude]

I just remembered, a few patients I tried to crack them up. I cracked jokes now and then, and shared some personal experiences. They laughed, and were kinda amused. How does these affect my performance?

Also, one of the patients after I examined her conjunctiva(she was 48 or so), I said spontaneously, "oh well, u've got pretty eyes"..she just smiled, and I was kinda dumb-struck Is that offensive and does it count as major mistake?

I am so scared of these mistakes. The anxiety got the idiot out of me 😱

 

[coxsackie]

hahah omg I did the exact same thing. I was joking around, and told one lady she had cute hair. I did really well in CIS. All the way to the right.

You're building a relationship with your patient, it's called rapport. There's nothing wrong with that, as long as you're not going overboard and crossing the line.

 

[ajs321]

For #3 case...if the patient had photophobia- he might have had meningitis. Did you do a kerngi's or brudzinski on him?

Yes you should.

 

[Smashingdude]

Yes I did. Surprisingly, Brudzinki was +ve, and kernig was -ve...I dont know why..

 

[CaptainSSO]

Yes you should.

It's funny we still check brudzinski's and kernig's sign because the sensitivity for both is about 5%. Nuchal rigidity wasn't that much better at about 30% sn.

http://cid.oxfordjournals.org/content/35/1/46.full.pdf

 

[coxsackie]

The 2 cs cases that are not graded: Are they the two you do poorly in or are they just any random two that they feel like taking out? Also, when they are grading...are they cumulatively adding together how you did on each case? It's not a case by case grade, right?

 

[umx]

The 2 cs cases that are not graded: Are they the two you do poorly in or are they just any random two that they feel like taking out? Also, when they are grading...are they cumulatively adding together how you did on each case? It's not a case by case grade, right?

With the caveat that no one knows precisely how CS is graded, my understanding was that up to two cases were designated as experimental and those two cases would not count towards your score. They would not throw out your two worst cases, only the cases you may have had that were experimental even if you did wonderfully on these cases. It's unclear to me if everyone gets 2 experimental cases and is only graded on 10 cases, or if some individuals get 0 or 1 experimental cases and have 11 or 12 graded cases.

I don't know if the grade is additively cumulative or an average of case grades...I think the grading curve would be a bit harsher if failing one case could lead to failing the whole thing though and if this were the case it would be unlikely that so many people pass on the first shot

 

[coxsackie]

OK so here goes...

1)it was starting off ok...then i started to get nervous. When asked about diet...she talked about her love of italian food. When i asked her if she had tattoos, she said no...i opened my big mouth and said, I'm surprised you don't have a tattoo of pasta on your shoulders or something. She laughed out loud for like 20 seconds...I don't know what that means. The case on its own went ok. The case ended just after counseling- when i was like any questions or conerns...and she was about to ask. I must have looked like i was really sad that time ended because she kept going, and was like i'll ask you again when you come back. ??? Don't know what to make of that case.
2) He said no to everything i asked..and ended up smoking a lot, so i counseled on that, and it seemed straighforward. I asked all the peritinet questions, and more ROS questions. I did a proper physical exam- pertinent to the case, and extremities, and heent or something. It was a routine closure.
3) OMG i hated her. lol She wasn't rude...but she was just very straighforward with everthing. It tripped me up a bit. At the end of it...she said no to everything I asked, but i'm sure i forgot to ask something. I don't think i got the right dx for this case.
4) i forgot how to do a hip exam. I was freaked out when i saw it was involved in the case. But i checked all the joint, made sure do a brief neuro exam, made him walk, and palpated his spine. Tested his gait. Closure was ok.
5) she was a cheerful obese lady, and it made me comfortable. I was ok talking to her, and i was able to figure out the main dx, i think. Then, randomly....out of nowhere....she started saying some psych ****, and it tripped me.
6) THis guy literally said no to every single thing that i asked. I know i asked a lot of questions too because i had a huge list of differentials. i wasn't sure abt the dx in this case
7) had something on the outside of the door, and when i went in...it was a different reason why he came in. Tripped me. Think I got the dx, but my questioning skills weren't that great just because i had to focus on something else all of a sudden
8)straighforward case...did everything right here, i think.
9)straightforward case
10)straighforward case
11)She was such a good actress...i was really into it. She made me believe what she had with so much conviction that i was able to focus on her problem so well. straighforward case.
12)straighforward case, but i know i fumbled a little bit on the closure because i started to get really thirsty all of a sudden.

Thoughts?

 

[ahmedjq]

OK so here goes...

1)it was starting off ok...then i started to get nervous. When asked about diet...she talked about her love of italian food. When i asked her if she had tattoos, she said no...i opened my big mouth and said, I'm surprised you don't have a tattoo of pasta on your shoulders or something. She laughed out loud for like 20 seconds...I don't know what that means. The case on its own went ok. The case ended just after counseling- when i was like any questions or conerns...and she was about to ask. I must have looked like i was really sad that time ended because she kept going, and was like i'll ask you again when you come back. ??? Don't know what to make of that case.
2) He said no to everything i asked..and ended up smoking a lot, so i counseled on that, and it seemed straighforward. I asked all the peritinet questions, and more ROS questions. I did a proper physical exam- pertinent to the case, and extremities, and heent or something. It was a routine closure.
3) OMG i hated her. lol She wasn't rude...but she was just very straighforward with everthing. It tripped me up a bit. At the end of it...she said no to everything I asked, but i'm sure i forgot to ask something. I don't think i got the right dx for this case.
4) i forgot how to do a hip exam. I was freaked out when i saw it was involved in the case. But i checked all the joint, made sure do a brief neuro exam, made him walk, and palpated his spine. Tested his gait. Closure was ok.
5) she was a cheerful obese lady, and it made me comfortable. I was ok talking to her, and i was able to figure out the main dx, i think. Then, randomly....out of nowhere....she started saying some psych ****, and it tripped me.
6) THis guy literally said no to every single thing that i asked. I know i asked a lot of questions too because i had a huge list of differentials. i wasn't sure abt the dx in this case
7) had something on the outside of the door, and when i went in...it was a different reason why he came in. Tripped me. Think I got the dx, but my questioning skills weren't that great just because i had to focus on something else all of a sudden
8)straighforward case...did everything right here, i think.
9)straightforward case
10)straighforward case
11)She was such a good actress...i was really into it. She made me believe what she had with so much conviction that i was able to focus on her problem so well. straighforward case.
12)straighforward case, but i know i fumbled a little bit on the closure because i started to get really thirsty all of a sudden.

Thoughts?

Given what you narrate, it seems like you did fine.

Was knowing FA Step 2 CS good enough? I am an AMG, never had any significant clinical problems, but the idea of this exam is nervewracking (even though I'm taking it in sept, i'm on an easy month so I started reading FA2CS. The amount of info in FA2CS makes me nervous at times.

 

[coxsackie]

I used u world, and i felt like it catered for the most recent exam changes. I don't like First Aid for cs, tbh.

 

[Monkey Jones]

Is this a recent exam coxsackie? Or was it the one you took previously? This one sounds really good....

 

[coxsackie]

This was the recent one. I took it on the 23rd. I dunno...i'm really nervous. I definitely fumbled some words, and it sucks because I have no speech problems. It was flowing, and they were with me...and as soon as I would start to fumble some random phrases...they would just look at me like what just happened. ughhh i have a tendency to do that :/

 

[IJL]

OK so here goes...

1)it was starting off ok...then i started to get nervous. When asked about diet...she talked about her love of italian food. When i asked her if she had tattoos, she said no...i opened my big mouth and said, I'm surprised you don't have a tattoo of pasta on your shoulders or something. She laughed out loud for like 20 seconds...I don't know what that means. The case on its own went ok. The case ended just after counseling- when i was like any questions or conerns...and she was about to ask. I must have looked like i was really sad that time ended because she kept going, and was like i'll ask you again when you come back. ??? Don't know what to make of that case.
2) He said no to everything i asked..and ended up smoking a lot, so i counseled on that, and it seemed straighforward. I asked all the peritinet questions, and more ROS questions. I did a proper physical exam- pertinent to the case, and extremities, and heent or something. It was a routine closure.
3) OMG i hated her. lol She wasn't rude...but she was just very straighforward with everthing. It tripped me up a bit. At the end of it...she said no to everything I asked, but i'm sure i forgot to ask something. I don't think i got the right dx for this case.
4) i forgot how to do a hip exam. I was freaked out when i saw it was involved in the case. But i checked all the joint, made sure do a brief neuro exam, made him walk, and palpated his spine. Tested his gait. Closure was ok.
5) she was a cheerful obese lady, and it made me comfortable. I was ok talking to her, and i was able to figure out the main dx, i think. Then, randomly....out of nowhere....she started saying some psych ****, and it tripped me.
6) THis guy literally said no to every single thing that i asked. I know i asked a lot of questions too because i had a huge list of differentials. i wasn't sure abt the dx in this case
7) had something on the outside of the door, and when i went in...it was a different reason why he came in. Tripped me. Think I got the dx, but my questioning skills weren't that great just because i had to focus on something else all of a sudden
8)straighforward case...did everything right here, i think.
9)straightforward case
10)straighforward case
11)She was such a good actress...i was really into it. She made me believe what she had with so much conviction that i was able to focus on her problem so well. straighforward case.
12)straighforward case, but i know i fumbled a little bit on the closure because i started to get really thirsty all of a sudden.

Thoughts?

I hate to say it, but it sounds like you failed bro.

 

[link2swim06]

I hate to say it, but it sounds like you failed bro.

Give him a break he already failed once.

While I don't really think CS is the time or place to be cracking jokes, nobody knows, it's a crapshoot. It comes down to the checklist and what they mark.

At the very least he can compare it to the last time he took it and probably judge his performance better than any of us.

 

[coxsackie]

LOL seriously? You think I failed? BTW, i'm a female. Yes, I did fail before in ICE...so I don't appreciate your comment IJL- esp if it's a joke. If it's not a joke, and you really think I failed...then ok, I understand.

Link2swim06- You're right. Thanks for the support. Only I'll be able to judge, but the reasons I posted my experience is for other people to see how it went as well.

 

[IJL]

Double post

 

[coxsackie]

IJL, you can GFY 🙂