Screwed up big and still passed CS???

[HappyMS]

Hi All,

Like a lot of fellow MS I think I did poorly on step 2 cs and was wondering if you guys that passed (or failed) can calm my nerves and share laughs at things that you did and still passed (whether comfortably or just barely). I found some funny and helpful stories in some other threads but thought it would be nice to have them in one place. Sorry if this annoys some...

Here is what I did (or didn't do) that makes me nervous:
1. Pt with a neuro complaint - forgot CN exam and reflexes entirely. Will miss points on exam and note.
2. Pt with a resp complaint - did not do Head and Neck exam at all, no lymph nodes. Just listened to heart and lungs. Again will miss points on hx and note.
3. Did not offer to comfort patients when I should have...
4. Did not ask about fevers, weight loss, etc. when the case called for it
5. Did not ask about smoking or alcohol use at all when I should have... nor did I document in my note.
6. For a few pts, didnt ask about allergies or family history.
7. Did not ask about sexual hx in a patient with risk factors.
8. did not document some dx tests or differentials

After writing this, I wouldn't be surprised if I failed.

Thank you all for your time,

Not so HappyMS

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[JacobtheMS]

I would sign up for the exam now to save a date...
J/k, you never know until the score comes... I heard people do worse things and still pass. Goodluck

 

[Frugal Traveler]

I'm still waiting for my score... I have nightmares periodically because I freak about forgetting to do this or that... or not being polite enough.

Bottom line is to chill out and wait for the score. It's a long 2-3 months.

Also, I would not post anything related to exam content because the NBME is very sensitive to people talking about their tests.

 

[HappyMS]

thanks Frugal for the words and suggestion. I made it very vague and took out anything that might be viewed as content by the nbme.

 

[QofQuimica]

thanks Frugal for the words and suggestion. I made it very vague and took out anything that might be viewed as content by the nbme.

I'm glad you edited your OP; I was concerned about you getting in trouble too.

I think most people come out of the test thinking about all the things they did wrong. I know that I did. We med students are a very self-critical bunch, you know? But the thing you have to remember is that the NBME is not looking for perfection. Everyone makes some mistakes, and it's easy to look back later and kick yourself for all the things you didn't do but know you should have done. The thing is, the assessment you've made of your performance is completely one-sided. If you review the same cases and think about what you did well for each one, I bet you'll be surprised at how you did a lot more things right than you did wrong. Seriously, try it.

 

[tarlovcyst]

My response to the original poster --

Don't worry about it. PM if you want an example. It's too long and too confidential to put out here.

But I do know of a medical student (AMG MS-4) who make even more catastrophic mistakes than you, such as leaving sections of a progress note blank. Plus, he didn't type out any complete sentences, and wrote phrases instead. So his English was very broken.

He passed 7.5 weeks later. If I remember the score report he showed me, he wasn't deficient in anything! He didn't have any stars next to any section on the breakdown.

 

[kdburton]

My friend completely forgot to do a physical exam on a patient. She passed. I don't know how the rest of day went though

 

[bestmed]

How long does it take for one to receive CS scores?

Does it matter when (i.e. Jan vs June,etc.) you take the exam?

 

[bigtymer]

hey I have a quick question about Step 2 CS if someone can help me out. Is First Aid better than USMLE world, and if I go through both should that be enough?

Also, Im an IMG in school in Europe and Im fresh off my medicine rotation but still have obs/gyn and peds left, so my question is do I need those to pass step 2 cs?

How much time do most people put in for CS?

 

[alesa]

hey I have a quick question about Step 2 CS if someone can help me out. Is First Aid better than USMLE world, and if I go through both should that be enough?

Also, Im an IMG in school in Europe and Im fresh off my medicine rotation but still have obs/gyn and peds left, so my question is do I need those to pass step 2 cs?

How much time do most people put in for CS?

Hey, the timing for CS is really up to U......It all depends on U and ur background, & communication fluency.
I think FA is enough, but UW is a good tool as well. Specially to see their clips. on PE's. & if u can afford Kaplan---of course its great to simulate things. But if u cant afford it, If u have a FA & a friend willing to be ur SP u should be fine...But u need to put ur part.
The key to this test, is practice practice practice.....If u have good comm, u wont have 2 much problems and u should be able to study if organized as little as 2-4 weeks. Praqqctice as if u were in the real thing, with the timing....& even Hx taking.

Hope that helps good luck to u.

 

[ieatmop]

I was sure that I failed CS after I took it. I was extremely nervous the whole time. I was extremely awkward when doing the physical exams. For example, on the first patient, I sort of tugged awkwardly at her gown to raise it in order to listen to her heart. After that, I only listened to the heart in the top 2 places that you can get to without messing with the gown.

I only listened to the lungs in 4 posterior quadrants. Never did any of the egophony or tactile fremitus things. In fact, I only did an extremely basic physical on all of the patients.

I barely palpated the abdomen, even with the light palpation, although I told them that I was palpating deeper.

On one patient I awkwardly checked reflexes, and failed to elicit any response at all.

Afterward I was convinced that I failed, just like a lot of other people. I really believed it. In the end, I passed, which was a huge relief.

 

[HappyMS]

Passed!!

hi all,

like a lot of fellow ms i think i did poorly on step 2 cs and was wondering if you guys that passed (or failed) can calm my nerves and share laughs at things that you did and still passed (whether comfortably or just barely). I found some funny and helpful stories in some other threads but thought it would be nice to have them in one place. Sorry if this annoys some...

Here is what i did (or didn't do) that makes me nervous:
1. Pt with a neuro complaint - forgot cn exam and reflexes entirely. Will miss points on exam and note.
2. Pt with a resp complaint - did not do head and neck exam at all, no lymph nodes. Just listened to heart and lungs. Again will miss points on hx and note.
3. Did not offer to comfort patients when i should have...
4. Did not ask about fevers, weight loss, etc. When the case called for it
5. Did not ask about smoking or alcohol use at all when i should have... Nor did i document in my note.
6. For a few pts, didnt ask about allergies or family history.
7. Did not ask about sexual hx in a patient with risk factors.
8. Did not document some dx tests or differentials

after writing this, i wouldn't be surprised if i failed.

Thank you all for your time,

not so happyms

 

[Frugal Traveler]

Passed!!

Congrats

 

[mdc848]

Nice! I think I was in a similar situation as yourself. I was absolutely terrible through the first few cases and after the test thought I had failed.

PASSED!!!!!!

 

[Speculatrix]

Passed. I didn't do a complete cranial nerve exam on anyone. I just did the H, looked at their pupils, and maybe tested V1-V3. No reflexes on anyone, hardly and strength testing though I guess I should have been more systematic about that. Maybe a bit of sensory testing. Fortunately my patient notes were fantastic (that was my one and only star -- what the hell, why not English proficiency), and that made up for my perceived low performance in data gathering. Write tons and tons for the patient note and fill up your differentials and I'm sure your performance will be excellent.

The data gathering "bar width" was the largest at 17 X's, and 5 of my X's were in the grey zone. Questioning skills had 13 X's and 2 X's of mine were in the grey. I'm sure I forgot to ask some people about their allergies or family history or something.

Hey, if I had to PCR someone's DNA during this encounter, I'm sure I would have received all *'s. If this MD/PhD can pass, so can you. Just take it seriously and be thoroughly familiar with FA.

 

[Sara010]

ugh! I am also having a periodic nightmares about not passing CS; here are my list of "shoulda, woulda, coudas"
1. pt w/hemoptysis - didn't do HEENT exam/LN exam, didn't percuss or do anterior auscultation or ask about vasculitic sxs
2. didn't ask a single pt about allergies (eek!!)
3. had virtually no clue about the dx in 2 patients
4. on pt with difficulty concentrating I didn't do much beyond serial 7s, remembering 3 objects, remembering what they did the day before
5. forgot to document a few minor things that I did ask about during the encounter
6. very basic physical exam in ~80% of the pt

 

[mdc848]

ugh! I am also having a periodic nightmares about not passing CS; here are my list of "shoulda, woulda, coudas"
1. pt w/hemoptysis - didn't do HEENT exam/LN exam, didn't percuss or do anterior auscultation or ask about vasculitic sxs
2. didn't ask a single pt about allergies (eek!!)
3. had virtually no clue about the dx in 2 patients
4. on pt with difficulty concentrating I didn't do much beyond serial 7s, remembering 3 objects, remembering what they did the day before
5. forgot to document a few minor things that I did ask about during the encounter
6. very basic physical exam in ~80% of the pt

That sounds like how my day went. Just missing chunks of physical exams, forgetting to ask about allergies, forgetting basic diagnoses, having no clue on 1 patient how to go about my line of questioning, etc. I had nightmares galore thinking about failing. But in the end, I still passed. And I'm sure you will too.

 

[DD214_DOC]

I'm in the same boat. I had one patient who was very clearly a PE, but for some reason that didn't pop into my head as part of the DDX because they did not present with chest pain (which, if I remember correctly, is the most common presenting symptom of a PE). I did not realize how obvious it was until I left the exam.

On some other patients, I know I got the diagnosis right but, feeling too pressed for time, I just put whatever popped into my head for the third part of the ddx. So I would end up with a patient who had two probable things for the ddx and something that didn't really make any sense.

I also had one patient who basically complained of an anatomic abnormality. On physical exam, this abnormality wasn't present. So, needless to say I was pretty lost as to what I was supposed to be doing.

I think on one patient I ran out of time when writing the note and only had 2 possible options for my ddx.

This is for COMLEX PE btw. Not sure how much the ddx stuff weighs.

So, we will see. I passed both level 1 and level 2 CE without any problems. Rotation grades are mostly H and HP. I'm always commented on my interpersonal and communication skills everywhere I go. I've also already matched, so I pray to God that I passed and things won't get screwed up for me.

 

[theophylline]

Are we to include treatment plans in the "Diagnostic Workup" section, such as pain management, any pharmacotherapy, PT, etc?

--
Post-script:
Having done my HW, I will now address my own question from the bulletin:

"Treatment, consultations, or referrals should not be included in your work-up plan."

 

[DD214_DOC]

Are we to include treatment plans in the "Diagnostic Workup" section, such as pain management, any pharmacotherapy, PT, etc?

--
Post-script:
Having done my HW, I will now address my own question from the bulletin:

"Treatment, consultations, or referrals should not be included in your work-up plan."

In the words of the COMLEX 2 PE proctors, your only answer will be, "Do what you were trained to do".

 

[J1515]

did not present with chest pain (which, if I remember correctly, is the most common presenting symptom of a PE).

It's dyspnea.

And to all those worrying, this test isn't looking for you to nail every single checkbox on the list. It's to make sure you're competent enough to know how to begin working up a patient's problem. If you are clueless on every patient and don't even know where to begin, what questions to ask, and what tests to order, you'll fail. If you forget to order an ANA and RF in a patient with joint pain but put down Lyme titers and xrays of the affected joints you will still be fine. They want to make sure you're competent enough to see patients as an intern (with seniors still double checking your work)

 

[eviljafar]

I forgot to wash my hands on 3-4 patients and still passed!
(And made many stupid mistakes along the way)

 

[uncndn]

I also took cs recently and am nervously awaiting my scores. Test day was probably my worst performance in a clinical setting since early second year of med school. At least 3 very basic diagnoses were not apparent to me until I submitted my note. Didn't ask about birth history or vaccines when I should have. Didn't ask about travel when I should have. Didn't ask about living situation when I should have. Improperly draped a patient during a PE. And this is only a small sample of the gazillion mistakes that I made during the test day. It seems like everyday I realize a new mistake that I made on test day. I won't find out my results until after match, so hopefully a big ol' FAIL won't ruin my residency status (I hope that they'll just let me retake it).

From other posts, it sounds like one can make a ton of mistakes and still pass. I'm banking on it. I'll post my score when I get it. In the meantime, for those of you who feel like you failed this exam, know that you're not alone with your anxieties. Also, be reassured that you probably did better than me. Eeek.

 

[Knicks]

Hi All,

Like a lot of fellow MS I think I did poorly on step 2 cs and was wondering if you guys that passed (or failed) can calm my nerves and share laughs at things that you did and still passed (whether comfortably or just barely). I found some funny and helpful stories in some other threads but thought it would be nice to have them in one place. Sorry if this annoys some...

Here is what I did (or didn't do) that makes me nervous:
1. Pt with a neuro complaint - forgot CN exam and reflexes entirely. Will miss points on exam and note.
2. Pt with a resp complaint - did not do Head and Neck exam at all, no lymph nodes. Just listened to heart and lungs. Again will miss points on hx and note.
3. Did not offer to comfort patients when I should have...
4. Did not ask about fevers, weight loss, etc. when the case called for it
5. Did not ask about smoking or alcohol use at all when I should have... nor did I document in my note.
6. For a few pts, didnt ask about allergies or family history.
7. Did not ask about sexual hx in a patient with risk factors.
8. did not document some dx tests or differentials

After writing this, I wouldn't be surprised if I failed.

Thank you all for your time,

Not so HappyMS

Did you take your exam in Philadelphia?

My response to the original poster --

Don't worry about it. PM if you want an example. It's too long and too confidential to put out here.

But I do know of a medical student (AMG MS-4) who make even more catastrophic mistakes than you, such as leaving sections of a progress note blank. Plus, he didn't type out any complete sentences, and wrote phrases instead. So his English was very broken.

He passed 7.5 weeks later. If I remember the score report he showed me, he wasn't deficient in anything! He didn't have any stars next to any section on the breakdown.

Did he take his exam in Philadelphia?



Anyone else in this thread who passed: did you take your exam in Philadelphia?

 

[uncndn]

I drove myself (and my wife) crazy waiting for the results of this stupid, ridiculously easy but tremendously anxiety-provoking exam. I made an enormous number of mistakes. I PASSED and none of the scored areas were borderline. In fact, my patient notes were off the charts, considerably better than my ability to speak English, apparently.

Please, please, please don't get caught up in the horror stories that you read on SDN about people failing this exam. Worrying about your results is a total waste of time. I can almost guarantee you passed. You will be fine. Don't worry.

Also, I took the exam in Atlanta. The staff was friendly. People hyped the test-day food but I thought it was pretty lame.

 

[Captopril]

I drove myself (and my wife) crazy waiting for the results of this stupid, ridiculously easy but tremendously anxiety-provoking exam. I made an enormous number of mistakes. I PASSED and none of the scored areas were borderline. In fact, my patient notes were off the charts, considerably better than my ability to speak English, apparently.

Please, please, please don't get caught up in the horror stories that you read on SDN about people failing this exam. Worrying about your results is a total waste of time. I can almost guarantee you passed. You will be fine. Don't worry.

Also, I took the exam in Atlanta. The staff was friendly. People hyped the test-day food but I thought it was pretty lame.

I did everything according to protocol, am a native English speaker, had decent DDx's, and I still failed. Don't play this test down just because you passed.

 

[Instatewaiter]

I did everything according to protocol, am a native English speaker, had decent DDx's, and I still failed. Don't play this test down just because you passed.

That sucks man. Good luck next go around.

After going through the experience, I really felt like it was a crap shoot. I was even more nervous about this exam than I was about step 2 CK or about the match. I figure I will post what I did and maybe someone will get something useful out of it.

Things I did to prepare:
1) I used FA for CS and went through each case and mini case kinda scanning it for the first round through

2) Went through a second time to make sure I would hit most of the DDx and tests they wanted (especially life threatening)

3) Went on the website and practiced using the software and made sure I had enough time to type up a note

4) The standardized patient exams (OSCEs) at my school gave us 25 minutes instead of 15, so I practiced my timing just a bit.

5) practiced kid and OB/Gyn ROS and questions since you ask some different questions for those histories

Things I'd recommend during the test:
1) Spending 30s at the door writing down vitals, esp the ones that are off, and thinking of a DDx and exams to do so that when you blank out you have a cheat sheet.

2) Get a quick, directed social history, past medical and a family history on EVERYONE. It will take like 30s-1min and is worth it. Ask everyone about tobacco, alcohol or drugs. They will prolly deny it unless you need to council. A few times on the real thing this opened up the door to their real problem and totally redirected my history.

3) Draping the patient as soon as you enter the room
. The gown should be on your stool.

4) wearing gloves instead of washing your hands (saves time) and cleaning your stethoscope with alcohol pads (can be done while talking and may add some points)

5) asking to undo the gown (these gowns catch on the shoulders of patients unlike normal hospital gowns, I looked like an idiot a few times as I struggled to move the gown)

6) Not spending too much time on the PE- listen to everyone's lungs and heart. Doing a focused exam should only take a few minutes. Neuro complaints do take a while though. Plan accordingly if that is their CC.

7) Closure- if done right will take less than a minute:
a. tell the patient 2 or 3 things that it could be (if you include cancer or MI or other scary **** tell them it is just something you need to r/o to be safe)
b. tell them what you are going to do: blood tests, X ray, CT, and if you say an acronym or big word (like MRI) explain it before they ask you
c. Ask them if they have any questions (if you do the above right they wont have any)
d. Ask them if they have any concerns (a biggie)
e. Tell them you know people always have questions when they leave the doctor so if they do have questions to call the office and you will call them back ASAP (will get you a lot of points and is a good thing to end on).

8) remember you have anything you can make up at your disposal: Social workers, office managers, nurses to call the patient, friends in congress, whatever you want to help you take care of the patient. You also have unlimited time to call the patient back. So "use" this stuff

9) Type the note.

10) Results come out only certain times during the year in batches. So it takes up to 3 months to get your results back If you are going through the match, take it before Dec 31 so that you get your results early. That way if you fail, you have plenty of time to get a passing result before you start residency. I was freaking out because if I didn't pass I was going to have to scramble to find a spot quickly so I could get my results before residency started.

Even with the horror stories, it is a very do-able exam if you play their game. FA does a good job of preparing you, I felt.

I came out and felt like I missed an absolute ton of stuff yet I got all stars (except English proficiency somehow). If you are nice, don't appear rushed, and make sure to always rule out the life threatening stuff I think you all will be fine.

Overall, I think it is kinda dumb that we have to take this exam and spend multiple thousands of dollars but c'est la vie.

 

[34140]

Did you take your exam in Philadelphia?



Did he take his exam in Philadelphia?



Anyone else in this thread who passed: did you take your exam in Philadelphia?

same question, i have mine in 20 days! yikes!

 

[Nellyakgo]

same question, i have mine in 20 days! yikes!

Hey all,
Why is Philly so popular? I guess the answer is somehow linked to the above question too.

I've been trying and trying to get a date in Philly to no avail. So I have a date in LA and it looks like I'll have to stick to it.

 

[deleted77919]

…

 

[34140]

Hey all,
Why is Philly so popular? I guess the answer is somehow linked to the above question too.

I've been trying and trying to get a date in Philly to no avail. So I have a date in LA and it looks like I'll have to stick to it.

yep like dakota said, its only because there is such a large concentration of med schools around here.

i hear philly is one of the harder places.

 

[Perry Mason]

I failed CS the first time, the communication skills part. I guess what got me was my reluctance to say to each patient "I'm really sorry to hear about your symptoms, I'll do my best to help you". I don't think I said it once, and I still believe it's a stupid way to demonstrate empathy and compassion. The mere fact of being a physician means you'll try your best to help the patient.

Anyway, during my second attempt I forced myself to mumble the above crap and I was fine. The first test I took in Chicago, the secon one in Houston.

 

[Nellyakgo]

yep like dakota said, its only because there is such a large concentration of med schools around here.

i hear philly is one of the harder places.

The exam is harder? Aren't they all supposed to be trained/calibrated to be the exact same for grading purposes?

 

[Richspiders07]

The exam is harder? Aren't they all supposed to be trained/calibrated to be the exact same for grading purposes?

southerners are more laid back, so maybe the standardized pts grade easier???

 

[Nellyakgo]

southerners are more laid back, so maybe the standardized pts grade easier???

Cool!

 

[Knicks]

I failed CS the first time, the communication skills part. I guess what got me was my reluctance to say to each patient "I'm really sorry to hear about your symptoms, I'll do my best to help you". I don't think I said it once, and I still believe it's a stupid way to demonstrate empathy and compassion. The mere fact of being a physician means you'll try your best to help the patient.

Anyway, during my second attempt I forced myself to mumble the above crap and I was fine. The first test I took in Chicago, the secon one in Houston.

damn! I don't think I did that either!!!!!!

But maybe I did,, can't remember. =/

 

[Sara010]

update: PASSED!!!!!!!!

WHEW!! sooooo glad that is over with!!!

 

[Knicks]

I'm so damn worried.

I was thinking about the "draping". If I didn't drape the patient before taking the history, is that ok? I believe I draped them before I started the Physical Exam. I'm getting really anxious about this.

 

[ucla41]

I'm so damn worried.

I was thinking about the "draping". If I didn't drape the patient before taking the history, is that ok? I believe I draped them before I started the Physical Exam. I'm getting really anxious about this.

i was anxious about this because i did not drape during history..but always draped before Physical....while the little chart in FA says to drape before history, if you look at the text it says you can drape before PE...dont worry man...

 

[Proverbs31]

Did you all review the pts problems with them at the end, i.e. summarize what they told you before going into the differential and your work-up plan for them?
Ive taken our COMLEX PE and passed and I didnt repeat anything back to the pt...merely told them what I thought they might have and what we were going to do to work it up and asked if they had questions and I passed.

I am taking USMLE's CS as well on Monday. I noticed in FA it says to summarize what the pt told you for their CC and then go into that. For those that have taken it AND PASSED, did you all summarize at the end? Is this something I need to make sure to do?
Basically is everything in FA Step 2 CS absolutely how I should do it?? Thanks very much in advance

 

[PathMD2010]

After the history, I summarized what they told me and asked if it sounded right, if they had anything else to add. I did this to make sure I had asked the majority of quesitons and if I had remembered their answers correctly.

I also did counseling during the history so that I would not forget to do that later and it is brief - Me: "smoke?" Pt:"yes". Me: "Do you want to quit?" Pt:" No". Me: "I want you to know that smoking is bad for your health and can make breathing harder, cause cancer, and heart disease. If you ever do want to quit, please let us know and we will help you." OR if they say yes, then say "I'm happy. I will arrange for counseling, and we will discuss your progress on our next visit."

Typically, I would be asked the "hard" quesiton at this point and so I would have to do a bit of the closure/ counseling before the physical. I also used the end of the physical to tell them what I was going to do on the physical (listent heart lungs, ect - not detailed)

I also did ROS that I forgot while doing that part of the physical. Probably not the best way to do things but better than not doing it at all.

At the end I would tell them basically what I thought - ie if CC was cough I may say something along the lines of your cough could be a viral or bacterial infection in your upper respiratory tract or lungs or it could be due to a problem with your heart. Based on the history and physical, X or Y may be more likely than Z. and I will do these tests to help me better narrow down the source. Do you have any questions? And this part WAS covered in FA. But not well.

On some pts I did not get to do all of this, but I made a sincere attempt to do this. Apparently, its a big part of the CIS (information sharing, ect)

Personally, I found FA GREAT for ICE (used it to study and got off the charts) but did not find it that great for the CIS part of grading. Except making you paranoid about draping - which I am convinced I still managed to do incorrectly - but passed and that's all that mattered. And it does have sample closures/ counseling but again, its just not emphasized.

Did you all review the pts problems with them at the end, i.e. summarize what they told you before going into the differential and your work-up plan for them?
Ive taken our COMLEX PE and passed and I didnt repeat anything back to the pt...merely told them what I thought they might have and what we were going to do to work it up and asked if they had questions and I passed.

I am taking USMLE's CS as well on Monday. I noticed in FA it says to summarize what the pt told you for their CC and then go into that. For those that have taken it AND PASSED, did you all summarize at the end? Is this something I need to make sure to do?
Basically is everything in FA Step 2 CS absolutely how I should do it?? Thanks very much in advance

 

[Proverbs31]

I reaLLY APPRECIATE ALL YOUR DETAILED ANSWER...i GUESS iM GONNA HAVE TO GET USED TO SUMMARIZING WHAT THEY TOLD ME BEFORE i GO INTO PHYSICAL EXAM OR CLOSURE.....IM JUST NOT USED TO DOING THAT AT ALL!
ANY OTHER SUGGESTIONS ARE WELCOMED! I REALLY APPRECIATE IT.

I THINK IM GONNA WRITE THE NOTES AND NOT TYPE...

TAKE IT MONDAY IN ATL

 

[Proverbs31]

Quick question: So you asked questions , like ROS during your Physical Exam part? Is that ok to ask additional questions then? I normally do that when I see patients and I talk to them the whole time but I see in FA it says not to do that? Can anyone comment? Thank you again!!

After the history, I summarized what they told me and asked if it sounded right, if they had anything else to add. I did this to make sure I had asked the majority of quesitons and if I had remembered their answers correctly.

I also did counseling during the history so that I would not forget to do that later and it is brief - Me: "smoke?" Pt:"yes". Me: "Do you want to quit?" Pt:" No". Me: "I want you to know that smoking is bad for your health and can make breathing harder, cause cancer, and heart disease. If you ever do want to quit, please let us know and we will help you." OR if they say yes, then say "I'm happy. I will arrange for counseling, and we will discuss your progress on our next visit."

Typically, I would be asked the "hard" quesiton at this point and so I would have to do a bit of the closure/ counseling before the physical. I also used the end of the physical to tell them what I was going to do on the physical (listent heart lungs, ect - not detailed)

I also did ROS that I forgot while doing that part of the physical. Probably not the best way to do things but better than not doing it at all.

At the end I would tell them basically what I thought - ie if CC was cough I may say something along the lines of your cough could be a viral or bacterial infection in your upper respiratory tract or lungs or it could be due to a problem with your heart. Based on the history and physical, X or Y may be more likely than Z. and I will do these tests to help me better narrow down the source. Do you have any questions? And this part WAS covered in FA. But not well.

On some pts I did not get to do all of this, but I made a sincere attempt to do this. Apparently, its a big part of the CIS (information sharing, ect)

Personally, I found FA GREAT for ICE (used it to study and got off the charts) but did not find it that great for the CIS part of grading. Except making you paranoid about draping - which I am convinced I still managed to do incorrectly - but passed and that's all that mattered. And it does have sample closures/ counseling but again, its just not emphasized.

 

[Knicks]

i was anxious about this because i did not drape during history..but always draped before Physical....while the little chart in FA says to drape before history, if you look at the text it says you can drape before PE...dont worry man...

I really hope so.

 

[Nellyakgo]

As long as you drape before you start the PE it is completely fine. BUT if an SP is lying down when you enter you must drape right away.

If you're running out of time, yes you can ask questions while you do the physical. It's better to have answers you need rather than miss them. But if they're questions that are not on the SP's check list (against whihc they give you points) you simply won't get any additionla points for asking/gathering that particular data.

 

[dusselas]

Help! Test in 2 days!

How helpful is it to study the notecards in the back of the Kaplan Step 2CS? Should I stick to repeating the 35 cases? Or is it worth it to memorize notecards?

Thanks for help. Stressed out.

 

[Knicks]

As long as you drape before you start the PE it is completely fine.

whew!

BUT if an SP is lying down when you enter you must drape right away.

 

[Proverbs31]

Ok, so I just took my USMLE Step 2 CS today! I now have officially taken both COMLEX PE and USMLE CS...

SO....to give back, because all of you helped me a lot. Some advice:

FA for step 2 CS is still the best review book I know. USE IT!
I practiced with my brother as the patient for 6 cases out of the FA book and I reviewed the minicases the night before and the day of and felt very prepared for today's test.
Honestly, I felt good walking out of it.....Ironically so. I took the exam in ATL and felt the staff were very friendly and helpful and believe it or not, I enjoyed the food too! SO that was a bonus. If youre a vegetarian, they have food options which is nice. I took the afternoon session starting at 3pm and was completely finished and sitting in my car texting my family I was done by 10:10pm. So we finished a little earlier than 8 hours. I truly believe that if you review FA for the CS, you should be prepared to handle any "case presentation" they throw your way. I am not going to guess reasons why great people fail, but in terms of being able to determine a good work-up and differential, FA will absolutely prepare you for that. I'll keep you guys posted when I recieve my score in a few months. Best of luck to you all and thanks for helping answer my questions prior to my exam today!

Im sure I made silly mistakes, but overall felt like nothing was out of left field. AGAIN - STUDY FA CS step 2. I also reviewed the online video on USMLE website about what to expect for test day and it is IDENTICAL to the real test day. So I felt comfortable with no surprises.
I also took the first 30sec to 1 -1/2 minutes at the initial "OK to begin" announcement and I wrote on my own scrap paper, "The given Name, Age, and CC, and thought of 3-6 differentials to think about for whatever the CC was and wrote them on my scrap paper. This helped guide my questions and reminded me at the end during the actual write up of my note. I also scribbled down quickly - "LOPQRST" - just to remind me to ask the simple "location, onset, etc " questions and I quickly just wrote the headings:" PMedHX: ; Meds; Surg HX; Allergies; Social; Fam HX; Summarize: Conclusion".

THAT IS THE BEST ADVICE I can give! It took no more than a minute and a half MAX to write all that and then I would enter my patients room and begin. This helped me remember to ask everything and to try and "summarize" the patients CC and HPI with them prior to my conclusion of the differential and work-up to them. (Something not required of COMLEX PE and something I wasnt used to doing.) I only forgot to ask some of these things on 1 patient for these pertinent easy points, all because my initial 30second to 1 minute writing at the exam start!! I DIDNT EVEN DO THIS FOR MY COMLEX PE and I wish I had. From practicing with my Brother, I found out that I always had about 4min left over from the exam, from our timed 15min, and I always caught myself forgetting to ask easy allergy or Fam Hx questions. So, I decided to write these headings on my scrap paper, along with a few quick first thoughts as to what could cause ...Blank "CC", once I was allowed to start. It really did help and reminded me to ask. I highly recommend it! Best of luck guys!

I do have a few questions for those that have taken and PASSED it already:

1. Did anyone list MORE than 5 differentials and/or work-ups on a patient? Im curious is that is counted against you or okay to do? I didnt see an answer for this online.

Thanks again to everyone for all your great advice!

 

[Captopril]

Hey Proverbs, disregard my PM requesting advice...looks like you laid it out very nicely right here. Awesome post!

Ok, so I just took my USMLE Step 2 CS today! I now have officially taken both COMLEX PE and USMLE CS...

SO....to give back, because all of you helped me a lot. Some advice:

FA for step 2 CS is still the best review book I know. USE IT!
I practiced with my brother as the patient for 6 cases out of the FA book and I reviewed the minicases the night before and the day of and felt very prepared for today's test.
Honestly, I felt good walking out of it.....Ironically so. I took the exam in ATL and felt the staff were very friendly and helpful and believe it or not, I enjoyed the food too! SO that was a bonus. If youre a vegetarian, they have food options which is nice. I took the afternoon session starting at 3pm and was completely finished and sitting in my car texting my family I was done by 10:10pm. So we finished a little earlier than 8 hours. I truly believe that if you review FA for the CS, you should be prepared to handle any "case presentation" they throw your way. I am not going to guess reasons why great people fail, but in terms of being able to determine a good work-up and differential, FA will absolutely prepare you for that. I'll keep you guys posted when I recieve my score in a few months. Best of luck to you all and thanks for helping answer my questions prior to my exam today!

Im sure I made silly mistakes, but overall felt like nothing was out of left field. AGAIN - STUDY FA CS step 2. I also reviewed the online video on USMLE website about what to expect for test day and it is IDENTICAL to the real test day. So I felt comfortable with no surprises.
I also took the first 30sec to 1 -1/2 minutes at the initial "OK to begin" announcement and I wrote on my own scrap paper, "The given Name, Age, and CC, and thought of 3-6 differentials to think about for whatever the CC was and wrote them on my scrap paper. This helped guide my questions and reminded me at the end during the actual write up of my note. I also scribbled down quickly - "LOPQRST" - just to remind me to ask the simple "location, onset, etc " questions and I quickly just wrote the headings:" PMedHX: ; Meds; Surg HX; Allergies; Social; Fam HX; Summarize: Conclusion".

THAT IS THE BEST ADVICE I can give! It took no more than a minute and a half MAX to write all that and then I would enter my patients room and begin. This helped me remember to ask everything and to try and "summarize" the patients CC and HPI with them prior to my conclusion of the differential and work-up to them. (Something not required of COMLEX PE and something I wasnt used to doing.) I only forgot to ask some of these things on 1 patient for these pertinent easy points, all because my initial 30second to 1 minute writing at the exam start!! I DIDNT EVEN DO THIS FOR MY COMLEX PE and I wish I had. From practicing with my Brother, I found out that I always had about 4min left over from the exam, from our timed 15min, and I always caught myself forgetting to ask easy allergy or Fam Hx questions. So, I decided to write these headings on my scrap paper, along with a few quick first thoughts as to what could cause ...Blank "CC", once I was allowed to start. It really did help and reminded me to ask. I highly recommend it! Best of luck guys!

I do have a few questions for those that have taken and PASSED it already:

1. Did anyone list MORE than 5 differentials and/or work-ups on a patient? Im curious is that is counted against you or okay to do? I didnt see an answer for this online.

Thanks again to everyone for all your great advice!

 

[PathMD2010]

Quick question: So you asked questions , like ROS during your Physical Exam part? Is that ok to ask additional questions then? I normally do that when I see patients and I talk to them the whole time but I see in FA it says not to do that? Can anyone comment? Thank you again!!

Did it and passed. Don't know if you are supposed to or not.
That said, I would pause and ask them ie, before doing abdominal exam realize I did not ask abdominal ROS. I did not ask WHILE palpating, and as I would do in real life. And I did not do it THAT often. Again, its just a check box and if you do it, it gets checked but it is probably best to keep a nice separation between the history and the physical.

And never talk while auscultating
Good luck