step 2 cs

[optiplex]

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hey guys:

quick q. step 2 cs - what did you use to prep for it? and secondly, it sounds like I can just pretend to do all the PE...so what about the writing up the PE...do I pretend I also heard friction rub if I know the patient should have a rub - even though the SP probably is healthy and just pretending to have pericarditis...?

dazed and confused...

 

[lord_jeebus]

Yes, you can often just go through the motions.

Document your actual findings, just like a real patient.

 

[BabyPsychDoc]

People most often either read FA for Step 2 CS or use UW to prepare for the exam.

Now, here is my question. Lord Jeebus, and the senior people on this forum who have already been through the evil test, I hope you could help me.

I just got FA for CS. On the whole, it seems to be a good book. However, there are things in there that I frankly just disagree with. For example, why on earth would I order CBC on somebody with likely migraine? Or, why would I do a rectal exam on someone with likely ascending cholangitis? I mean, I understand American docs practice much more of a defensive medicine than we do in the UK, but....damn. What do you say?

 

[lord_jeebus]

Use your common sense.

I think if you order things you would order in real life you will be fine. FA is mainly useful as a guide to the types of cases you might see, and some ideas for possible tests - but don't treat it as a set of "answers" to the cases.

 

[BabyPsychDoc]

Use your common sense.

I think if you order things you would order in real life you will be fine. FA is mainly useful as a guide to the types of cases you might see, and some ideas for possible tests - but don't treat it as a set of "answers" to the cases.

Thank you, Jeebus! This is what I was hoping to hear.

 

[bigdan]

I think FA for CS is gold. Bang thru that and you'll be fine.

I think the best part of the book is getting used to what questions to ask when, and as I reviewed the presented cases in FA, I got used to a pattern. My school trained us to ask open-ended questions, and to give pts time to speak - CS wants no part of that: knock, wash your hands (I simply did this the moment I entered the room on EVERY pt), and bang out the checklist in your mind - What brought you in? Then do that location/intensity/quality/etc thing - don't wait for elaboration, 'cause they won't give it. Don't forget ROS - this is money. Everyone gets the heart and lung exam. Your goal is to get points on their list of required items. You can add time to your history by doing ROS as you do the PE. And don't forget to explain and make recs at the end...even at the expense of an full PE, I'd say to stop and make sure you talk to the pt before you leave the room.

You can do a short focused note; don't go crazy, and don't worry about getting EVERYTHING down. Be sensible. Who cares why to get a CBC with a migraine - every ER in the USA would order one for that. Just put down things that make sense to you. I forgot to order troponins in a case when I *absolutely* should have, and things worked out. Same with you listed differential. Just be sensible.

And speak some form of understandible English. I'd wager that was the rate limiting step for some.

Good luck to all.

dc