Step 2CS

[Medstudentquest]

So I will be taking Step 2CS this month. I am planning on studying for about 2 weeks for it. Does it sound like a good time frame? I have first Aid for step 2CS.

For anyone who's recently taken the test, do you suggest anything other than Step 2 First Aid?

Also, does it matter to take it in the am or the pm? Lastly, how long do the scores typically take?

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[Antoni B]

2 weeks will be more than enough time. I'd look through the First Aid book carefully, since the cases there are very similar to the real thing. I don't think you need to use anything else.

Something that I wish I had done (but I still passed) was to practice some cases with a friend to get a feel for time management. The toughest part for me was not figuring out what is wrong with the SPs, since they are portraying common illnesses, but managing my time in the encounter and being concise while writing the H&P.

I took the exam in the AM in Atlanta, and was done by 3:15 PM. I heard rumors that the PM session was done around 10:00. Unless you're a serious night owl, I'd shoot for an AM time.

Just got my score back yesterday, and I took the exam in early Feb. Here's a link to the reporting dates:

http://www.usmle.org/Examinations/step2/step2cs_reporting.html

 

[Medstudentquest]

2 weeks will be more than enough time. I'd look through the First Aid book carefully, since the cases there are very similar to the real thing. I don't think you need to use anything else.

Something that I wish I had done (but I still passed) was to practice some cases with a friend to get a feel for time management. The toughest part for me was not figuring out what is wrong with the SPs, since they are portraying common illnesses, but managing my time in the encounter and being concise while writing the H&P.

I took the exam in the AM in Atlanta, and was done by 3:15 PM. I heard rumors that the PM session was done around 10:00. Unless you're a serious night owl, I'd shoot for an AM time.

Just got my score back yesterday, and I took the exam in early Feb. Here's a link to the reporting dates:

http://www.usmle.org/Examinations/step2/step2cs_reporting.html

Thanks!

 

[Medstudentquest]

Thanks!

One more question-how many dd'x and workups do we need to write down? is 5 ok, less, more?

I didn't see this info on the website. Thanks again

 

[Antoni B]

There is space for 5 of each, but you can (and probably should) include more than one workup on a given line if things are related (for example: listing CPK-MB and Troponin I together for a rule-out MI). I remember putting down fewer than 5 DDx's for some cases, but that may be just that I couldn't think of them. The key is to think broadly, listing the most likely thing first. By the time I got to #5, it was usually something that kinda fit parts of the case, but was very unlikely.

Hope that vague answer helps...

 

[Medstudentquest]

There is space for 5 of each, but you can (and probably should) include more than one workup on a given line if things are related (for example: listing CPK-MB and Troponin I together for a rule-out MI). I remember putting down fewer than 5 DDx's for some cases, but that may be just that I couldn't think of them. The key is to think broadly, listing the most likely thing first. By the time I got to #5, it was usually something that kinda fit parts of the case, but was very unlikely.

Hope that vague answer helps...

Ok, that helps. So the max is 5 for each. Good to know!

 

[Veg]

I took it in Atlanta this week. The test center staff are very pleasant. (If I spent all day telling people to quit writing on their paper and get in line, I would be much more irritable)

I got out around 3:30. I'd agree that the afternoon session might be a bit much.

 

[Medstudentquest]

I took it in Atlanta this week. The test center staff are very pleasant. (If I spent all day telling people to quit writing on their paper and get in line, I would be much more irritable)

I got out around 3:30. I'd agree that the afternoon session might be a bit much.

I had to switch my date, and it was hard to find an am spot! i imagine everyone else would want a morning one too. I have my date on April 21 so I think I should have enough time (I hope!). I agree that being there at night might be kind of exhausting, and one might not be as thorough or as good as in the morning since the exhaustion factor might come into play. i also would imagine the patients might be more cranky! so i'm glad i got a morning spot

 

[abbaroodle]

I took it in the PM in Atlanta. The SP's are different for the two sessions, so that shouldnt be too much of an issue. I was kinda miffed when I heard it went until 10 (what a stupid time to start an 8 hour exam!), but it worked well for me. I am a night person, so I got to sleep in, meet a friend for brunch, review a bit, and then go get it over with.

I read First Aid and also studied for a couple weeks. Maybe only 1, I dont really remember. I am a bit of a worrier, and I didnt want to blow it off and have to take it again since I was stubborn and refused to study. I also felt like I hadnt had real "medicine" in a while. (ophtho, research month, interviews, trauma - all useful, but not your bread and butter chest and abdominal pain and other common things.) The cases in the back of FA are key. I also read through their DDx section just to refresh my memory and to brainstorm DDxs and tests for different CC's. There were a few diagnoses that I felt pretty weak on so I went and read a tiny bit about them. I figure it never hurts to spend 20 mins filling in a gap. But I dont think it was needed.

I think the weirdest thing for me was counceling and answering their really stupid "challenging" questions without laughing sometimes. As a med student, I think its pretty rare that we go in, do an H&P, and then tell a pt what we are going to do. So think about how you want to say things. First Aid has some good info for that.

You will be fine. Just dont blow it off since its too expensive to have to take it again!

 

[Medstudentquest]

I took it in the PM in Atlanta. The SP's are different for the two sessions, so that shouldnt be too much of an issue. I was kinda miffed when I heard it went until 10 (what a stupid time to start an 8 hour exam!), but it worked well for me. I am a night person, so I got to sleep in, meet a friend for brunch, review a bit, and then go get it over with.

I read First Aid and also studied for a couple weeks. Maybe only 1, I dont really remember. I am a bit of a worrier, and I didnt want to blow it off and have to take it again since I was stubborn and refused to study. I also felt like I hadnt had real "medicine" in a while. (ophtho, research month, interviews, trauma - all useful, but not your bread and butter chest and abdominal pain and other common things.) The cases in the back of FA are key. I also read through their DDx section just to refresh my memory and to brainstorm DDxs and tests for different CC's. There were a few diagnoses that I felt pretty weak on so I went and read a tiny bit about them. I figure it never hurts to spend 20 mins filling in a gap. But I dont think it was needed.

I think the weirdest thing for me was counceling and answering their really stupid "challenging" questions without laughing sometimes. As a med student, I think its pretty rare that we go in, do an H&P, and then tell a pt what we are going to do. So think about how you want to say things. First Aid has some good info for that.

You will be fine. Just dont blow it off since its too expensive to have to take it again!

Sure, for some people it may work. I wouldn't want to take it that late! I'd much prefer to take it in the am. I am not blowing it off, I too have the fear of failing it and having to dish out another 1K. Not fun. I feel it's kind of a ridiculous test and SP's usually are more difficult than real patients. I have been reading the DDx and the workup section of FA, and I have the kaplan material as well. I think that should be enough.

Out of curiosity, how many times did you read through the stuff? And did you really do all the things that FA suggests. For example for certain complaints, they give a list of all the PE things you should do. If we only have 7-8 minutes for a PE, I don't see how you can do all that they want!

My biggest fear is running out of time!

 

[abbaroodle]

I agree that it is a stupid test. I think of it as a speed bump - something you just need to get over to move on in your career.

I only read through FA once. As I said, I reviewed a couple areas I felt weak on. (For example, I realized I had no recollection about vertigo and the names just werent ringing a bell.) Probably overkill. FA really jogged my memory about what to order and DDx for some CC's that I encounter less commonly. It should just be review and refresh your memory, not memorize and learn.

I dont remember if I did everything that FA said to do. I have to admit, I usually thought FA recommended things I would have done anyway - or at least should have done for the PE. I guess I dont usually listen to the neck since my impression is it is a poor PE finding (low sensitivity and specificity), but I definitely listened for carotid bruits on a few pts. I dont normally drape someone if I am just going to look at their ankle, but I did do that. (And asked permission to examine, undo gown, helped retie, said something like "lets keep you covered up" while they lifted their gown to examine belly and I pulled up the sheet, etc.) I tried to listen to heart and lungs since FA says to on everyone, but if I was short for time I skipped it. I never rechecked BP, did it standing and lying down, both arms, or anything like that. Never did dix-hallpike. I had a pt with a CC of a psych problem (trying to stay vague here) and I didnt do a PE but I did try to run through as much of the mental status exam as I could remember and included that in my note.

Again, I have no idea what is necessary and what I lost points for not doing. I only know I passed. So do what you think you would do in a real setting.

I only had trouble with time in a couple cases and then I finished but felt rushed. Most of my real pts have these really long PMH and FMH and med lists they cant remember and it usually takes a while to do a decent history. (My second cousin twice removed has asthma, and, oh, my husbands sister-in-law has HTN and I once had some bloodwork that showed my iron was low, and I had my appendix out in 1975, oh no, wait, it was 1976. Well, maybe it was 1974. And I take a football-shaped pill for this, I tried a green square pill but that didnt work, and I am allergice to these 12 meds but I dont know what happens when I take them. Groan!!!) But during the exam they were all very brief and to the point - "my dad died of a heart attack at age 80" or "I take xx mg of yyy for HTN" or "I get a rash when I take PCN." So that saves a ton of time over real life.

I was pretty relaxed and treated it just like a normal pt encounter. It actually felt pretty real (some SP's more real than others!!!) and I just asked the q's I would normally ask and did the exam I would normally do and let things flow. I have seen a lot of pts the last couple years, as I am sure you have too, so its not as if its a new skill set!

Just be cool and I am sure you will be fine!

 

[Medstudentquest]

I agree that it is a stupid test. I think of it as a speed bump - something you just need to get over to move on in your career.

I only read through FA once. As I said, I reviewed a couple areas I felt weak on. (For example, I realized I had no recollection about vertigo and the names just werent ringing a bell.) Probably overkill. FA really jogged my memory about what to order and DDx for some CC's that I encounter less commonly. It should just be review and refresh your memory, not memorize and learn.

I dont remember if I did everything that FA said to do. I have to admit, I usually thought FA recommended things I would have done anyway - or at least should have done for the PE. I guess I dont usually listen to the neck since my impression is it is a poor PE finding (low sensitivity and specificity), but I definitely listened for carotid bruits on a few pts. I dont normally drape someone if I am just going to look at their ankle, but I did do that. (And asked permission to examine, undo gown, helped retie, said something like "lets keep you covered up" while they lifted their gown to examine belly and I pulled up the sheet, etc.) I tried to listen to heart and lungs since FA says to on everyone, but if I was short for time I skipped it. I never rechecked BP, did it standing and lying down, both arms, or anything like that. Never did dix-hallpike. I had a pt with a CC of a psych problem (trying to stay vague here) and I didnt do a PE but I did try to run through as much of the mental status exam as I could remember and included that in my note.

Again, I have no idea what is necessary and what I lost points for not doing. I only know I passed. So do what you think you would do in a real setting.

I only had trouble with time in a couple cases and then I finished but felt rushed. Most of my real pts have these really long PMH and FMH and med lists they cant remember and it usually takes a while to do a decent history. (My second cousin twice removed has asthma, and, oh, my husbands sister-in-law has HTN and I once had some bloodwork that showed my iron was low, and I had my appendix out in 1975, oh no, wait, it was 1976. Well, maybe it was 1974. And I take a football-shaped pill for this, I tried a green square pill but that didnt work, and I am allergice to these 12 meds but I dont know what happens when I take them. Groan!!!) But during the exam they were all very brief and to the point - "my dad died of a heart attack at age 80" or "I take xx mg of yyy for HTN" or "I get a rash when I take PCN." So that saves a ton of time over real life.

I was pretty relaxed and treated it just like a normal pt encounter. It actually felt pretty real (some SP's more real than others!!!) and I just asked the q's I would normally ask and did the exam I would normally do and let things flow. I have seen a lot of pts the last couple years, as I am sure you have too, so its not as if its a new skill set!

Just be cool and I am sure you will be fine!

Thanks! I can't wait to get done with Step 2!!!

 

[abbaroodle]

I was very glad when I finished the test - and glad to know I am done with it for good now!!!

Something else from FA: in the note, they often put CAGE 0/4. So I asked almost everyone all 4 Cage q's and put it in my note the same way. No idea if necessary, but it doesnt hurt.

 

[Medstudentquest]

I was very glad when I finished the test - and glad to know I am done with it for good now!!!

Something else from FA: in the note, they often put CAGE 0/4. So I asked almost everyone all 4 Cage q's and put it in my note the same way. No idea if necessary, but it doesnt hurt.

I'm getting slightly concerned. I am studying and some of the questions that First Aid has for the examples seem very detailed!!

Is CS super detailed?

 

[abbaroodle]

I'm getting slightly concerned. I am studying and some of the questions that First Aid has for the examples seem very detailed!!

Is CS super detailed?

I dont remember. Can you give me an example of what you think is super detailed? What section?

 

[Medstudentquest]

I dont remember. Can you give me an example of what you think is super detailed? What section?

It seems that some of the questions on regular complaints are alot more detailed than normal. Also I'm taking my step 2CS at the end of april-now i'm wondering whether it'll be sufficient time to get the score back? I mean i'm still trying to find a residency, but what if the score is not back by July 1?

 

[abbaroodle]

It seems that some of the questions on regular complaints are alot more detailed than normal. Also I'm taking my step 2CS at the end of april-now i'm wondering whether it'll be sufficient time to get the score back? I mean i'm still trying to find a residency, but what if the score is not back by July 1?

I dont remember. I wouldn't worry too much about it. Just have a good set of H&P q's, tests, and DDx for common complaints. (Abd pain, chest pain, SOB, HA, fatigue, joint pain, GU, kid with fever, dementia, etc.) Use the cases in the back to remind you what the common cases are. And the middle section to review a bit more.

As for getting it back, Mar 29 through May 23 is reported June 24th to July 22nd. Nothing you can do about that now since March 29th came and went already. So just focus on learning what you can from the opportunity to study and do your best on the exam.

 

[funshine]

Do you think we could just order orthostatics or dix-hallpike to be done, instead of doing the maneuvers ourselves? I'm just afraid of running out of time...

plus, it'd be kinda hard to elicit nystagmus unless the patient really has BPV!

 

[lord_jeebus]

Do you think we could just order orthostatics or dix-hallpike to be done, instead of doing the maneuvers ourselves? I'm just afraid of running out of time...

plus, it'd be kinda hard to elicit nystagmus unless the patient really has BPV!

I would definitely order dix-hallpike, and would only do orthostatics if I had a lot of time.

 

[Law2Doc]

i

Do you think we could just order orthostatics or dix-hallpike to be done, instead of doing the maneuvers ourselves? I'm just afraid of running out of time...

plus, it'd be kinda hard to elicit nystagmus unless the patient really has BPV!

If the SP says they get dizzy or pass out with positional changes, then if you are truly simulating an office visit I imagine you really have to check orthostatics -- it's an awfully important part of the exam for that set of symptoms, so I would think they are looking for you to test for that. But I agree that if you do it right (waiting 2 mins between position changes, etc), it uses up all your exam time, so it had better be the main physical exam you feel the need to do.