USMLE Step 2 CS Tips and Tricks

[Distant]

General Considerations I wish I knew Before my CS Exam:
-The CS patients are Very Helpful, they understand that you are in a stressful exam, and they make every effort to make it easy for you, they are fast, informative, and don't try to confuse you.

-I found that Most of the Answers to my hx questions negative, unless one of two things:
1) It supports the Main Diagnoses.
2) It supports a Differential Diagnosis.
-So Nothing in the hx is there to waste your time with the patient or with the Patient Note.
-The Telephone case is the easiest Case!, You don't have to examine anybody and you leave the pt early and get extra time for your note... can write your mnemonics and ask accordingly without worrying about the eye contact.
-During the Patient encounter, you can always take your time to think, patients will not react to your moment of silence.
-In ALL the "Challenging Questions". Start the answer by .. At this point ....
-Make up your mnemonics, Stick to them, you'll do fine..
One of the ones I made up were:
Social Hx: SAW LSD.
Support?
Alcohol
Work?[occupation]/Workout? excersize frequency

Live with?
Smoking Hx?
Diet, eating habits?

Attached PDF file that really helped me with me mnemonics and organization during my practice then with the exam.

-After the Hx taking and PE I used to end the patient encounter by all the things one tends to forget and miss.
"Okay Mr/Ms...., Thank you for letting me examine you, Thank you for answering all of my questions.. Before I tell you my Impression, I would Like to ask you a few more Question..
What do you think is causing this?
How is this affecting Your life? ((Impact on pt life))
((Summery and closure)) From your Hx [Can mention some +ve Findings] and PE [Mention some Positive findings], I AM CONCERNED that you might have an .. [Main Dx].. Which is a an [a few words explaining the illness]. I would like to run further investigations and some blood samples/X-ray/U/S/Check your hormone level, to confirm the Dx and Exclude other possible causes, in the mean time ((Counseling)) I would Like to Advise you to Cut down Smoking/Alcohol, Healthy Eating, Excersize Regularly... How does that sound to you?/Do you agree?((Mutual Plan)). Do you have any Question? Thank you.."

I used to practice with all of the above mnemonics and statments so I'd use it passively on the day of my Exam..

Needless to say, You HAVE to practice writing the Patients Note Here:
http://www.usmle.org/practice-materials/step-2-cs/patient-note-practice2.html

Also I used This Timer for arranging my time during practice:
http://www.online-stopwatch.com/interval-timer/
By setting it in (10 + 5), since there is a notice when 5 minutes are remaining in the pt encounter [Total 15]. Then (8 + 2) 2 minutes remaining in the Patient Note [total 10]

I also Found this Vid Very Useful:


I got my Results 2 days ago .Passed.

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[NewGuyMD]

General Considerations I wish I knew Before my CS Exam:
-The CS patients are Very Helpful, they understand that you are in a stressful exam, and they make every effort to make it easy for you, they are fast, informative, and don't try to confuse you.

-I found that Most of the Answers to my hx questions negative, unless one of two things:
1) It supports the Main Diagnoses.
2) It supports a Differential Diagnosis.
-So Nothing in the hx is there to waste your time with the patient or with the Patient Note.
-The Telephone case is the easiest Case!, You don't have to examine anybody and you leave the pt early and get extra time for your note... can write your mnemonics and ask accordingly without worrying about the eye contact.
-During the Patient encounter, you can always take your time to think, patients will not react to your moment of silence.
-In ALL the "Challenging Questions". Start the answer by .. At this point ....
-Make up your mnemonics, Stick to them, you'll do fine..
One of the ones I made up were:
Social Hx: SAW LSD.
Support?
Alcohol
Work?[occupation]/Workout? excersize frequency

Live with?
Smoking Hx?
Diet, eating habits?

Attached PDF file that really helped me with me mnemonics and organization during my practice then with the exam.

-After the Hx taking and PE I used to end the patient encounter by all the things one tends to forget and miss.
"Okay Mr/Ms...., Thank you for letting me examine you, Thank you for answering all of my questions.. Before I tell you my Impression, I would Like to ask you a few more Question..
What do you think is causing this?
How is this affecting Your life? ((Impact on pt life))
((Summery and closure)) From your Hx [Can mention some +ve Findings] and PE [Mention some Positive findings], I AM CONCERNED that you might have an .. [Main Dx].. Which is a an [a few words explaining the illness]. I would like to run further investigations and some blood samples/X-ray/U/S/Check your hormone level, to confirm the Dx and Exclude other possible causes, in the mean time ((Counseling)) I would Like to Advise you to Cut down Smoking/Alcohol, Healthy Eating, Excersize Regularly... How does that sound to you?/Do you agree?((Mutual Plan)). Do you have any Question? Thank you.."

I used to practice with all of the above mnemonics and statments so I'd use it passively on the day of my Exam..

I got my Results 2 days ago .Passed.

Glad to hear you passed. Can you tell us where you took the exam? Because I encountered a few SPs that weren't quite as helpful as you say. Curious if this is a site specific thing or just your personal experience.

 

[Distant]

I took it in Chicago - November 2014.

Yes the patients were fast and easy to deal with. You can ask them: is there anything you would like to add that I might have missed? "they really do their best trying to remember if they can give you more info". I asked this question 2-3 times with every patient., and most of them added a few important points.

I did run out of time in one elderly pt since her responses were slow, where i missed the closure, summery and counseling, which I keep to the end.

 

[Watshoody]

if we have one month to prep, what should we do ? obviously FA and just practice ??

 

[Distant]

I actually started by prep with the 5 day Kaplan course, a couple of days after my Step 1 exam.
I'd say it helped me shorten the prep time I needed in terms of getting me out of the Step 1 into the CS mood. I might have got the same result but would go into the exam with a lot less confidence and would have definitely needed more prep time.
It also helped with the communication skills part which are 40 points in total. [knock door, introduce your self, empathy, transitions, etc] I mention a bunch of these points in my topic above.

After the Kaplan course I only needed 2 weeks to practice by doing the FA cases PLUS the Kaplan Course book cases [total 40], where I would typically do 7-8 cases daily.
you don't have to ask all the questions in each case, but about 80% of them is good enough, since the SP will volunteer information once you relate to the symptom in anyway.

All the best.

 

[drake19]

General Considerations I wish I knew Before my CS Exam:
-The CS patients are Very Helpful, they understand that you are in a stressful exam, and they make every effort to make it easy for you, they are fast, informative, and don't try to confuse you.
.

This is a completely subjective statement - how do you know SPs understand you at all? IN my experience for the most part they did not make every effort to make it easy for you.

I only encountered this once where the SP went out of her way to provide hints..I clearly forgot to mention additional counseling and being supportive since she had some anxiety problem and asked me if it was okay if she went to her college for cousneling (hinting that maybe I should offer her some counseling sessions)

But other than that every SP I had was very vague and many times answered "no" to my questions

 

[Distant]

This is a completely subjective statement - how do you know SPs understand you at all?

In their body language as well as their answring tone and clear cut answers. It also depends on which exam center you took it, but I'd say that 8/12 SPs were sitting on the edge of their beds trying to race me through answering my Questions so fast not to waste any of my time.

I only encountered this once where the SP went out of her way to provide hints..I clearly forgot to mention additional counseling and being supportive since she had some anxiety problem and asked me if it was okay if she went to her college for cousneling (hinting that maybe I should offer her some counseling sessions)

I was also helped similar to this, after I gave her my impression of an incorrect Diagnosis, she gave me a sharp look and indirectly told me that I'm wrong about the Diagnosis.

But other than that every SP I had was very vague and many times answered "no" to my questions

This is actually a very positive thing, since you won't have to write too much in the Pt Note, and you won't be distracted from the diagnosis as I said earlier ..

-Most of the Answers to my hx questions negative, unless one of two things:
1) It supports the Main Diagnoses.
2) It supports a Differential Diagnosis.

 

[Watshoody]

im taking it in chicago as well, beginning of june, hopefully after i do CK, giving myself one month of prep time

 

[Dactino]

I'm taking the exam end of may in Chicago. Glad to hear positive feedback about that place. Im worried about the clinical findings in patients. I read somewhere that they mimic reduced breath sounds etc by doing weird acting stuff and what not. Are the clinical findings in the exam very obvious? :s

 

[Distant]

I'm taking the exam end of may in Chicago. Glad to hear positive feedback about that place. Im worried about the clinical findings in patients. I read somewhere that they mimic reduced breath sounds etc by doing weird acting stuff and what not. Are the clinical findings in the exam very obvious? :s

The Clinical signs are nothing to worry about, for they are obvious. However, There is one Trick to keep in mind:
While Auscultating the patients lungs, keep your EYES on the Patients LIPS and try to figure out what he is faking. Is he pursing his lips? is he whistling? Is he breathing quietly?

And don't repeat the test more than twice, If you find a Negative Result, Then it is Negative sign, this applies mostly to DTR.. and Nerve Sensations and Abdominal Tenderness guarding. etc.

Best,

 

[Dactino]

Thanks for the input! Any chance of getting murmurs on the exam?

 

[Distant]

Not a chance since they can't fake it..

You know that the opthalmoscope and otoscope examinations are just you acting as if you are examining them, i mean dont waste your time "trying to find something" because they simply wont put anything inside there, use your judgment and time wisely.

 

[Distant]

I added a Few Points to the Main Post..

Needless to say, You HAVE to practice writing the Patients Note Here:
http://www.usmle.org/practice-materials/step-2-cs/patient-note-practice2.html

Also I used This Timer for arranging my time during practice:
http://www.online-stopwatch.com/interval-timer/
By setting it in (10 + 5), since there is a notice when 5 minutes are remaining in the pt encounter [Total 15]. Then (8 + 2) 2 minutes remaining in the Patient Note [total 10]

I also Found this Vid Very Useful:

 

[Annabelle27]

I added a Few Points to the Main Post..

HEY thanks for all that info,just one quick question,at kaplan they told to be focused on the system that the case is presented,and i did read on top of that on this forum, ppl do heart and lung for all cases in addition to focused exam thats needed !!how did u do it for yours?

 

[D1stant]

HEY thanks for all that info,just one quick question,at kaplan they told to be focused on the system that the case is presented,and i did read on top of that on this forum, ppl do heart and lung for all cases in addition to focused exam thats needed !!how did u do it for yours?

Great Question:
-Well here is where you have to balance things, because the truth is that nobody knows if it is really required or not. So what I did was, if time allowed me, and I was already examining the abdomen for example, I'd ask the pt to lift up his gown further and do a quick Cardiac Auscultation. I did this for about 3-4 cases. .. BUT Don't make my same mistake!, I forgot to Cover the Pt's abdomen while auscultating his chest.

-When I got a respiratory Case > You have to include an HEENT examination.

-If it's a UTI or PID or any case where would you examine the pelvic region [not allowed] > Just Examine the Abdomen. and Inguinal LNs [allowed].

Best,

 

[MrGrrrMonster]

To answer an above question: Yes you can have a murmur. I had a pt. with an actual aortic valve replacement. They had a murmur.

 

[dwyt]

HEY thanks for all that info,just one quick question,at kaplan they told to be focused on the system that the case is presented,and i did read on top of that on this forum, ppl do heart and lung for all cases in addition to focused exam thats needed !!how did u do it for yours?

so what they tell at Kaplan ? do they tell not to do heart and lung for a case if it is not cvs or respi case ? what they tell about the general exam recommended by some people in 3o seconds or so ? did u take any Kaplan course and if yes what is ur review of the same ?
Thanks