Transcript Step 2 CS…….. Made Ridiculously Simple

Muhammad Ali Khan M.D.
 The Exam Overview
 The Exam Itself
 How to Prepare
 Mnemonics for History (made by Adnan Saleem
Polani)
 Pearls for the Exam
 5 cities ( Atlanta, Chicago, Houston, Los Angeles & Philadelphia)
 Schedule the exam 4 to 5 months before the intended date.
 One year eligibility period, you have to take the exam within it.
 Choosing the Center and myths about them
 Preparation time varies from 2 to 4 weeks.
 Check out the reporting period at www.usmle.org
 Watch the orientation video at www.usmle.org
 Orientation of 20 minutes
 12 patient encounters
 An encounter includes
 History taking
 Physical Examination
 Counseling and Conclusion
 Each patient encounter is of 15 minutes followed by a 10
minute patient note
 Book to use
 First Aid for CS
 Practicing is the key for success
 Practice preferably with a medical student or doctor.
 If not the above you can practice with anyone.
 If you do not find anyone then you may practice in front
of a mirror.
 Do all cases at least twice
 Doorway information
 You write down patient’s name, age & chief complaint.
 Write down the mnemonic.
 Make four differentials.
 Knock on the door.
 Address the patient by his/her name.
 Greet warmly, shake hands and introduce self by
name.
 Ask the simulated patient (SP) if he/she is comfortable
in the room.
 Drape the patient.
 Please during the encounter, no matter what goes
wrong, do not have this question mark look on your
face.
 Just be CONFIDENT, YOU ARE GOING TO DO
WELL.
 O
 P
 F
 A
 A
 A
Onset
Progression
Frequency
Alleviating Factors
Aggravating Factors
Associated Symptoms (Depends on the DDs)
 P
 F
 F
 R
 A
 W
 S
Previous Episodes of this particular complaint.
Fatigue
Fever
Rash
Appetite changes (Diet and Exercise)
Weight changes
Sleep changes
 R
Review of systems (go head to toe)
 A Allergies
 M Medications
 P Previous medical history
Previous surgical history
Family history
 Sex
 S
 O
 D
 A
 T
 L
 A
Sexual history (Active, Partners within last 1 year,
contraception, protection etc.)
Smoking
Occupation
Drugs (Recreational)
Alcohol
Travel
Living condition
Anything else?
 L
 M
 P
Last menstrual period
Menarche
Periods lasting how long
 R
 T
 V
Regular/Irregular
Tampons/Pads (How many )
Vaginal Discharge





C
S
P
A
P
Cramps in abdomen
Spotting
Pap Smear
Abortions
Pregnancy
 B
Birth History
 D
Development History
 I
Immunization history
 D
Diet
 After completing the history (say in 7 minutes), wash
your hands.
 Proceed on to the Physical Examination after taking
permission from the patient.
 Do the relevant system first, then if you have time you
can do CVS and Respiratory system examination.
 Be precise in your clinical methods and do not waste
time, there are no findings on the simulated patients.
 When the 10 minute warning announcement occurs
you should be half way through your examination.
 If you are lagging behind, speed up, you will need time
for counseling and closure.
 Avoid medical terminology.
 Tell the patient about your initial diagnostic
impression and the tests you would like to run.
 Counsel the patient as required for
 Smoking
 Alcohol consumption
 Safe sex practices
 Social issues
 In the end ask the patient if he/she has any questions
for you.
 Shake hands and say good bye.
 Relax the day before the exam (do what you like &
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enjoy).
Book a cab the day before your exam.
Reach the exam center one hour before the mentioned
time.
HOLD YOUR NERVES.
Most important thing in the encounter is to finish it
with adequate counseling.
It does not matter if you mess up a case or two or even
three, just keep on telling yourself that you will pass.
 Just be yourself and you will see how things click for
you.
 Confidence is the key.
 You should be polite and smile (but not excessively).
 Show empathy to the patient.
 The best time to take CS is when you go for electives in
final year.
 Feeling sad or after the exam????????????
 It is PERFECTLY NORMAL!!!!
Thank you