ULTIMATE CS PREP STRATEGY - usmlesuccess.net · - Alternating hand test - Romberg test (for balance...

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THE ULTIMATE STEP 2 CS PREP

STRATEGYIMPORTANT INFORMATION YOU MUST KNOW

BEFORE TAKING YOUR EXAM

THE ULTIMATE STEP 2 CS PREP STRATEGY

EVERYTHING YOU NEED TO KNOW BEFORE TAKING YOUR USMLE STEP 2 CS EXAM

USMLE Success Academy www.usmlesuccess.net

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WHAT WE’RE GOING TO DISCUSS◦ WHAT YOU NEED TO DO TO SUCCEED◦ UNDERSTANDING THE ICE COMPONENT◦ UNDERSTANDING THE CIS COMPONENT

◦ WHY MNEMONICS ARE YOUR BEST FRIEND ON THE CS EXAM◦ HOW TO TACKLE THE PATIENT NOTE◦ ANATOMY OF THE ENCOUNTER

◦ MASTER THE SOFT SKILLS◦ KNOW HOW TO TACKLE CHALLENGING SCENARIOS & QUESTIONS◦ THE PHYSICAL EXAM AND THE STEP 2 CS

◦ HOW TO STUDY FOR THE STEP 2 CS (si/sx, practice, etc)

WHAT YOU NEED TO DO TO SUCCEED

◦ MASTER THE MAIN COMPONENTS◦ MASTER THE SKILLS NEEDED FOR THE EXAM◦ MASTER THE PATIENT NOTE CREATION PROCESS

◦ IMPLEMENT & REPEAT ALL SKILLS DURING PRACTICE◦ GET FEEDBACK FROM FELLOW COLLEAGUES◦ FINE TUNE YOUR SKILLS


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THE I.C.E COMPONENT – INTEGRATED CLINICAL ENCOUNTER

◦ WHAT IS IT?

◦ WHAT’S THE POINT OF THE ICE?

◦ HOW DO I GET MY POINTS?

THE C.I.S COMPONENT – COMMUNICATION & INTERPERSONAL SKILLS

◦ WHAT IS IT?

◦ WHAT’S THE POINT OF THE CIS?

◦ HOW DO I GET MY POINTS?


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THE IMPORANT ROLE OF MNEMONICS

◦ WHY SHOULD YOU USE THEM?

◦ HOW TO USE THEM?

HOW TO TACKLE THE PATIENT NOTE

◦ WHAT IS THE ROLE OF THE PATIENT NOTE?

◦ WHAT ARE MY OPTIONS FOR CREATING THE NOTE?

◦ DIFFERENTIALS AND SUPPORT

◦ ADDITIONAL TIPS (SPELLING, GRAMMAR, STRUCTURE)


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ANATOMY OF AN ENCOUNTER

◦ WHAT IS THE ‘ANATOMY’ OF AN ENCOUNTER?

◦ THINKING OF THE ENCOUNTER AS A GROUP OF SPECIFIC SECTIONS

◦ HOW MUCH TIME TO ALLOCATE TO EACH

MASTERING THE SOFT SKILLS

◦ EMPATHY/SYMPATHY, PATIENCE, RESPECT, KINDNESS

◦ HOW TO SHOW EMPATHY:

◦ HOW TO SHOW PATIENCE:

◦ HOW TO SHOW RESPECT:

◦ HOW TO BE KIND:


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CHALLENGING QUESTIONS & SCENARIOS

◦ WHY DO THE SPs PUT US THROUGHCHALLENGING Q’S OR SCENARIOS?

◦ WHAT IS OUR GOAL IN TACKLING THESEISSUES?

◦ HOW TO TACKLE CHALLENGINGQUESTIONS

◦ HOW TO TACKLE CHALLENGINGSCENARIOS

THE PHYSICAL EXAM FOR THE CS

◦ WHAT SHOULD WE ALWAYS DO?

◦ WHAT SHOULD WE DO FOR THE PHYSICAL EXAMS?

◦ DOCUMENTING YOUR FINDINGS


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HOW TO STUDY THE Si/Sx FOR THE CS EXAM

◦ CREATE LISTS OF 3-5 SPECIFIC FINDINGS:

◦ CREATE COMPARISON CHARTS:

BEFORE WE GO…..

Join our exclusive invitation only Step 2 CS Facebook group…

Run exclusively by myself (Dr. Paul), I’m going to give away as much free

Step 2 CS help as I possibly can!


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https://www.facebook.com/groups/usmlesuccessacademycsgroup/

PHYSICAL EXAMS


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What To Do For Each Physical Exam

Cardiovascular:

- Inspect & palpate

- Auscultation

- Auscultate carotids

- Check pulses

- Check PMI (left lateral decubitus)

- Auscultate carotids in supine position


Respiratory:

- Inspect & palpate

- Auscultate

- Check lung expansion

- Percussion

- Fremitus (99)

- Egophony


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What To Do For Each Physical ExamNeurology:

- MMSE (if LOC or AMS present)- CN 2-12

- Sensory in upper/lower extremities- Motor in upper/lower extremities- DTR’s in upper/lower extremities

- Alternating hand test- Romberg test (for balance assessment)- Gait test


HEENT:- Inspect the head

- Palpate lymph nodes

- Palpate sinuses

- Look into the eyes, ears, and nose

- Look into the mouth, look at throat

- Palpate thyroid gland


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What To Do For Each Physical ExamAbdominal (GI/GU/OBGYN):- Inspect (1st)- Auscultate (2nd)

- Percuss (3rd)- Palpate (4th)- On palpation: Watch for rebound tenderness, assess for appendicitis with Rovsing,

Psoas, & Obturator tests, Murphy’s test for cholecystitis


Musculoskeletal:

- Inspect & palpate

- Range of motion (compare to unaffected side)

- We have several ‘special tests’ that will be discussed shortly (Knee, Shoulder, Back, andWrist have special tests we need to know)


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Special Maneuvers For Each System

HEENT: Weber & Rinne tests, Brudzinski & Kernig tests

KNEE: Ballottement, McMurray, Anterior/Posterior drawer, Varus/Valgus stress

WRIST: Phalen, Tinel

SHOULDER: Arm-drop (open can)

BACK: Straight leg test

DOCUMENTING YOUR PE FINDINGS


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Documenting Your PE FindingsHEENT:Head: NC/ATEyes: EOMI, PERRLA, normal eye fundus

Ear: TM intact, no ear discharge, no tinnitus, no redness, no fullnessNose: Nasal turbinates not congestedMouth: No tonsillar erythema, exudates, or enlargement, good dentition

Neck: No JVD, normal thyroid, no lymphadenopathy, no carotid bruit

Documenting Your PE FindingsNEUROLOGY:CN 2-12 grossly intact, motor strength 5/5 in all muscle groups, DTRs are 2+ intact & symmetric, sensation intact to sharp and dull, rapid alternating movement intact, cerebellum intactIf MMSE is done: AAOx3, good concentration


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Documenting Your PE FindingsRESPIRATORY:

CTAB/L, no rales, rhonchi, wheezing, or rubs.

Inspection: no bruises, cuts, or scars

Normal to palpation, no tactile fremitus, no dullness, whisper pectoriloquoy -, egophony -

Documenting Your PE FindingsCVS:S1/S2, RRR, no MRG, no JVD, no pedal edema, pulses 2+ in all extremities

ABDOMEN:Soft, non-tender, non-distended, Murphy’s sign +/-, rebound tenderness +/-, Psoas sign +/-, Rovsing sign +/-, Obturator sign +/-

MSK:

ROM increased/decreased, sensation intact, motor strength intact (then findings of any special maneuvers)


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Documenting Your PE FindingsExtremities:

- No deformity or trauma, +/- tenderness, ROM increased/decreased, muscle strength5/5 in all groups, DTR’s 2+ bilaterally, sensation intact to sharp/dull, no cyanosis,clubbing, or edema

COMMON CASESNOTE: This list is not meant to be comprehensive


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Possible Chest-Related Complaints(CVS, Pulmonary)

◦ Acute coronary syndrome

◦ Pericarditis◦ Costochondritis◦ Pulmonary embolism◦ Stress

cardiomyopathy◦ Angina pectoris

◦ Myocarditis◦ GERD◦ Aortic dissection◦ Pneumonia◦ Pneumothorax◦ Pleuritis/pleurisy

§ Esophagitis

§ Ruptured esophagus

§ Esophageal dysmotilitydisorder

§ Substance-induced(cocaine)

§ Broken rib

§ Panic disorder

Possible HEENT-Related Complaints◦ Cluster headache◦ Migraine

headache◦ Tension headache◦ Sinus infection◦ Brain tumor◦ Dehydration◦ Blurred vision◦ TMJ disorder◦ Bruxism◦ Stroke ◦ TIA/Stroke◦ Retinal

detachment

§ Hearing loss

§ Otitis media/externa

§ Strep throat

§ Lymphadenitis

§ Hypothyroidism

§ Hyperthyroidism

§ Tinnitus

§ Temporal arteritis

§ Central retinal artery occlusion

§ Amaurosis fugax

§ Multiple sclerosis


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Possible MSK-Related Complaints◦ Joint pain (any joint)◦ Scaphoid fracture◦ Lunate dislocation◦ Medial/lateral epicondylitis◦ Rotator cuff injury◦ Fractured bone(s)◦ Plantar fasciitis◦ Gonococcal arthritis◦ Tenosynovitis◦ Ligament tear◦ Costochondritis◦ Lumbar strain

Possible Neuro-Related Complaints◦ Headache

◦ Vascular dementia◦ NPH

◦ Diabetes◦ Multiple sclerosis

◦ Spinal stenosis

◦ Eating disorder◦ Parkinson’s disease

◦ Major depressive disorder

§ Alzheimer’s disease

§ TIA/Stroke

§ Seizure disorder

§ Neuropathy

§ Prolapsed disc

§ Anxiety disorders

§ Drug use/abuse

§ Adjustment disorder

§ Bipolar disorder


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Possible OBGYN-Related Complaints◦ Ectopic pregnancy◦ Ruptured ovarian cyst◦ Cervicitis

◦ Ovarian cancer◦ Decreased libido◦ Fibroids

◦ PCOS◦ Vaginitis◦ Irregular menstrual periods

§ Pregnancy/missed period

§ Ovarian torsion

§ Cervical cancer

§ Endometrial cancer

§ Dysmenorrhea

§ STD’s

§ UTI

§ Endometriosis

Possible GI-Related Complaints◦ GERD◦ Gastroduodenal ulcer◦ Ectopic pregnancy

◦ Diverticulitis◦ Intestinal obstruction◦ IBD (Crohn’s, UC)

◦ Diarrhea◦ Appendicitis◦ Colon cancer

§ Gastritis

§ Pancreatitis

§ Ovarian torsion

§ Diverticulosis

§ IBS

§ Gastroenteritis

§ Constipation

§ Cholelithiasis


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Possible GU-Related Complaints◦ BPH◦ Hematuria◦ UTI

◦ Pyelonephritis◦ Nephrolithiasis◦ Cystitis

◦ Overactive bladder◦ Bladder cancer

§ Prostatitis

§ Prostate cancer

§ Epididymitis

§ Urolithiasis

§ STD’s

§ Incontinence

§ Erectile dysfunction

§ Renal carcinoma


ULTIMATE CS PREP STRATEGY - usmlesuccess.net · - Alternating hand test - Romberg test (for balance...

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