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* Failed.....plz.guide especially abot CIS?????thank
 #144084  
  drdepressed - 12/07/06 17:59
 
  Hey friends,I did oasis trick last night and shocked when new application opened...Oh my God,I have only 1 IV and no chance of more IVs and match now..But friends I want to pass CS in next 1 to 2 months(so be able to participate in next match)..I hav'nt received score report but I think CIS would be the cause...Plz.answer my qs.....Should we drape the patient immediately after greeting or bofore physical exam??should we say"Oh"or"I am sorry to hear that"after hearing chief complaint??How to auscultate tricuspid area in females?When we summarize history,before physical exam or after physical exam just before giving DD and work up?Should we councel as we go to during history taking or at the end after explaining dd and workup to pt(I forgot to counsel many at the end,even thought to counsel initially in the encounter)??plz.any other suggestion to improve CIS??I forgot to summarize history,drape patients(draped them only when doing abdominal exam)and forgot to councel in 3 to 4 cases in exam,so I failed.......Thanks to all and congratulation to all who passed......  
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* Re:Failed.....plz.guide especially abot CIS?????th
#582142
  iurie - 12/07/06 18:19
 
  where did you take ur exam???
u drape once u entered the room.listen to the tricuspid just below the bra line.summary isn't the most important point.sometimes when you summarize u can harm urself,by using medical terms.my friends,and my wife didn't summarize at all.they all passed.
 
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* Re:Failed.....plz.guide especially abot CIS?????th
#582158
  drdepressed - 12/07/06 19:00
 
  I took exam in Philadelphia..............  
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* Re:Failed.....plz.guide especially abot CIS?????th
#582369
  desidr - 12/07/06 22:39
 
  Heyyyy. Dont lose hope..Its just an attemp to CS.
When you enter the room, greet the Pt first. You dont have to drape him at the start. But Doing it before the physical exam is imp. Show sympathy to the pts complaints. Dont be very dramatic. Give an appropriate responce.
You dont have to auscultate Tricuspid and mitral area in Simulated Pt. Do it in Aortic and pulm area. Even if you dont hear anything, thats fine. Pt is not going to come to know that, but he'll make it sure that you get a credit for that if you do that part of examination.
Summorize history before giving the DD. You may do it after taking the full history or examiation also.
If you think you'll Forget to counsel at the end or if you are scared of falling short of time at the end then counsel when the Pt mentions that complain like smoking, Intercourse without contraceptives, or noncompliance with the treatment of HTN or DM. Even if you do it in two or three lines, you'll get a credit for that.
All the best...Keep it cool.
 
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* Re:Failed.....plz.guide especially abot CIS?????th
#582411
  coach - 12/07/06 23:34
 
  hi just wanna share my experience..i took mine at chicago...im an img..english is kinda good but not as good as other but still i've lot of confidence in myself that i know i can do it...

i tot that i failed my cs after i took it coz most of my cases i didnt give any counseling and summarization...but still try to do it on your 2nd time around..

first, get the pt name and vital sign and chief complaint..do all wat they want you to do...try to stay outside for 40sec. to think other diiferential dx

then knock

then intorduce your name and greet the pt with their name..then drape the patient

start with HPI then do the PAM HUG FOSS...dont miss anything on that coz they will give you credit in every question you ask..always make transition..

then do PE..just do the important thing related to the complaint...SP's are not doctors so they dont know exactly d procedure but they have the idea wat you suppose to do...

opps dont forget to wash your hands before PE ok..its a must

then...after im done with my PE..i always say this.."thank you for the info and physical examintaion i've done to you..as of now i still dont know exactly waht is the cause of your symptoms..i still need to run some lab work up and imaging studies..as soon as i get the result i will call you and we'll meet again and i will tell you my definite dx and also my treatment option...is that sounds good to you..."
but if im sure about the dx..this is wat i say..."there is a possibility that you have------ but there some other diagnosis that would present your sx..in order to find out exactly the cause of your sx i still need to run some lab...............................

then after that always ask the px if he has other concern or question before you go...
thats it...

just be cool and confident...
 
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* Re:Failed.....plz.guide especially abot CIS?????th
#582499
  drdepressed - 12/08/06 02:52
 
  Extremely thanks for ur guidance....God bless you all...Now I am feeling the courage to take this exam again..................  
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* Re:Failed.....plz.guide especially abot CIS?????th
#582500
  coach - 12/08/06 03:05
 
  and also i forgot...try to be organized as much as possible in asking question.. HPI and PAMHUGFOSS is the best thing you should practise..by that you wont get loss....counseling and summarization is always in the end....have you ever use UW?..  
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* Re:Failed.....plz.guide especially abot CIS?????th
#582519
  clindamycin - 12/08/06 05:53
 
  enter the room greet the patient and say oh, lemme drape u first so that you will be more comfortable... drape and then start asking about the PC... say Oh I am so sorry to hear that I will try my best to make you feel better. I will be asking you some questions if that is ok with you?.. transitional sentences are imp....
if you cant rememeber the relevant questions in HPI then just jump to PMH and ask PAMHUGSFOSS... you will definitely rem some thing relevant to HPI while doing that... and even if you rem it while doing the PE then ask.. it doesnt matter...
then tell the pt tht i need to do the PE for that lemme quickly wash my hands and while I am doing that lemme briefly summarize you what you just told me... and just summarize the main points of his history... its OK if you dont cover every thing but you get the point of summarizing.... and cousil the patient during the whole encounter... while you r taking the social H and the Sexual H and the Drug history.. congratulate him on being compliant with the medications if he is.. and if he is not then ask him to... stuff like that...
i did the GPE in all pt.. checked the eyes for anemia jaundice mouth and throat.. Lymph nodes......is it ok if i untie ur gown? lemme untie your gown pretty quickly. listen to the heart real quick... and while im at it lemme hear your lungs... take deep breath in and out... thank you.... all of this try to do in ALL pts... and this examination shud not take you more than 2 mins.... just put the steth on aortic mitral and tricusp areas... pausing for 1 sec only... listen to the lungs just once on each side... and then focus on specific systemic examination... what ever it is.... if you get neuro then you have to be fast thru out the history... you have to practice... start from eyes and then move to toes.... i checked for ROM divergence convergence.... shrug ur shoulders.. clench your teeth... say AHHH... move head from side to side...pull ur hands out... pull them in.. check both hands together... you dont have to check arms too... push your legs out.. pull them in... do u feel my hands on your legs... quickly grab the cotton ball and tooth pick.. touch each leg only once... ask do u feel it... wiggle ur toes... and please walk on ur heels to the wall and come back on your toes... now stand still... and close ur eyes... dont worry i m here n i wont let you fall... then ask the pt to sit down... and while he is doing tht... ask for any other concern.... pt usually ask the specific concerning questions while u r taking the history.... you have to run thru the exam... touch every thing... you cant go in detail...

key is practice... with an alaram clock... time your self... set the alarm for 15 mins then for 5 min and then for 10 min ( for PN).... you shud be on your PE on 15 mins... time flies fast when you are in there... so dont hang over the history... if you cant think of any questions jump on PAMHUGS AND FOSS.... trust me u will rem the questions while doing the exam... think ahead of time and practice... practice alone... always time your self... practice PN... memorize all the DDs of the imp cases.... USMLE W has a good list of system specific TESTs to order... memorize that... i just studied for ONLY 10 days... and did the cases twice... and i wasnt studying more than 3/4 hours a day...

just dont be jittery.... if you stsay calm... it will be must easier and smoother...

All the best...
 
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* Re:Failed.....plz.guide especially abot CIS?????th
#582530
  pt - 12/08/06 07:43
 
  Hi my friend,
I totaly understand your feeling. Everyone has given very good advices so that I just want to say good luck to you for your retaking eaxam. I will pray for you. Be prepared and confident next year.
I dont know what else to say.
My dear freind, just keep hoping for the best for the next time. You definiely will get it.

With my best wishes.
 
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* Re:Failed.....plz.guide especially abot CIS?????th
#583042
  iurie - 12/08/06 15:26
 
  drdepressed ,when was ur exam???  
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* Re:Failed.....plz.guide especially abot CIS?????th
#583051
  y_me - 12/08/06 15:29
 
  http://www.usmle.org/step2/Step2CS/CommSkills.htm  
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