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Pass at second attempt, Now I am back to help you - sure4
#11
OK NOW HOW ONE SHOULD COUNSELL THE PATIENT?

Counseling

Awrite ! All our lives, haven't we simply loved to give advice to anyone and whenever we get a chance (coz deep inside makes you feel kinda superior and good about yourself ;-) ) It ain't nothing different when it comes to 'counseling' your SP on the CS exam !

Difference is - you got to be fast and to the point or concise. Because after you leave the room and the SP starts marking his checklist to grade you - the very fact that you addressed the issues worth counseling will make him/her put a tick-mark next to counseling. No matter how much time you spend 'counseling' you still gonna get the same tick-mark. So decide if you will spend 1 minute and be done or spend 5 lengthy minutes !

Smoking : "Mrs. Ray, as a concerned physician, I must ask if you are aware of the bad-effects of smoking on your health... Have you ever tried quitting ? coz' it will save you a lot of health and money in the long run. I understand that old habits die hard and all people experience difficulty in giving it up due to stressful symptoms. But you can use Nicotine patches or Gum to help reduce those withdrawal symptoms and we even have a professional team to help you deal with it better. Feel free to contact me anytime if you decide to quit. "

Alcoholism / Alcoholic Patients:
"As a concerned physician, Mrs. Dodge, I must caution you about the ill-effects of alcohol consumption. Alcohol has tons of calories but lacks nutrients. Besides altering judgement, excess consumption raises your risk of high blood pressure, strokes, vehicular accidents, and is known to cause Liver Cirrhosis, Inflammation of the pancreas, brain and heart damage along with birth defects if consumed during pregnancy.

- Limit intake to one drink per day ( for women) or two per day (for men).
- Eating food while drinking will slow alcohol absorption.
- Avoid drinking before or when driving, or whenever it puts you or others at risk.

We have a professional support group who would be eager to help you overcome your habit, if you wish to give up but find it tough to do it by yourself."


Diabetes: After you are done with explaining investigations - "So Mr. Jim - we will begin your treatment once I have evaluated your lab results. I want you to know that besides drugs, there are other simple but important measures to keep yourself healthy and reduce complications. 1. Follow regular exercise and diet instructions that will be provided to you 2. Diabetic patients are vulnerable to injury-induced ulcers on the foot, so make a habit of using soft footwear whenever you walk - indoors or outdoors. 3. Be regular in blood-sugar monitoring so that dose adjustments can be done on time. Now was that too bad ?" (smile)

Hypertension Counseling: "Mr. Demiris, for a majority of patients, we cannot detect a cause for High Blood Pressure and is well controlled with exercise, diet changes and drugs, if needed. However, there may be some patients with treatable causes - we shall do a few tests soon to see if we can detect those in you."

Enuresis (Bed wetting) Counseling : "Mrs. Cole, kids with bedwetting usually undergo natural healing with age, but this problem needs tenderness. Punishing your child could worsen it - a much better technique would be to rather reinforce positive behaviour by praising and rewarding him if he stays dry while sleeping. I would advise you to monitor your child's drinking habits before going to bed and encourage the child to go to bathroom before going to bed. We also need to do some tests to rule out other conditions."

HIV Counseling:"The biggest danger in HIV may not be the HIV itself - rather other diseases that can occur more easily due to reduced body resistance. This means that your body must be fortified in advance against such disease with vaccines. Secondly, even the mildest suspicion of an infection must be tackled aggresively. Thus, periodic examinations and followups are important. We have a professional support group here which will help you with strengthening you emotionally and tackle other social issues with you."

Safe-Sex Counseling points:
1. Multiple sexual partners and unprotected sex put you at risk of Sexually transmitted diseases like HIV, gonorrohea and increase the risk of Cervical Cancer, unwanted pregnancies and complications from abortions.
2. Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you.
3. Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner's genital area, or pain while urinating.
4. Use contraceptive methods to protect yourself - u can consult your family physician for specific methods that will work best for you.
5. Add counseling about PAP smear depending on the Patients age !
6. Be responsible - Avoid sexual contact if u have symptoms of an infection. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times.

Lab-Result (Trichomonas): Lets go over some relevant points in this case -
1. Both the SP and her partner needs treatment.
2. While on Metronidazole therapy - alcohol is to be avoided, since that will cause nausea and vomitting (Disulfiram like reaction)
3. Abstinence from sexual intercourse until therapy is complete 4. If lady has multiple sexual partners - counsel on protection, risk of other STDs like HIV & risk of cervical cancer (need for PAP smears).
5. Ask her if she has had a pregnancy test recently and when - if not done, ask her to consider having that done. (and mention that on your PN as an Investigation)
Counseling for Heel Pain:

1. Use soft-heeled or soft-padded footware
2. Refrain from long standing positions or long walking activities
3. Do see us again if the prescribed pain medications do not work

Counseling a Non-Compliant Seizure Patient who wants to drive:

1. Ask him what he knows about his disease and how often does he get seizures
2. When did he last have a seizure
3. Importance of compliance for seizure control ...
4. Explain that most states in USA allow issuing non-commercial licenses to seizure patients based on the length of the "SFI" = Seizure Free Interval ..and can range from 3 to 12 months..whereas for commercial driving license, 10 years or so are required and that too while NOT taking anti-epilepsy drugs..
5. Tell him why driving is dangerous not only to him but also to others on the road in event of a seizure
Safe Sex Counseling:

1. Multiple sexual partners and unprotected sex put you at risk of Sexually transmitted diseases like HIV, gonorrohea and increase the risk of Cervical Cancer, unwanted pregnancies and complications from abortions.
2. Don't have more than one sex partner at a time. The safest sex is with one partner who has sex only with you.
3. Watch for symptoms of STDs, such as unusual discharge, sores, redness, or growths in your and your partner's genital area, or pain while urinating.
4. Use contraceptive methods to protect yourself - u can consult your family physician for specific methods that will work best for you.
5. Add counseling about PAP smear depending on the Patients age !
6. Be responsible - Avoid sexual contact if u have symptoms of an infection. If you or your partner has herpes, avoid sexual contact when a blister is present and use condoms at all other times.
Reply
#12
IT IS VERY IMPORTANT TO KNOW DIFFERENCE BETWEEN INDIAN AND ENGLISH WORDS FOR OUR EXAM HERE WE GO.....................

ENGLISH IN INDIA AND USA

In India In the U.S.
accelerate the car step on the gas
aerial (T.V.) antenna
air hostess flight attendant
all year also, year-round
anti-clockwise counter-clockwise
at weekends on weekends
Autumn also, Fall
bag, handbag also, purse or pocketbook
bank holiday also, state or federal holidays
barrister trial lawyer
Basin bowl [a basin in the U.S. is usually a bathroom sink]
Bath Shower [a bath is when one fills a tub and sits to wash]
behind also, in back of, after, following
bell pepper also, green pepper
beverages also, drinks
Bill check (restaurant) [bill is correct for most other things]
biscuits (sweets) Cookies
biscuits (salt) Crackers
block of flats apartment house / building / complex
bonnet hood of a car or trunk lid
bookstall Newsstand
boost, a raise A raise, pay increase or hike
brinjal Eggplant
Brown bread also, whole wheat bread
bucket also, a pail
Bun also, a sweet roll
Cabin Office,a small,primitive house in mountains/lakeside;/one's quarters onboard ship
camp bed cot, roll-away
Can you give me a lift? also, Can you give me a ride?
canteen or mess cafeteria [camping or army-type water container]
car accelerator also, gas pedal or gas
car bonnet Hood
car park parking lot
caravan Trailer
card punch key punch
carrier bag Shopping bag
cashier store cashier, bank teller
charge call collect call
chemist druggist or pharmacist
cheque Check
cinema also, movie theatre or movie house
Clever smart, bright
clothes to be washed Laundry
Coach Bus
colony neighborhood
condom also, rubber
confectionary or icing confectioner's sugar or powdered sugar
coolers sunglasses or shades
cooling glasses sunglasses or shades
coriander leaves Cilantro
Cotton thread [cotton is the fiber or cotton balls]
creche nursery or daycare [creche is a Christmas nativity]
Curd yogurt [curd is in cottage cheese or sour milk]
current account checking account
CV or bio-data curriculum vitae or resume
departmental store Grocery store or supermarket
deposit account Savings account in a bank
dialled Dialed
diary (record) journal (entry)
dickey, car boot Trunk [a dickey is a false shirt collar, as worn under a sweater or jacket]
dispatch goods to ship goods
dispensary drug store or pharmacy
district County
doctor also, physician
draught Draft
dress circle mezzanine (in theatre)
Driver (car) also, chauffer (especially of a limousine)
dry grapes Raisins
dustbin trashcan
earth wire ground wire
electric powerpoint outlet or wall socket
electricity also, power
engaged (phone line) Busy
ex-serviceman veteran, vet
expensive stores also, up-scale stores
Flats apartments [flats are shoes w/out high heels]
football Soccer
Fridge also, refrigerator [in some parts of the US, it is sometimes still called an 'ice box'
Frock Dress
full stop Period
Gang Mob
garage also, shop, or service station if it also sells gas
Goods Freight
Goods wagon Freight car
gramophone phonograph, turntable, or record player
greens (keerai) spinach
Grey Gray
ground floor also, first floor
half sleeves short sleeves
hand book pocketbook or purse
high street main street
highway freeway, expressway, interstate
hoarding billboard
home work also, assignment
hotel (to eat) restaurant
hotel (to stay) could also be a motel, an inn, a "bed & breakfast" (or B&B)
identity card identification or ID card
Ill also, sick or unwell
Jacket also, coat
jumble sale garage or yard sale, rummage sale
karnews/ukapillai curry leaves
Kiosk also stall or booth
lady's finger okra [lady fingers are small sponge cakes]
lamp post also, street light
lawyer also, attorney
leather shoes also, dress shoes
level crossing railroad crossing
Lift elevator
line of open shops strip mall or shopping center
Lorry Truck
lucky dip grab bag
main city area downtown, sometimes uptown
Mate friend [one's mate is one's spouse]
minerals soft drink soda, soft drink, pop, drink
money note bill (as in a one-dollar bill)
moped also, mini-bike or scooter
motion picture movie, film
motorway speedway
multi story high-rise
Nappy Diaper
neckerchief Scarf
news proprietor publisher
Nice also, cool
nightdress night gown
note pad also, scratch pad or tablet
number plate license plate
omelette sometimes, omelet
operation theatre operating room (in a hospital)
ordinary also, normal, plain or regular
ordinary call Station to station call
ordinary share common stock
over size or outsize extra large or "big & tall" (men), women's sizes (women)
overbridge, flyover overpass
pack of cards deck of cards
Paisa Penny or a cent
past performance also, track record
pavement sidewalk
Perks also, fringe or employment benefits
personal call Person-to-person call
Petrol Gas
Petrol bunk or station gas station or service station
Pizza (pronounced pee' - tza)
plot of land Lot
policeman also, cop
Porter doorman
Post Mail
post box mailbox
Postal code/ pin code ZIP code
perambulator or pram baby carriage (when they lie down), stroller (when they sit)
provision, vegetable store grocery store or green-grocer
provision store man Grocer
Public school Private school [public school is paid for by taxes and open to all residents]
punctured tire flat tire
Purse Wallet
put the phone down hang up or disconnect
race course race track or "the track"
railtrack railroad, railroad track
reduced price Sale
Return ticket round-trip ticket
rubber Eraser [a rubber in the U.S. is a condom]
Saccrine artificial sweetener
sanitary towel sanitary napkin or pad
Shop also, store or boutique
shop assistant sales clerk
shopping complex Mall
Signal also, light or traffic light
Single ticket one-way ticket
sleep in the afternoon Nap
soft drink soda, sometimes drink or pop
solicitor Lawyer
spectacles glasses
Sports shoes sneakers, athletic shoes, running shoes, etc.
stand in queue stand or wait in line, or wait on line
Stone also, rock
suitcase(s) also, luggage, baggage or one bag
sweet, toffee, chocolates, lollies Candy
switchboard Power-strip,[switchboard is for a telephone operator]
Tap also, faucet
Taxi also, cab
telegram also, wire
telephone call also, a call or phone call
telephone call box public or pay phone
phonecall w/o charge toll-free call (or 800- number)
telephone dialing code area code
telephone is engaged line is busy
timber also, lumber
Tin Can
toilet, bathroom in public, a restroom; in a home, bathroom
tomato sauce ketchup, or catsup, [tomato sauce is not as sweet]
Torch flashlight , [torch is a flame on a handle]
trade union labor union
Tram also, streetcar
trolley also, streetcar
trousers also, pants or slacks
trunk telephone call long distance call
under bridge under-pass
vacuum flask thermos
waist coat Vest
washing items toilet articles or toiletries
windscreen windshield
yoghurt or curd Yogurt
Zero also, "O" as in the English alphabet



























Speaking English - The American Way!

No matter how much the sticklers of British English language sneer and repulse at American English, I love it ! It's fun, casual, young, friendly sounding and yet can be sophisticated.

- You don't open a telephone conversation with a HELLO but with a "Hi"
- The telephone is never "engaged", it's always "busy".
- U don't "disconnect" a phone, U simply "hang-up".
- U never "mess-up" things, U only "screw them up".
- U never have a "residence" tel. no., U have a "home" no.
- U don't stop at the "signals", but halt at the "lights".
- U don't "accelerate", U "step on the gas".
- Your tire never "punctures", U may have a "flat".
- The trains have "coaches" or "boggies' no more but "carriages" or "boxes".
- There R no "petrol pumps", but "gas stations".
- "I don't know nothing", 2 negatives don't make a positive here.
- U no longer meet a "wonderful" person, U meet a "cool" guy
- U don't pull the switch down to light a bulb,rather flick it up.
- There's no "Business Area" only "business districts", and no "districts" but "counties".
- No one stays "a stone's throw away", might"a few blocks away".
- There's no "Town Side", it's "Down Town".
- In hotel U no longer ask for "bill" and pay by "cheque", rather ask for "check" and pay with (Dollar) "bill"s.
- There R no "soft drinks", only "sodas".
- Life's no longer "miserable" it "stinks".
- U don't have a "great" time, U have a "ball".
- U don't "sweat it out", U "work U'r butt off".
- Never "post" a letter, always "mail" it and "glue" the stamps, don't "stick" them.
- U no longer live in "flats" or "blocks", find an "apartment".
- U don't stand in a "queue", you are in a "line".
- U no longer "like" something, U "appreciate" it.
- "#" is not "hash", it's "pound".
- U R not "deaf", U have "impaired hearing".
- U R not "lunatic", U are just "mentally challenged".
- U R not "disgusting" U R "sick".
- U can't get "surprised" U get "zapped".
- U don't "schedule" a meeting, U "skejule" it.
- U never "joke", U just "kid" [am not kidding ;-)]
- U never "increase" the pressure, U always "crank" it up.
- U never ask for a pencil "rubber" U ask for an eraser. a rubber is a condom
- U don't try to find a lift U find an elevator.
- U no more ask for a route but for a "RAUT"
- U don't ask somebody "How r u ?", U say "What's up dude?"
- U never go to see a game U go to watch a game.
- If U see "World" champions(or Series),read "USA"champions(or Series).
- There's no "zero" but "o", no "Z" but "zee".
- There's no FULL STOP after a statement, there's a PERIOD.
- You don't say "How do you do", you say "How you doin'"
- In short U don't speak English, U speak American.
- Well u dont' say life is boring u say LIFE SUCKS !!!!!
COMMON BRAND NAMES OF DRUGS FOR STEP 2 CS (william Beaumount, Michigan)


Tylenol = Acetaminophen / Paracetamol
Advil = Ibuprofen
Allegra = Fenoxifenadine (allergy relief)
Maalox = Antacid (Aluminum Hydroxide and Magnesium Hydroxide)
Mylanta = Antacid (Mg. OH and Ca. Carbonate)
Nexium = Esmoprazole
Prilosec = Omeprazole
Zantac = Ranitidine
Lopressor = Metaprolol
Augmentin = Amoxcillin + Clavulanic Acid
Zyban = Bupripion (Antidepressant + smoking deaddiction )
Demerol: mepridine

Adv reactions:
Anti-hypertensives-orthostatic hypotension
ACE-I: cough
Beta Blockers: impotence, -
Beta agonists: tremors
statins: rhabdomyolysis
Reply
#13
SORRY FOR MISTAKE

FIRST WORD OR GROUP OF WORDS ARE BRITISH / INDIAN ENGLISH WHILE WORD / WORDS AFTER = IS FOR AMERICAN ENGLISH

ENGLISH IN INDIA AND USA

In India In the U.S.
accelerate the car =step on the gas
aerial (T.V.) =antenna
air hostess =flight attendant
all year =also, year-round
anti-clockwise =counter-clockwise
at weekends =on weekends
Autumn =also, Fall
bag, handbag =also, purse or pocketbook
bank holiday =also, state or federal holidays
barrister =trial lawyer
Basin =bowl [a basin in the U.S. is usually a bathroom sink]
Bath =Shower [a bath is when one fills a tub and sits to wash]
behind =also, in back of, after, following
bell pepper =also, green pepper
beverages =also, drinks
Bill =check (restaurant) [bill is correct for most other things]
biscuits (sweets) =Cookies
biscuits (salt) =Crackers
block of flats =apartment house / building / complex
bonnet =hood of a car or trunk lid
bookstall =Newsstand
boost, a raise =A raise, pay increase or hike
brinjal =Eggplant
Brown bread =also, whole wheat bread
bucket =also, a pail
Bun =also, a sweet roll
Cabin =Office,a small,primitive house in mountains/lakeside;/one's quarters onboard ship
camp bed =cot, roll-away
Can you give me a lift? =also, Can you give me a ride?
canteen or mess =cafeteria [camping or army-type water container]
car accelerator =also, gas pedal or gas
car bonnet =Hood
car park =parking lot
caravan =Trailer
card punch =key punch
carrier bag =Shopping bag
cashier =Store cashier, bank teller
charge call =collect call
chemist =druggist or pharmacist
cheque =Check
cinema =also, movie theatre or movie house
Clever =smart, bright
clothes to be washed =Laundry
Coach =Bus
colony =neighborhood
condom =also, rubber
confectionary or icing =confectioner's sugar or powdered sugar
coolers =sunglasses or shades
cooling glasses =sunglasses or shades
coriander leaves =Cilantro
Cotton =Thread [cotton is the fiber or cotton balls]
creche =nursery or daycare [creche is a Christmas nativity]
Curd =yogurt [curd is in cottage cheese or sour milk]
current account =checking account
CV or bio-data =curriculum vitae or resume
departmental store =Grocery store or supermarket
deposit account =Savings account in a bank
dialled =Dialed
diary (record) =Journal (entry)
dickey, car boot =Trunk [a dickey is a false shirt collar, as worn under a sweater or jacket]
dispatch goods =to ship goods
dispensary =drug store or pharmacy
district =County
doctor =also, physician
draught =Draft
dress circle =mezzanine (in theatre)
Driver (car) =also, chauffer (especially of a limousine)
dry grapes =Raisins
dustbin =Trashcan
earth wire =ground wire
electric powerpoint =outlet or wall socket
electricity =also, power
engaged (phone line) =Busy
ex-serviceman =veteran, vet
expensive stores =also, up-scale stores
Flats =apartments [flats are shoes w/out high heels]
football =Soccer
Fridge =also, refrigerator [in some parts of the US, it is sometimes still called an 'ice box'
Frock =Dress
full stop =Period
Gang =Mob
garage =also, shop, or service station if it also sells gas
Goods =Freight
Goods wagon =Freight car
gramophone =phonograph, turntable, or record player
greens (keerai) =spinach
Grey =Gray
ground floor =also, first floor
half sleeves =short sleeves
hand book =pocketbook or purse
high street =main street
highway =Freeway, expressway, interstate
hoarding =billboard
home work =also, assignment
hotel (to eat) =restaurant
hotel (to stay) =could also be a motel, an inn, a "bed & breakfast" (or B&B)
identity card =Identification or ID card
Ill =also, sick or unwell
Jacket =also, coat
jumble sale =garage or yard sale, rummage sale
karnews/ukapillai =curry leaves
Kiosk =also stall or booth
lady's finger =okra [lady fingers are small sponge cakes]
lamp post =also, street light
lawyer =also, attorney
leather shoes =also, dress shoes
level crossing =railroad crossing
Lift =elevator
line of open shops =Strip mall or shopping center
Lorry =Truck
lucky dip =grab bag
main city area =downtown, sometimes uptown
Mate =Friend [one's mate is one's spouse]
minerals soft drink =soda, soft drink, pop, drink
money note =bill (as in a one-dollar bill)
moped =also, mini-bike or scooter
motion picture =movie, film
motorway =speedway
multi story =high-rise
Nappy =Diaper
neckerchief =Scarf
news proprietor =publisher
Nice =also, cool
nightdress =night gown
note pad =also, scratch pad or tablet
number plate =License plate
omelette =sometimes, omelet
operation theatre =operating room (in a hospital)
ordinary =also, normal, plain or regular
ordinary call =Station to station call
ordinary share =common stock
over size or outsize =extra large or "big & tall" (men), women's sizes (women)
overbridge, flyover =overpass
pack of cards =deck of cards
Paisa =Penny or a cent
past performance =also, track record
pavement =sidewalk
Perks =also, fringe or employment benefits
personal call =Person-to-person call
Petrol =Gas
Petrol bunk or station =gas station or service station
Pizza =(pronounced pee' - tza)
plot of land =Lot
policeman =also, cop
Porter =doorman
Post =Mail
post box =mailbox
Postal code/ pin code =ZIP code
perambulator or pram =baby carriage (when they lie down), stroller (when they sit)
provision, vegetable store =grocery store or green-grocer
provision store man =Grocer
Public school =Private school [public school is paid for by taxes and open to all residents]
punctured tire =Flat tire
Purse =Wallet
put the phone down =hang up or disconnect
race course =race track or "the track"
railtrack =railroad, railroad track
reduced price =Sale
Return ticket =round-trip ticket
rubber =Eraser [a rubber in the U.S. is a condom]
Saccrine =artificial sweetener
sanitary towel =sanitary napkin or pad
Shop =also, store or boutique
shop assistant =sales clerk
shopping complex =Mall
Signal =also, light or traffic light
Single ticket =one-way ticket
sleep in the afternoon =Nap
soft drink =soda, sometimes drink or pop
solicitor =Lawyer
spectacles =glasses
Sports shoes =sneakers, athletic shoes, running shoes, etc.
stand in queue =Stand or wait in line, or wait on line
Stone =also, rock
suitcase(s) =also, luggage, baggage or one bag
sweet, toffee, chocolates, lollies =Candy
switchboard =Power-strip,[switchboard is for a telephone operator]
Tap =also, faucet
Taxi =also, cab
telegram =also, wire
telephone call =also, a call or phone call
telephone call box =public or pay phone
phonecall w/o charge =toll-free call (or 800- number)
telephone dialing code =area code
telephone is engaged =Line is busy
timber =also, lumber
Tin =Can
toilet, bathroom =in public, a restroom; in a home, bathroom
tomato sauce =ketchup, or catsup, [tomato sauce is not as sweet]
Torch =flashlight , [torch is a flame on a handle]
trade union =labor union
Tram =also, streetcar
trolley =also, streetcar
trousers =also, pants or slacks
trunk telephone call =long distance call
under bridge =under-pass
vacuum flask =Thermos
waist coat =Vest
washing items =toilet articles or toiletries
windscreen =windshield
yoghurt or curd =Yogurt
Zero =also, "O" as in the English alphabet



























Speaking English - The American Way!

No matter how much the sticklers of British English language sneer and repulse at American English, I love it ! It's fun, casual, young, friendly sounding and yet can be sophisticated.

- You don't open a telephone conversation with a HELLO but with a "Hi"
- The telephone is never "engaged", it's always "busy".
- U don't "disconnect" a phone, U simply "hang-up".
- U never "mess-up" things, U only "screw them up".
- U never have a "residence" tel. no., U have a "home" no.
- U don't stop at the "signals", but halt at the "lights".
- U don't "accelerate", U "step on the gas".
- Your tire never "punctures", U may have a "flat".
- The trains have "coaches" or "boggies' no more but "carriages" or "boxes".
- There R no "petrol pumps", but "gas stations".
- "I don't know nothing", 2 negatives don't make a positive here.
- U no longer meet a "wonderful" person, U meet a "cool" guy
- U don't pull the switch down to light a bulb,rather flick it up.
- There's no "Business Area" only "business districts", and no "districts" but "counties".
- No one stays "a stone's throw away", might"a few blocks away".
- There's no "Town Side", it's "Down Town".
- In hotel U no longer ask for "bill" and pay by "cheque", rather ask for "check" and pay with (Dollar) "bill"s.
- There R no "soft drinks", only "sodas".
- Life's no longer "miserable" it "stinks".
- U don't have a "great" time, U have a "ball".
- U don't "sweat it out", U "work U'r butt off".
- Never "post" a letter, always "mail" it and "glue" the stamps, don't "stick" them.
- U no longer live in "flats" or "blocks", find an "apartment".
- U don't stand in a "queue", you are in a "line".
- U no longer "like" something, U "appreciate" it.
- "#" is not "hash", it's "pound".
- U R not "deaf", U have "impaired hearing".
- U R not "lunatic", U are just "mentally challenged".
- U R not "disgusting" U R "sick".
- U can't get "surprised" U get "zapped".
- U don't "schedule" a meeting, U "skejule" it.
- U never "joke", U just "kid" [am not kidding ;-)]
- U never "increase" the pressure, U always "crank" it up.
- U never ask for a pencil "rubber" U ask for an eraser. a rubber is a condom
- U don't try to find a lift U find an elevator.
- U no more ask for a route but for a "RAUT"
- U don't ask somebody "How r u ?", U say "What's up dude?"
- U never go to see a game U go to watch a game.
- If U see "World" champions(or Series),read "USA"champions(or Series).
- There's no "zero" but "o", no "Z" but "zee".
- There's no FULL STOP after a statement, there's a PERIOD.
- You don't say "How do you do", you say "How you doin'"
- In short U don't speak English, U speak American.
- Well u dont' say life is boring u say LIFE SUCKS !!!!!
COMMON BRAND NAMES OF DRUGS FOR STEP 2 CS (william Beaumount, Michigan)


Tylenol = Acetaminophen / Paracetamol
Advil = Ibuprofen
Allegra = Fenoxifenadine (allergy relief)
Maalox = Antacid (Aluminum Hydroxide and Magnesium Hydroxide)
Mylanta = Antacid (Mg. OH and Ca. Carbonate)
Nexium = Esmoprazole
Prilosec = Omeprazole
Zantac = Ranitidine
Lopressor = Metaprolol
Augmentin = Amoxcillin + Clavulanic Acid
Zyban = Bupripion (Antidepressant + smoking deaddiction )
Demerol: mepridine

Adv reactions:
Anti-hypertensives-orthostatic hypotension
ACE-I: cough
Beta Blockers: impotence, -
Beta agonists: tremors
statins: rhabdomyolysis
Reply
#14
NOW IT IS THE TURN OF PNEMONICS


A MNEMONIC FOR HEADACHE CASE

Mom: "Jennifer - u holding your head..wuts wrong ? "
Jennifer: Mm...It aches mom

"MM...IT ACHES" - that phrase gives us our mnemonic for the differential diagnoses for a headache..

M - Migraine
M - Meningitis

I - Increased Intracranial Pressure
T - Tension Headache + Temporal Arteritis

A - AV Malformations
C - Cluster Headache
H - Hypertension
E - Eye Disorders (Refractory Errors + Glaucoma)
S - Sinusitis + Sub-Arachnoid Hemorrhage + most Systemic illnesses

HEADACHE

H.- Headache type.
E.- Eye vision abnormalities.
A.- Anticipatory (events).
D.- During (events).
A.- After (events).
C.- Constant, Chronic, Causes
H.- High temperature (fever)
E.- Eye pain.
FORGETS HIM
F=FAINTING
0=ORTHOSTATIC HYPOTENSION
R=RUNNING URINE [INCONTINENCE]
G=GAIT
E=EYE[VISION]
T=TRAUMA, TINGLING
S=STRENGTH,SEIZURES

H=HEADACHE
I=INFECTION[SYPHILIS,MENINGITIS]
M=MOOD

and this one for the CNS Examination, for someone like me, who'ld forget parts of the examination in all the tension...

CPR GCS
C=CRANIAL NERVES
P=POWER
R=REFLEXES

G=GAIT [with romberg's]
C=CEREBELLAR
S=SENSORY

MMM.....IT ACHES

M - Migraine
M - Meningitis / Encephalitis
M - Medications

I - Increased intracranial pressure (Brain tumour, abscess, etc) +Intracranial venous thrombosis
T - Tension Headache + Temporal Arteritis + Trigeminal neuralgia

A - AV Malformations + Artery Dissection (vertebral art)
C - Cluster Hdache + CNS vasculitis
H - Hypertension + Haemorrhage (intracranial)
E - Eye problems (refractory errors + glaucoma)
S - Sinusitis + Sub Arachnoid Hhage + most Systemic illnesses + Seizures (partial) + pSeudotumour Cerebri

and also keep in mind to r/o secondary causes before considering the primary (i.e. Migraine, Tension and Cluster headaches)

Phone Encounter !

Inside the Telephone Room: Wouldn't it be hilarious if someone actually knocks on the door for a phone case ? Ha ha..hmmm...Jokes apart - after you enter, wait till you are ready, then pick up the handset and press the Red Button/Yellow Button on the phone when you are ready ! However, please follow the instructions given to you before the test - they may change. One useful hint - Smile while you pick up - will show in your speech and also give you more confidence. And don't forget to write your mnemonics on your paper before you start !

Personally, I feel a Telephone case is simpler as there is no clinical physical examination which gives you a comfortable time to finish the case well within 15 minutes (I was done in 10 !)

Instructions for using the Telephone:

These instructions come from USMLE.org :

When you enter the room, sit at the desk in front of the telephone.

* Do not dial any numbers.
* Push the speaker button by the yellow dot on the phone to be connected to the patient
caregiver or patient.
* You will be permitted to make only one phone call.
* Do not touch any buttons on the phone until you are ready to end the call “ touching any buttons may disconnect you.
* You will not be allowed to call back after the call is disconnected.

Handling a Telephone Case:

Handle it like any other case, don't forget to ask the kid's name and refer to him/her by name.
At the end of your questions, explain possible diagnoses and mention that you need to examine the kid and do some investigations. If the mom has no time / no car / no one else to get the kid - ask her to call 911 !! And don't forget to keep the kid sipping on a rehydrating solution like Pedilyte or home-made ORS (See Below)

Most people seem to be failing on the CS due to inadequate data collection. If this is of any help, I would like to share a mnemonic I formulated to ensure u ask everything during a phone encounter for a case of diarrhea in an infant ( The person on the other end would typically be the kid's mom )

"ON CALL IDIOT"
['On Call'since this is a phone encounter] - please dont think about "idiot" being offnesive - it is just a mnemonic people !
O - Onset ?
N - Number of Times a Day?

C - Consistency ? / Color? / Content ? [Blood, Fat, Mucous ?] + Crying ? Cramps Suggestive ?
A - Associated Symptoms [Fever, Runny Nose, Rash, Cough, Ear Discharge, Vomitting, Rash ?]
L - Listless baby ? Lethargic, not Sleeping ?
L - Liquids not passing ? [i.e. not urinating ?]

I - Immunization up to date ?
D - Diet Change ? Dehydration signs ? Day Care Center ? Developmental Milestones
I - Infections in family ? Immunicompromised mom ? [HIV ?]
O - ORS counseling (Oral Rehydration Solution - see below)
T - Travel history recently ?

Write this mnemonic down on ur sheet while you sit front of the telephone, before u pick it up...and u are ready to rock and roll !! practice the order of questioning at home on a phone while u practice with ur study partner!

For a case of vomitting, I guess you can tweak the mnemonic a bit !

Practice this with a phone partner and encourage the person at the other end to ask you challenge questions..

ORS Counseling : Enquire if the woman knows about Oral Rehydration Solution and whether she has Pedialyte at home - if Yes, she can start having her baby sip on it. If she does not, you can suggest a quick home-made solution like this:

1. Water - 4 Cups
2. Salt - 1 TeaSpoon
3. Sugar - 8 TeaSpoons

And yes ....you do have to write a PN even for a Phone Case - but leave the physical examination section blank ...or perhaps a better idea would be to write "Will be performed when Damian arrives at the hospital"


Rock-N-Roll

Q. Does everyone always get a Phone Case / Telephone Encounter ?
A. Not Always ! On the other hand, some may even get two phone cases...

Man: "No, you idiot!" the man shouts. "This is her husband!"


domestic abuse-- SCARS

S - Sex-ever forced by hubby?
C - Children-husband relationship
A - Attacked by a weapon by abuser?
R - Relationship details with abuser. Duration etc.
S - Suicide plans.
D/D in child with fever. When a child is sick, we give him anything to make him feel better, even gum. So when he's sick, he gets a GUM PASS.

G astroenteritis
U RI/UTI
M eningitis, Measles, Mumps
P neumonia
A cute Otitis Media
S epsis
S carlet fever

BJM's CHILDREN
B=BIRTH HISTORY
J=JAUNDICE [NEONATAL]
M=MILESTONES

C=CRYING,CHECK UP
H=HEAD [MENINGITIS, SEIZURES]
I=IMMUNIZATION
L=LETHARGY
D=DAYCARE
R=RASH
E=EYE/EAR
N=NOSE, NUTRITION
THE "GET UP AND GO" TEST

This test is to used as a measure of balance in elderly patients. I would rather that this test were called "Get up, go and Get back" Test ..you will see why.

How is the Test Done ?

Have the patient sit in a straight-backed chair and ask him/her to:

1. Get up from a chair to standing position
2. Walk forward feet in a straight line
3. Turn back around & walk back to the chair
4. Sit down again

Interpreting the test:

You can either score it by the timing (Less than 20 seconds for the whole procedure is normal , More than 30 seconds indicates gait/balance problems) Or you can score it on a grading system like:

0 - patient does not use arm-rests to get up
1 - uses arm-rest in one attempt
3 - needs multiple attempts
4 - cant get up without assistance

all this Besides noting gait stability while walking

On the USMLE Step 2 CS, I would rather recommend either doing the easy timed method OR simply noting what you observed during the test - like difficutly in getting up , unsteady gait and needed assistance to sit back down..etc.

Test tandem gait by asking the patient to walk a straight line while touching the heel of one foot to the toe of the other with each step. Patients with truncal ataxia caused by damage to the cerebellar vermis or associated pathways will have particular difficulty with this task, since they tend to have a wide-based, unsteady gait, and become more unsteady when attempting to keep their feet close together.

THE "DIX-HALLPIKE" MANUEVER / TEST ?

Every now and then, on various USMLE forums you come across a message asking about the Dix-Hallpike Test or maneuver ! Since the blog is dedicated to be a beacon of light for everyone thinking of , planning to or taking the CS, here goes ;-) :

This funny-sounding Test is a confirmatory diagnostic test for "Benign Paroxysmal Positional Vertigo", which accounts for probably about 1/5th cases of dizziness in the USA. So, this means, if you get a case of vertigo on the CS, or complaints like "Doctor I get dizzy", "The world goes round and round around me", etc. etc. .you should do this clinical test as a part of Physical Exam.

Beep : Dix-Hallpike test is also called the "Tilt Test" - you will soon see why ...

Yo Digitaldoc ! How do you do this test ?

Get the Standardized Patient (SP) to sit erect on his/her bed. Then, have the SP lie supine on the bed quickly , with the head turned (tilted) 45 degrees to one side and extended about 20 degrees backward. Once supine, the eyes are typically observed for about 30 seconds. If no nystagmus occurs, the person is brought back to sitting stance, only to test again with the head now turned to the opposite side.

On the exam , I don't expect anyone to get a positive test, simply because I don't imagine anyone with the condition actually volunteering to get Nystagmus 12 times a day ! But lets note that this test is considered "Positive" if the patient exhibits a burst of nystagmus when lying supine :-)

Handling a Lab-Result Explanation Case ?

This presents an amusing paradox - on most cases on the CS, we are worried about finishing on time, whereas the main concern on this one is how to expand all you can talk to fit those 15 minutes ! This somehow reminds me of my daytime sleep ;-) it seems to effortless expand and fill-up all the space it gets ;-)


But tell you what, lets have a protocol to tackle any kind of Lab-Result Explanation cases. Here's one for, say, a Trichomonas lab result:

1. Reveal the lab findings to the SP and explain the diagnosis in layman terms
2. Tell the SP it's nothing too serious and explain how trichomonas is contracted
3. Get History about Vaginal Discharge, then Sexual + Menstrual history
4. History pertaining to other STDs (rash, genital lesions, lymph-nodes, etc.)
4. Ask her if she has any new complaints and tell her you would like to repeat a general physical exam
5. Ask her if she has any specific questions and if she knows how to avoid Trichomonas in future

6. Counseling should cover the following :

a. Explain that both the SP and her partner would treatment.
b. Tell her that if she will put on Metronidazole therapy - alcohol is to be avoided, since that will cause nausea and vomitting (Disulfiram like reaction)
c. Abstinence from sexual intercourse until therapy is complete
d. Counsel on protection, risk of other STDs like HIV & risk of cervical cancer (need for PAP smears) .
e. Ask her if she has had a pregnancy test recently and when - if not done, ask her to consider having that done. (and mention that on your PN as an Investigation)
f. If not pregnant, advise about birth-control methods.

I guess this particular case is more about SEP and CIS component !

On the PN - merely include general exam in the Physical Exam section - the rest of the PN will be like any other case.

SORE THROAT WAS BAD !

S- wallowing food is painful ?
O- rigin, Duration, Progress
R- unny Nose
E - ar Problems ?

T- emp ? / Chills ?
H- eadache
R- espi. Sympt - Cough, SOB, Chest pain
O- ccupation ?
A- spiration + Abdominal Symp.- Nausea, Vommiting, Pain (esp in LUQ)
T- iredness(Fatigue), Touch with ill people (ill contacts - boyfriend, girl friend)

W- t. loss ?
A- ppetite Change / Alcohol ?
S- moking Sleep changes ? Sexual History

B - owel Habbit
A - nything else do you wanna tell me ???
D - rugs ( illegal IV drugs ?)

THROAT

T - hroat Culture
H - IV antibody and viral titer
R - apid streptococcal antigen
O - mOnospot test
A - nit EBV Antibody
T - routine Tests - CBC, Pripheral smear.
D/D of COUGH (a step 2 CS favorite, from what I hear). These are from First Aid mostly:

Pleural Cap

P neumonia (atypical/typical)
L ung cancer
E xacerbation of COPD (Bronchitis)
U RI
R eactive airway dz.
A bscess
L ymphoma
C HF
A sthma
P ostnasal drip


d/d of sore throat -sore HIPS

Hepatitis
HIV
Infectious mononucleosis
Pharyngitis
Secondary syphilis
Scarlet fever
Shoulder examination ?

Let us look at examination for a case of Shoulder Pain (People you gotta supplement this with your standard notes). Assuming that you have already washed, wiped and warmed your hands...

1. Expose both the shoulders - and examine as if you are comparing both shoulders for swelling, deformity. Especially look out for painted bruises - cause those suggest elderly abuse (besides a fall) and implies you got to address that part while counselling.

2. Next, say this to ur SP = "Let us examine your shoulder gently to locate the origin of pain - is that ok ? Let me know immediately if it hurts anytime"

3. Palpate affected shoulder for tenderness and look out for any sign of wincing on the SP's face. Should there be any wincing/moaning, say "sorry that hurt" and never repeat at that site.

4. Ask the patient to perform shoulder motions to check for his/her range of motion - A more effective way to do it is ask the SP to mimic your actions-then you move your shoulder the way you want him to move - simpler than explaining each action and wasting time eh ?

5. The above can aslo be combined with you resisting his motion and checking out strength of motion in addition!

6. And dont forget to feel for his pulses in the affected hand and verify they are felt normally.

A Quick Mnemonic for Shoulder pain D/Ds : (Think of a deformed shoulder)

'DEFORMS'

D - Dislocation
E - Elderly Abuse
F - Fracture
O - Osteoporosis / Osteomyelitis
R - Rotator Cuff Injury
M - Myositis
S - Sac Inflammation (Bursitis) + Sprain (as suggested by a reader in the comments below)

You will realized that the above mnemonic can be a general guide to any joint pain / swelling for that matter !

Q. Does the Patient / SP Understand 'abduction', 'flexion' etc. of the shoulder - do we have to spend time explaining all that to him/her ?

A. While asking the patient to perform ANY maneuver, remember that actions speak louder than words - "Could you move your shoulder out like this " for abduction and then doing it yourself to indicate how is better and faster. OR, while checking active Range of Motion (ROM) you could simply say at the start, "Mr. Allen, I will now make various arm movements at my shoulder joint and I want you to copy my actions, to help me understand how severe your problem is - Is that fine ? shall we begin ? "
What's with 'SPORTS' & Knee Pain ?

The Knee is a pretty common injury in Sports....So lets use the word 'SPORT' to our advantage on the Step2CS - a pretty good mnemonic for D/Ds for Knee Pain !!!!

S - Septic arthritis
P - Pseudo-gout + Patello-femoral pain syndrome + Psoriatic arthritis
O - Osteoarthritis
R - Rheumatoid arthritis, Reactive arthritis (Rieters syndrome)
T - Tophi (Gout), Trauma (Fall, Elderly Abuse and SPORTs!)
S - Sac Inflammation (Bursitis)

Again, as I mentioned before, each of these D/Ds should help you ask specific data-collection questions:

For e.g. :
Septic Arthritis : - Ask about fever, and a warm joint feeling
Rheumatoid Arthritis - Ask about morning stiffness and other small joints...and so on.

HEEL PAIN...
"FOOT PAINS"
F - Fat Atrophy (age related) + Foreign Body
O - Osteomyelitis (not common)
O - Osteoporosis (not common)
T - Tarsal Tunnel Syndrome, Tendonitis (Achilles) + Tumor

P - Plantar fascitis (Most Common Cause), Periostitis (Calcaneum)
A - Apophysitis (Calcaneal), Arthitis (Reiters, Rheumatoid, Reactive)
I - Ischemia (Peripheral Vacular Disease)
N - Nerve Entrapment (Jogger's Foot)
S - Stress Fractures in Athletes and Spurs in Bone (Calcaneum)

Thus, the above mnemonic also tells us what questions to ask in the history taking, as per the Steps I mentioned in the Art of History Taking. Applying the steps to this case ...

Step 1 - Patient tells you that his heel pains

Step 2 - you gotta drill him about the pain (LIQOR AAA)

Step 3 - Data-Collection for this case ( Ask about leg swelling, redness, fever, trauma history, footwear preference, walking habits, long standing hours, morning stiffness, rashes, etc.)

Step 4 - Other Leg symptoms you can think of - like Numbness [Can u feel the heel ;-)], tingling, weakness, et. )

Step 5 - Complications like associated Knee Pain due to change in gait - and then move on to PAM HUGS FOSS..

Hope this is a good indicator of how to go about a case using the history-taking steps...

g/l

To read more about Heel Pain - Check this out !

A few pointer to Clinical Exam in Heel Pain :

As in Shoulder pain, expose Both Feet ! Then check out for swelling, redness, foreign body and trauma signs in Inspection along with range of active movements. Next palpation: first check for warmth (active inflammation) , superficial and deep palpation to pinpoint location. Then go ahead and check peripheral pulses, sensations over both feet, passive joint movements , power, etc...

At each stage, dont forget to compare with the normal leg..

Finally ask the Pt. to walk to futher qualify the pain

Counseling for heel pain ?
1. Use soft-heeled or soft-padded footware
2. Refrain from long standing or long walking
3. See us again if presribed pain medications do not work
I have FFFOOTTT.

F : Fasciitis / Fascia rupture
F : Fat atrophy
F : Fracture x stress
O : Osteomyelitis
O : Osteoporosis fracture
T : Tendonitis / Bursitis
T : Tarsal tunnel syndrome
T : Tumor
CHEST PAIN : A MNEMONIC

A Mnemonic to remember what else you need to ask the SP besides specifics of the pain itself i.e. LIQOR AAA.

This one is of good help for data-collection in a case of chest pain ...

"CHEST P"

C - Cough
H - Hemoptysis, HeartBurn
E - Emesis (Vomitting) & Diarrhea AND Edema over ankle
S - Shortness of Breath (SOB), Sweating, Syncope
T - Temperature (Fever), Tenderness on the chest ( chondritis - also ask for Trauma) + Tenderness of Legs (suggestive of DVT that can predispose to Pulm. Embolism) +

P - Palpitations - "Did you feel your heart pounding or racing ?"

Now don't tell me u need a mnemonic to remember this mnemonic ;-) . An interesting trivia : The word "mnemonics" is derived from Mnemosyne who, in Greek mythology, was the goddess of memory! That's why it humors me tons when someone spells it as "pneumonic" ..he he

A Potent Mnemonic for Impotence

LIMP P3ENIS

When things don't stand ... it's time to use this outstanding mnemonic for data-collection in a case of Erectile Dysfunction on the Step 2 CS ;-)

L-ibido changes
I-njury
M-edications (B-blockers)
P-ast / Present medical history (HTN, DM, Vascular= e.g.: Leriche Syndrome)

P-revious prostate Sx
P-erformance Anxiety
P-eyronie's Disease
E-rection at all? (Are you able to have an erection at all?)
N-octurnal erection ?
I-ncontinence
S-tress/Depression

DOC!! My Penis Doesn't Go UP

D epresion
O H (alcohol)
C laudication (Leriche Syndrome)

M edications
P resure (HBP)
D Mellitus
G onads (Hypogonadism)

U nknown etiology ED
P rostate surgery, Peyronies Dz
"STOP erection":
SSRI (fluoxtine)
Thioridazone
methyldOpa
Propranalol
curtosy medicalmnemonics.com

"A PV BLEED"

A - Abortion + Adenomyosis

P - PID + PCOD
V - Vaginal Injuries

B - Bleeding Diathesis
L - Leiomyomas (fibroids)
E - Ectopic Pregnancy
E - Endometriosis + Endocrine causes (Thyroid, Prolactin)
D - DUB ! (e.g. Anovulatory Cycle)


And another reader, Lisbeysi Calo, MD, was generous enough to share another great mnemonic, which, I admit, is far better than my own ..


"VAGINAL BLEEDS"

V - Vaginal injuries
A - Adenomyosis + Abortion
G - Genital cancer
I - Infections: PID
N - Neoplasms [Maligant(endometrial CA) + benign ( fibromas)
A - Abruptio placentae

B - Beeding disorders
L - Leiomyomas
E - Ectopic pregnancy
E - Endocrinopathies, Endometriosis
D - DUB
S - Sores, Condylomas ( after trauma)

DISCHARGE

D.- Duration, Dyspareunia, Dysuria
I.- Itch (Vaginal Itching)
S.- Smell
C.- Color
H.- High Fever (Temperature)
A.- Abdominal Pain
R.- Recurrent episodes
G.- General health and symptoms.
E.- Endo-cervical swabs
"VAGINAL BLEEDS"
v- aginal injuries
A-Adenomyosis
G-Genital cancer
I-pID
N-Neoplasms, benign ( fibromas)
A-Abrupto placentae

B-Beeding disorders
L-Leiomyomas
E-Ectopic pregnancy
E-Endocrinopathies, Endometriosis
D-DUB
S-Sores, Condylomas ( after trauma)

For amennorrhea,i hv another mneumonic.Pregnant AMENORRHEA
P-Pregnancy
A-Absent ovulation[anovulation]
M-Menopause
E-Eating disorders[Anorexia nervosa]
N-Nursing mother[Lactational amenorrhea]
O-Ocp's
R-Raised prolactin[Hyperprolactinemia]
R-Raised adrenal hormones
H-Hypothyroidism,Haemorrhage[PPH]
E-?
A-All A's in ur post[Anxiety,Asherman's,etc]

Is the depressed SP depressing you ?

First things first - get your data collection sorted out (Step 3 of History Taking) - and we a have a mnemonic for doing just that...

This pic should help you remember this mnemonic :

"FACE SLIPS"

F - Feelings of : Guilt, anger and worthlessness ?
A - Appetite (include diet , weight history) ?
C - Concentration levels ?
E - Energy levels in daily activities ?

S - Sleep disturbances ?
L - Libido Levels ? + Loneliness ?
I - Interests , hobbies ?
P - Psychomotor symptoms ? Pleasure Levels ?
S - Suicidal Ideation , any plans for suicide...?

So here we are armed with specific data-collection points for history.

But what if ...your SP seems bugged and does not seem to come out with why on earth he/she is sad in the first place...so get smarter and try this :

" I know this is a very tough time in your life, but I assure you that we can deal with this much better together. I really want to understand your problems and help you as a friend and a physician. You said you were perfectly happy and healthy 3 months ago - could you try and tell me what exactly happened 3 months ago that started this ?"

This should hit the nail right on the head ! coz, basically the SPs are trying to assess whether you can connect with them at a emotional level or not ....logical, since they are testing your psychiatry skills...

Sticky Situation: What if SP goes "I want to Die Doctor!"

Hmmm...Again lets modify our formula a bit - "I know this is a very tough time in your life, but I also know that running away from problems is not the answer. I really want to understand your problems and help you get your strength back, because I know it is possible. We can deal with this together."

Some pep-talk like that and gently divert the SP back to your questioning :-)

In a way, if the patient puts on the "I wanna die" comment, it saves you the trouble of ascertaining whether the patient has any suicide ideation ;-) - LOL - Am I mean or funny ? Anyways, here's a way to ask the patient about suicide ideation, as I answered to a reader on the comments to this post.


I prefer the Two Question Series -

Question 1:"Have you ever felt like you don't want to ever get up from sleep"
OR "Have you ever had thoughts about ending your life"

Question 2: "In the recent weeks, did you make any plans or attempts on hurting yourself or killing yourself"

Why two questions ? - coz' asking only the first question can mean nothing - "wanna kill myself" is something I feel & say too when really frustrated with myself, but dont mean it, while asking only the second question could take them off-guard and put the patient on the defensive.

"SIGE CAPS"
S-SLEEP
I-INTEREST
G-GUILT...ANGER
E-ENERGY LEVEL
C-CONCENTRATION
A-APPETITE
P-PSYCHOMOTOR SIGNS
S-SUICIDAL TENDENCIES


I AM SAD
I- Insight
A- Appearance
M- Mood, MMSE
S- Suicidal intent, Speech
A- Affect
D- Delusions and hallucinations.
Amenorrhea !!!

Well..calling it stupid coz the word really means nothing and it against my principles of having a mnemonic that is self-suggestive. This one really means nothing - Do you even wanna know what it is ? ..well..if you think it will help you on the CS -( coz it did help me ) so why not !!!!!

P6 A5

i.e. PPPPP AAAAA

P- regnancy
P - rolactinemia (Prolactinoma / Hypothyroidism)
P - COD
P - ills
P - erimenopausal woman (ask for Hot flashes / Dry Vagina)
P - Post-Partum Hemorrhage (As suggested by a kind reader)

A - Anorexia Nervosa
A - novulatory cycles
A - nxiety
A - sherman's syndome
A - Adrenal Hyperfunction !


"Fellow Has DARK Pee"

F-Foods like Beet, Blackberry
H- Hematuria
D - Dehydration + Drugs like Rifampin, Vit-B
A - Alkaptonuria
R - Rhabdomyolysis
K - Kernicterus ( well not really - but let the word remind u of Hyerbilirubinuria)
P - Paroxysmal Noct. Hemoglobinuria
HITTERS
H:Hematologic/coagulation disorders
I:Infections (cystitis)
T:Trauma
T:Tumors:RCC,bladder cancer,prostate
E:Exercise
R:Renal disorders (glomerulonephritis)
S:Stones
DRAIN gives us the D/Ds for Hematochezia :

D - Diverticulosis (Most Common Reason), Drugs -(warfarin)
R - Rectal Bleed [Piles, Fissures]
A - Angiodysplasis + Anal Sex
I - Inflammatory Bowel Disease [UC + Crohn's], Infectious Diarrhea, Ischemic Colitis + Injury (as suggested by a cool reader)
N - Neoplasms

Insomnia counselling =ABCDEFGHJKLMN
Avoid
Bedtime
Concerns (worries)
Drugs (nicotine/caffeine/Alcohol)
Excercise/Excitement (TV Shows)

Follow
Good
Habits for sleep.
Jetlag
Keep
List (Diary)
Monitor
Naps (day time)

hypertension. I hope it works for someone. Just misspell the word with two I´s.
High cholesterol(h/o)
Impotence(medicatios or PVD)
Peripheral vascular disease+PICKLE mnemonic
Exercise and Eat right.
Retinopathy+Respiratory symptoms(chest pain,sob,cough)
Taking meds. regularly
E.T.O.H.
Na Cl (sodium intake and diet)
Smoking, Swelling of legs, Sugar(blood glucose),Stress
Illicit drug intake
Others with HTN in family.
Nose bleeds and dizziness.

D/D = BACK PAIN Pneumonic = LIMCOTS
* Lumbar Spinal stenosis
* Intervertebral disc herniation
* Multiple Myeloma/ Mets (Prostate, Breast ,Lung)
* Cauda equina synd/ Cancer
* Osteoporosis/Osteoarthritis
* Trauma/ TB
* Strain (muscle)

Check list= SIQQOR AAA & then ROS =Age/ Bone pains/ constipation=MM/Bowel, bladder/Relieving factors/ Phx of trauma/Surgical Hx(Prostate) /Chest pain,hemoptysis ,Fever &chills/ With bone & joint problems =Functional impairment (SOS=Help)Q's i.e Sleep/Occupation/Suport

Nasuea & Vomiting = A MOPING
* Anorexia
* Metabolic( DKA)/Meds
* Obstruction (pyloric /Intestinal)
* Pregnancy
* Inflammation( Pyelo/Cholecysto/Appi/Pancreas/PID)
* Neurological (BETA)= Bleed/Encephalitis/Tumor/Abscess
* Gastroenteritis

Here's a mnemonic for the ObGyn Hx : LMP RTV CS PAP
LMP !!
Menarchae
Period ( lasts .... days?)
Reglarity ( every .... wks?)
Tampoons/Pads # per day
Vaginal discharge, itching , dryness
Cramps (Dysmenorrhea)
Spotting ( intermenstrual / post coital )
Pregnency ( Hx & complications)
Abortion /miscarriage
PAP smear ( last time result ?, Hx of past abnormal result ? )

or the causes of Dyspareunia : DATIVE
Domestic abuse
Atrophic vaginiyis ( don't forget to ask about s/s of Menopause)
Tumor ,Pelvic
Infection ( lower : Vulvovaginitis - Cervicitis / Upper : PID )
Vaginismus
Endometriosis ( don't forget to ask 'bout Cyclic pelvic pain )


FOR PEDIATRIC HISTORY.

F E V E R C U D Seizure + P A M I F B I G D E A L S.
FEVER- Fever, Ear pulling, Vomiting, Ear discharge,eyes discharge, Rash, CUD- Chest symptoms n Cold-runny nose,cough,chest painfast respirations,shortness of breath, Urination-any increased or decreased urination,no. of wet diapers,any odour,colour of urine, Diarrhea-frequency,onset,mucus in stool,blood in stool,any cryin during defecation , Seizure-any jerky movements,any leakage of urine or stool during fits,ant post ictal irritability,or loss of consciousness.


PAM - P-Past medical,past surgical hx, previous hospitalizations. A-Allergies, M-Medications, IF I-Ill contacts, F -family history, BIG -B- birth hx, I-Immunizations, G-Growth n development,ht,wt,milestones. D-DEALS- Day care, E-Eating habits,feeding of da baby, A-Appetite, L-Look of tha baby or appearance, S- Sleep


Menstrual History FM DIAL
F Frequency
M Menarche

D Duration
I Intensity
A Amount
L LMP

For back pain "red flags" TUNA FISH
Trauma
Unexplained weight loss
Neurological signs
Age > 50

Fever
Intravenous drug use
Steroids for long time
History of cancer


Mental state examination: stages in order
"Assessed Mental State To Be Positively Clinically Unremarkable":
Appearance and behaviour [observe state, clothing...]
Mood [recent spirit]
Speech [rate, form, content]
Thinking [thoughts, perceptions]
Behavioural abnormalities
Perception abnormalities
Cognition [time, place, age...]
Understanding of condition [ideas, expectations, concerns]


Short statue causes RETARD HEIGHT:
Rickets
Endocrine (cretinism, hypopituitarism, Cushing's)
Turner syndrome
Achondroplasia
Respiratory(suppurative lung disease)
Down syndrome

Hereditary
Environmental (postirradiation, postinfectious)
IUGR
GI (malabsorption)
Heart (congenital heart disease)
Tilted backbone (scoliosis)


Pyrexia of Unknown Origin: history taking SIT ON FRAD:
Sexual history
Immunisation status
Travel history

Occupational history
Nutrition (consumption of dairy products, etc.)

Family history
Recreational habits
Animal contacts (including ticks and other vectors)
Drug history

Enuresis Counselling = SMILE SAM
Supportive (of the child)
Monitor Intake (@ Day)
Limit (@ Night)
Encourage Washroom( @ bedtime)
Sheets ( Rubber flannel sheets)
Alarms ( >5yrs )
Motivate (thru Rewards)

Conselling DM & HTN= MEDOWS
Medications (regularity)
Excercise ( for obese/sedentary life styles)
Diet Modification( Salt/Fatty foods)
Opthalmoscopic exams (annual routine)
Weight Management (/control)
Suger Check ups


Smoking Cessation counselling = SPANCSTER
Stressor ( any stress in life/tension etc )
Problems ( Heart /Lung/ CA)
Advantages ( Improved breathing & Increased energy)
Nicotine Patch ( I can offer you reading materials )
Counsellors ( I can refer u/ give # )
Support systems ( I can refer u /give #)
Taper down ( if u cant do cold turkey den just taper down a bit)
Excercise Programs ( eg Swimming )
Rewards ( reward urself, treat urself with a dinner 4m money saved off of quitting)

STD / HIV Counselling STRIP BIMBO !
SAFE SEXUAL PRACTICES
TRANSMISSION ( to partners )
RISKS ( acquiring more STD's)
IMMUNIZATIONS ( for Influenza/ Pneumococcal )
PREVENTION COUNSELLING ( REFER TO SW /CAN GIVE #)
BEHAVIOUR COUNSELLING (REFER / CAN GIVE #)
INTERVENTIONAL COUNSELLING ( REFER /CAN GIVE #)
MEDICATIONS
BARRIER METHODS (CONDOMS
OPPURTUNISTIC INFECTIONS/OBSERVATION (FOR LABS)


HOPI For A CC OF URINARY COMPLAINT (b)FINISHED PUBS(/b)
Frequency ( How frequent do u Ux)
Incontinence( Do u hav trouble holding Ux)
Nocturia ( do u hav 2 wak up @ Night)
Incomplete emptying ( do u feel fullnes after Ux)
Stream (How is ur stream?)
Hematuria ( did u notic any blood)
Hesitancy (do u hav 2 wait b4 starting Ux)
Dysuria (Did u hav diff Ux)
Pyuria ( did u pus in Ux)
Urgency (do u hav 2 rush)
Burning (dysuria) (does it burn)
Strain (Do u hav to strain during Ux


CC of Memory Loss/Dementia/Alzheimers/MID/Creutfeldt jakob/Pseudotumor cerebrii etc
HOPI Particularts to ask -ADL = Activities of daily living = DEATH

Dressing
Eating
Ambulation (can u find ur way thru home)
Toiletry (do u manage ur toiletry un assisted)
Housing
IADL - Instrumental acitivities of daily living =SHAFT
Shopping
Housekeeping? unsure about that
Accounting
Food (do u do ur cooking ,etc)
Transportation (do u drive )

OBESITY OBESITY-DISC
Osteoarthritis
Breathing problems
Excess Cholestrol
Sleep Apnea
Increased Incidence Ca's (Endomet/Breast/Colon)
Type 2 DM
hYpertension
Depression
Incontinence
Stress
Cholelithiasis/Cycle disturbances/Cardiac


Obesity counseling ABCDEF
Avoid Advice (Eg.Sedentary/Steroids) /Advantages Advice (Low Heart/Brain/Ca etc risk)
Books (self help reading material)
Counseling/Consult/ Cholesterol checks
Dietitian
Exercise
Fatty Food (cut backs)

Psychiatric Hx Checklist MISS SPEARS PAD MATCHED
Mood, Idea ( abt de problem?), Stress, Support, Sleep ,Plan,Energy ,Aims, Routine , Suicide, Pills (drugs),Apetite ,Duration,Memory, Alone,Concentration, Hopes, Hallucinations , Delusions

D/D Confusion Pneumonic = DEMENTIA
* Diabetes /Dementia/ Drugs
* Epilepsy
* Migraine/Mult Infarct Dementia
* Ethanol (withdrawl / Toxicity)
* Neurological Deficit diseases= BETA (Bleeds,Encephalitis,Tumors,Abscess,Meningitis)
* TIA/ Trauma
* Insulin/ Infections
* Alzheimers/Abscess
Check list accordingly :- Numbness weakness/Headach ,Flashes, N/V /Jerky movements, LOC/ Insulin use /PHx Trauma/FHx of Alzheimer + Risk factor screen (Cholestrol,HTN,DM etc). For Suspected DEMENTIA =Instrumental inquiry = SHAFT Q's (Shop/Housekeep/Aaccount/Food prep/ Transport) , & Daily activity inquiry =DEATH Q's (Dress/Eat/Ambulate/Toilet/Hygiene)

Reply
#15
MOST IMP THING THE FORMAT WHICH I FOLLOWED IN EXAM..........WITHOUT MAKING ANY MISTAKE I LEARNED BY HEART ALL QUESTIONS AT SPINAL LEVEL SO THERE WAS NO NEED TO ASK THINK ABOUT WHICH QUESTION TO BE ASKED NEXT

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Introduction

Mr. Smith? (smile) Hi! Good Evening, (shake hand). I am Dr. Brijesh. I am doctor in this hospital. I am here to ask you some questions and do some examination on you. Is there everything aright in this room? Let me make you more comfortable by covering you. (drap the patient) (while draping speak) Hope you don™t mind if I make some notes while our discussion. During our conversions If you have any concern (question) please let me know.

History of present illness

(Challenging patients (1) Silent patient -Stay silent for few seconds. Establish a eye contact. Put a hand on her shoulder & say, œI know that this is very hard time for you. Will you share it with me? I am here to help you. We can do it together. (2) Over talkative patient-Excuse me Mrs for interrupting you I know that all these things really bothering you very much but my number one priority right now is you. So let us talk about you for now.)

1. Chief complain - So, Mr. Smith œHow can I help you, today?

[Oh! I am sorry to hear that. Can you tell me something more about it?]

2. Location - Can you locate the exact site of pain? [so it is in around your umbilicus]
3. Intensity - In the scale of 1 -10, where the 10 is worst pain of your life, How would you grade your pain? [so it is 5 out of 10]
4. Quality - How would you describe your pain? (choking dull aching, throbbing)
5. Onset, Duration, Progress - When did pain start very first time? What were you doing at that time? Then what happened? For how long you it last? How did the pain progress? Is it continuous or comes and goes?
6. Refer “ Does the pain move?
7. Alleviating factors “ Have you found anything which makes your pain better? [rest]
8. Aggravating factors “ Have you found anything which makes your pain worst? [Activity]
9. Associated factors “ Do you have any other associated complains like
1. Nausea
1. Do you feel nauseated?
2. Vomiting
1. Did you vomit? When? How many times?
2. What was the content of vomitus?
3. What is the color?
4. Was there any blood in it?
3. Cough
1. Do you have a cough?
2. When did it start?
3. How often do you cough?
4. Is it continuous or comes and goes?
5. Do you bring up sputum with cough?
6. What was the color of it? amount? [teaspoon, table spoon, cupful]
7. Have you found anything which makes your cough better?
8. Have you found anything which makes your cough worst?
4. Headache
1. Do you have a headache? How frequently you get headache?
2. Onset “ When did it start first time? How long does it lasts? How many times a day you get headache? Was it sudden or gradual? Is it continuous or comes and goes?
3. Tell me what happens before your headache? Was there any change in your Vision “blurred / double? Watering of your eyes? Running nose? Ear discharge? Numbness? Weakness? Nausea? Vomiting? Fever? Neck stiffness? Any such thing happened during your headache? or after your headache?
4. Locate “ Can you locate the exact site of your headache?
5. Intensity “ In the scale of 1 to 10 where 10 is worst headache of your life how would you grade your headache?
6. Quality “ How would you describe your headache? [throbbing, dull aching, shooting]
7. Refer “ Does the pain move?
8. Alleviating factor “ Have you found anything which makes your headache better?
9. Aggravation factors “ Have you found anything which makes your headache worst?
10. Do you have a headache during specific time of a day? Do you need to wake up during night because of your headache? Does your headache disturb your daily activity?
5. Fever
1. Do you have a fever? Chills? Night sweats?
2. How high your fever goes? How frequently?
3. Is it continued of comes and goes?
4. Have you been exposed to anybody having similar complain?
6. Breathing problem (shortness of breath)
1. Do you get short of breath?
2. Onset - When did it start very first time? Was it sudden or gradual? Is it continuous / comes & goes?
3. When are you getting short of breath? [walking, climbing upstairs] ? How far do you walk on level ground before you have SOB? How many steps can you climb before you get short of breath?
4. Do you wake up at night because of this problem? How many pillows you need at night? Why?
5. Alleviation factor “ Have you found anything which makes you better?
6. Aggravation factor “ Have you found anything which makes you worst?
7. Associations
1. Do you have a cough? Chest pain? Wheezing? Fever? pain in your leg (calf)? swelling anywhere in the body? racing of your heart? Dizziness?



7. Joint pain
1. Do you have pain in any of your joints? where? for how long?
2. L I Q O R A A A “ B/L?
3. Do you feel pain during sleep or resting state?
4. Have you noticed any muscular weakness around knee?
5. Have you found any crackling sound during movement?
6. Chest pain / cough (Infective endocarditis) Do you have chest pain? Cough? Fever?
7. Insect bite (lymes) Do you have a history of insect bite recently?
8. Travel / Trauma “ Have you been traveled recently or encounter with an accident?
9. Rash (SLE) - Have you noticed any rash with your joint pain?
10. Ulcer in mouth (Reactive Arth. SLE) Do you have ulcer in your mouth?
11. Stiffness / Swelling / Redness (RA, OA, AS) “ Do you have stiffness in your joints? stiffness at which time of the day?
12. Hair loss (psoriatic arthritis) “ Do you have history of hair loss?
13. Photo sensitivity (SLE) “ Are you sensitive to bright light?
14. Temperature (Hyperthyroidism, Janeway™s spot)

Osteoarthritis Joint Pain (OA)

Mrs. Smith. As you know it is aging problem. What you have to do is regular exercise, weight reduction and regular pain killer to relieve your pain. Regular exercise can help manage pain as well as keep joints moving and make muscle strong around joints, increase energy, improve sleep, weight control and making your heart stronger. We may also try heat and cold therapy, joint protection techniques and surgery and joint replacement therapy in advanced cases.

8. Dizziness
1. Do you ever feel dizzy?
2. Tell me exactly what do you mean by dizziness?
3. Did you feel the room is spinning around you (vertigo) or you are moving inside room?
4. When did it started first time? What were you doing at that time? How long does it lasts? How frequently do you get it? How did it developed “ was that all of sudden or gradual? Is that continuous or comes and goes?
5. Was there any relation with posture?
6. Have you found anything which makes you better?
7. Have you found anything which makes you worst?
8. Did you black out? Lost consciousness? Weakness? Numbness? any change in your hearing? Ringing in your ears? Chest pain? Racing of your heart? Felt nauseated? Vomited? Sweating?

Aright, Mr. Smith Now I would like to ask you some question regarding you general health and health in your past.

1. Past History “ Have you ever had similar kind of complain in your past? When? Then what you have done? Was it cured completely? Do you have any illness of long duration like
1. High Blood Pressure,
1. Do you have high blood pressure?
2. When it was detected? How?
3. Are you taking any medication for your high blood pressure? No. Can you tell me why it is so?
4. Which medication you take for that? Do you have any prescription for that right now?
5. Do you take medicines regularly? (No) why it is so?
6. Do you measure your blood pressure regularly? When was the last time your blood pressure measured? What was the reading?



Hypertension counseling

Mr. Smith As a concerned physician I must ask you whether you know any adverse effect of uncontrolled high blood pressure? Uncontrolled high blood pressure might have many bad effects on your heart, blood vessels, eyes, kidney and so many other organs. It might lead to Heart attack, Stroke, Kidney failure, blindness and even death too. On the other hand if your blood pressure is well controlled we can avoid such kind of effects and you can live like any normal health person.

It is my sincere advice that you should get your Blood Pressure checked periodically at every fortnight and take appropriate treatment regularly. You should also consider for dieting and losing your weight (if obese), exercise can be beneficial. You should decrease salt in your diet.

2. Diabetes,
1. Are you suffering from Diabetes?
2. When it was diagnosed?
3. Do you take any medication for your diabetes? No “ why it is so?
4. Which medication do you take for that? Do you have any prescription for that right now?
5. Do you take medication regularly? (no) why it is so?
6. Do you check your blood sugar regularly? When did u do last time? What was the reading? No why it is so?



Diabetes

Mr. Smith As a concerned physician I must ask you whether you know any bad effect of uncontrolled diabetes? That uncontrolled high blood sugar might have many bad effects on your heart, blood vessels, eyes, kidney and so many other organs. It might lead to Heart attack, Kidney failure blindness, coma and death too. On the other hand if your blood sugar is well controlled you can avoid such kind of bad effects and you can live a normal life.

It is my sincere advice that you should get your Blood sugar checked periodically at every fortnight and take appropriate treatment regularly. You should also consider for dieting and losing your weight (if obese), exercise can be beneficial. You should wear soft heeled foot ware to avoid any injury to your leg which might be hard to cure by the routine treatment.

3. High blood lipid,
4. Asthma,
5. Tuberculosis
6. Cancer?

2. Allergy “ Are you allergic to anything? Like a drug or specific food?

3. Medicine “ Are you currently on any kind of medicine? What is that? Why? For how long?
4. Hospitalization, Surgery, Trauma “ Have you ever had been hospitalized? [for what?] Had any Surgery? [for what], Met with an accident? [when, what happened?]
5. Urination “
1. Change - Do you have any problem with your urination?
2. Type - Which kind of problem you have regarding your urination?
3. Duration “ For how long?
4. Frequency - How many times a day do you pass the urine?
5. Nocturia Do you have to wake up in night to go to bathroom?
6. Appearance / color “ How does your urine looks like? Color?

(Infection / tumor / stone / incontinence)

7. Blood “ Have you noticed blood in your urine? Pus?
8. Burning - Do you have any burning sensation after urination?
9. Urgency - Do you have to rush to bathroom to pass the urine?
10. Control-Have you ever noticed that you have passed urine without your control?
11. Incontinence - Have you ever passed urine without your notice?

(obstruction)

12. Hesitancy - Do you have to wait to start urination?
13. Straining - Do you have to strain to pass urine?
14. Flow - How was the flow of urine?
15. Fullness of Bladder -Have you noticed fullness of urinary bag after passing urine?



6. GIT “
1. Change - Did you notice any change your bowel movements?
2. Type “ What is that Constipation? Diarrhea? For how long you have been?
3. Frequency - How many bowel movements do you have per day / week?
4. Appearance / color - What does your stool look like? What was the color?

(Infection)

5. Blood / Mucus - Is there any blood or mucus in your stool?
6. Pain - Do you feel any pain when you have bowel movements?

(obstruction)

7. Straining - Do you need to strain at bowel movements?
8. Incomplete evacuation - Do you feel that your bowel is not empty after your bowel movements?

(diarrhea)

9. Urgency - Do you need to rush to bathroom for your bowel movements?
10. Incontinence - Have you lost your control of your bowel movements?
11. Travel - Did you travel recently?

7. Sleep “

1. Do you any problems falling asleep? Staying asleep? Waking up?
2. Do you feel refresh when you wake up?
3. Do you snore?
4. Do you feel sleepy during day?
5. How many hours do you sleep?
6. Do you take any pill to help you to go to sleep?



8. Gynecological History “
1. Mrs. Smith, at which age you had your first period?
2. What was the last date of menstruation?
3. Are your periods regular?
4. How many days are consisting of for a typical cycle you have?
5. For how many days your period lasts?
6. On a heavy day, how many pads do you need to change?
7. Do you have any bleeding in between the cycle?
8. Have you ever had bleeding after sexual intercourse?
9. Have you undergone PAP smear examination? What was the last result?
9. Obstetric History “
1. Have you ever been pregnant? How many times?
2. Have many deliveries you had so far? Was it full term? What was the mode of deliveries? Was that normal or assisted or C-section?
3. Have you ever had abortion / miscarriage? Do you know the reason for that?

Okay, Mr. Smith now I would like to take your family history.

10. Family History
1. How are your parents doing? [ if died, I am sorry to learn that your father / mother / parents is / are no more]
2. Does any of your family members suffer from High Blood Pressure, Diabetes, Thyroid problem, High lipid in blood, Asthma?



11. Sexual History

Okay, Mr. Smith Now I am going to ask you some questions regarding your sexual health. Please be assured that whatever you tell will be kept confidential. Please try to be as honest as possible. (no answer) Mr. Smith, Medical Science works in such a way that some hidden clues can be received by such kind of information. Aright, shall we start with it?

1. Are you currently sexually active? (No) Were you sexually active with anybody in last year? (yes) with whom?
2. Do you have any other sexual partner?
3. Do you use any mean of protection? Condom? Birth control pills? (no)
4. Do you use such protections regularly? (no)
5. Is there any specific reason why you don™t use it / use it regularly?
6. Have you ever been diagnosed with Sexually Transmitted Disease? When? Were you treated? Cured?
7. Have you ever been tested of HIV? When? What was the result?
8. Do you have any penal / vaginal discharge? [Since how long? what is the color & consistency? How is the smell?]

Sexually promiscuous patient with unprotected sex

Mr. Smith as a concerned physician I must inform that multiple sexual partners and unprotected sex put you at risk of sexually transmitted disease like HIV, gonorrhea, Chlamydia and even increase risk for a type of genital cancer unwanted pregnancies abortions and even death. It is my strong recommendation that you should use / insist your male partner to use condoms each times you have sex. You should be also check for any sores, redness, discharge, blister in genitals of yours and that of your partners too and be also responsible by avoiding sex. You should also bring all your sexual partners to bring over here to get tested and treated. You should avoid sex till the treatment is completed.

HIV counseling

Mr. Smith, the biggest danger in HIV man not be the HIV itself “ rather other disease that can occur more easily due to reduced body resistance. So you should take appropriate vaccines to prevent such disease. And with this you should get early and complete treatment of any such illness without fail. Thus periodic examinations and follow-ups are very important for you. We have a excellent professional support group to help you to tackle your emotional and social issues with you.

Trichomonas

Mr. Smith as a concerned physician let me inform that trichomonas is sexually transmitted disease which can be associated with other disease like HIV and might lead to cervical cancer. As this report is positive for you, you and all of your sexual partners must be investigated for that and treated completely if anybody turn out to be positive for that. If the drug for this disease and alcohol are taken to gather it interacts with each other and give bad effects like nausea and vomiting, I would rather recommend avoiding alcohol till the treatment is completed. You also should avoid sexual contact till the treatment is completed or else you can use protection in the form of condoms at all times. With this you should consider for PAP smear examination periodically.

Aright, Mrs. Smith now I would like to ask you some personal history

12. Social History / Personal History
1. Appetite
1. How is your appetite?
2. Has there been any change in your appetite?
2. Diet
1. Has there been any change in your eating habits?
2. What do you usually eat?
3. Do you eat anything lately? Why it is so?
4. What did you eat before the symptoms started?
5. Is there any special kind of diet that you are following?
3. Weight
1. Have you notice any change in your weight recently? What? How much? Over what period of time?
2. Was that intentional?
4. Tobacco
1. Do you use tobacco in any form? Have you ever used? In which form?
2. For how long you have been smoking?
3. How many packs per day?
4. Do you know bad effects of smoking?
5. Have you ever tried to quit smoking? Then what happened?



Smoking

Mr. Smith as a concerned physician I must ask you if you are aware of the bad effects of smoking on your health? (No) Mr. Smith Smoking h can cause damage to your lung, heart and blood vessels and might lead to early death. On contrarily to that quitting smoking will have good effect on your health and you can save lots of money on long run, sounds good?

Have you ever tried quite smoking? (yes but it didn™t worked) Mr. Smith I can understand it happens to most of the people. But don™t worry I have solution for that I will give you Nicotine patch or gum so that you will have no problem on quitting smoking.

Are you ready to quit smoking right now? (no response) we have excellent professional support group, that will help you quit smoking. (no right now). Aright Mr. Smith I wonder if you can cut your smoking by half? (No doc). Okay Mr. Smith it seems that you are not ready to make a decision right now but I understand you. But by chance in future if you plan to quit smoking then please feel free to contact me at any time. Please collect my contact number from my nurse outside. I will do my best to help you quit smoking at any time.

5. Alcohol
1. Do you take alcohol in any form? Have you ever used? In which form?
2. How many packs per day? How many days a week?
3. For how long you have been taking alcohol?
4. Cut “ have you ever thought to cut down your drinking?
5. Annoyed “Have you ever felt annoyed by criticism of your drinking habit?
6. Guilty “ Have you ever felt guilty about your drinking?
7. Eye opener “ Do you need to take alcohol in early morning? (Have you ever taken alcohol in early morning?
8. Have you ever tried to quit alcohol? Yes “ then what happened? If no then why not?

Alcohol

Mr. Smith as a concerned physician I must ask you if you are aware of the bad effects of alcohol on your health? (No) Mr. Smith Alcohol can cause damage to your liver, pancreas, heart, brain. All these things might alter your judgment power and raised your risk for high blood pressure, stroke, accident. It can responsible for birth defect to a child if taken during pregnancy. Alcohol have tons of calories but lacks nutrition. On the other side you on quitting alcohol intake will have good effect on your health and you can save lots of money on long run, sounds good?

Have you ever tried to quite alcohol intake? (yes but it didn™t worked) Mr. Smith I can understand it happens to most of the people. But don™t worry I have solution for that I will give you something so that you will have no problem on quitting alcohol.

Are you ready to quit alcohol right now? (no response) we have excellent professional support group, that will help you quit alcohol. (no right now). Aright Mr. Smith I wonder that you can cut your alcohol by half? (No doc). Okay Mr. Smith it seems that you are not ready to make a decision right now but I understand you. But by chance in future if you plan to quit smoking then please feel free to contact me at any time. Please collect my contact number from my nurse outside. I will do my best to help you quit alcohol at any time.

6. Drugs
1. Do you use any illicit drug in any form? Have you ever used? In which form?
7. Work
1. Do you work? Which kind of work do you do?
2. How would you consider your working environment? Environment at home?
3. Is there any stress related to your work or at your home?
4. Do you need to work with / near heavy machinery?
5. Does your work condition have constant heavy noise around?
6. Does your work need to drive long distance?
8. Have you traveled far recently?

Mr. Smith apart from all these, would you like to tell me anything else?
Thank you very much for answering my questions.

PHYSICAL EXAMINATION

Now I would like to wash my hands. Excuse me for a while. (while washing hands). Mr. Smith now I will be performing examination on you. I will keep informing you while examining you. Do you have any special concern for now?

(Patient resisting for physical examination

Mr. Smith, I can understand your feelings but to clearly understand your disease I have to do this examination. It won™t take more than a minute. Don™t worry I am here to assist you. I will inform you whatever I am going to do.)

Mr. Smith Now I am examining your head and neck, is that okay with you?

PICKLE - (examine in sequence Head, Ears , Eyes, Nose, Mouth, Neck, Hands, Leg)

Head - Let me look at your head for any swelling, scar or any visible abnormality.

Face “ Let me press on various parts of your face for any areas of pain or swelling (tenderness, edema)

Ear “ Let me look in your ear for any swelling, discharge of deformity. (otorrhea)

Eye -I am checking your eyes for pallor or yellowness. Please see downwards and upwards. Thank you. (pallor, icterus)

Nose “ Let me see in your nose for any swelling, discharge or deformity. (discharge, deformity)

Mouth “ Let me examine your mouth. Please open your mouth. Stick out your tongue, say Aha ha (if RS infection). Thank you. You may close your mouth now (pallor,cyanosis,icterus,adenitis)

Neck “ Let me examine your neck for any swollen glands (lymphadenopathy)

Hands “ Please show me your hands for pallor and pulsation.

Nail “ Let me look at your nails of hand for any abnormality (koilonychia)

Legs “ Now let me check your legs for pulse and swelling, for that I might need to raise your gown, is that okay with you? (edema, pulsation). Thank you. Let me cover it again.

Respiratory system

Mr. Smith Now I am going to examine your chest. For that I need to untie your gown. Is that okay with you? Let me help. (Pt “ it™s okay) You “ thank you

Inspection “

Now I am looking at your chest for any abnormality, swelling, redness, visible movements (listen for wheeze, watch for swelling, observe for chest retraction, use of accessory muscle)

Palpation-

I am going to press on your neck, chest, let me know if it hurts

(Palpate for tracheal deviation, for tenderness, assessment for expansion and symmetry of chest“ Can you please take few deep nice breaths for me , TVF “ Can you please speak 99 for me? PMI)

Percussion

Now I am going to tap on your lungs to look for any fluid or excess air. (do percussion). Let me know if it hurts.

Auscultation

Now I would like to listen to your lungs. Can you please take some nice deep breaths for me? (Auscultate for full inspiration and expiration)

Bronchophony - Can you please tell 99 repeatedly for me?

CVS

Right side, 3 positions

Now Mr. Smith I would like to examine your heart and blood tubes in sitting and then lying down positions for that I need to untie your gown. Is it okay with you? (okay) thanks, let me help you untie your gown.

(check radial, dorsalis pedis, carotid pulse, and carotid bruit in general examination)

Inspection

Mr. Smith Now I am looking at your heart for any visible abnormality.

Now I want to examine your heart in lying down position. Please lie down for me. Let me help you for that.thank you. Let me pull out leg extension to make you little more comfortable. (Sounds good?)

Now I am looking to your neck for any visible pulsation. Now I am looking to your heart for your heart beats.

Palpation

Now I am touching your chest to feel your heart beats. (thrill, PMI, heave, - note site, location and quality of impulse)

Auscultation

Mr. Smith Now I am listening to your heart. Could you please stop breathing for a while for me? Auscultate 4 areas

Mr. Smith, Could you please turn to your left side for me? Thanks

Mr. Smith, could you please sit again for me? Thanks. Auscultate 4 areas

Mr. Smith, could you please lean forward for me? Thanks. Auscultate 4 areas

Now you can resume your normal sitting position. Let me help tying your gown. I appreciate your co-operation.

Abdomen

Mr. Smith Now I need to examine your belly. For that I need you to lie down. Let me help you for that. Thank you.

Now, I need to raise your gown to examine your belly.

Inspection

Now I am looking to your belly for shape of your belly, any scars, swelling, hernia, visible bowel movements or pulsation

Auscultation

Mr. Smith now I am listening to your belly for your bowel sounds (bell “ peristalsis, bruit of abdominal, renal, iliac artery)

Percussion

Mr. Smith Now I am going to tap on your belly to find any excess fluid or mass. Please let me know if it hurts.

Palpation

Now Mr. Smith I am going to press your belly first lightly and then deeply, please let me know if it hurts. (Liver-press, gall bladder “ hook finger (Murphy) , Abdominal aorta aneurism, Spleen)

Rebound tenderness “ Now I would like to press in & release. Please let me know if it hurts when I press in or let it go (release)- peritonitis

Appendicitis

Psoas sign “ To check your appendix infection, I want you to turn to your left. Thank you. I am going to pull your left thigh to your back side. Please let me know if it hurts. (left lateral position, right leg extension, and pain in RIF)

Obturator sign “ To check your appendix infection, I am going to bend your knee and hip. Please let me know if it hurts. (flex right hip & knee, internal rotation at hip)

Rovsing sign “ To check your appendix infection, I am going to press your right side of belly. Please let me know if it hurts. (press in LIF “ pain in RIF)

CNS

MMSE (3Q-time,place,person, 3-words-recent/intermediate/remote, 3-command,3-misc)

Okay, Mr. Smith now I would like to ask you some questions to test your brain functions

What date is today? Where are we right now? Who is president of USA?

I am going to tell you three words I want you to repeat them immediately and after some time, okay.pen ball cat

What would you do, if you see your friend™s house on fire?

Please count down from 7 to 1 for me.

What is this? Take this pen by your left hand, transfer it to your right hand and then give it back to me by your right hand.

What happened on 9/11?

Can you please repeat those three words for me?

Cranial nerves

Now I am going to check your brain nerve functions

II (optic) “ Please cover your Right (then left) eye, Can you please count my fingers? Confrontation (visual field method “ finger movements), pupilary light reflex (dim light, direct pt to look far on wall, shine light obliquely on each pupil)

III (oculomotor), IV (trochlear), VI (abducent) “ H & X (follow the finger movement without moving head) , convergence (follow the finger movement)

V (trigeminal) “ Motor “ Please clench your teeth for me. Palpate the masseter muscle

Sensory “ sharp dull sensation on 6 face areas(forehead,cheek,jaw)with closed eyes

VII (facial) “ Can you please smile / raise your eyebrow / frown / show your teeth for me? Close your both eyes. I will try to open it up. Please don™t let me open

VIII (acoustic) “ finger rubbing, weber, rinne

X (vagus) “ Ask the patient to swallow saliva (already done for thyroid)

XI (spinal accessory nerve) “ Can you please shrug your shoulder (against resistant) for me, Please turn your head toward right(press from left) and vice versa

XII (Hypoglossal) “ Can you stick out your tongue and move side by side?

MOTOR

Power

1. - no movement at all
2. “Some flickering
3. “ Movements but not against gravity
4. “Movements against gravity
5. “ Movements against gravity against some resistance
6. “ Movements against gravity against full resistance

Upper limb

(Flexion“at wrist,elbow & Abduction at Shoulder,Extension“at wrist,elbow & Addu at Shoulder)

Hand “ Can you spread out your fingers? Please hold my fingers as tight as possible & don™t let them go. Thank you.

Wrist “ Can you push up? Can you push down? Thank you.

Elbow “ Can you please pull in? push out? Thank you.

Shoulder “ Can you push out? Can you pull in? Thank you.
Lower limb


Hip “ Can you push up / push down your thigh? Thank you.

Knee “ Can you kick out / pull in your leg? Thank you.

Foot “ Can you pull up / push down your foot? Thank you.

Reflex “

I would like to check your jerks. First let me begin with your arms. Can you please clench your teeth for me? Biceps, Triceps and Brachioredialis, Knee, Ankle

Babinski -Now I am to stroking at your sole

Sensory- Now I would like to check your sensation in different part of your body.

This is dull and this is sharp. Now close your eye and tell me which is what?

Position sense-Grasp big toe and show the pt ˜up and down™ now tell pt to close your eye and identify position of toe.

Vibration sense-

Two point discrimination-

Cerebellar test- now I would like to check your balance and movement.

Finger nose test “ please touch your nose and then my finger by your finger repeatedly

Rapid alternate pronation and supination of hand “ please do like this,

Now for balance test I want you to step down for few moments. Would you please? Yes, Thank you let me pull out step for you so that you can climb down of table

Romberg test “ please stand up with yours feet together and hands apart and close your eyes. Mr. Smith please be assure that I will not let you fall down ( ask pt to stand with your both feet together and close your eye for 5 second without support-test for sensory ataxia),

Gait - Can you please walk across the room, turn about and come back? Can you please walk in a straight line for me?

Spine

Now Mr. Smith I want you to bend you at your back. Please try to touch your toes by your hands
Special test-

Kerning™s sign-flex both knee and hip, then try to extend the knee only?

Now I am going to move your thigh and knee joint and will resume again It™s normal position

Brudzinski™s sign- When you flex the neck, there may be flexion of hip and knees

Now I am going to bend your neck to try to touch your chest.

Neck stiffness - Place your hand behind neck and flex it until his chin touches his sternum



Closure

All right, Mr. Smith, thank you very much for you kind co-operation. Now I would like to sit down and talk discuss my impression. First let me summarize.

You just told me that you have.so and so.and you also said that so and so.., is that alright?

According to the information I got form you and the examination, I am considering a couple of possibilities. It may be or possibly..

I need to run some tests in order to find out exactly what the problem is.

As soon as I get the results, let us meet again to go over everything. At that time I will explain the details and we will talk about your options for treatment? Is it okay with you?

I have noticed that you have so and so .. As a concerned physician I have also recommended to get over this habits and accept healthy life styles. If you need any more help from me, just let me know. I will be glad to help you.

Mr. Smith, do you have any concern or questions before I go?

Ok, then, Mr. Smith It was nice working with you. I will do my level best to make you feel better. Thanks for your co-operation. Have a nice time. Bye for now, take care.(shake the hand with smile and leave the room)










Counseling

1. Enuresis

Mrs. Smith as a concerned physician let me inform that bed wetting is very common problem with male children of this age group. It might be a very stressful and embarrassing situation for your child and which might lead to loss of self confidence and avoiding social contact. As a caring parent you should be very supportive and tackle this condition with great care and understanding. What you can do is-

A Watch his fluid intake throughout the day

B Restrict fluid intake 2 hours before going to bed

C Encourage child to go to bathroom before going to bed

D Use Sleep alarms every 2-3 hours during night hours which will train child to go

to bathroom and pass the urine

E Use bedwetting alarms

F Encourage child to change Pajjamas and Bed sheet if child has spoiled by chance

G Praise and reward child for dry nights


Psychiatry

General

Silent patient “ Mr. Smith I know this is a very tough in your life, but I assure you that we can deal with this much better to gather. I really want to help you and for that I need to understand your problem. You said you were perfectly happy and healthy 3 months ago “ could you try and tell me what exactly happened 3 months ago that started this?

I want to die doctor “ I know this is a very tough time

Introduction “ Tell me about you and your future goals

Duration “ How long have you been feeling like this?

Etiology “ Do you have any idea why it happens? Please share it with me.

Psychological trauma “ Do you have any idea why it happens? Please share it with me. Any unusual traumatic episode? Emotional problem? Any financial problem? Any traumatic event in your family?

Drug withdrawal “ Do you take caffeine, Alcohol, Drug? For how long you are taking? When did you take it last time? Do you take a lot of caffeine, colas, tea, chocolates?

Thyroid “ Have you noticed any change in your bowel habits? Constipation? Diarrhea?

Has your skin been very dry or very moist recently?

Have you been losing your hair?

Do you find yourself having trouble adjusting to cold or hot temperature, recently?

Do you have trouble sleeping?

Support “ Whom do you live with?

Do you have any friends or family members you can talk to? How do they react to your behavior?

How is your family life? Tell me more about your relationship with your family members and friends. Or ask for help when needed?

Work “ Do you work? Which kind of it is?

Do you have any problem at your work place? How is your performance at your job?

Day to day life “ Tell me how do you spend your whole day?

Do you take any interest in your daily activity?

How is your mood now a day?

Do you think that things will get better with time?

Family History “ Has anyone in your family have similar kind of complain?

What was the diagnosis? Depression? Mental illness?

Depression (F A C E S L I P S)

Feeling of guilty, Anger or worthlessness “ Do you feel any loss or worthlessness, guilty or anger about? for what?

Appetite “ Did you notice any change in your appetite, recently? Do you feel like eating? Did you notice any change in your weight recently?

Concentration “ Do you have any difficulty in concentrating? Any loosing of memory problem?

Energy “ How would you consider your energy level?

Sleep “ Is there any change in your sleep? Did you notice any change in your sleep recently? Difficulty in falling asleep? Staying a sleep? Awakening from asleep? Do you wake up early in morning hours? Have problem to go back to sleep? Need to take sleeping pills?

Libido “ How would you consider your desire to have sex now a day? Is it satisfied? (If no) why it is so?

Interest / Hobbies “ Do you have any hobbies / interests? Tell me about it. Do you enjoy them?

Psychomotor / pleasure level “ Are you able to get interest or pleasure in those activities which you were used to get in past?

Suicidal ideation - Have you ever thought about hurting yourself or ending your life / others? Do you have any plan? Have you ever tried to do so? Please tell me about it. Do you have any gun or pill for that?

Psychosis (digfast)

Distractibility

Indiscretion

Grandiocity

Flights of Idea

Anxiety

Speech deficit

Talkativeness

Hallucination “ Do you see or hear anything which others don™t know? Tell me about it.

Delusion “ Do you think that other people are trying to harm / control you?

Dementia

Tell me about your day yesterday?

DEATH“Do you need any help in getting dressed [dressing]? (for what), eating[eating]? For transferring from your bed to chair [ambulation]? Going to bathroom [toileting]? Do you ever had any accident with your urine or bowel movements [hygiene]?

SHAFT“Do you need any help in shopping [shopping] ?, cleaning your house [house keeping] ? Managing your money [accounting] ? Preparing food [food preparation] ? Getting from place to place [transportation] ?

MLT“Do you need any help in taking your medication? Doing laundry? Using telephone? Which kind of help?


Abuse

I can see you are wearing an ace bandage on your wrist. Can you tell me about it?

Are you in danger from anyone in your personal life?

Tell me about your home life.

Does anybody calls your name or puts you down?

Is it related with drug, alcohol, sexual relationship?

How often does it happen? What happened?

Were you harmed repeatedly by anyone during your childhood? Were you left alone often?

Does anybody calls your name or puts you down?

Safe - Are you safe at your home in (relationship) ?

Afraid of “ Do your parents (husband / wife, boyfriend / girlfriend, roommate) treat you badly? Please tell me more about it. How is your relationship with them?

Family aware - Are your parents / friends are aware of your current condition?

E- Do you have any emergency plan to leave your home?












Pediatric case

History

Is this Mrs. Smith? Good Evening, I am Dr. Brijesh and I am doctor in this hospital. My nurse told me that you are on the line for your child illness, right? During our conversation if you have any concern or confusion then please let me know, I will do my best to help you, sounds good?

Okay Mr. Smith! How can I help you today?

Oh I am sorry to hear that your child is having. Mrs. Smith May I know by which name do you call your son? (Jone) so it is Jone, right? And how do you spell it? J O N E ..i gat it.

Mrs. Smith could you please tell me more about Jone™s illness ?

Onset “ When did it start very first time?

Duration “ So for how long he has been suffering from? How did it progressed?

Frequency “ For how many times he passed stool? How many diapers you need to change during this time? How many times he has passed during this period?

C “ What is the appearance of his stool ? and color? Consistency? How is jones cry? Is it vigorous or weak or drowsy? because of that? Is there any cramp in his belly? Was there any blood in it? How does his skin looks like? Is it shining or dull? Is it turgid?

Mrs. Smith please let me know that when was he totally normal by bowel movements? (6 days before) So how was his bowel movements before 6 days?...

Is there any relationship with taking food by mouth?

Did you give any kind of medication to him? What was that? Did it help?

Associated problems “

Is there any fever? Chills? Night sweats? Duration? Is it continuous or comes and goes? How high? How frequently? Is there anybody in home or his contact in day care centre or friends having fever?

Is / was there any chest infection? Fast breathing? Nausea? Vomiting? Rash? Shaking(seizure)?

Travel - Has he been traveled recently?

Contact - Does he attends day care centre / kinder garter / nursery / school? Any ill contact over there?

Eat “ Mrs. Smith generally what kind of food does he take? Does he take breast milk? Any formulas?

Medicine “ Does he take any kind of medicine right now? Is he allergic to any medicine or food item?

Okay now Mrs. Smith I would like to ask Jones health related questions in general, is that okay with you?

Pa/H - Did Jone suffer from similar kind of illness in past? Then what did you do for that? Is he suffering from any kind of medical illness? Had he any surgery?

Last check up- When did he had last check up? Was there everything normal?

Immunization “ Did he receive all his vaccination shots? (update) I am glad that you are taking very good care of your child. That is really good for him to save from many illnesses (not taken) Is there any reason for that? Mrs. Smith, As a concerned physician let me inform that this kind of vaccines are given free of charge by federal government health program. With this they can protect child from many illness so I would highly recommend it.

Pre natal History

Aright, Mrs. Smith Now I would like to ask some information regarding pregnancy of her mother, is that okay with you?

Had mother got routinely checked during her pregnancy?

Had mother under gone baby scanning what we call as sonography during her pregnancy? When for how many times?

Had mother any illness / infection / hospitalization during pregnancy? When? For what? Then what happened?

Has mother taking Alcohol during pregnancy? Smoking? Any Illicite drug?

Birth History

Aright, Mrs. Smith now I would like to ask some details regarding his birth, is that okay with you?

At which month of pregnancy you gave birth to your kid?

Was that at home or hospital?

If hospital was it normal delivery or cesarian?

Was there any problem (complication) during child birth? What was that? Then what was done?

When did your baby cried after your delivery?

Post Natal

Was there any problem after delivery to you and / or your kid? What kind of problem? Please tell me more about it.

When did your kid started his first feeding? Was it your breast milk or some thing else? (what as that) why you had not given your milk?

When did your child had his first bowel movements?...................

Family History

Aright Mrs. Smith, Now I would like to ask some family history to access the case. Is that okay with you?

Smoking “ Is there any smoker at home ?

Is there any thing you would like to tell me, Mrs. Smith? Thank you very much for providing me information

All right, Mr. Smith, thank you very much for you kind co-operation. Now I would discuss my impression. First let me summarize.

You just told me that you have.so and so.and you also said that so and so.., is that alright?

According to the information I got form you, I am considering a couple of possibilities. It may be or possibly..

I need to do examination on..in order to find out exactly what the problem is. For that I want you to bring at the hospital

But before you arrive at the hospital on the way from your home to hospital I would like to do one important thing for.. Do you have ORS or Pedialyte? Okay let tell you how to make quick home made solution “ take 4 cups of water in a pot, add 1 tea spoon of salt and add 8 tea spoons of sugar and shake it till sugar and salt melts in solution. You should give your baby to sip on it till you bring her hospital.

On your arrival at the hospital I will go over everything. At that time I will explain the details and we will talk about _______options for treatment? Is it okay with you?

Mr. Smith, do you have any concern or questions before I go?

Ok, then, Mr. Smith It was nice working with you. I will do my level best to make _______ feel better. Thanks for your co-operation. Have a nice time. Bye for now, take care.

ORS
Reply
#16
and this is what i have done for my CS

I will be more than happy to help any body..............in case of any special concern leave your email ID over here. I will do my best to help you

Wishing you very good luck for all your future endeavors.

Cheers

And yes don't forget to pray for me to get in a good residency program
Reply
#17
can somebody please help me with the cs cases. my exam is in another 20 days. I cannot afford 2 trips to USa. kindly help. my emaiis
mapbrains
Reply
#18
god bless you...our love is always with you...i appreciate dude.
Reply
#19
mapbrains

What ever material needed is over here only....................if you want to pass the exam.........all you need is LIVE PRACTICE with partner who wants to take CS and with video recording and if possible with a guy who have passed CS recently.

in addition which kind of help regarding CS CASES do u need? Did you explore this forum?
Wishing u very good luck

angle567
thank you ......... good luck to you
Reply
#20
hi sure4,

congrats and wish u all the best wid ur residency match.

i took the xam abt 3 weeks back.im reminded now and then abt the mistakes i made.my mail i.d is mleprep08.want to clarify a few things.

GL
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