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Passed CS IMG - shonyajeidi
#11
Could you tell me, if one of the dd is MI, and there are no physical findings whatsoever, do write no JVP, no murmurs, no acute distress in the dd of pe or leave it blank?
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#12
The above question Is about the diagnostic column and not the pe colum that cones after history.
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#13
Can you also give dome tips on how to fill the diagnostics column?
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#14
sorry i ll just rephrase everything i asked:

Lissn I have to ask something....there is a physical exam section and there is a physical exam column in the diagnostics section. The following is about the physical exam colum in diagnostic section.
Given dd of MI, there are no exam finding what so ever, do we write no JVP, no murmurs, no distress in the columns or leave them blank?
also, plz give some tips reg how to fill the diagnostics stuff?
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#15
nkc,

Thank you.
I would leave it empty or just write none.
You should write what is positive for the dd.
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#16
mojo2525,

I just sent you an email.

Good luck to everyone!!!
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#17
Hey mojo2525 I will post some of the mnemonics that I used.
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#18
Knock on the door: three times.
Hello, I am doctor xxxxx, I will be your physician for today, nice to meet you.
Before asking few questions, let me cover you with this and make you more comfortable.

Ok. Ms. Holland, What brings you in today?
Tell me more about your pain.
Where the pain is exactly?
how would you rate your pain in a scale of 1-10?
describe your pain?
when did it start?
Does the pain move to somewhere?
anything makes better?
anything makes worse?
Associated factors: fever, numbness, weakness, fall, trauma, tinglings, nausea, vomiting, recent heavy lifting,
weakness,numbnesss,recent trauma,heavy lifting,trouble breathing, fever, night sweats,weight loss headaches,dizziness, photophobia, nausea, vomiting

Mnemonics for USMLE STEP 2 CS CASES

LIQORAAA ( location/intensity/quality/onset/duration/radiation/allev/aggrav/associated)


PMH HUGS FOSS

DIRECTIONS: Drugs/infection/Rheumatologic/Endocrine/Cardiovascular/Trauma/Inflamatory/Other/Neoplasm)

PREMENSTRUAL SYMPTOMS: HAVOC: HOTFLASHES/ATROPHY OF VAGINA/VAGINAL DRYNESS/OSTEOPOROSIS/CORONARY ARTERY DISEASES.

DYSPAREUNIA: DATIVE ( YOU HAVE TO BE ON A DATE TO HAVE SEX)
Domestic abuse
Atrophic vaginitis
Tumor, pelvic
Infection: vulvovaginitis/cervicitis/PID
Vaginismus
Endometriosis

DISCHARGE:
Duration/dyspareunia/dysuria
Itching
Smell
Color
High fever
Abdomen
Recurrent infection or discharge
Gonorrhea
Endocervical smear or pap smear

SEXUAL ABUSE: B2EING R2AP2ED- C3OM
B2: BRUISES/BLEEDING
E: EJACULATION
I: INTERCOURSE
N: NUMBNESS/WEAKNESS
G: GENITAL BLEEDING

R2: REPORT/RECOGNIZE
A: ASSAULT OBJECTS
P2: PAIN/PALPITATION
E: EXACERBATING/ALLEVIATING FACTORS
D: DESCRIPTION OF ASSAULT

C3: CONDOMS/CONTRACEPTION/LOSS OF CONSCIOUSNESS
O: ORAL/VAGINAL/ANAL
M: MENSTRUAL PERIOD


FOR PEDIATRIC HISTORY.


F E V E R C U D , Seizure + P A M - I F S - 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 pain, fast respirations,shortness of breath,drooling,difficulty swallowing Urination-any increased or decreased urination,number . of wet diapers, any odour, color of urine, Diarrhea-frequency,onset,mucus in stool,blood in stool,any cry during defecation Dehydration – dry mouth ,sunken eyes , sunken spot on head, Seizure-any jerky movements, any leakage of urine or stool during fits,ant postictal 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-last check up , Look of tha baby or appearance, S- Sleep
HYPOTHYROIDISM
3c
constipation
cold intolerance
change in hair
change in skin
change in voice

SLEEP :
O P D A A A Activities which make u…DIES and CRIES
Ask DIES – daytime nap ,daytime sleepinesss ,interruption , early awakening , snoring
Ask CRIES – caffeine (hw much? , tremors ? palpitation ? sweating ?) , relationships , illness, irritability , exercise , stress
Ask 3Cs , joint pains/body aches

Psychiatric Hx TRIM DR. WADE ASAP
Talk to (someone to talk to when he is in distress), traumatic episodes; think (why is he here)
routine, daily
Interests and hobbies
Mood throughout the day and memory loss
Delusions and hallucinations
Realize, he has a problem
Weight, willing to get help
Appetite
Diet
Energy
Attitude towards life
Suicide
Affinity to his family
Plan (gun or pills)

DM follow up

O ISC MLRH5 VIP MGUN

O onset
I insulin Rx
S schedule intake
C compliant ( regular intake )

M monitor glucose level
LR last glucose reading
H5 ( HBA1c, heart symptoms( palpation , chest pain), HT, Hypercholesterolemia, hypoglycemia attack )

V vision changes ( blurring vission , last check up )
I infection ( Gum , feet )
P pulmonary symptom ( cough ...

M mood ( deprees, stress.....)
G git ( abd pain , bowel changes, dyspepsia )
U urine changes ( polyuria, dysuria, hematuria)
N neuro ( headache , numbness , weakness , dizziness, TIA Hx , Stroke Hx
Passed out (PASS the BLT SANDWICH)
Palpitations
Aura
Shaking (duration)
Spinning/ lightheaded

Bladder, incontinence
Loss of consciousness (duration)
Tongue biting

Speech difficulties
Atraumatic (head trauma)
Numbness
Difficulty breathing
Weakness
Irregular gait
Confusion after the event
Headache

Domestic abuse: SAFEGARD
S Safety
A Afraid of anyone?
F Family/friends?
E Emergency plan?
G Gun at home?
A Alcohol?
R Relationship with spouse.
D Drugs? Depression?

Depression: SIGECAPS
S Sleep 
I InterestG Guilt
E Energy
M Mood
C Concentration
A Appetite
P Psychomotor
S Suicidal
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#19
Congratulations and thanks for wonderful input. I just started preparing and have no study partners. I would like to know how much time did u take on whole to prepare and since when did u start preparing with partners. I would be thankful for your reply.
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#20
Hi Jus,

I studied for three months. The first months we studied 4-5 hours everyday.
the second and last months we studied for 7-8 hours everyday.
I study since the beginning with my partner. We study mnemonics, DD, workup plan, and discussed each mini case together.
If you study very hard and practice a lot, you could do it in one or two months. For my IMG I suggest to do it in two months.
If you do not have a partner yet, Still study alone, Once you start studying do not postpone it more than three months.
Best of luck to everyone.
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