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THE ULTIMATE STEP 2 CS PREP
STRATEGYIMPORTANT INFORMATION YOU MUST KNOW
BEFORE TAKING YOUR EXAM
THE ULTIMATE STEP 2 CS PREP STRATEGY
EVERYTHING YOU NEED TO KNOW BEFORE TAKING YOUR USMLE STEP 2 CS EXAM
USMLE Success Academy www.usmlesuccess.net
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WHAT WE’RE GOING TO DISCUSS◦ WHAT YOU NEED TO DO TO SUCCEED◦ UNDERSTANDING THE ICE COMPONENT◦ UNDERSTANDING THE CIS COMPONENT
◦ WHY MNEMONICS ARE YOUR BEST FRIEND ON THE CS EXAM◦ HOW TO TACKLE THE PATIENT NOTE◦ ANATOMY OF THE ENCOUNTER
◦ MASTER THE SOFT SKILLS◦ KNOW HOW TO TACKLE CHALLENGING SCENARIOS & QUESTIONS◦ THE PHYSICAL EXAM AND THE STEP 2 CS
◦ HOW TO STUDY FOR THE STEP 2 CS (si/sx, practice, etc)
WHAT YOU NEED TO DO TO SUCCEED
◦ MASTER THE MAIN COMPONENTS◦ MASTER THE SKILLS NEEDED FOR THE EXAM◦ MASTER THE PATIENT NOTE CREATION PROCESS
◦ IMPLEMENT & REPEAT ALL SKILLS DURING PRACTICE◦ GET FEEDBACK FROM FELLOW COLLEAGUES◦ FINE TUNE YOUR SKILLS
USMLE Success Academy www.usmlesuccess.net
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THE I.C.E COMPONENT – INTEGRATED CLINICAL ENCOUNTER
◦ WHAT IS IT?
◦ WHAT’S THE POINT OF THE ICE?
◦ HOW DO I GET MY POINTS?
THE C.I.S COMPONENT – COMMUNICATION & INTERPERSONAL SKILLS
◦ WHAT IS IT?
◦ WHAT’S THE POINT OF THE CIS?
◦ HOW DO I GET MY POINTS?
USMLE Success Academy www.usmlesuccess.net
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THE IMPORANT ROLE OF MNEMONICS
◦ WHY SHOULD YOU USE THEM?
◦ HOW TO USE THEM?
HOW TO TACKLE THE PATIENT NOTE
◦ WHAT IS THE ROLE OF THE PATIENT NOTE?
◦ WHAT ARE MY OPTIONS FOR CREATING THE NOTE?
◦ DIFFERENTIALS AND SUPPORT
◦ ADDITIONAL TIPS (SPELLING, GRAMMAR, STRUCTURE)
USMLE Success Academy www.usmlesuccess.net
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ANATOMY OF AN ENCOUNTER
◦ WHAT IS THE ‘ANATOMY’ OF AN ENCOUNTER?
◦ THINKING OF THE ENCOUNTER AS A GROUP OF SPECIFIC SECTIONS
◦ HOW MUCH TIME TO ALLOCATE TO EACH
MASTERING THE SOFT SKILLS
◦ EMPATHY/SYMPATHY, PATIENCE, RESPECT, KINDNESS
◦ HOW TO SHOW EMPATHY:
◦ HOW TO SHOW PATIENCE:
◦ HOW TO SHOW RESPECT:
◦ HOW TO BE KIND:
USMLE Success Academy www.usmlesuccess.net
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CHALLENGING QUESTIONS & SCENARIOS
◦ WHY DO THE SPs PUT US THROUGHCHALLENGING Q’S OR SCENARIOS?
◦ WHAT IS OUR GOAL IN TACKLING THESEISSUES?
◦ HOW TO TACKLE CHALLENGINGQUESTIONS
◦ HOW TO TACKLE CHALLENGINGSCENARIOS
THE PHYSICAL EXAM FOR THE CS
◦ WHAT SHOULD WE ALWAYS DO?
◦ WHAT SHOULD WE DO FOR THE PHYSICAL EXAMS?
◦ DOCUMENTING YOUR FINDINGS
USMLE Success Academy www.usmlesuccess.net
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HOW TO STUDY THE Si/Sx FOR THE CS EXAM
◦ CREATE LISTS OF 3-5 SPECIFIC FINDINGS:
◦ CREATE COMPARISON CHARTS:
BEFORE WE GO…..
Join our exclusive invitation only Step 2 CS Facebook group…
Run exclusively by myself (Dr. Paul), I’m going to give away as much free
Step 2 CS help as I possibly can!
USMLE Success Academy www.usmlesuccess.net
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https://www.facebook.com/groups/usmlesuccessacademycsgroup/
PHYSICAL EXAMS
USMLE Success Academy www.usmlesuccess.net
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What To Do For Each Physical Exam
Cardiovascular:
- Inspect & palpate
- Auscultation
- Auscultate carotids
- Check pulses
- Check PMI (left lateral decubitus)
- Auscultate carotids in supine position
What To Do For Each Physical Exam
Respiratory:
- Inspect & palpate
- Auscultate
- Check lung expansion
- Percussion
- Fremitus (99)
- Egophony
USMLE Success Academy www.usmlesuccess.net
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What To Do For Each Physical ExamNeurology:
- MMSE (if LOC or AMS present)- CN 2-12
- Sensory in upper/lower extremities- Motor in upper/lower extremities- DTR’s in upper/lower extremities
- Alternating hand test- Romberg test (for balance assessment)- Gait test
What To Do For Each Physical Exam
HEENT:- Inspect the head
- Palpate lymph nodes
- Palpate sinuses
- Look into the eyes, ears, and nose
- Look into the mouth, look at throat
- Palpate thyroid gland
USMLE Success Academy www.usmlesuccess.net
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What To Do For Each Physical ExamAbdominal (GI/GU/OBGYN):- Inspect (1st)- Auscultate (2nd)
- Percuss (3rd)- Palpate (4th)- On palpation: Watch for rebound tenderness, assess for appendicitis with Rovsing,
Psoas, & Obturator tests, Murphy’s test for cholecystitis
What To Do For Each Physical Exam
Musculoskeletal:
- Inspect & palpate
- Range of motion (compare to unaffected side)
- We have several ‘special tests’ that will be discussed shortly (Knee, Shoulder, Back, andWrist have special tests we need to know)
USMLE Success Academy www.usmlesuccess.net
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Special Maneuvers For Each System
HEENT: Weber & Rinne tests, Brudzinski & Kernig tests
KNEE: Ballottement, McMurray, Anterior/Posterior drawer, Varus/Valgus stress
WRIST: Phalen, Tinel
SHOULDER: Arm-drop (open can)
BACK: Straight leg test
DOCUMENTING YOUR PE FINDINGS
USMLE Success Academy www.usmlesuccess.net
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Documenting Your PE FindingsHEENT:Head: NC/ATEyes: EOMI, PERRLA, normal eye fundus
Ear: TM intact, no ear discharge, no tinnitus, no redness, no fullnessNose: Nasal turbinates not congestedMouth: No tonsillar erythema, exudates, or enlargement, good dentition
Neck: No JVD, normal thyroid, no lymphadenopathy, no carotid bruit
Documenting Your PE FindingsNEUROLOGY:CN 2-12 grossly intact, motor strength 5/5 in all muscle groups, DTRs are 2+ intact & symmetric, sensation intact to sharp and dull, rapid alternating movement intact, cerebellum intactIf MMSE is done: AAOx3, good concentration
USMLE Success Academy www.usmlesuccess.net
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Documenting Your PE FindingsRESPIRATORY:
CTAB/L, no rales, rhonchi, wheezing, or rubs.
Inspection: no bruises, cuts, or scars
Normal to palpation, no tactile fremitus, no dullness, whisper pectoriloquoy -, egophony -
Documenting Your PE FindingsCVS:S1/S2, RRR, no MRG, no JVD, no pedal edema, pulses 2+ in all extremities
ABDOMEN:Soft, non-tender, non-distended, Murphy’s sign +/-, rebound tenderness +/-, Psoas sign +/-, Rovsing sign +/-, Obturator sign +/-
MSK:
ROM increased/decreased, sensation intact, motor strength intact (then findings of any special maneuvers)
USMLE Success Academy www.usmlesuccess.net
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Documenting Your PE FindingsExtremities:
- No deformity or trauma, +/- tenderness, ROM increased/decreased, muscle strength5/5 in all groups, DTR’s 2+ bilaterally, sensation intact to sharp/dull, no cyanosis,clubbing, or edema
COMMON CASESNOTE: This list is not meant to be comprehensive
USMLE Success Academy www.usmlesuccess.net
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Possible Chest-Related Complaints(CVS, Pulmonary)
◦ Acute coronary syndrome
◦ Pericarditis◦ Costochondritis◦ Pulmonary embolism◦ Stress
cardiomyopathy◦ Angina pectoris
◦ Myocarditis◦ GERD◦ Aortic dissection◦ Pneumonia◦ Pneumothorax◦ Pleuritis/pleurisy
§ Esophagitis
§ Ruptured esophagus
§ Esophageal dysmotilitydisorder
§ Substance-induced(cocaine)
§ Broken rib
§ Panic disorder
Possible HEENT-Related Complaints◦ Cluster headache◦ Migraine
headache◦ Tension headache◦ Sinus infection◦ Brain tumor◦ Dehydration◦ Blurred vision◦ TMJ disorder◦ Bruxism◦ Stroke ◦ TIA/Stroke◦ Retinal
detachment
§ Hearing loss
§ Otitis media/externa
§ Strep throat
§ Lymphadenitis
§ Hypothyroidism
§ Hyperthyroidism
§ Tinnitus
§ Temporal arteritis
§ Central retinal artery occlusion
§ Amaurosis fugax
§ Multiple sclerosis
USMLE Success Academy www.usmlesuccess.net
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Possible MSK-Related Complaints◦ Joint pain (any joint)◦ Scaphoid fracture◦ Lunate dislocation◦ Medial/lateral epicondylitis◦ Rotator cuff injury◦ Fractured bone(s)◦ Plantar fasciitis◦ Gonococcal arthritis◦ Tenosynovitis◦ Ligament tear◦ Costochondritis◦ Lumbar strain
Possible Neuro-Related Complaints◦ Headache
◦ Vascular dementia◦ NPH
◦ Diabetes◦ Multiple sclerosis
◦ Spinal stenosis
◦ Eating disorder◦ Parkinson’s disease
◦ Major depressive disorder
§ Alzheimer’s disease
§ TIA/Stroke
§ Seizure disorder
§ Neuropathy
§ Prolapsed disc
§ Anxiety disorders
§ Drug use/abuse
§ Adjustment disorder
§ Bipolar disorder
USMLE Success Academy www.usmlesuccess.net
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Possible OBGYN-Related Complaints◦ Ectopic pregnancy◦ Ruptured ovarian cyst◦ Cervicitis
◦ Ovarian cancer◦ Decreased libido◦ Fibroids
◦ PCOS◦ Vaginitis◦ Irregular menstrual periods
§ Pregnancy/missed period
§ Ovarian torsion
§ Cervical cancer
§ Endometrial cancer
§ Dysmenorrhea
§ STD’s
§ UTI
§ Endometriosis
Possible GI-Related Complaints◦ GERD◦ Gastroduodenal ulcer◦ Ectopic pregnancy
◦ Diverticulitis◦ Intestinal obstruction◦ IBD (Crohn’s, UC)
◦ Diarrhea◦ Appendicitis◦ Colon cancer
§ Gastritis
§ Pancreatitis
§ Ovarian torsion
§ Diverticulosis
§ IBS
§ Gastroenteritis
§ Constipation
§ Cholelithiasis
USMLE Success Academy www.usmlesuccess.net
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Possible GU-Related Complaints◦ BPH◦ Hematuria◦ UTI
◦ Pyelonephritis◦ Nephrolithiasis◦ Cystitis
◦ Overactive bladder◦ Bladder cancer
§ Prostatitis
§ Prostate cancer
§ Epididymitis
§ Urolithiasis
§ STD’s
§ Incontinence
§ Erectile dysfunction
§ Renal carcinoma
USMLE Success Academy www.usmlesuccess.net