USA Residency criteria

Typing a patient note : New Compulsory Formate in step 2 CS

2011-03-19T19:15:00.004-04:00

As of July 17, 2011, all examinees taking the USMLE Step 2 CS will be required to type the patient note.
Here are some rules for patient note formate.
You will be given specified space to write Pt. note.
History - 950 characters
Physical Examination - 500 characters
Differential Diagnosis - 80 characters for each diagnosis
Diagnostic Workup - 80 characters for each workup recommendation
The patient note screen that appears during the actual examination will contain a status bar for each field, indicating how much space remains.

NO Matters how do you write, all CAPS or/ small and caps or/ all small ..., the final patient note and full sentences must be easy to read and understand.

You can practice here as many times as you want.
click on the image to see sample Typed Pt. notes.

Good luck for new formate.

Sample Patient note

2011-03-02T16:05:00.000-05:00

This is Sample Patient note.( The writer of this had passed exam in first attempt)

ERAS token

2010-07-06T17:34:00.001-04:00

The ERAS application includes the following documents:

• MyERAS Application, which is comprised of the information in both the Profile and Application
• Personal Statement
• Medical Student Performance Evaluation (MSPE)
• Letter(s) of Recommendation (LoR)
• Medical School Transcript
• USMLE Transcript (optional)
• COMLEX Transcript (optional)
• ECFMG Status Report (International Medical Graduates only)
• Postgraduate Training Authorization Letter (PTAL) or “California Letter” (International Medical Graduates only)
• Fifth Pathway Certificate (International Medical Graduates only)
• Wallet-sized color photograph (optional)

ERAS will transmit these documents you designate to the programs to which you apply. Any
documents not listed are considered non-ERAS documents. You should contact the program to which you are applying directly and ask how they would like to receive non-ERAS documents.

Day 1 and Day 2

2010-01-28T20:27:00.002-05:00

Step 3 is a two-day examination.
DAY 1:

7 Blocks [(48 MCQ/60 min) = 1 block, total 336 MCQ] = 7 hrs.
+
45 mins. break
+
15 mins. tutorial
=
8 Hours

DAY 2:

4 blocks[(36MCQ/45 mins.=1 block) total 144 MCQs]= Approxy. 3 hours
+
15-minute CCS tutorial.
+
45 mins. break
+
9 CCS, (1CCS/25 mins) approxy. 4 hours .
=
8 Hours

contents of MCQ in Step 3 exam

2010-01-07T15:59:00.004-05:00

Step 3 is organized along two principal dimensions: clinical encounter frame and physician task.

I am writing here about its distribution of the content [ % ].

Scoring of the Step 2 CS Subcomponents

2009-12-26T16:03:00.007-05:00

Examinees are scored in three separate subcomponents:

Integrated Clinical Encounter (ICE),
Communication and Interpersonal Skills (CIS), and
Spoken English Proficiency (SEP).

The ICE subcomponent includes assessment of:

Data gathering – patient information collected by history taking and physical examination
Documentation – completion of a patient note summarizing the findings of the patient encounter, diagnostic impression, and initial patient work-up

Data gathering is scored by checklists completed by the SP. The checklists are developed

by committees of clinicians and medical school clinical faculty and comprise the essential history and physical examination elements for specific clinical encounters. The patient note is scored by trained physician raters. .

The CIS subcomponent includes assessment of:

1. Questioning skills – examples include:

• use of

- open-ended questions, transitional statements, facilitating remarks

• avoidance of

- leading or multiple questions, repeat questions unless for clarification, medical terms/jargon unless immediately defined, interruptions when the patient is talking

• accurately summarizing information from the patient

2. Information-sharing skills – examples include:

• acknowledging patient issues/concerns and clearly responding with information

• avoidance of medical terms/jargon unless immediately defined

• clearly providing

- counseling when appropriate

- closure, including statements about what happens next

3. Professional manner and rapport –

examples include:

• asking about

- expectations, feelings, and concerns of the patient

- support systems and impact of illness, with attempts to explore these areas

• showing

- consideration for patient comfort during the physical examination

- attention to cleanliness through hand washing or use of gloves

• providing opportunity for the patient to express feelings/concerns

• encouraging additional questions or discussion

• making

- empathetic remarks concerning patient issues/concerns

- patient feel comfortable and respected during the encounter

The SEP subcomponent includes assessment of:

1.Clarity of spoken English communication within the context of the doctor-patient encounter (eg, pronunciation, word choice, and minimizing the need to repeat questions or statements)

SEP performance is assessed by the standardized patients using rating scales and is based upon the frequency of pronunciation or word choice errors that affect comprehension, and the amount of listener effort required to understand the examinee's questions and responses.

** both scoring card are of unfortunate students who failed in exam.

this post's information is taken from www.usmle.org 2010

Searching for date of your choice for step 2 CS??

2009-11-02T20:30:00.004-05:00

I found many of my friends searching for some specific dates on many forum sites.and asking for exchange with other. but even if you dont ask for date to some one else, you can easily find dates in 2-3 days.
follow this steps.

First Option:
Refreshing the page

go to the ECFMG home page
select step 2 CS calendar and scheduling.
enter your ECFMG ID and password.. follow instruction.
this will lead you to the page of calender where you can select dates. open the month of your choice in your selected testing center on the calender. now wait and keep refreshing that page every 10-15 minute. you will surely get some dates on your favorite center in month of your choice in a day or two, for sure.

Second Option:
Step 2 CS Scheduling Email Notification System

The Step 2 CS Scheduling Email Notification System allows registered applicants to indicate their preferences for test dates and centers. When a testing appointment is canceled, all applicants participating in the email notification system who have expressed a preference for this date/center are notified immediately by email. but you often get this email some what late by 2-3 minutes and when you open the page it may happen that you will not get date. Thats why refreshing of page is very good option.

[you can alway edit or add your preferences of notification by “Add/Edit Scheduling Email Notifications.”

Even if you chose this second option keep your calender page open always while you are doing practice. whenever you get email just refresh the page. By doing this you can have immediate access to the date.

Choose yahoo email id for your email notification and keep yahoo messenger ON everytime. yahoo msngr gives you alarm sound on receiving any email. so you can immediately refresh the page of calender/date on ecfmg.]

Njoy....

Do the Best Use of all space of rough/ scrap paper

2009-10-28T01:25:00.000-04:00

Here I am providing you my method. I used to use my rough paper like this ,let me flash some more light on it.

1. always write name and age of person before entering room, many times it happens that in stress u forget name of the SP . so it will help you to remind.

2. Spare some time to write differential diagnosis by just guessing it from the chief complain. it will help you to remind and ask questions on the history of present illness.

3.Marking or canceling each letter of mnemonics help you to asure that you have asked about that part. it will help you to cover all points and also help to avoid asking repeatedly same question by mistake.

4. As I mentioned in picture, it will save time to write good points on Patient Note.

5. Counseling has a good effect on patient and it also covers good marks of overall exam marks.

You can use both sides of the rough/scrap paper.
They directly discard it after collecting it from you when you complete each encounter.

Schedule for Reporting Step 2 CS Results 2009 & 2010

2009-10-27T22:14:00.000-04:00

"Starting with Step 2 CS results reported on August 19, 2009, both failing and passing examinees will receive this feedback. Consistent with current reporting policy, the Performance Profiles are intended only for examinees and will not be reported to or verified to any third party."- USMLE.ORG 2010

** this post's information is taken from www.usmle.org

Practice cases to prepare for USMLE Step 2 CS

2009-10-27T20:59:00.001-04:00

Mostly all common symptoms / diseases are covered under practice cases of reputed books. here I am posting same, divided in system vise category.

Respiratory:

Hemoptysis
Night Sweat + Wt loss,
Chest Pain (Pleuritic, Sickle cell associated pain. etc)
Shortness of breathe

ENT:

Sore throat
Acute cough
Hearing loss ( sensory neural, presbycusis etc.)
Noisy breathing

CVS:

Palpitation
Fatigue
Fainting
Chest Pain

Ortho:

Hip pain
Back ache/ Lower back ache
Pain in elbow
Knee Pain ( OA, Gout etc. )
B/L leg Pain (calf pain , general pain etc. )
Trauma (single/multiple site)
Heel pain

Abd:

Dysphagia
Abd Pain
Abd Pain + wt loss
Hemetemesis
Hemetimesis + Epi. Pain
Blood in stool

GUT:

Incontinence
Blood in urine
Polyurea

CNS + Psychia:

Headache
tingling/weakness
Fatigue
Fainting episode/s- Loss of consciousness
Confusion
Insomnia
Dizziness
Depression
Hallucination (auditory/ visual)
Domestic violence
Tremor

Pediatric cases*:

Vommiting
Picky eater
Fever
Fever + runny nose
Jaundice
Constipation
Enuresis
Temper tantrum

*Pediatric Cases are generally telephone cases. rarely pediatric case is not telephonic though there will not any pediatric patient present in exam room.

OBGY:

Menopause
Amenorrhoea
Vaginal bleeding/ discharge

Msc. :

Pre employment Physical examination
HT , DM, Pregnancy follow up.
Domestic Violence.

Terms and Abbreviations on STEP 2 CS

2009-10-26T14:48:00.000-04:00

As we have a very limited time for a single case( 25 mins total ) abbreviations can really help to save time in patient note and a rough note. here is the list of terms and abbreviations used in the USMLE step 2 CS. You will find a similar paper hanging on the table out side the encounter room. where you sit down to write the Patient Note.

yo year-old
m male
f female
b black
w white
L left
R right
hx history
h/o history of
c/o complaining of
without or no
+ positive
- negative
Abd abdomen
AIDS acquired immune deficiency syndrome
AP anteroposterior
BUN blood urea nitrogen
CABG coronary artery bypass grafting
CBC complete blood count
CCU cardiac care unit
CHF congestive heart failure
cig cigarettes
COPD chronic obstructive pulmonary disease
CPR cardiopulmonary resuscitation
CT computed tomography
CVA cerebrovascular accident
CVP central venous pressure
CXR chest x-ray
DM diabetes mellitus
DTR deep tendon reflexes
ECG electrocardiogram
ED emergency department
EMT emergency medical technician
ENT ears, nose, and throat
EOM extraocular muscles
ETOH alcohol
Ext extremities
FH family history
GI gastrointestinal
GU genitourinary
HEENT head, eyes, ears, nose, and throat
HIV human immunodeficiency virus
HTN hypertension
IM intramuscularly
IV intravenously
JVD jugular venous distention
KUB kidney, ureter, and bladder
LMP last menstrual period
LP lumbar puncture
MI myocardial infarction
MRI magnetic resonance imaging
MVA motor vehicle accident
Neuro neurologic
NIDDM non-insulin-dependent diabetes mellitus
NKA no known allergies
NKDA no known drug allergy
NL normal/normal limits
NSR normal sinus rhythm
P pulse/heart rate
PA posteroanterior
PERLA pupils equal, react to light and accommodation
po orally
PT prothrombin time
PTT partial thromboplastin time
RBC red blood cells
SH social history
TIA transient ischemic attack
U/A urinalysis
URI upper respiratory tract infection
WBC white blood cells
WNL within normal limits

"This is not intended to be a complete list of acceptable abbreviations, but rather represents the types of common abbreviations that may be used on the patient note. There is no need to use abbreviations on the patient note; if you are in doubt about the correct abbreviation, write it out." - usmle.org (2010 hand out)

Tricky Pediatric Cases In USMLE step 2 CS

2009-10-24T14:11:00.000-04:00

Here I am posting how to ask questions and points to cover on the tricky cases of pediatrics.Include all other questions of normal pediatric case also.

Picky Eater
So why do you think that your kid is picky eater? I mean
Does he have any specific preference to food?
Since when are you noticing this behavior?
Is it remaining same or getting worse?
What is your response to this? Have you ever punish / reward him?
How does it affecting your child’s life? Your life?
Have you taken any intervention for that? Like scheduling meal time?
Does he watch TV before/ during meal?
Does he take high calorie drinks like soda, juice in between the meal?
Do you have any other concern beside this?
Counselling
Well Mrs. …….., from the information I got from you, I feel that your son is probably going
through normal phase of behavior.
It is the common problem in this age group and it responds well to few behavior changes.
First of all, I suggest you to strictly follow meal schedule for your child.
I also recommend you not to give high calorie drinks in between the meals.
Do not watch tv before/during meal. Have a fun at meal time
Please never punish your child for his behavior. Do not force him to eat.
Regarding constipation, I would like to suggest taking high fiber diet.
However to confirm my diagnosis………
Causes
- low fiber diet
- hypothyroidism
- lead poisoning
- ADHD
- Oppositional defiant disorder
Investigations
- CBC, ESR
- T3, T4, TSH
- Blood lead level
- Blood calcium level
- Stool for ova and parasite

Temper tantrum
- How often does it occur?
- Can you tell me what happens at that time?Does he hold his breath? Does he harm himself during it? Does he pass out?- seizure
- does he harm himself?
- Do you know anything which may be responsible for this ? like fever? Pain? Missing meal?
Travel? New surrounding?
- Have you taken any intervention for that? – time out
- What is your response to tantrum?
- Are there any specific psychologic problems?
- Are the episodes starting or getting worse after age 4? -depression, autism,ADHD
- who lives with him at home in your absence?
Counseling
I advise you to keep his routine regular.
Please never punish your child for his behavior. It will definitely not work.
You should consider for TIME OUT.
Causes
-Normal growth and development
- ADHD
- Autism
-Depression
- Seizures, arrhythmia – passes out
Investigation
- CBC, ESR
- EEG,
- CT Brain
- MRI Brain
- echocardiography

Enuresis
- How often does it occur?
- Urine h/o - Frequency, urgency, color, blood, pain - Does he cry during urination? – UTI
-Bowel h/o - Frequency, consistency, color, blood, pain - Does he cry during Bow mov? - Consti
- Does he snore at night? – sleep apnea
- Does he have any stress? - secondary
- Does he have problem with walking? - secondary
- What is your response to it?
- Have you taken any intervention for that? – bed alarm
- Family h/o
Counseling
It is the common problem in this age group and it responds well to few behavior changes.
You should not give more fluid at bed time.
you should also take him for pee before going to bed.
Causes
-Primary nocturnal enuresis
-Secondary nocturnal enuresis
-UTI
-constipation
-Obstructive sleep apnea
Investigations
- P/R examination
- CBC, ESR
- UA
- USG kidney
- CT ABD

Consipation

12 cases in USMLE step 2 CS

2009-10-24T14:01:00.000-04:00

You may have cases in USMLE Step 2 CS exam like this.

Cases
1. normal- rs/cvs/gi (number of cases 2-3)
2. psychiatry(number of cases 1-2) – fatigue, depression, insomnia, psychosis
3. CNS- Head & Neck (number of cases 1-2)
4. abuse
5. pedia (number of cases 1-2)
6. follow up ( refill drug, BP, DM....)

Rare cases

Insurance
Bad news
Terminal stage

Tricky Pediatric Cases:

Patient Note writing paper

2009-10-24T13:22:00.001-04:00

At the USMLE Step 2 Clinical Skills examination center, they give you a bunch of only 12 PN sheets and only 12 scrap paper sheets.you can write on the both side of the scrap paper to make note. You should take care not to write outside the frame of the sheet, because the paper will be scanned and nothing outside the frame will be read. Use the pen provided by the examination center, you are not allowed to use your own pens.A sample of sheet is provided here, which is exactly like an original sheet ( original PN sheet will also have your name, the number of the encounter, and a bar code printed on top of it. ) "Patient notes are rated by physicians who are well trained at reading notes and can interpret most handwriting. However, extreme illegibility will be a problem and can adversely impact a score. Everyone who writes patient notes by hand should make them as legible as possible." - usmle.org (2010 hand book)

How to write physical examination part on the Patient Note?

2009-10-24T13:17:00.000-04:00

Pt. is not in acute distress/ pt is in acute distress.
VS: WNL

HEENT:
Head: NC/AT
Eyes : EOM intact, PERRLA, vision WNL , Fundoscopy WNL
Ears: TM & canal- clear
Nose: not congested, WNL
Throat : no erythema, no vesicles, no exudates, no other abnormality seen. Tonsils normal
Neck: no swellings, thyroid normal.

CNS:
A&O x 3 , memory & concentration good, CN ll-Xll intact
motor strength 5/5 UE & LE B/L; Sensations intact to dull & sharp
DTR+ 2 symmetric
Gait WNL, Romberg negative, finger-nose normal
- kernig & / or brudzinski

RS:
- cynosis, clubbing, - rales, rhonchi, respirations normal,
- tenderness , TVF WNL, tympanic/dull on percussion

CVS:
+ S1S2, RRR, - m,r,g, -JVD sitting @ 45
PMI nondisplaced, Pulses 2+ B/L
- pedal oedema

Abd:
- scars or skinabnormalities, NT ND,Tympanic to percussion 4Q, - hsm, +BS in 4Q,
- rebound, - murphy's, posas,obturator

Lumbosacral- Back:
- scars or skinabnormalities, NT , ROM WNL,motor strength 5/5 UE & LE B/L; Sensations intact to dull & sharp,DTR+ 2 symmetric, Gait WNL,
Pulses 2+ DP.

Abbreviations are allowed and they are helpful to save time writng PN and rough note. so it is better to practice with the abbreviations commonly used in the USA hospitals.

USMLE Step 2 - CS proforma

2009-10-20T14:48:00.003-04:00

Sample Proforma
Knock the door thrice,
(smiling patient – not in distress - GIVE SMILE not smiing- in distress – NO SMILE, DO NOT SIT)

Good Morning Mr. / Miss._________ I am Dr. Patel. I will be your physician today. Today I will ask you some questions and perform a physical exam. ok?
Are you comfortable in this room? Let me make you more comfortable by draping you. (If says no - Is there anything bothering you?) (Drape the patient) (While draping …) During our conversation if you have any concern then please let me know. Hope you don’t mind if I make some notes while asking you questions.

[SILENT PATIENT (anxious, sad- crying, depressed) - Stay silent for few seconds. Put a hand on her shoulder & say, “Mr.__________You seems to be upset. Will you please share it with me? I am here to help you”.]

Chief complain -
So, Mr. _____________ “How can I help you?”

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

History of present illness
O D P L I Q O R A A A

When did it start? (When did you first notice it?) (What were you doing at that time?)
Do you know anything which may be responsible for your ……? (Do you remember anything which might have brought it?)

So as you told me that you have………….. Then has it been remaining same or getting worse?
Is it continuous or comes and goes? (if intermittent- How often does it occur? How long does it
last for?)
What does make it better?
What does make it worse?
Do you have any other complains besides ….?
(CVS/RS – Cough, Breathlessness, Chest pain, CVS – Palpitation, Sweating)
(ABD-Pain in abdomen, Bowel- bladder, Jaundice)
(CNS – Headache, Dizziness, Seizures, Sensations, Weakness, Difficulty - vision, hearing, speech,
walking, Loss of consciousness)
PAIN- (Chest, Abdominal, Headache, Joint pain)
- When did it start?
-So as you told me that you have………….. Then has it been remaining same or getting worse?
-Is it continuous or comes and goes? (if intermittent- How often does it occur? How long does it
last for?)
Location - Can you show me the exact site with your finger? (except vagina/penis, anus, back –
where do you feel it? )
Intensity –How would you grade your pain on a scale of 1 -10, if the 10 is the worst pain of your
life?
Quality - How does it feel like? (I mean sharp, dull, throbbing, burning)
Radiate – Does it move anywhere?
Alleviating factors – what does make your pain better?
Aggravating factors – what does make your pain worst?
GENERAL - Do you have any fever, nausea, vomiting?
a. Fever
i. Do you have any fever?
ii. Is it continuous or it comes and goes? (if intermittent -How often does it occur? How long
does it last for?)
iii. Do you have any chills? Any night sweats?
iv. Have you measure your temperature?
b. Nausea
- Do you feel nauseated?
c. Vomiting
i. Did you vomit?
ii. Can you estimate the amount of it? (Cup full)
iii. What was its color?
iv. Was there any blood in it? (If Yes - How much?)

(A.) RS + CVS
Do you have any cough? Short of breath? Chest pain? Racing of your heart?
a. Cough
i. Do you have cough?
iii. Sputum- Do you bring up anything with it?
iv. Quantity - Can you estimate amount of it?
v. Color - What is its color?
vii. Blood – Is there any blood in it? (If Yes - How much?)
viii. Smell – Is it foul smelling?
b. Breathlessness
i. Do you have short of breath?
iii. Relation with exertion - When do you get SOB? [walking, climbing upstairs]?
How far can you walk on ground level before you have SOB?
How many steps can you climb before you have short of breath?
iv. PND - Do you have attacks at night?
What do you do to relieve your short of breath?
c. Chest pain- Do you have chest pain?
L I Q O R A A A
d. Palpitation – Do you have racing of your heart?
Sore throat
Do you have any Running nose? Ear discharge? Swollen glands in neck? Rash?

(B.)ABDOMEN
Do you have pain in your belly?
Do you have any problem with your urination? bowel movement?
Have you notice any change in color of your skin? Your eyes?
a.Abdominal pain –
Do you have pain in your belly?
L I Q O R A A A
- is there any relationship with food?
b.Jaundice
Have you notice any change in color of your skin? Your eyes?
Do you have any itching? Any joint pain?
Have you ever received any blood transfusion? Immunization for jaundice?
(bowel – color of stool, Bladder – color of urine, sexual, alcohol, travel)

(C.)CNS
Do you have any Headache? Dizziness? Jerking movements?
Do you have any Numbness?Weakness?
Do you have any problem with your Vision? Hearing? Speaking? Walking?
Have you ever passed out?
a. Headache
I. Do you have headache?
ii. L I Q O R A A A
iii. Aura - Can you tell me what happens before your headache?.
1.AnyWatering of your eyes? Any Running nose?
2. Any Unusual lights, sounds, smells?
iv. Neck stiffness - Do you have any stiffness in your neck?
b. Dizziness
1. Do you feel dizzy?
2. Is it continuous or comes and goes? (if intermittent- How often does it occur? How long does
it last for?)
3. Is there any relation with position? - BPPV
4. Do you feel that the room is spinning around you or you are moving inside the room?
5. Do you hear ringing of bell in your ears? - Tinnitus
6. Do you have any ear discharge?
c. Seizures
Do you have any jerking movement?
When did it occur last time? How long does it last for?
How often does it occur?
What did happen at that time? Did you pass out? Fell down?
Can you tell me what happened before the attacks?
-Racing of your heart? Dizziness? Unusual lights, sounds, smells?
Can you tell me what happened during the attack?
-jerking movement? – can you describe it? Tongue bite? Frothing from mouth? Loss of
control of urination or bowel movement?
Can you tell me what happened after the attacks?
- numbness, weakness, headache, confusion,?
Loss of conciousness-
Have you ever passed out?
When did it occur last time? How long does it last for?
How often does it occur?
Difficulty in hearing-
On which side of ear, you have problem with hearing?
When did you notice it?
Do you hear ringing of bell in your ears? - Tinnitus
Do you have any ear discharge?
j. Joint pain
i. Do you have any joint pain?
ii. L I Q O R A A A –
iii. Trauma – Do you have any injury recently? (if yes - Do you have any weakness around your joints?) (Nerve injury)
iv. Stiffness/Swelling/Redness – Have you noticed any redness/swelling/stiffness in your
joints? When does it occur? How long does it last for? (RA/OA/AS)
v. Insect bite Have you noticed any insect bite recently? (Lymes) (Travel – Have you traveled recently?)
vi. Rash - Have you noticed any rash in your body? (When did you notice it? Where did it first start? How did it progress? Can you describe your rash?
– pain/ burning, itching, discharge- color , foul smelling)
vii. Photosensitive- Are you sensitive to bright light?
viii. Mouth ulcers – Do you have any ulcer in mouth?
ix. Hair loss- Have you noticed any hair loss recently? (SLE)
x.Do you have similar complains in other joints?
Osteoarthritis (OA) -Mr. _____. Your problem may be due to your aging. So I advise you to do
regular exercise and you should also consider for weight reduction.

PAM HUGS FOSS

Well, Mr. _____ Now I am going to ask some questions about your past medical health. ok?
1. Past History – Have you ever had similar complain in the past? if yes- Can you tell me more
about it. Do you have any major illness like Diabetes, high blood pressure, high cholesterol?
A. Diabetes?
i. When was it detected?
ii. Do you get your blood sugar checked regularly? What was the last reading?
Iii. Are you taking any medication for it? (No) Can you tell me why it is so?
iv. Which medication are you taking? (No) Do you have any prescription for that right now?
v. Do you take it regularly?
(Vi. Do you have any side effects from it like …?
hypoglycemia – sweating, palpitaion, black out
Polyurea - nocturia, polydypsia, polyphagia, fatigue , weight loss
Fundoscopy)- if follow up
Diabetes
Mr._____ As a concerned physician, I must inform you that high blood sugar may damage your
heart, blood vessels and many other organs.
So I recommend you to get your Blood Sugar checked periodically and take your treatment regularly. You should also consider for soft heeled foot ware.
B. High Blood Pressure?
i. When was it detected?
ii. Do you get your blood pressure checked regularly? What was the last reading?
Iii. Are you taking any medication for it? (No) Can you tell me why it is so?
iv. Which medication are you taking? (No) Do you have any prescription for that right now?
v. Do you take it regularly?
(vi. Do you have any side effects from it like…..?
CCB- headache, constipation, B blocker- depression,impotence, ACE- cough, Diuretics – ototoxhearing
loss, tinnitus
Fundoscopy) –if follow up
Hypertension
Mr._____ As a concerned physician, I must inform you that high blood pressure may damage
your heart, blood vessels and many other organs. So I recommend you to get your Blood Pressure checked periodically and take your treatment regularly. You should also low salt in your diet.
C. High cholesterol?
- Are you taking any medication for that?
Ask specific P/H related to the system.
Obesity
- Do you know anything which may be responsible for this weight gain?
- How is it affecting you life? Ask about height and weight in closure
Thyroid – cold intolerance, hair loss, constipation
CVS-RS, GI, CNS, Metabolic- DM ,Ortho
1. Depression
2. Hypothyrodism
3. Cushing’s syndrome
4. Polycystic disease
5. Sedentary lifestyle
6. family h/o
2. Allergy – Do you have any allergy? Which allergy do you have? If RS or SKIN –what kind of
allergic reactions did you have?
3. Medicine –Are you taking any medications (Apart from ….........)?
(Which medications are you taking? Since when are you taking these medications? Why are you taking these medications? )
4. Hospitalization, Surgery, Trauma – Have you ever been hospitalized before? [for what?]
Have you ever had any surgery before (Apart from….)? any major injury in your life ?
5. Urination –
Change – Do you have any problem with your urination?
Frequency - How often do you go for urination?
Nocturia - Do you wake up at night for urination?
Urgency - Do you have to rush for urination?
Burning - Do you have any pain during urination?
Do you have any burning during urination?
color – what is its color?
Blood – Is there any blood in urine? Any Pus in it?
Hesitancy - Do you have to wait to start urination?
Straining - Do you have to strain to pass urine?
Flow - How is the flow of urine? I Mean continuous or dribbling
Incomplete evacuation – do you feel that your urinary bag is not empty even after urination?)
Control - Have you ever passed urine without your notice?}
6. GIT –
Change – Do you have any problem with your bowel movements?
Frequency - How many bowel movements do you have?
Consistency- What is its consistency?
color - What is its color?
Blood - Is there any blood in it? Any pus in it?
Pain - Do you have any pain during bowel movements?
Straining - Do you have to strain during bowel movements?
Incomplete evacuation - Do you feel that your bowel is not empty even after your bowel movements?)
control – have you ever passed stool without your notice?
7. Sleep –
Do you have any problem with your sleep?
Do you have problem in falling asleep? Staying with sleep? Do you wake up early in the morning?
How many hours do you sleep?
Do you feel refresh when you wake up?
Do you feel sleepy during day? Do you snore at night? If insomnia case)}
Falling- what do you do before going to sleep ? -watch tv, heavy meal
Staying – how often do you wake up at night?
8.Family History
Well, Mr. ______ Now I am going to ask some questions about your family health. Is that ok?
Does anyone in your family have similar complain?
How are your parents doing? [If died, Oh! I am sorry to hear that. But can you tell me the cause
of their death?]
9. Gynecological History –
Well, Mizz.______. Now I am going to ask some questions about your female health. ok?

When was your last menstrual period?
Are your periods regular?
How many days are there in your cycle?
How long does your period lasts for?
How many pads do you need?
Do you have any pain during menstruation?
Have you ever bleed in between the cycle?
Have you ever undergone PAP smear examination? What was the last result?)

Obstetric History –

How many kids do you have? –If mentioned in hospitalization or surgical h/o then- Apart from)
Have you ever had any abortion? In which month/week of pregnancy? Do you know the reason for that?
10. Sexual History
Well, Mr. ____, now I am going to ask you some questions about your sexual health.
(Please be assured that whatever you tell, will be kept confidential. Is that ok? )
(Mr. ______, sometimes hidden clues can be found by such kind of information, which may help in your diagnosis. Is that ok?)
a. Are you sexually active? (No) May I know why it is so? Do you have problem with desire-libido, excitement- arousal, erection, ejection, satisfaction?
b. How many sexual partners have you had in last one year?
What is your partner preference? I mean male or female?
c. Do you use any mean of protection? (Does your male partner use condom regularly? Condom? Birth control pills? )
d. Do you use it regularly? (No) may I know why it is so?
e. Have you ever been diagnosed with Sexually Transmitted Disease? Was it cured completely?
f. Have you ever been tested for HIV? What was the result?
g. Do you have any penile / vaginal discharge? Since when? what is its color? Is it foul smelling?

Sexually promiscuous patient with unprotected sex
Mr. ______ I must inform you that multiple sexual partners and unprotected sex may put you at high risk of sexually transmitted so I recommend you to should use condoms each times you have sex. – if male .so I recommend you to insist your male partners to use condoms each times you have sex. – if female STD… is sexually transmitted disease which may acquired from your partners So it is needed to test and treat all of your sexual partner as well otherwise you will be at risk of contracting infection again.
You should also avoid sex till the treatment is completed.
I recommend you to/ should use condoms each times you have sex.- if male
I recommend you to insist your male partner/s to use condoms each times you have sex. – if female
11. Social History / Personal History T A D E R O T S (TOBACCO, ALCOHOL, DIET-APETITE, WEIGHT, RECREATION DRUG, OCCUPATION, TRAVEL, STRESS)
Well, Mr. _____ now I am going to ask some questions about your personal habits. Is that ok?
Smoking
i. Have you ever smoked? Since when?
ii. How many packs per day do you smoke?
Alcohol
i. Have you ever drink alcohol? Since when?
ii. How much alcohol do you drink?
(Cut – have you ever tried to cut down your drinking?
Annoyed –Have you ever annoyed by criticism of your drinking?
Guilty – Have you ever felt guilty about your drinking?
Eye opener – Do you take alcohol in early morning?) – if binge drinking Drugs

Have you ever take any recreational drugs? Since When? How do you take it? I mean do you inject or smoke it? Smoking / Alchohol
Mean while I strongly recommend you to quit smoking and/or alcohol as it can damage your heart, lungs/liver and many other organs So are you ready to quit (the smoking/alcohol)?
(yes ) I am glad to hear that. We have excellent support group, who will help you in this matter.
I will give their contact number to you. Is that OK?
(no ) I can understand that. But whenever you are ready to quit, then I will be here to help you.
Please collect my contact number from my nurse outside.
(I had tried quite but it didn’t worked- Mr. _____ I can understand that. It happens to most of the people. If no smoke/alcohol – I appreciate that you are taking good care of your health and also hope that you will also continue in future. If quit - I am glad to hear that you have stop ….. And also hope that you will not take it in future also.)

{Diet Are you on special diet? (diabetes, kidney failure)}
Appetite
Is there any change in your appetite?
Is there any change in your weight ?( How much? Over what period of time?)
What do you do for living?
Have you traveled recently?
Do you exercise regularly?
{Do you have any stress in your life? May I know with whom do you live with? How is your relationship with them? (elder) Do you have any contact with person with similar complain? ( ill contact exposure – infections like TB, Pneumonia, diarrhea etc.)}

SO.. AS YOU SAID YOU HAVE....

PHYSICAL EXAMINATION
Well Mr. ….Now I need to examine you. Before that would you like to tell me anything else?
Ok, Let me wash my hands first. Excuse me for a while. (Ask about work, travel, exercise)
Can I proceed with your examination?
If pain occurs- I AM SORRY, I WILL NOT REPEAT THAT AGAIN.
Patient resisting for physical examination
“Mr._____, I can understand your concern. But the physical examination I want to do is very important to determine what is causing your complain. I will be quick and gentle as possible. And I will inform you whatever I am going to do.”
If ask for pain medication-
“Mr._____, I can understand your concern. But right now giving medication may harm you. Once I find out exact reason for your pain, I will able to give you something to feel you comfortable.”
General Examination – not in HEENT and NEURO
("PICKLE" –( Pallor, icterus,) (Cyanosis, Clubbing, Koilonychia,) Lymphadenopathy and Edema Feet" )
Let me start with your eyes.
Can you please look up? Look down? Thank you.
Please open your mouth. Stick out your tongue. Say Aaah for me. Thank you. (9,10)
I am going to check your neck for any swollen glands.
Please show me your hands. Your nails. Let me check your pulse. Thank you.
Well. Mr.........Now I need to examine your legs. For that I need to raise your drape for me? Is that ok? Thank you. Let me cover it again.
HEENT
Head – I am looking at your head for any swelling.
Face – I am going to press on your face. Let me know if it hurts. (sinus tendernees. - frontal and maxillary)
Eye – vision acuity, EOM {PERLA, Fundoscope - (dim light) – HTN, DM Follow up, vision problem}
Please cover your Right eye- can you please read the smallest line you can? Thank you.
Now cover your left eye. You may uncover your eye.
Can you please follow my finger without moving your head? Thank you.
{Now I am going to check your vision with the instrument called Fundoscope. Excuse me for a while.
3. Now I am going to throw light in your eyes. Can you please see at that wall?
4. Fundoscopy - Now I am going to check your eyes deeply. }
Ear – I am looking at your ear for any redness.
I am going to press your ears. Let me know if it hurts.
Now I am going to check your ears with the instrument called Otoscope. Excuse me for a
while. (change the speculum)
{ 8 nerve - Deafness
Weber- Now I am going to put this tuning fork on your forehead. Can you hear it? Does it sound same or different in both ear?
Rinne- Now I am going to put this tuning fork on front and back of ear. Then tell me which one sounds better?}
Nose – I am going to check your nose for any discharge.
Throat - Please open your mouth. Stick out your tongue. Say Aaah for me. Thank you
Neck – I am going to check your neck for any swollen glands.
Now I am going to check gland of your neck which is called thyroid. Can you please swallow for me? thank you.
Respiratory system
Now I am going to examine your chest and your heart. For that I need to untie your gown. Is that ok? Let me help you.
Inspection –
Now I am looking at your chest for any abnormality.
Palpation-
Now I am going to press your chest. Let me know if it hurts. (m - 4, f - 2)
Can you please say 99 repeatedly, when I touch your chest? (m - 4, f – 2)
Now I am going to check your breathing movement. Can you please take deep breaths for me?
(m – 1+1, f – 1+1)
Now I am going to feel your heart beat.
Percussion
Now I am going to tap on your chest. (m - 4, f – 2)
Auscultation – (keep stetho for full inspiration and expiration)
Now I am going to listen to your chest. Can you please take deep breaths for me? Thanks. You may relax now.
(m – 1+2, f – 1+2)
Now I am going to listen to your heart. Can you please stop your breath for a while?
(Auscultate – aortic- pulmonary- tricuspid- mitral areas.) Thank you. You may relax now. Let me tie your gown.
CVS
(check radial, dorsalis pedis and edema in general examination)
Now I am going to examine your chest and your heart. For that I need to untie your gown. Is that ok? Let me help you.
Inspection –
Now I am looking at your chest for any abnormality.
Palpation-
Now I am going to press your chest. Let me know if it hurts. (m - 4, f - 2)
Now I am going to feel your heart beat.
Auscultation
Now I am going to listen to your heart. Can you please stop your breath for a while?
(Auscultate – aortic- pulmonary- tricuspid- mitral areas.) Thank you. You may relax now.
Now Can you please lie down for me? Let me help you. Thanks.
Now I am looking at your veins in your neck ( jvp)
Now I am checking your pulse in your neck. ( palpate and auscultate for carotid bruit )
Now I am going to listen to your heart. Can you please stop your breath for a while?(auscultate 4 areas.) You may relax now.
Now you can sit up. Let me help you.
Now I am going to listen to your chest. Can you please take deep breaths for me? Thanks. You may relax now. (m – 1+2, f – 1+2)
Let me tie your gown.
Abdomen – P/R EXAMINATION – in closure
Now I am going to examine your belly. For that I need you to lie down. Let me help you. Thank you. (pull foot rest out)
Can you please raise your gown for me? Let me help you.
Inspection
Now I am looking at your belly.
Auscultation
Now I am going to listen to your belly.
Percussion
Now I am going to tap your belly.
Palpation
Can you please bend yours knees for me?
Now I am going to press your belly. Let me know if it hurts.
Now I am going to press your belly deeply. Can you please take a deep breath for me?
Now I am going to press your belly and then release it immediately. Let me know if it hurts on
pressing or releasing? - Rebound tenderness
Thank you. Now you can cover your gown. Let me help you.
Ohk, Mr.______. Now I need to examine your back. For that I need you to sit up. Let me help you. (push foot rest inside). Now I need to untie your gown. Is that ok?
Now I am going tap your back, let me know if it hurts. - costovertebral tenderness
Let me tie your gown.
Appendicitis
Psoas sign – Can you please move your knee towards your chest against my hands? And Let me know if it hurts. (flexion of hip)
Obturator sign –I am going to move your knee. Let me know if it hurts. (internal rotation of hip)
Rovsing sign –I am going to press your left side of belly. Let me know if it hurts on right side.
Cholecystitismurphy's
sign- I am going to press your belly. Can you please take deep breaths for me? And
Let me know if it hurts?
CNS
MMSE – Depression, Dementia
Okay, Mr. _____ now I am going to ask you some questions to check mental function.
1. What is your full name? What is the date today? Where are we right now?
2. Now I am going to tell you three words. I want you to repeat them immediately and after
some time, is that ok?………….cat, apple and table
What is the importance of 4th July? - (Independence Day)
3. Can you please count back from 7?
4. What would you do, if you see your friend’s house on fire? - (call 911)
5. Can you please repeat those three words for me?
Cranial nerves
Now I am going to check your nerve function.
Do 2, 3-4-6, 7, 9-10-12, 5, 8, 11
II - Please cover your Right eye- can you please read the smallest line you can? Thank you. Now
cover your left eye. You may uncover your eye.
III, IV and VII - Can you please follow my finger without moving your head? Thank you.
VII- Can you please raise your eyebrow, smile for me? Thank you
V -can you please clench your teeth for me?
VIII - Can you please close your eyes? Can you hear this?
IX, X, and X, XII- Please open your mouth. Stick out your tongue. Say Aaah for me. Move Side to
side. Thank you
XI -Can you please shrug your shoulders against my hands?
MOTOR
Now I am going to check your muscle strength.
Upper limb
Please hold my fingers tightly and pull it towards your side and push it towards my side. Thank
you.
[Wrist – Can you please pull up? Push down? Thank you.
Elbow – Can you please pull in? Push out? Thank you.]
Lower limb
Knee – Can you please kick out? Pull in? Thank you.
[Foot – Can you please pull up? Push down? Thank you.]
REFLEX
I am going to check your jerks. Biceps, (Brachio radialis) Knee, (Ankle)
SENSORY
Now I am going to check your sensation.
See this is sharp and this is dull. Now please close your eyes? And tell me which one is sharp
and which one is dull?
4 face areas (forehead, cheek) , arm(hand) leg (foot)
Cerebellar test- Now I am going to check your balance.
Finger nose test – Please take your right finger. Now touch my finger and then touch your nose
repeatedly. Now repeat it with your left finger.
Gait - Now I need you to walk few steps for me. Let me help you (pull out foot step). Please be
assure that I will not let you fall down.
Now please turn and come back.
Romberg test – Please stand with put your feet together. Now close your eyes.
Special test-
Kerning’s sign- Can you please bend your thighs and knee. Now I am going to move your knee.
Let me know if it hurts.
(flex both knee and hip, then try to extend the knee only.)
Brudzinski’s sign- Now I am going to bend your neck. (When you flex the neck, there may be
flexion of hip and knees)
SPINE
Now I am going to check your back. For that I need to untie your gown. Is that ok? Thank you.
inspection
Now I am looking at your back for any abnormality,
palpation
Now I am going to press at your back. Let me know it hurts. (cervical, thoracic, lumbar, sacral.)
range of motion
Now I am going to check movement of your back. Can you please bend forward, backward,
sideward, move side to side? – flexion, extension, lateral flexion, twisting.
gait
Now I need you to walk few steps for me. Let me pull out foot step for you.
Now please turn and come back?
Motor, reflexes, sensations
lower limbs
Pulsations
SLR

Closure

All right, Mr._____, thank you for you kind co-operation. First of all, let me summarize.
As you told me that you have………….is that right?
According to the information I got from you and from the examination, I am considering the
possibilities like you may have….. But to confirm the diagnosis, I need to run some tests like blood test and scanning of your________ . if ABD- P/R Exam . if gynec – Pelvic Exam . As soon as I get the results, we will meet again. And at that time I will explain you in the details and we will also discuss the treatment options. ok? Counseling –smoking, alcohol, STD ( If not done previously) Have you understand what we discussed today? Do you have any questions for me? No- If you have any question later on, you can call me at any time. Ok, Mr._____It was nice to meet you. Bye. Take care. (shake the hand with smile and leave the room )

Challenging questions-answers

So doc I have....?
Well Mr....... I can understand your concern, but first of all I would like to do physical examination and run some tests. Once the test results available, I will be in better position to
tell more about it.
(Well Mr.......From complain you have told there is less chance of......... but first of all… Well Mr......, It may be one of the possibilities. But there are also other conditions which mimics
your complains. So first of all….)
Cancer?
Mr….I can understand your apprehension. Some cancers are hereditary. But that does not
mean that you will get it.
So am I going to die?
Mr….I can understand your apprehension. But I want to assure that here you are in the safe
hands and we will do our best to feel you better.
Am I going to get better?
Mr…. I can understand your concern. There are number of conditions which mimics your
complains and many of them are treatable.
Angry
I am sorry that I keep you waiting. Actually we had some unexpected delay with earlier patients. But right now I am here and I will focus on you and your concerns. And I will also keep
in mind that it will not happen again.
[Over talkative patient- “Excuse me Mr______. I can understand that those issues are important to you. But right now I want to focus on you and your current problems. ” come to the problem where stop.
If want to ask again -“I am sorry. Can you please repeat it again what you have just said?”
if time is over - "Oh. I am sorry. We have an emergency. I have to leave. I will be back as soon I can."]

PSYCHIATRY
General

Mr._______ you seem to be upset. Will you please share it with me? I am here to help you.
Mr._________ I really want to help you and for that I need to understand your problem. Can
you please tell me what happened to you? (Is there anything which I can do to feel you better? Or I will do everything which I can to feel you better.) I want to die doctor – I can understand that its hard time for you. But running away from the problem is not the solution. We can deal with it to gather in much better way.

Etiology –

Is it associated with any event?
Any emotional problem? Any family problem? Any financial problem?
Do you have trouble in adjusting with temperature? Have you notice any hair loss?
support – May I know Whom do you live with?
Is there any one for your help when needed?
DEPRESSION (FACE SLIPS)
Feeling of guilty – Do you feel guilty about anything?
Appetite – Is there any change in your appetite, weight?
Concentration – Do you have any difficulty in concentrating? Memorizing things?
Energy – How is your energy level? (Sleep –Libido –)
Pleasure level – Are you able to get interest in those activities which you were enjoying in the past?
Suicidal ideation - Have you ever thought about hurting yourself or ending of your life? Do you
have any plan for that? Have you ever tried to do so?
Hallucination – Do you hear anything that other people can’t?
Do you see anything that other people can’t?
Delusion –Do you have belief about yourself or world that other people find odd?
Do you have any belief that other people are trying to harm or control you?
Counseling
Your problem is common in our society and you are not alone.
You can call me at any time whenever you feel worse.
We have excellent counselor and support group who will help you in this matter. I will give their
contact numbers to you.

DEMENTIA
Do you have difficulty in performing daily activities? like remembering names, phone numbers, keys, turn off stove, ?
DEATH–Do you need any help in getting dressed [dressing]? Eating [eating]? moving from your
bed to chair [ambulation]? Going to bathroom [toileting]? [ Have you ever had any accident with urine or bowel movement [hygiene]?]
SHAFT–Do you need any help in shopping [shopping] ?, cleaning your house [house keeping] ?
Managing your money [accounting] ? cooking [food preparation] ? moving from one place to other [transportation] ?
Counselling
I need your permission to talk with your caretaker who can help me with your diagnosis.
I would also like you and your care taker to meet with social worker who will suggest you about
home safety measures.
Meanwhile I will remain in contact with you and your family to provide help and support.
ABUSE
support – May I know Whom do you live with?
How is your relationship with them?
Well Mrs. I am concern about your safety and I want to make sure that you are not victim of abuse.
Safe - So are you safe at your home?
Well Mrs. I want to assure that whatever you tell, will be kept confidential.
So can you tell me what exactly happen to you? How often does it happen?
(So does anyone in your life have hurt you physically? Emotionally?)
Afraid of – Are you afraid that it will happened again?
Family aware - Are your parents / friends are aware of your current condition?
Emergency plan- Do you have any emergency plan to leave your home?
A- Does your husband drink alcohol?
D- How is your mood whole a day?
How many kids do you have? Are they being abused or threaten?
Counseling
I am concern about your safety. I will be here for your help and support.
Please assure that whatever you have told will be kept confidential.
I will give you contact numbers of social support group and shelter where you can go for help whenever needed.
Moreover I must inform child protective services if your child is being abused.

Pediatric case (mostly a telephone case)

Good morning. I am Dr. Patel. I am physician in this hospital. May I have your name please?
(May I know to whom I am talking to?)
Ok. Miss…..today I will ask you some questions about your child’s health is that ok?
During our conversation if you have any concern then please let me know.
So Mrs.______, How can I help you today?
Oh I am sorry to hear that your child has……………….
Can you tell me more about it?
Onset – When did it start?
Progress - How did it progress?
Frequency – how many bowel movements does he have?
What is its consistency?
What is its color? Was there any blood in it?
How does his skin looks like? Is it shining or dull? How many times does he urinate?
Has he traveled recently?
Is there any relationship with any food?
[Does he attend day care center? Is there any ill contact over there?
How does he look like? Playful, tired, irritated?
How does he cry like? Vigorous, weak?]
[Does he have any fever? Vomiting? Rash?
Cough, Fast breathing? Running nose? Ear discharge? Difficulty swallowing
Shaking?
Do you think that he has pain in……….?]
Well, Mrs. _____, now I am going to ask some questions about …...'s Past Medical Health. Is
that ok?
P/H – Did he have similar complain in the past?
Did he have any major illness like jaundice?
Does he have any allergy?
Are you giving any medications to him?
Did he ever been hospitalized before?
Did he have any surgery?
Does his have any problem with urination? Bowel movement? Sleep?
Pre natal ,natal postnatal History
All right, Mrs. …..Now I am going to ask about ….........'s birth and your pregnancy. Is that ok?
Did you get routinely checked during her pregnancy?
Was there any problem during pregnancy?
Were you smoking during pregnancy? Taking alcohol? Recreation drug? Medications?
What was the mode of delivery? Was it normal delivery or cesarean?
Was the baby full term? If no- At which month of pregnancy did you give birth ?
Was there any problem during delivery? After delivery?
When did he first cry after delivery?
When did he start his first feeding?
When did he pass his first stool?
Feeding history
Have you ever breast fed your child?
When did you start to give solid foods?
What does he eat now?
Are you giving any multivitamins?
Is there any change in his appetite? Weight?
Developmental history
Is he growing normally?
Is his current weight and height appropriate to the growth chart?
When did he first smile? First speak word? Sit up, Crawl, walk, ….
Routine care
When was his last check up? How was his health at that time?
Immunization – Are his immunizations up to date? Do you have vaccination card with you?
I am glad to hear that you are taking good care of your child.
(not taken) May I know why it is so? Mrs.....As a concerned physician I must inform you that
vaccine can protect child from many illness. So I strongly recommend you to complete his
vaccination as soon as possible. (And this kind of vaccines are given free of charge by federal
government health program.) if financial reason Would you like to tell me anything else, Mrs.______?
All right, Mr. Smith,_____ thank you so much for you kind co-operation.
Now let me tell you what I think so far. First of all let me summarize.
As you told me that he has……is that ok?
According to the information I got from you, I am considering possibilities like...But to confirm diagnosis, I need to examine him/her and run some tests like.... For that I want you to bring your child to the hospital
At that time I will explain you in details and we will also discuss about treatment options? ok?
Have you understand what we discuss today?
Do you have any questions? If no- If you have any question later on, you can call me at any time.
Ok, then, Mrs......It was nice to meet. . Bye. Take care.

** Dr. Dharmesh Mehta had contributed actively in making this proforma.

Steps to Work on USMLE Step2- CS..

2009-10-16T17:45:00.001-04:00

Person who ask question is fool for 5 minutes but who never ask, is fool forever.
And one more thing also....
Giving advise is really easier than following it.

Even though CS is totally unpredictable exam , from the experience of all of my friends and mine, here I am giving you few steps to follow to Pass Clinical Skills.

1) Read pdf of the orientation material provided by the ECFMG. and also download video and watch it.
look at

Onsite orientation step 2 CS video
Video Stills of Step 2 CS video
PDF.

2) read FIRST AID book Chapters

Guide to the USMLE step 2 CS
Patient Encounter

3) Find out the partner to practice, either online or in person.
4) Mug up performa.
ask for performa made by your friends or given in famous books/online like First Aid , Kaplan CS book, USMLE World.
Here in next post i am giving you performa made by two efficient Doctors. They have gathered data from different books.

5) Start doing Major cases given in Book- First Aid.
In starting , practice speaking of

Whole performa alone.
Questions of Symptomatology alone.
Examination alone.

Than switch on to whole cases ( without timer ON ) including writing practice of Patient note. You can exclude doing Examination at this time of practice. In your free time watch videos of USMLE World ( If you are FMG/IMG and not good at English Pronounciations , watch Hollywood movies too in your free time) and learn how to examine in proper manner. ( you need not have to do whole examination in proper way,Practice speeding up for the all examination )

Patient Note sample Given in the orientation Material by ECFMG is too poor in quality. ask for patient note of your friend.

I will post sample patient note in few days.

6)Once you complete all cases in the First Aid, switch to the cases given in the USMLE World.

Practice this cases with timer ON, including writing practice of Patient note.

7) Repeat First Aid Major Cases and do mini cases and start practice of giving spontanious answers to odd questions asked by the SPs near end of the encounter. ( Students, who have passed CK, need not to do minicases. Minicases in the First Aid are for those who can not think of DD of one symptom)

Few challenging quetions and sample answers are given in the First Aid.
Gather odd Cases encounterd by your friends and think of questions of those perticular symptomatology.
Practice few common cases with your friend/s who have given the exam.

You are done with your Part of the CS Preparations.