USMLE Step 2 CS, How many days to needed to study for it?

[mpd210]

I only have 12 days after my step 2 ck to study for cs... is that enough time? how should I study in that short time?

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[GreenOne]

that will be too much time!
I read first aid twice for it and even that was a lot... I read it once a week before and the other time that day before the exam. I was in the middle of my surgery rotation, took 2 days off to fly to atlanta to take the exam-- I felt doing surgery was perfect timing, ironically, cuz we do some much PEs, notes, etc...
Be nice to the patients, wash your hands, introduce yourself, blah blah blah...just like what first aid says...
it has good examples for the notes...
hey good luck...

 

[GreenOne]

And Don't Forget To Watch The Practice Video, The One They Send When You Register-- Make Sure You Watch It-- It Is So Helpful, Even Watch It A Couple Of Times...

 

[UrbanAmish]

uh...i registered for step 2 cs like 8 months ago and NEVER was sent a practice video.

can this video be found on the web?

 

[GreenOne]

hope this helps...just make sure you guys WATCH it a couple of times...that is the CS exam
http://www.usmle.org/Orientation/2008/menu.html

 

[GreenOne]

you won't be surprize during the actual exam if you do the orientation cd they send...look at everything in this video and at the notes to get an idea what they expect from you to pass the cs
good luck

 

[lord_jeebus]

If you've been seeing patients recently, 1-3 days should suffice.

I read through the website and flipped through the sample work-ups section of First Aid and that was more than sufficient.

 

[mdphd2b]

Hi mpd210.

I will reiterate--you have plenty of time. I did exactly what you did. Took CK on 10/26, and just took CS last Friday 11/9 (2wk later) At this point you already have studied the DDX and diagnostic testing stuff for CK, so just review FA (once is enough), especially the cases with notes and checklists, and also check the CS orientation materials on the website. When you get to the real CS exam, they also spend over an hour on orientation stuff, so you will get more familiar with the center.

Last Friday in Philly, I had 12 cases (remember one is experimental and not counted, but you don't know which one). All the SP's have very common chief complaints, no zebras. There was one case of a concerned parent (but no ped pt in the room, so just H w/o P). Rest were all adults, no telephone case for me. You do 5 cases, then 30min lunch (ours sucked, but you can bring your own food/snacks), then 4 cases, then 15min break, then the last 3 cases. After the 1st case, your anxiety goes down and the adrenaline kicks in, so you should fall into a good routine. It's a VERY long and tiring day. Also, I chose to use gloves instead of hand-washing, which saves some time and doesn't freeze the SP! I also hand-wrote the note b/c I felt I could think/write more details in the space.

Good luck--it's not too bad, just an inconvenient means to squander the time and $$$ I could use on interviews.

 

[mpd210]

thanks for all the advice! much appreciated! thanks.

 

[lluvia2rain]

hey I am scheduled for chicago nov 15??? I been so stressed about everything else I am doing that I have not yet been able to study for this test. With only three days left and a crazy schedule with a interview the day before the exam should I cancel????? Finding dates sucks though. I am an AMG but still stressed that I might not pass? plus I know flying into chicago renting a car getting to the hotel with only five hours to sleep is also going to impact negatively my test day.

 

[UrbanAmish]

if you're taking CS in chi-town, you might not have to worry about renting a car. the subway/rail CTA blue line brings you to the test center at the cumberland stop. http://www.transitchicago.com/ for the nice automated trip planner.
good luck!

 

[arthrodisiac]

for anybody who took it...did you have to know the immunization schedules...catchup schedules, etc?

 

[lord_jeebus]

for anybody who took it...did you have to know the immunization schedules...catchup schedules, etc?

No, and I would be surprised if anyone did.

 

[mpd210]

Do I focus on the minicases or the 31 practice cases in first aid? The minicases have no explanations.
Also, do you have to do a complete physical for every case?

 

[mpd210]

do we have to repeat the vital signs (like retake the bp, temp, etc)?

 

[lord_jeebus]

Do I focus on the minicases or the 31 practice cases in first aid? The minicases have no explanations.
Also, do you have to do a complete physical for every case?

I found the minicases more useful but going through the practice cases is useful to see a "correct" use of the limited time that you have.

Part of the exam is your ability to focus your exam to what is pertinent. Unless a neuro exam was indicated, I generally only spent about 3 minutes on physical examination.

You don't have to repeat vital signs although you can do so if wish. Besides the various things you can do with BP I see no point.

 

[mpd210]

do you think we're graded by the number of differentials we can come up with? Would it be ok if we only came up with 3-4 differentials for each case?

What are the things we get points for? This is what I know we get points for:"
knocking
introducing self
verifying pt name
looking pt in eye
washing hands
explaining what you're going to do
drapping
explaining possible dx and mngmnt

anything else we get points for?

 

[lluvia2rain]

Well I did it it is over I am very happy now. All the cases were basic. Just like first aid and my schools simulated patient encounters. I only read first aid on plane flight. Give me two months and I will update everyone. Good luck.....

 

[mpd210]

Good luck, I'm sure you passed. Were the encounters the same as the first aid mini-cases or the 31 first aid practice cases?

I was wondering, do we miss points for ordering incorrect tests (ct, u/s, etc) or forgetting to order correct tests, or comming to the wrong dx?

 

[RugbyJC]

I don't think anyone outside of the NBME could tell you how you are eveluated. I even found subtle differences between what First Aide said and what we were told at orientation. I just took the exam on Wednesday and the best advice I could give anyone is to use the time wisely. You are going to be rush, you are not going to have time to do an adequate exam and you probably won't have enough time to write your note as thoroughly as you might normally do. Then again, I am a fast typer and don't like to abreviate, so I wasted unnecessary time trying to fit everything in the allotted space for typing.

Regardless, I think knowing this ahead of time would have been more beneficial than knowing even what cases were going to be present. They were all pretty much outpatient bread and butter, but I realized that when a patient has a completely normal exam (or phyicial exam findings irrelivant to the cc--I had a patient with 2+ pedial edema for an unrelated complaint) and you don't read the chart ahead of time, coming up with differentials is a lot more difficult than I would have expected.

Good luck.

 

[mpd210]

i know we probably don't have to check vitals, but if a patient comes in with syncope, should we check bp for orthostatic hypotension? I'm guessing we don't...

 

[overthebars]

i know we probably don't have to check vitals, but if a patient comes in with syncope, should we check bp for orthostatic hypotension? I'm guessing we don't...

that they say to approach the SP's as if they were "real" patients. When I have abnormal VS on a triage sheet I recheck it and any related sign. I would be pretty shocked it hey don't give you a point for rechecking a pulse over 100 or whatever.

 

[lord_jeebus]

i know we probably don't have to check vitals, but if a patient comes in with syncope, should we check bp for orthostatic hypotension? I'm guessing we don't...

What kind of licensing exam wouldn't give you credit for checking for orthostatic hypotension in a patient complaining of syncope?

 

[Arsenic]

i know we probably don't have to check vitals, but if a patient comes in with syncope, should we check bp for orthostatic hypotension? I'm guessing we don't...

totally. case 14 in first aid CS is a pt with dizzyness and they had "checked orthostatic vitals" on the physical exam checklist that the pt fills out. then they wrote "no orthostatic changes" in their sample note. i think thats about the only time ill bust out the BP cuff on the exam.

i take this thing next week in atlanta, started looking at the FA book a few days ago..... biggest thing freaking me out right now is the time, how to move fast and not sound disrespectful or hurried while still getting the full HPI, PMH, PSH, meds, allergies, social hx, fam hx, and ROS in 7-8 mins and then PE/closure in another 7 mins without forgetting anything.

 

[xthine]

Hey there Arsenic!
Do tell us how it goes. Good luck to you

 

[AlternateSome1]

I just recently took the exam. The proctors told us that we should assume all triage vitals are correct. We are allowed to retake vitals, but should assume the triage ones were correct when creating a differential diagnosis. This makes retaking vitals pretty useless and I skipped it on most patients. I don't know if I passed yet, so they may have wanted them taken.

 

[overthebars]

I just recently took the exam. The proctors told us that we should assume all triage vitals are correct. We are allowed to retake vitals, but should assume the triage ones were correct when creating a differential diagnosis. This makes retaking vitals pretty useless and I skipped it on most patients. I don't know if I passed yet, so they may have wanted them taken.

Good point, the whole idea behind retaking VS is obviously to make sure they are correct. The more the proctors explained things the more confused I got.
I suppose you could always write "check supine/sitting/standing HR and BP" in the workup section of your note as well, should you not have a watch or clock. Though I have no idea if that is acceptable or not. To do the orthostats completely takes ~5 minutes, I generally don't have my patients stand during the PEx.

 

[mpd210]

"In some instances you may be instructed to perform a physical examination that relates to a specific medical condition, life circumstance, or occupation. Synthetic models, mannequins, or simulators provide an appropriate format for assessment of sensitive examination skills such as genital or rectal examination, and may be used for these cases. In such cases, specific instructions regarding the use of these devices will be provided."

Anyone know anything about this or experience this in their exams? Should I brush up on genital, pelvic, and rectal exams? The only exams I looked over are heart, lungs, abd, neuro, ext...

 

[arthrodisiac]

"In some instances you may be instructed to perform a physical examination that relates to a specific medical condition, life circumstance, or occupation. Synthetic models, mannequins, or simulators provide an appropriate format for assessment of sensitive examination skills such as genital or rectal examination, and may be used for these cases. In such cases, specific instructions regarding the use of these devices will be provided."

Anyone know anything about this or experience this in their exams? Should I brush up on genital, pelvic, and rectal exams? The only exams I looked over are heart, lungs, abd, neuro, ext...

no genital, rectal, breast, corneal reflex...period. can do inguinal/axillary ln, and can undo bra if warranted ( i dont think it is).

 

[Arsenic]

"In some instances you may be instructed to perform a physical examination that relates to a specific medical condition, life circumstance, or occupation. Synthetic models, mannequins, or simulators provide an appropriate format for assessment of sensitive examination skills such as genital or rectal examination, and may be used for these cases. In such cases, specific instructions regarding the use of these devices will be provided."

Anyone know anything about this or experience this in their exams? Should I brush up on genital, pelvic, and rectal exams? The only exams I looked over are heart, lungs, abd, neuro, ext...

not sure where you got those instructions but rectal and pelvic exams are not done on step 2 cs, not even on models or mannequins. if you think they are warranted for the case you are presented with, you just write them as the first thing you'd do in your diagnostic workup.

 

[mpd210]

I got the info from the usmle website (last paragraph):
http://www.usmle.org/Examinations/step2/cs/content/description.html

From the repsonses I'm figuring I'm not going to have to do pelvic/genital/rectals so I'm not going to worry about it.

On the computer screen, for DDX, first aid lists a lot of ddx, do you think that we should just list the most likely dx or even the once that are a stretch (like first aid does)?

also, on the computer screen, for workup, you think it'd be a good idea to list CBC/electrolytes for every case I get?

Thanks! Happy thanksgiving to everyone, btw.

 

[mpd210]

I just took the CS in chicago and would like to help all those out there. The exam is pretty much everything thats covered in first aid. common everyday things you see such as whats listed in first aid.

I almost forgot to do ROS, past medical/surgical/family/social hx in one encounter, so all the following encounters, before walking into the room, I wrote down ROS, etc so that I remembered to ask it. (a lot of times when you're so busy trying to figure out the dx you forget to do the ROS etc, and go straight to the physical exam.... at least I do).

also, as soon as I saw anything that might need counseling or anything important in the history (possible lung cancer), I circled it. then as I was closing I could easily see what needed to be addressed and so I wouldn't forget it. I dunno, this worked for me.

also read the doorway instructions. i forgot to read pretty much all of them since i was so used to it always saying the same thing in first aid when I practiced. looking back some of them may have had different instructions such as breaking bad news of lab results... [DID MOST people out there who took the test have the same instructions for each encounter?]

don't spend too much time on the physical exam. just move the stethescope to the next spot if you don't hear any murmurs or adventitious breath sounds. try to save time cause it runs out fast.

when i was asking questions and writing notes I had my watch on backwords so i could see it while i wrote and the sp wouldn't notice. after 5mins of trying to figure out what the dx was, I started the ROS, past hx's, which I know takes me 2-3mins. This left me 7-8mins for PE and closure (if you start the PE and closure when they give you the 5min warning you may run out of time).

the computer screen to type is a little different than that on the usmle website in that there is limited space you can use in the real test. I ran out of space once and couldn't write the social history or allergies.

I dunno if this advice is correct or not. this is what i did. if it helps anyone then i'm glad.

[Again, if anyone knows anything about the instructions listed before the patient encounter please let me know. i hoipe i ddon't fail because of it. and lastly, on one patient note i was running out of time so wrote hx instead of history. anyone know if this is a problem?]

 

[arthrodisiac]

i think all of my instructions were the same....how would you break bad news of lab results if it doesn't have the bad lab results on the sheet? all of mine only had age, name, vital signs.

 

[Arsenic]

Just finished my CS today and wanted to let you guys know how it went. So... yeah, everything was basically common outpt stuff. It was easier than what I thought it would be, my major worry before was the time constraints which is probably the hardest part of it all but I finished just about every encounter and note right at the buzzer. Just about everything is in First Aid CS which was great! That book is gold.

The time definitely flies. I think everyone forgets something the day they take the exam, make peace with that fact NOW. the test will be easier than you expect but you will still make some mistakes. my simple mistakes I can remember off the top of my head:

-on anywhere from 3-5 pts I forgot to tie their gown again after I did the PE with the time crunch
-forgot to get sputum cultures on a productive cough! got the rest of the stuff though like CBC, CXR, etc...
-missed a couple of super obvious ddx on a pt with a psych issue, that one really bugs me. I listed 1 psych dx and the rest of the ddx was medical and i know there were 2 really obvious psych ones i should have listed as #1 and #3 instead. grrrrrrrr.
-had to rush/half ass a neuro exam on like 2 pts and missed things like straight leg raise and pinprick sensation (got all components except those and just did soft touch secs before the encounter ended)
-failed to pick up on the fact that a pt that was looking at me the whole time with really wide eyes was *probably* simulating exopthalmos. which is something that i didnt include on any of my pertinent negatives anywhere, neither that or cold/heat intolerance. ooops... lol. seriously, either she was really simulating it or just weird and its all in my head.
-forgot to do an OB/gyn hx on a woman with back pain. sounded like musculoskeletal all the way so i didnt even think of ob/gyn til after i started writing the note. ugh.

Thats about all the mistakes i can remember, even with all that im not really stressing this now..... i mean I always got a mostly complete hx and PE on all my pts, closed all the encounters and finished all my notes with ddx and plans that made sense so I'm pretty sure im in the 96% that pass this thing on first attempt... i just wish i didnt have to wait 3 months.

my biggest advice would be to list as many pertinent negatives in the space you are given in the note. seriously, things like exopthalmos, lid lag, etc... i think it def makes it sound like you know what you are talking about. hard with the space limitations though.

also, i typed all my notes and thought it was awesome. if your good with typing, do it. its so much easier to then cut and paste things around or re-organize your work up list or add something you just thought of to the HPI.

good luck everyone!

 

[lord_jeebus]

On the computer screen, for DDX, first aid lists a lot of ddx, do you think that we should just list the most likely dx or even the once that are a stretch (like first aid does)?

Whatever you'd want to rule-out if the patient was real.

also, on the computer screen, for workup, you think it'd be a good idea to list CBC/electrolytes for every case I get?

Would you order CBC/lytes on every patient you see in clinic?

 

[Ypo.]

-failed to pick up on the fact that a pt that was looking at me the whole time with really wide eyes was *probably* simulating exopthalmos. which is something that i didnt include on any of my pertinent negatives anywhere, neither that or cold/heat intolerance. ooops... lol. seriously, either she was really simulating it or just weird and its all in my head.

LOL. I'm sure I would have been thinking (what did I do to piss this lady off, or...what drugs has she been taking?). I can't wait to hear a "pseudo wheeze."

Someone mentioned earlier that their SP had "2+ pitting edema" unrelated to the CC. How are we supposed to recognize that on a simulated patient?

also, i typed all my notes and thought it was awesome. if your good with typing, do it. its so much easier to then cut and paste things around or re-organize your work up list or add something you just thought of to the HPI.

good luck everyone!

I'm tempted to do this, but my worry is that I'll end up running out of time trying to make it perfect. Whereas if I have to write, if I screw up, I just move on.

 

[NuMD97]

"In some instances you may be instructed to perform a physical examination that relates to a specific medical condition, life circumstance, or occupation. Synthetic models, mannequins, or simulators provide an appropriate format for assessment of sensitive examination skills such as genital or rectal examination, and may be used for these cases. In such cases, specific instructions regarding the use of these devices will be provided."

Anyone know anything about this or experience this in their exams? Should I brush up on genital, pelvic, and rectal exams? The only exams I looked over are heart, lungs, abd, neuro, ext...

It's my understanding that they will utilize mannequins for FUTURE testing, not now. If you think that it's important to perform, you should put it in the tests to be ordered. Some of this thinking is tricky since in a real situation you would do it automatically. Similarly, if there is a peds case, (I have seen this written in a review book) the first thing in the list of orders is "examine the child". I can see why this would be a stressful case, but best advice is just to go with the flow.

Good luck to all with this monstrosity still pending.

Nu

 

[Arsenic]

Just finished my CS today and wanted to let you guys know how it went. So... yeah, everything was basically common outpt stuff. It was easier than what I thought it would be, my major worry before was the time constraints which is probably the hardest part of it all but I finished just about every encounter and note right at the buzzer. Just about everything is in First Aid CS which was great! That book is gold.

The time definitely flies. I think everyone forgets something the day they take the exam, make peace with that fact NOW. the test will be easier than you expect but you will still make some mistakes. my simple mistakes I can remember off the top of my head:

-on anywhere from 3-5 pts I forgot to tie their gown again after I did the PE with the time crunch
-forgot to get sputum cultures on a productive cough! got the rest of the stuff though like CBC, CXR, etc...
-missed a couple of super obvious ddx on a pt with a psych issue, that one really bugs me. I listed 1 psych dx and the rest of the ddx was medical and i know there were 2 really obvious psych ones i should have listed as #1 and #3 instead. grrrrrrrr.
-had to rush/half ass a neuro exam on like 2 pts and missed things like straight leg raise and pinprick sensation (got all components except those and just did soft touch secs before the encounter ended)
-failed to pick up on the fact that a pt that was looking at me the whole time with really wide eyes was *probably* simulating exopthalmos. which is something that i didnt include on any of my pertinent negatives anywhere, neither that or cold/heat intolerance. ooops... lol. seriously, either she was really simulating it or just weird and its all in my head.
-forgot to do an OB/gyn hx on a woman with back pain. sounded like musculoskeletal all the way so i didnt even think of ob/gyn til after i started writing the note. ugh.

Thats about all the mistakes i can remember, even with all that im not really stressing this now..... i mean I always got a mostly complete hx and PE on all my pts, closed all the encounters and finished all my notes with ddx and plans that made sense so I'm pretty sure im in the 96% that pass this thing on first attempt... i just wish i didnt have to wait 3 months.

my biggest advice would be to list as many pertinent negatives in the space you are given in the note. seriously, things like exopthalmos, lid lag, etc... i think it def makes it sound like you know what you are talking about. hard with the space limitations though.

also, i typed all my notes and thought it was awesome. if your good with typing, do it. its so much easier to then cut and paste things around or re-organize your work up list or add something you just thought of to the HPI.

good luck everyone!

just quoting my post back from when i took the exam... just got my score today, PASSED. Even with all that i posted above and all the mistakes i remembered later. thank god, i just didnt want to shell out another $1,000 for this and have to go through the stress of rescheduling for results before residency. good luck to everyone waiting on scores!

 

[Lauraaa]

Anyone take CS before taking CK? And if so, how did that go, any tips for that partcular situation - would you recommend going through lengths to make sure you took CK first, or do you think that it does not matter if you read Frist Aid for CS and have had your medicine sub-I?

 

[bananaphone]

Anyone take CS before taking CK? And if so, how did that go, any tips for that partcular situation - would you recommend going through lengths to make sure you took CK first, or do you think that it does not matter if you read Frist Aid for CS and have had your medicine sub-I?

SHORT ANSWER: used 2 nights to study for CS from 1st aid. memorize your routine! CS before CK is fine. don't need med sub-I...CS doesn't take place in an ICU.

LONG ANSWER:

i took CS before CK and passed CS on 1st attempt. per the NBME info, the CS content is similar to stuff you'd see in family practice or urgent care clinic. for example, during my primary care clerkship i encountered lots of headache, back pain, young females with acute abdomen, dude with depression, sore throats etc. my medicine sub-I experience did not help me much.

all i used for CS was 1st aid for two evenings. at that time i had recently completed my primary care clerkship, so primary/urgent care workups were fresh in my mind. i focused on the routine i would follow with each case instead of medical knowledge.

something that really helped me was taking a little extra time before entering the patient's room to organize my scratch paper with the typical name/age/CC/HPI/... headings so i didn't miss anything (especially FamHx and SocHx!). i made sure to copy the vitals. if the CC was something like back pain, i made sure to write into my PE section inspect, rom, palpate, special tests to make sure i did them. at the bottom of my sheet i had a column for the 5 DDx and another for the 5 tests. i often filled these in during the actual patient encounter, and sometimes before i even entered the room.

i saw a lot of other CS takers entering the pt rooms like 2 seconds after the bell. i thought it made more sense to spend 45 sec or so collecting my thoughts and getting a script organized for the encounter.

for the patient encounter, the one outlined in 1st aid worked great. knock, say "mr/ms ____?, hi, i'm ___ , nice to meet you. i'm here to examine you," shake hands, drape, talk, empathize and paraphrase, ask if you can examine, gloves on, ask before examining each system and explain findings to pt, regown/redrape them as you exam, summarize case with 3 DDx for pt and offer emo support, tell them you'll need to run more tests and indicate you'll discuss further at follow-up, thank them and bye bye.

when it came time to write the note, i propped my clipboard and scratch paper right next to the computer monitor and typed away. worked like a charm for each encounter. i always finished my note with time to proofread and relax.

anyway, studying the CS content first helped me with the primary care material later on in CK.

good luck!