ONLINE STEP 2 CS PREP
STEP 1 & STEP 2 CK TUTOR SESSIONS

Accessible Online Patient notes

We prepare you for the ICE, CIS components of this test through our online note grading. We provide detailed information about the step 2 CS examinations with emphasis on history taking skills, physical exam skills and excellent patient note taking and typing technique.

USMLE Step 2 CS 

USMLE STEP 2 CS SAMPLE PATIENT NOTE 


                                                                                                   SAMPLE PATIENT NOTE 


Once you complete any encounter, you'€™ll be given at least 10 mins to compose a PN.
I will start by saying for practice purposes  try as much to be completing your PN in 8-9 mins (may be challenging initially but keep practicing).
You need to strategize how to flow, navigate and complete this task. After you exit the patient’s (SP’s) room, try to take a few seconds to review the information you gathered, prepare your mind.
Be confident that you can compose the best note; trust yourself (very important).
Decide on the PN style you will use:  €™narrative €™or €™Bullet€™ style.
 
CHIEF COMPLIANT: CC, onset, frequency, it's progression, main presenting symptoms (a lot of mnemonics everywhere choose what works for you: LIQORAAA™ for location, intensity, quality, onset, radiation, aggravating factors, alleviating/relieving factors, associated symptoms).
Now that you've explored this case, then R/O differential diagnosis ( Neg. for : blah blah blah, or No: blah, blah , blah, or Denies blah, blah , blah)
Document other key points:

PAMHUGSFOSS:

Previous episode, PMH/PSH, Allergy, Meds, Hospitalization, Urinary habits, GI habits, Sleep, FH, OBGYN,  Sex, SOCIAL: Smoking, ETOH, Illicit drugs, occupation, diet , exercise, relationship status(married, single) , living condition  etc..



PHYSICAL EXAM:
key physical findings, includes pertinent positives and negatives
Pt. is in or no acute distress

VS: WNL
HEENT: NC/AT, EOMI, PERRLA, no cyanosis, no icterus, no pallor
NECK: supple, Thyroid wnl, no LAD, no nuchal rigidity
MOUTH AND PHARYNX: clear, moist, no erythema, no exudates, no lesions
CHEST/RESP: CTAB, no rales, rhonchi, wheezing, or rubs, no tenderness on palpation, rhonchi, wheezing, or rubs, no tenderness on palpation
CVS: RRR, S1/S2 WNL, no murmurs, rubs, or gallops, no JVD , PMI not displaced
ABD: soft, NT, ND, BS+ in all 4Q, no HSM. Neg. for: rebound tenderness, psoas etc..
MSK: motor strength 5/5 in all 4 ext. full ROM at joints.., sensation intact to sharp and dull bilaterally, special tests..
Extremities: pulses(radial or Dorsalis pedis....) +2  b/l, no cyanosis, clubbing or edema .
NEURO: Mental status (Alert &Oriented x3...), CNs , DTRs, special tests..


DIFFERENTAIL DIAGNOSIS
DDX: closest possible 2 or 3 DDX with pertinent history or physical findings


 WORK UP PLANS

Physical exam for all Peds cases
Pelvic, genital exam for all OBGYN cases
Rectal exam for all GI cases
Mental Status exam for all Depression, Dementia, Delirium, Fatigue, Forgetfulness cases
Pregnancy Test (bHCG) for all premenopausal OBGYN cases
Start with simple inexpensive, affordable tests first for all cases (such as ultrasounds, CXR, TSH, electrolytes).
 
 
With Integrity USMLE Course; score high!