HPI (history of present illness) Ask for: LIQOR AAA L Location of the symptom (forehead, wrist...

) I Intensity of the symptom (scale 1-10, 6/10) Q Quality of the symptom (burning, pulsating pain...) O Onset of the symptom + precipitating factors R Radiation of the symptom ( to left shoulder and arm) A Associated symptoms ( palpitations, shortness of breath) A Alleviating factors (sitting with my chest on my knees) A Aggravating factors (effort, smoking, large meals) NOW LETS TALK ABOUT YOUR PAST MEDICAL HISTORY PMH (past medical history) Search for: PAM HUGS FOSS P Previous presence of the symptom (same chief complaint) Have you ever had similar complaints in the past? A Allergies (drugs, foods, chemicals, dust ...) Do you have any allergies? M Medicines (any drugs the patient used) Are you on any medication? Any recent change in doses of medication? Any new added medication? H Hospitalization for any illness in the past Have you ever been hospitalized? (what? & duration?) Any illnesses? o Have you ever been diagnosed with HBP, DM, High cholesterol, Asthma, Epilepsy, stroke Duration Medication Life style interventions Under control? Remember to counsel the patient at the end if chronic illness is present!!!!!1 Trauma? o Do you have any history of trauma or injuries Surgeries? o Do you have any history of surgeries (when? Indication, complications, outcomes)

U Urinary changes ( esp if diabetic, elderly...) Do you have any problems with your bladder? G Gastrointestinal complains Have you had any changes in your diet and appetite? Have you noticed any changes in your weight recently Have you noticed any changes in your bowel movements Have you traveled to anywhere recently (diarrhea) S Sleep pattern (waking up/going to sleep...) Have you noticed any change in your sleep pattern? NOW LET ME ASK YOU ABOUT YOUR FAMILY HISTORY F Family history Does anyone in your family have a similar complaint? Does anybody in your family have any serious illness? O OB/GYN history (LMP, abortions, para...) G (gravida) o Have you ever been pregnant? How many? P (Para) o How many times have you given birth? A (Abortion) o Have you ever had any abortions or miscarriage? M (menstrual history) o When was your LMP o Are your periods regular NOW LET ME ASK YOU ABOUT YOUR SEXUAL HISTORY. BUT BEFORE WE START LET ME ASSURE YOU THAT WHAT EVER WE TALK ABOUT WOULD BE HELD HIGHLY CONFIDENTIAL! S Sexual habits Are you sexually active What are your sexual preferences Have you been diagnosed with any STD S Social life

 For Social History I use TIA SHOE: o T obacco o I llicit drigs o A lcohol o o o o S exual H ouse life O ccupation E ating (diet)

Changes to CS (including First Aid 4th Edition and Preparing for it )

USMLE CS First Aid 4th Edition is available now Please do share..how much has first aid changed according to new pattern. I just went through Amazon and compared to my fa and felt satisfied . Found some new cases on laryngeal tubercle. Laryngeal cancer, metastatic cancer, Mitral valve stenosis or some infection, hypothyroid SECTION 3-MINICASES ADDED Child with GI symptoms Child with red eye Child with short stature SECTION 4 PRACTISE CASES ADDED 62 yr old with Hoarseness laryngeal tubercle. Laryngeal cancer, metastatic cancer, Mitral valve stenosis or some infection, hypothyroid 67 yr old with neck pain DD of Disc prolapse, osteoporosis, cervical fracture, muscle spasm, nerve impingement, metastatic cancer, multiple myeloma.

11 month old with seizures DD of febrile seizure, meningitis, UTI, sepsis, hyponatremia However i have USMLE FA CS 3rd Edition, Haven't started with Preparation but i guess There are not much changes why pay 45+$ Why I am choosing to Give it later? 1. NO USCE -having a good rotation in the USA as electives will; help as this exam mostly based on how u interact with the pt ... if u can speak English very good, interview with pt , ask the right Q to get the info write a good note with good DX ..will pass 2.Need to complete my rotation here in my medical school 3.Don't want to give it unprepared 4.No Dates available in later date in May 5.Haven't given any step so Clinical experience might help Some excerpts from usmle website. Keep Yourself Updated at the website Major changes in usmle cs exam from June 17,2012 Communication and Interpersonal Skills (CIS) scale will focus on five functions: 1. Fostering the relationship 2. Gathering information 3. Providing information 4. Making decisions: basic 5. Supporting emotions: basic Supporting emotions: advanced; and helping patients with behavior change. Changes to the patient note

In the new note, examinees will continue to be asked to document relevant history and physical examination findings and to list initial diagnostic studies to be ordered. Examinees will also be asked to create a reasoned, focused differential (maximum of three diagnoses) listed in order of likelihood and to indicate the evidence obtained from the history and physical examination that supports (or refutes) each potential diagnosis. Information on usmle cs exam New patient sample note
Last edited by mbbs2usmd; March 2nd, 2012 at 03:30 AM. Reason: Admin already created blog about changes