my experience at 3rd CS experience - nitforum

[ArchivalUser]

dear forum, I have been trying to gather as many data as posible to get a guide to know the chances I got to either pass or fail this attempt,I took it in Houston exam center everything including SP and proctors were fine,too in the morning time,
What I did in every case:
meeting and greeting professinally by my last name treated sp by his her last name too and told them my position
Asked about comfort of SP in the room
Asked permission for everything I did in there, replying thnx in all case (sitting asking Qs and doing PE)
Used transitional phrases after each Q block (LIQORAAA,PAMHUGSFOSSSoda and from Qs to PE)
I was compassionate (said sorry after knowing CC and after every hard news, also after the problem Q from SP I always used this start skript. I am sorry and I understand ur concern and then went on with my response)
followed religiously LIQORAAA and on top of it for associated symptoms asked directly about symptoms I was looking for according to SP's CC
thanked SP after each set of Q (LIQORAAA to PAMHUGSFOSSSODA and from it to PE)
thanked SP after PE
start skript for closure: Well ms /mr --- thnx very much now I need to sit down with you and discuss about my impression,ok? htnx,then said just summarizing(desribed CC and main items of it) on the PE I found (let them know what was found out),then said:at this point my suspission is that you might have(DD in lay man terms just 2 0r 3),but to pin point the actual cause of your symptoms I need to order some tests and then said in lay man terms what work up was needed, with results of them handy I'll sit down w you again to discus about the final diagnosis and a proper treatment for you,ok? after that I said,well in the mean time I will give you my contact info so in case of need you can easily reach me as I'll be ready to help you,ok?Ill also give you some web site addresses where you'll find more info about your symptoms and ho many tools we have to help you fix it,ok? do you have any Q for me? thnx and left, on PE always kept doing bla bla bla as it counts for info sharing: I used to say well now I need to check(ur chest,tummy,back,head and neck eyes and so and requested permission word (OK?),let them know what I was to do and what was found i mean it is normal here there is no scar,no masses,I see some streaks in your belly,it is tender here oh I am so sorry about! and so forth,in SODA whenever they said I drink even 1 glass of wine a month I asked CAGE q's and for the rest of stuff I did councelling about all these habbits smoking sex EtOH etc, always asked them about their appetite sleeping, body weight household members and problems there,in some of my encounters I could not finish my closure although I could start my closure skripts and saying DD in all cases,In all encounters I could paraphrase,councelling,answer problem Q's,said main DD in all case I shaked hands at very beginning and before living SP room,always smailed at very beginning at was reassuring I mena
-Good morning are you Mr/ms-----,thnaks I am dr------I'll be ur physician tday,nice to meet ya, then I would like asking you some Q's and do a PE is it OK w u?thnx,then said Mr/MS-- are u ok woth the settings of this room? Thnxs Anyway I will do something just to help you feel more comfortable ok?(draped),Dont u mind if I sit down and write down some notes based on what you say?thnx and started LIQORAAA, after CC always said oh I am so sorry to hear about that,as I know it is a hard time x you,but I want you to know I'll do my best x for ok????and went with rest of Qs,
I always helped them sitting up lying down standing up, tying and untying gown after letting them know about and asking their permission,took care of draping and handling w table extensors after permission to do so,when ran out of time my excuse was I was paged and shaked their hands at the same time I told them Mr/Ms I am so sorry but I have an emergency call,as soon as I finish it I will be back to go on helping you ok?
For PN which was my previous failing item I typed them this time,I could finish all of them but I know I did more PE and Q s that as irrelevant I did not write in PN I always used gloves In every case I did HEENT neck chest belly and exts plus the focussed exam part for heent and neck always used light sources so I was forced to do fundi and otoscpy I also inspected w it nose and mouth
answering problem Q's all the Qs they asked could be luckilly answer by a reasonable skript something like:
Well Mr Ms-I am sorry and I understand ur concern (compassion and understanding) but to give u a proper answer I first need to do a PE and order some test and with them handy I will be able to sit down w u to discuss(involving Sp in course of actions and follow up) about the final D and a proper treatment that really help you getting better (letting them know about what s next and follow up course) never said dont worry about or I dont think so rather be compassive reassuring and after that say well it might be one of the causes of ur symptoms although other conditions such as bla bla blas can also cause them)
always tried to use lay man terms
palpate- press
percuss tap
auscultate listen to (ur lungs heart guts belly)
inspect take a look at ur-----
examine-check
work up-tests
US sound wave picture
XR picture
CT MRI series picture
ANgiography veins picture
cervical culture -front passage fluid test
bacteria-bug
puncture-tap
motor -muscle strength
reflex muscle response
sensation sharp and dull check
deambulation-gait
endoscopy-watching the inside of ur(airways,belly,guts bladder)

lay man terms used for DDs
cancer-mass
itis-inflammation or infection
hemorrhoids varices-vein dilatation
gastric duodenal ulcer- spots in your stomach or gut
uterus womb
lithiasis-stome
secretions and body fluid main qualificationmelly,bloody,color(yellowish,brownish greenish etc) amount(spoonful,teaspoonful,cupful)more frequent time mori=ning,afternoon,evening sleeping time

Dear forum sorry for being so extensive but I tried to share w u guys own experiences,and based on it please let me know what you think about it,I tried to be as inclusive as posible anyway let me know in case of any Q and please remember positive and negative opinions will be highly valued as they will help in my future study
God bless all of oyu guys,sincerely Nitforum

[ArchivalUser]

well,thanx.dat luks surely helpful.
i've a confusion though,plz tell me whether to stand or sit while taking history?also is it ok if v write jst da positive points while taking history?

[ArchivalUser]

I always preferred sitting down and wrote +s but in PN you surely will have to write what was+ plus relevant negatives too what I did and I dont know if it is OK,it wa sin HPI after describing CC LIQORAAA ,writting and denies any other urinary or digestive symptom sleeping or appetite problems,in case there was no other symptom related to the CC organ system then I also wrote denies bla bla bla ej;for neuro denies tingling diplopia seizures or decrease in muscle strength, (dat was written after describing what was +) in previous attempt I only wrote +s and failed in PN so this time I tried to follow kaplan and FA PN schemes and examples,is it clarifying ur Q???????????if more Q dont hasistate and ask them,at this moment I am having a very hard and stressing time too so the minimum I can do is sharing my own experiences for the better outcome of all of u guys,God bless u all,niforum
standing can be treated by SP as a way to stress or hurry them up,so eliminate dat negative tick mark and look easy and sitting down

[ArchivalUser]

what is best time for counseling,just after hx or in closure?

[ArchivalUser]

Based on what overall you have done as you says, I believe you are going to pass.

Most says you don't need to be perfect to pass, you need to be complete and that's what you did.

One thing I would like to know from other readers of the forum, -do we have to ask permission to sit down in front of the patient?

Thanks nitforum to let us know your experience. That's helpful.

[ArchivalUser]

Dear freinds,you sohud ask permission for whatever you are gonna do,draping,sitting down, asking Q doing PE take down notes,passing from one to other set of Qs do that for sure and they will show you a kind smile in my first attempt I did what one normally does this is a little bit superfluous and I failed everything they looked serious not happy,be genuine when telling them u r gonna do ur best to help them,as you actually will because first of all you need to pass it and dat means you are earning points towards passing look in my second attempt I did so and I passed CIS, so do not feel afraid of asking permission for everything and saying I am sorry for everything negative it happens to SP remembers the exam is in big part about bedside manners so be meticulous with it,I never washed hands but did wear gloves, always ask is EtOH in ur skin OK/while cleaning up ur steth w EtOH pads they'll apreciatte it and even more will watch over you to see whether you do what you said actually, so my best recommendation do all these stuff for sure I trainned myself everytday in the following general set of Q as basic

Entering room
Knock door,Good morning r you Mr Ms-?thnx am Dr-i'll be ur physician tday,I would like ask u a few Qs and do a PE, is that OK w u?thnx
Mr Ms are u OK w the settings of this room?thnx anyway I'll do something just to help u feel more comfortable,OK? then drape SP, as the next u will see is a chair where drape is on easy next Q Mr Ms dont u mind if I sit down and ask u a few Qs thnx
Openning How may I help u?
compassion and reassurance Ohhh I am really sorry to hear about that, I understand its a tough time x u but I want u to know I'll do my best to help u OK? thnx
then ask LIQORAAAA but most of them wont tell u anything when asking about associated symptoms so ask one by one assosciated symptoms that can rule in or out ur DDs
when done well Mr MS thnx very much but now I'd like to know more about ur health in general or in the past ok? thnx
-are u allergic?
d'you take any meds?
-D'you have any other med condition?
How about surgeries?
Accidents,
Hsopitalizations
can u tell my about ur parents' health? if there is any problem here say always am sorry to hear that
-Are u sleeping OK
How's been ur appetite
How's been ur body weight
Have u had chest pain
how about SOB
Pain in ur belly
Changes in bowel movements
Discomfort during urination
Bloody urne
Bloody stool
in every female with no ob gyn problems only ask When was ur LMP/
have u noticed any change in ur skin
have you had LOC
-transition well Mr MS thnx very much but now I'd like to know more about ur private lifestyle and whatever u say here will be confidential is it OK w u?
-what;s ur job
who dyou live at home with,dyou have problems there
are u sexually active
how many sexual partner dyou have
dyou use anything x protection
dyou smoke
dyou drink EtOH
dyou use any recreational drug
how's been ur mood
-transition well Mr Ms thnx so much now Id like to do a quick PE on you OK?thnx allow me a couple of minutes just to put on my gloves and clean up my steth OK? and when putting on gloves ask are u OK w EtOH on ur skin?thnx

well dear friends I hope this quick set of Qs be of help I self trainned on it and u can do them all in max 5 minutes min 3-4 min, so ull have 10 extra minutes x PE and closure
I personally recommend as soon as I get the info about the habbit as soon as they say I smoke or I drink once a year etoh or I have sex only w husband or wife and do not use anything x protection even in old SP I councell x unprotected sex,EtOHism or whatever in my last attempt I had a fatigue case of an adult male,u know where problem was Financial problems as was laidoff from his company and had problems w his wife cause of it and used marihuana in military years so I councelled him about both suicidal risks rec drugs and SP with economic issued and cost concerns,I told him about social workers food transportation bills payment benefit and even more help w medical care costos,got it??????????
well if u have any doubt that come up just let me know to help and ask God to help u accept him in ur heart and daily life he will always help u let hm guide u too, I hipe this stuff help once more feel free to ask in case of doubt Ill help u 4 sure,notforum

[ArchivalUser]

AAAAAAAAAHHHHHHHHHH
super important!!!!!!!!!!!!!!!!!!

x CV exam always lift up 45 grades the head of the table and let SP know about it ok?
remember x CV exam:
check fundi
check neck JVD and carotid pulses and auscultate them
Chest Lungs adb Hepatomegaly HJ reflux
EXT pulses and CCE