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HIGH YIELD
USMLE STEP 2 CS
THE BEST MNEMONICS EVER
• 20+ Mnemonics cover ALL possible cases you may
encounter in USMLE step 2 CS exam.
• 30+ EXTRA tips for the most common mistakes.
•
• Suggested dialogue inside the exam room.
• Suggested form for Patient notes.
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KHALIL, EZEKIEL
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Contents
Mnemonics • History of present illness
• Past medical/surgical history
• Social/sexual history
• Urinary system
• Headache
• Pediatric case (any)
• OBGYN
• Amenorrhea
• Premenopause-
• Domestic abuse
• Diabetic pt
• Neuro- case
• Forgetfulness(Memory Loss / Dementia/ Alzheimer’s)
• Joint pain
• Depression
• Hear loss
• Thyroid
• Nausea / vomiting
• Erectile dysfunction
Tips • Dizziness/Palpitation
• Chronic cough
• Sexual history
• Cranial Nerves
• Tests & Signs u need to know
• Friends for DD
Dizziness “vertigo”
Headache / Migraine
Psychiatry
PED.
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In these notes, you will find mnemonics that cover all possible cases
you may have in USMLE step 2CS exam. So, you will feel comfort
during history taking session.
But we will be very happy to receive your comments, modifications
and new creative mnemonics.
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A Amount
B Blood
C Color
C Consistency
C Content
D Duration
O Odor
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Neck stiffness
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NB:
+Oral Rehydration: Pedialyte or Home-made +in WU: Scheduled PE
“1L of water<5 cups> +1/2 tsp. salt+6 tsp. sugar” “WU= Work Up”
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F Fatigue
L Libido
A Anorexia nervosa /Anxiety & Depresion
G Galactorrhea
Premenopause : HADOC
H Hot flashes
A Atrophy of vagina
D Dryness of vagina
O Osteoporosis (council) “increase wt bearing exercise,vit D-ca”
C Coronary artery disease
Any Female>50 yr: ask about:
1-R u taking vit. D & Ca ?
2-have u ever tried HRT?
drkhalilezekiel@yahoo.com KHALIL’S HIGH YIELD STEP 2 CS MNEMONICS (2nd Ed)
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D Duration of disease
Diet (Sugar/Salt/Fatty foods)
I Insulin regimen/ oral hypoglyemics regimen/ Compliant?
Who gives u insulin?where?SE?
A A1c hg -> Gluc. monitoring (fast, home, HgA1c)
Appetite/Diet / Weight
B Blurry vision (retinopathy)
E Extremity (foot ulcer/infection)
Exercise ( for obese/sedentary life styles)
Eye exam (annual routine)
T Tingling/numbness (neuropathy)
I Infections (Resp/urinary)
C Cardio Risk Factors (HTN, CHOL, Heart disease)
S Sugar Checkup/ last time?
Sex
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H HEADACHE
I INFECTION [SYPHILIS, MENINGITIS]
M MOOD “feel sad”
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S Sleep (difficulties falling/maintain asleep, wake up, snoring, med. to help sleep,
how many hours, nightmares),
Suicide: thoughts, plan, attempts (do u have pills/guns @ home? )
Stress
Support
I Interest, What do you do in your free time? How are you doing in your job? do you
enjoy what you do?
G Guilty
M Mood. ( anxious, sad, hopeless, lonely?
Memory problems
E Energy
C Concentration
A Appetite, changes in your Weight
Attitude towards life (positive/negative frame of mind)
P Psychomotor agitation/retardation (do you feel easily agitated or angry/do u feel
not to do anything?)
Psychiatric “Delusions, Hallucinations, Hopes”
T Thyroid dysfunctions (ABCD HV for HYPOTHYROID)
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P Pain
D Discharge
F FB
I Imbalance / Infection
N Noise
R Ringing
S Spinning
T Trauma / Tinnitus
THYROID: ABCD
HV
A APPETITE/DIET
B BOWEL
C COLD INTOLERANCE
D DEPRESSION
H HAIR/SKIN
V VOICE-Hoarseness
M Metabolic( DKA)/Meds
A Anorexia
N Neurological (BETA) = Bleed/Encephalitis/Tumor/Abscess
G Gastroenteritis
O Obstruction (pyloric /Intestinal)
I Inflammation (Pyelonephr/Cholecyst/Appendic/Pancreat/PID) “-ITIS”
P Pregnancy
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TIPS
DIZZYNESS:
-ROOM SPINNING>>EAR
-LIGHT HEADEDNESS>>HEART/BRAIN
DIZZINESS / PALPITATION:
ANY CASE OF BOTH, ASK ABOUT THE OTHER
Sexual history:
- Are you Sexually Active?
- How Many Partners are you active with?
- Are your partner male or female or both? “Unless the SP says wife or
husband in Q 2”
- Do you use protection during intercourse?
- What kind of protection do you use?
- Ask about anal intercourse in male homosexuals
- H/ STD's, Rx for STD's
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Cranial Nerves:
2 optic -Test visual acuity / Visual field
-Test pupillary reflexes (direct&consensual)
-Test accommodation reflexes
3 Oculomotor -Assess pupillary reactions to light
4 Trochlear -Assess corneal reflection
6 Abducent -Perform H-test for EOM
5 Trigeminal -Sensory: close eyes,touch face&ask where?
-Motor: Assess strength of muscles of
mastication;bite down and palpate masseter
7 facial Ask patient to;
-smile
-wrinkle forehead,
-blow out cheeks
-close eyes
8 Vestibulocochlear -whisper,
-Weber
-Rinne tests
10 vagus Assess movements of the soft palate;
swallow and palpate neck
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Friends for DD
Dizziness “vertigo” Headache / Migraine
-BPPV -Migraine
-Labrynthitis -Cluster headache
-vestibular Neuritis -Tension headache
-Meneire’s dis
Psychiatry PED.
-schizoaffective disorder -GE
-schizophrenia -URI
-schizophreniform disorder -UTI
-psychotic disorder due to GMC -Meningitis
-OM
-Scarlet fever
-Measles
-Varicella
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and
ANY C/O:
1-CC
2-ASSOC. SYMP “SAME
SYSTEM”
Analyze CC in 6 Qs:
3-ROS “HEAD TO TOE”
-Onset/Course/Duration ………………………………
-PRECIPitating/ALLEViating/AGGravating CC: “OCD,PRECIP.,Av/Ag”
-WHEN DID IT START?
factors -HOW OFTEN DO U
HAVE IT?
In this way you will cover more than 80% on a -SINCE IT STARTED,
HAVE U NOTICED ANY
case you do not know! CHANGE IN IT?
You PASS ! -WHAT DO U THINK
(Learn the table on the margin by heart; you will THE CAUSE FOR IT?
appreciate it on the day of exam!) -HAVE U NOTICED ANY
THING THAT MAKE IT
BETER?
-HAVE U NOTICED ANY
THING THAT MAKE IT
WORSE?
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Resp;
1. Do you have any Cough? any blood in it?
2. Do you feel SOB?
3. Do you have any Chest pain?
4. Do you have any runny nose?
5. Do you have any sore throat?
6. have u been wheezing?
7. is there any discharge back into ur mouth?
CVS;
1. Do you have any Cough? any blood in it?
2. Do you feel SOB?
3. Do you have any Chest pain?
4. Do you feel your heart is racing rapidly?
5. Do you feel dizzy?
6. Do you have any swelling in your feet?
7. Do you feel tired?
8. have u ever felt light headedness?
GIT;
1.Do you have any stomach pain?
2. Do you have Heartburn?
3.Do you feel nauseated?
4.Do you have any vomiting?
5.Do you have any Diarrhea? (Bowel mov.)
6. Do you have any constipation?
7.What is the color of the stool? Any blood in it?
Neuro;
1.Do you have any Headaches?
2.Do you have any changes in the vision?
3.Do you have any changes in the hearing?
4.Do you have any difficulty in walking?
5.Do you have any Weakness?
6.Any numbness? Any Tingling?
8.Do you feel dizzy?
9.Do you have any LOC?
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MsK;
1.Do you have any joint pain?
2. Do you have any Muscle pain?
3.Do you have any stiffness?
4. Any swelling of the joint?
5. Any numbness?
6.Any weakness?
7.Any tingling?
8.Do you have any difficulty in walking?
THYROID;
1.Do you have difficulty adjusting to changes in the weather?
2.Have you noticed any Changes in your skin? hair?
3. Do you feel sad?
4.Any changes in Bowel habits?
5. any changes in weight/appetite?
Urinary;
FINISH CUP
1. How often do u pass urine?
2. Do you feel like ur bladder is not fully empty?
3.Do you have to go to bathroom at night?
4. do u lose control of urine?
5. How is your urinary stream?
6. have u ever passed stones?
7. Do you have to push hard during urinat.?
8. Do you have to wait 4 urine to come out?
9. Have you noticed any Blood in urine?
10. what is the color of urine?
11. Do you have to rush to bathroom for urination?
12. Do you have pain during urination?
13. do u have flank pain?
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PHYSICAL EXAM
Patient is in no acute distress OR looks ..(anxious, tired, …)
( The source of information is the patient’s mother. the mother of a …. -month/year-old
female/male c/o her child having …..)
+ VS: WNL (except for temp. Of …)
+ HEENT: NC/AT, PERRLA, no conjunctival pallor.No fundoscopic abnormalities.
Nose,mouth and pharynx WNL
+ Neck: Supple, No LAD, thyroid normal, no carotid bruits.
+ Chest: no tenderness, clear breath sounds bilaterally.
+ Heart: RRR, normal S1/S2, no murmurs, rubs or gallops
+ Abdomen: soft, non-tender, non-distended, +BS, no guarding, no hepatosplenomegally
+ Extremities: no edema, normal DTR in lower extremities
+ Skin: no rash
+ Neuro: MMSE: AOx3, spells backward, recalls 3 objects, Cranial nerves: 2-12 grossly
intact, Motor: strength 5/5 throughout -sensory: intact to soft touch and pinprick, DTR:
symmetric 2+ in all extremities (or lower extremities), - Babinski bilateral, Gait:
normal,
Cerebellar: - Romberg, rapid alternating movement and heel to chin test normal and
symmetric
+ Back: No obvious deformities or signs of trauma. No spinous process or paraspinous
tenderness. Range of motion normal anteriorly.
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