Of all the odd things...

... in this world a 4 yo mayor. Aiiii. A town in northern Minnesota elected a young child as its Mayor. Is this a prank was the first thought that passed through. Looking at the source it is quite unlikely to be. Is being the Mayor of that town so insignificant that anyone can do it even a child. hahaha. Ever heard of those jokes even my grandmother, my grandfather, my daughter or son can do it better. Well we have a prime example right here. Below is the link to the article for your viewing pleasure...

4 yo male. USATODAY.

On a side note everyone has a friend that never offers to contribute gas money but always wants a ride. What if you did this.... hahaha i kid. 

http://www.youtube.com/watch?v=unShRhci-Iw

How to invest like a medical student: pearls of wisdom

Sitting, feeling sick. A slight fever with fatigue. Yes, I have had contact with an ill person, an answer to one of the questions I always pose my sick patients. Today, I will leave a quote I passed onto a good and old friend that continues to lose money in the markets. It imbues the mentality with which I approach the market. One does not have control over the direction in which a stock will move. Consequently one can simply not avoid making any losses altogether. However one can:
 

Minimize one's losses in stocks till one finds that one or two or three stocks that are moving in the desired direction.

Ramblings

Nothing much going on but its my resolve to post every tuesday so here is nothing. hahaha. Tried getting up around 5 today to do some ck studying. Quite ambitious. I woke up to my alarm blaring and instantly snoozed it and knocked right back out. There has to be a world record there somewhere. Finally woke up at 6 did some work and then headed to muay thai class. Its always great to get a good sweat on. Now I'm completely beat.

Thoughts on Step 2 cs

Like I said before I did not complete one of my notes, additionally I am not enthused with my performance overall. There a few more questions I could have asked, a few more physical exams that I could have performed. However, it is a focused exam with time limitations so I hope I did enough to pass. That said, the whole exam is organized to make things run smoothly. I can not divulge anything about the exact cases that I was tested on so I will not talk or answer questions about the actual cases I had.

I got to the center about thirty minutes early. We waited in the lobby for a few minutes. From there we were ushered upstairs and after confirming that we were scheduled for the day we were moved into a room with a locker for our things, a bunch of wooden desks and a tv. We watched the orientation video below; its the same one that is on the Step 2 cs website. After this we got to play with the tools that we would be using. Then it was down to business.

There were two scheduled breaks. During the first break they served some food. Nothing too extravagant but good enough to provide the fuel needed for the rest of the day. So if you were like me and only showed up with a pack of gum you were all set. Hey at least some of that exorbitant fee for taking this exam went towards food.

I was allowed to use my long coat. thank goodness.

The staff was helpful and did not do anything to distract us from the task at hand. The patients played their roles well. We played our roles. Now I just sit and wait for THREE MONTHS. This is so long. They have to change this lengthy waiting period.

This brings my posts of Step 2 cs to a close. Hope you enjoyed it.  

Update:
I failed!!! I was devastated. How could I fail the CS exam?? Thinking back there main reason was that I did not prepare myself adequately.

On my second attempt, I made sure to devote sufficient time and as well as practice to the exam; I made sure that I understood what they were looking for in grading the exam. I passed, but man that blemish will be on my record forever.

This is now about two years after the exam and I have tutored others to make sure they do not fall where I fell.

My advice to you, if you are reading this, is to not take this exam lightly. Study appropriately with knowledgeable partners and you will pass. Any questions let me know.

Good luck.

So whats next?

Currently in bed with a headache. Step 2 cs is done. It was long in the beginning but then it just breezed by. The only thing that worries me is that I did not complete one of the notes. For now its wait and see. Three months is a long time.

Countdown to step 2 cs: Its D Day:

Woke up at 5. snoozed the alarm and woke up again at 6. Showered, did a few push ups and now i'm having breakfast. See you after the exam! Wish me luck!

Countdown to step 2 cs: 1 days left:

Did some practice cases in the morning. Then went shopping for a shirt and white coat. I found found easily. But guess what when I got home and opened the wrapping for the white coat it was a full length attendings coat and not the short medical school version. My goodness. I tried it on in the store all the lady had to do was retrieve the same coat. I told her I was a medical student. Aaaa. well.... thats water under a bridge now. It will be handled, all that is left is to focus on my exam tomorrow. Later that evening i practiced my cases.

Countdown to step 2 cs: 2 days left

I woke up, practiced my full physical examination and then focused on my neurological examination. Around 4 pm I drove off to showdown site, and checked into the sheraton a block away from the test center.
 At this point I have already gone through all the cases in first aid, and have reviewed the mini cases multiple times. In the evening, i reviewed a full length case and noticed i had tunnel vision because i knew what was coming and what answers were expected in the case. The solution for this is to  treat every case like new, like its the first time you are seeing it, ask open ended questions, and figure out solution from scratch.

Finally, I am meeting my time deadline of 15 minutes per case. For this to happen I changed my approach to being more focused both in the amount of questions and in the physical exam. Now I do not ask every question under the topic instead i get chief complaint, the associated problems and get descriptions of all problems (quality, duration, location etc.)

Later while lounging in my nice hotel room, I noticed I left my white coat and shirts at home in my haste. Not to worry, there's macy's close by. Tomorrow I will do some shopping. This is why you always give yourself some time leeway. Good thing I arrived a two days prior.

Tomorrow is my last free day before D day. Will iron out a few details and just practice to make sure I have the overall routine to approaching the patient down.

Vine: That moment you see you are in the same class as someone you know.

youtube link: http://www.youtube.com/watch?v=KxG035tQJ8c

Count down to Step 2 cs: 3 days left

In the afternoon, I completed all the other cases with my buddy. After this we went over performing a full physical exam to make sure I was doing my physical exams correctly. In the evening, after practicing , I packed my bags and headed to my girlfriends house. I will go through the physical exam a few more times and also review some of the cases i found difficult. Then around 2 pm tomorrow, Sunday, I will head of to philly.

I have a splitting headache. Most likely a tension headache, quite possibly caused by the lurking exam.

Count down to Step 2 cs: 4 days left

I practiced 5 cases with a medical school buddy. He pointed out a few things i could tweak here and there. The pressure of the exam being so close is beginning to hit me.

edit: this post is from two days ago. 

Countdown to step 2cs: 5 days

I made a lot of progress. I now have only nine cases to go through, meaning I will have seen all the cases at least once ahead of the planned time, saturday. This leaves saturday to do some revision.

Today, I went through 13 cases: 9 back to back in the afternoon, and 4 back to back in the evening. This time i spent ten minutes after every case writing my notes. My head felt really stuffed and heavy after about the 6th case but i pushed on.

Issues:
1) still struggling with time. My best time was 10 -11 min but that was a pediatric case that involved no physical exam. My best time with adult cases was 15 min. My slowest time was 22 min.
2) Enuresis, rape,  mva, and pregnancy cases

Solution:
1) time: stick as closely to pneumonic as possible and then after ask extra questions.
2) make a list of cases that I need to focus including the ddx, diag wkup, and questions and review them daily





















Side note: its thanks to my sister and girlfriend that I have progressed so quickly!

Count down to Step 2 cs: 6 days left

I followed my normal morning routine so there's nothing to write about there. In the afternoon I did 3-4 cases with my sister and then 8-9 cases  back to back in the evening with my girlfriend. I was inconsistent in asking about the job, stds, drugs. At times I would ask at other times I would be so caught up in the case that I would forget. Also, I need to work on my DM and HTN follow up visits, and to work on being more observant of the patient, what they are doing and their environment. I might have missed things because I was exhausted but exhaustion is can not and will not be used as an excuse. I have to be on point always. Will review what i missed tomorrow morning in addition to the usual.

Today my best time for completing the patient section was 16 minutes.

modifications:
1)for chronic cases always screen for depresion
2)for each new complaint get a description ( if in ros there is pain somewhere else rewrite SIQORAAA, if there is another complaint rewrite DOCPAAA, and if there is vomitus get descriptions and ask if blood or mucous and ask to descrip.
3)for social history use pneumonic to remember alcohol use and drug use work etc.
4)for sexual history use pneumonic to remember std, protection, types of partners, counsel
5)counsel as you go along 
6)focus focus focus and pay attention to details around you.

Countdown to Step 2CS: 7 days left

Day 1 of step 2cs studying was fine. I took it a little easy to ease myself back into the groove of going hard, and to let my sister get used to the format. By easy I mean I did only four to five cases back to back. Tomorrow, I will do 6-7 cases back to back. I will now detail how I organized my day and what i have learned.

In the morning, whilst in my car  for an hour and a half awaiting the end of alternate side parking,  I reviewed/memorized the blue sheet structure and mnemonics outlined in laura's video. (check out my earlier post) When i got home i looked over some mini cases mainly to review differential diagnoses as well as the possible lab tests to run. I also read through the special scenario section, which details how to handle difficult patients, questions, ethics etc. Then i relaxed.

At 2 pm, I practiced 4 cases, with my sister being the standardized patient. Then we took a break till 8pm at which time we did the remaining 5 cases. I did not write up any patient notes today. The longest time I took to complete a patient encounter including the physical exam was about 22 minutes, with my best time being 18min (technically it was 12 minutes but that was for a short pediatric case so i'm not counting that.)

I noticed that I occasionally missed a few things: asking permission to start physical examination; counseling about smoking or sex (this was at the end so maybe i was tired); and for pediatric cases hearing, vision, vaccination, and last check up. I will make a list of the things that i keep forgetting to do and just review it everyday, especially on the morning of the exam. To make sure I dont neglect to counsel patients with bad habits i will place a big star beside the desired section (smoking, drugs etc) the moment i write down the information.

Neymar vs Celtic Away HD

Neymar was trully jostled, kicked, pulled elbowed  throughout the whole match against celtics today. If he can toughen up like messi  and grow from these rough matches he is bound to become a versatile weapon for barcelona. As a skilled striker a lot of teams will be using rough tactics to try and disrupt his momentum. Will he grow above that and still shine? That is yet to be seen. I will follow his games hoping upon hope that his true potential shines through. (side note: I'm not saying he sucks. He is a way above average player as he is now. But he can get even closer to messi/ronaldo status and thats what i want to see.)