This presentation was prepared by me to help the USMLE step 2 CS test takers, especially the IMGs, but will be helpful to the AMGs as well. I have included the tips and tricks of the exam preparation that I developed myself and also those ideas that I gathered from interaction with friends. Also I have compiled a list of drug brand names, abbreviations, etc that will surely be of great use to IMG test takers. I wish this will be beneficial to all the test takers. Please let me know if this was beneficial to you. Best of luck for the CS exam and for the MATCH.

1. USMLE STEP 2 CS Prep
Head Start
by
Dr. Swachchhanda Songmen
Kathmandu, Nepal
May 8, 2017

2. ** notes
• Disclaimer: nothing to disclose
• Shared in slideshare

3. Outline
• TT carry
• Prerequisite
• CS basics: importance; timeline; test center; test
day & center tips
• Preparation phase:
– Requisite
– ICE, CIS, SEP
– Misc: Don’ts, Feedback, cultural issues, Brand names
• Questions about step 2 CS

4. • “I did not take the test seriously but in
retrospect I wish I have prepared better. If
nothing else, more preparation would have
made the test day and post-test waiting more
bearable knowing that I have done everything
I could.” CS examinee

5. TT carry
• Overcoat
• 1 carry on- for interview
• Post cards of Mt Everest & Nepal, visit NTB
• V neck sweaters
• Meds
• Umbrella
• ERAS timeline for Port of Entry

6. http://www.nrmp.org/wp-content/uploads/2015/08/Main-Residency-Match-Calendar.pdf

7. My performance
• 1 month
• One live partner
• Houston

8. Pre-requisites for head start
• CS basic format
• step 2 CS FA section 2 “The patient encounter”
• usmle.org: video about CS, “on the test day” &
“exam format” sections
• 1. apron 2. stethoscope 3. laptop, keyboard &
mouse 4. reflex hammer, pen torch 5. of course,
FA step 2 CS
• Volunteers
• However the most imp thing is:

10. CS- Importance

11. Early
Prep:
• Timeline:

12. Test center choice
• Order of preference
• Early appointment
• Paid agent to change your date ~90$
• “Check4change” add-on in mozilla firefox

14. Rescheduling fee
• >14 calendar days of test date no charge
• 3-14 calendar days before  $400
• 2 calendar days before  $640
• 1 day before  $1,280
• Miss without canceling  $1,280

15. Q & A
• ??? Most imp resource/book:
• ??? Most imp section of encounter:
• ??? Most imp minute:

16. Test Day morning & Before
• Ensure: 1. confirmation notice 2. scheduling
permit 3. passport 4. steth/apron
• Figure how to reach the center in time (early
morning traffic jam, weather)
• If possible, hotel near test center ~ 30$/day
• Adequate sleep
• ??? Antianxiety meds!!!
• Dress formal (as in interview)
• Carry more food items

17. Test center tips
• Reach in time
• Listen presentations again from usmle.org- bit
diff
• Not carry mobile phone to test center, switch off
• 2 areas- 1. locker 2. table for food items, tissue,
drink, mouth freshener
• Check instruments esp. bed, otoscope (click),
opth,
• ???QQQ Gloves/sanitizers/hand wash
• Use larger gloves; err to larger

19. During Test
• 12 cases (3 10min 3 30 min (lunch) 3
10min 3)
• Take deep breath in & out at door: pressure
release
• Upto 1 min: Note: surname, CC, any abN vitals,
D/D, sp exam, smile & knock 3 times
• Leave door to close itself
• 10 min: mid of PE
• 15 min: “Sorry. I got an emergency call. But I will
get back to you once I am done with it. Thank
you. It was nice meeting you.”

20. • Throw gloves outside room
• Click “submit” when told to stop typing.
• Be ready to perform low in first few cases 2-3
• ‘All is well’.
• Think bad cases were dummies & forget.

21. Preparation phase
• Requisite
• How to practice?
• ICE
• CIS
• SEP
• Misc

22. Prep- requisite
• Best: Single LIVE partner together entire prep
• Alt: 2 partners/ “skype”/ kaplan CS practice
center/ foreign fren/ >> non CS examinee
• Adequate time: 1 month (2 weeks- 2 months)
• Order of observership & CS exam
• Materials:
– FA: long cases twice; mini cases
– CS materials from usmle.org
– Others: Neeraj notes, any other resources for newer
cases e.g. AFP, acute urine retention, SPIKES, picky
eater, eating disorders,

23. How to practice?
• section 2 sentences: learn by heart; do not improvise
• Own set of standard format: from introdn to closure.
• same single format for all the cases.
• Practice introduction & closure repeatedly
• Learn it by heart.
• Adv: not fumble, incorrect word, grammatical error,
confidence (affect CIS & SEP); non-std English

24. • 2 frens alternate cases; without reading at first.
• Simulate as much as possible e.g. door
knock, steth, apron, pt gown, pen torch,
• FOCUS Hx & PE
• Identify most imp Q in a group:
– CAGE: all 4 in all cases?
– SIGE CAPS: suicide
• Counseling: smoking, drinking, recreational
drug, safe sex, rape, dementia, suicide, domestic
abuse, etc.
• Transitions & request: esp menstrual, sexual Hx

25. Introduction
• Hi. I am Dr. (Your Surname). Nice to meet you. I am
your physician for today. I am here to ask you few
questions about your problem and give you a brief
physical examination. Is that OK with you? Thank
you.
• Are you comfortable in here?
• Would you mind if I take few notes while we talk?
Thank you.
• How can I help you today?
• I am so sorry to hear about your problem. I will do
my best to help you in this regard. Is that OK?
Thank you.
• Can you tell me more about it?

26. MID
• Thank you very much for sharing these
information. Now let me summarise your
history. It seems that you are having …………………
• Is that all? Did I miss anything?
• Now I would like to give you a brief physical
exam. Please excuse me while I wear the gloves.
(What kind of work do you do? Do you enjoy
your job? Have u been screened by PAP,
mammography or colonscopy?) May I proceed?
• Your vital signs are normal.

27. Closure
• Thank you very much for letting me examine you.
• Based on the evaluation, I have few possibilities in my mind. You
may be suffering from ………… or ……….. or something else. I am
not sure at the moment.
• (I need to perform………. which I will do later).
• Also I need to run a few tests including some blood tests and
……………. Once the results of these tests are available, we will
sit together and discuss the further management plan.
(Despite any diagnosis, I will be always there for you in every
step of the management process.)
• Meanwhile, I would recommend you to …………………….
• Did you understand what we discussed today? Do have any
question for me?
• (After answering again) Did I answer your question? Do you
have any more question for me?
• Thank you very much. It was nice meeting you (hand shake with
gloves on). Have a nice day.

28. ICE: Data gathering (Hx, PE) & Data entry (PN)

29. Modify to your own taste
• LOEFPQIRAAA
• TUBSAWED/ FEVER CUDS/+ neonate
(Suck,awake,Cry)
• PAMHFOSS/ PAM IF BIG DEALS

30. TYPING
• At USMLE.org
• Better: http://usmle-cspractice.com (Time
division/ PDF save option)
• Time: 8 & 10 min; app like Time+ in ios
• Capital or small/capital
• Backspace/ leave as u go.
• Write specific Dx as much as possible e.g. Lt or Rt,
acute or chronic,

31. Abbreviations: http://www.usmle.org/pdfs/step-2-cs/cs-info-manual.pdf

32. Additional abbreviations
• BS: breath sound
• RRR: rate & rhythm
regular
• NC/AT: normocephaly,
atraumatic
• PCN: penicillin
• ASA: aspirin
• IVDA: IV drug abuse
• LOW: loss of wt
• LOA: loss of appetite
• Tsf: teaspoonful
• Tbs: tablespoonful
• Meds: medications
• N/V: nausea, vomiting
• PE: physical exam
• ADLSs: activities of daily
living
• UTD: uptodate
• CTA B/L: clear to
auscultation bilaterally
• NCV: nerve conduction
velocity

33. Order of typing
• History positive point Exam positive
points Differential 2-3 Investigation
supporting points for Differential most
striking ones fill up the negative history &
negative exam formats More supporting
points in differential when any points come
up in mind + add any relevant negative
history

34. CIS
• SP: cooperative, elaborative
• SMILE
• First impression: v imp
• Closure: most imp
• 23 points e.g. Knock; proper dress; introduce; eye
contact; last name; empathy; focused attention;
draping; nonjudgmental; open ended Q; non
leading; multiple Qs; interrupt; paraphrase;
layman terms; transitional; explain PE;
reassurance; summarize; Dx; tests; advices; invite
queries

35. • Eye contact: at forehead, during note taking
• Write down on your sheet with eye contact or
with brief pause
• Stand or sit (only child mother/phone)
• Uhum/ okay

36. SEP
• Standard English: rot memory
• American pronunciation e.g. EKG, antibiotics,
phlegm
• Loud voice
• Grammatical mistakes: plural/singular, Did you
had ….. ?
• Easier in Houston probably

37. Time mgm: Pt encounter
• Internal clock
• Practice∞
• FOCUSSED
• Avoid time consuming portions e.g.
ophthalmoscopy, repeating vitals
• PE: perform specific first, then general

38. Don’ts
• Inadequate practice
• No or poor closure
• Not being specific
• Lack of confidence- eye contact; voice loudness
• Faking PE
• Exam through the gown on
• Pressure on PE e.g. abd, otoscopy
• MUST NOT BE DONE: rectal, pelvic,
genitourinary, inguinal hernia, female breast, or
corneal reflex

39. Difficult patients
• Handle as FA
• Always put pt comfort first e.g. may need to
perform PE & order some pain medication before
Hx.

40. Feedback
• Partner/ fren/ skype/ senior
• Self (record)
• Mirror esp smile
• On ICE, CIS, SEP separately
• Try all & stick to the best fit

41. Cultural Issues
• Hygiene
• Single use otoscope speculum
• Warm up steth bell (or pretend)
• Lip smacking, etc.
• Personal space
• Strong perfumes
• Politeness: Could u plz/ for me/ thank you.
• More psychiatric cases
• Always be in line: during lunch, restroom breaks

42. Layman terms e.g.
• PR exam: examine your back passage
• Urodynamic study: urine flow study
• Ophthalmoscopy: Look inside of your eyes
• Endoscopy: put a pipe fitted with a camera to
look inside of your stomach/ intestine
• Urinary urgency: enough time to make it to the
bathroom once u feel the urge to pass urine

43. Drug Brand Names
• Ecstasy: MDMA
• Angel dust: PCP
• Adderall: amphetamine
• Tylenol: cetamol
• Lipitor: atorvastatin
• Lopressor: metoprolol
• Robitussin: anti tussive
• Zocor: simvastatin
• Maalox/Tums: antacid
• Prilosec: omeprazole
• Nexium: esomeprazole
• Zantac: ranitidine
• Claritin: loratidine
• Advil: ibuprofen
• Anvil: pheniramine
• Valium: diazepam
• Augmentin: co-amoxiclav
• Dyazide: HCTZ+triamterene
• Kaopectate: Antidiarrheal
• Demeral: meperidine
• Ginseng: stimulant (HTN)
• St John wart: CNS stimulant
• Synthroid: levothyroxine
• Ventolin: albuterol
• Advair: salmeterol/
fluticasone

44. Thank you
• ?? Questions about step 2 CS