Re: Step-2CS
adonis123 - 10-01-09 11:10



Ideally, one must do the Snellen's both with specs on and off.But, in Step-2CS u donot have that much of a time and u need to cut it short and just do the finger counting.
Remember always to save time.
The doctor has no need to remove the specs.
U can ask the following questions regarding milestones:

Is yur child growing normally?
When did yur child first smile?
When did yur child start talking?
When did yur child start walkng?
When did yur child learn to tie his shoes?
When did yur child start using short sentences?
When did yur child learn to dress himself?

Good Luck!

Re: Step-2CS
docbul - 10-06-09 10:36

Could anyone tell me pls in which cases we need to perform Vision test(from Snellens,the one pasted on the wall during the encounter with SP)

Re: Step-2CS
adonis123 - 10-06-09 11:44



One can check visual acuity in cases with Visual Problems, cases where Visual Complications can occur, like DM, Hypertension and in cases where one will be checking out Cranial nerves.
This can be done with the Snellen's chart.But, on Step-2CS test it is usually enough to test visual acuity by making the patient count fingers at three feet.
GoodLuck!

Re: Step-2CS
docbul - 10-07-09 00:25

hi ,do u have any list of cases on which we are supposed to check Cranial nerves for sure..thanks

Re: Step-2CS
adonis123 - 10-07-09 00:39



Any neurological case like that of weakness,headache,vertigo,etc.
Any case which can have neurological complications like: Diabetes,Hypertension.
Good Luck!

Re: Step-2CS
bingousmle - 10-07-09 00:43

hey can you give a sample encounter with possible questions to ask in a case who has been diagnosed with HIV and the counselling to be given.

Re: Step-2CS
adonis123 - 10-07-09 01:32



The questions in such a case should be:

How can I help u today/What brings u in today?
When were u diagnosed with HIV?
R u taking any medications for it?
Do u know about CD-4 count? What is the latest test result?
Has there been any change in yur weight ?
Has there been any change in yur appetite?
Has there been in change in yur bowel habits?
Has there been any change in yur vision?
Do u have any rashes anywhere?
Do u have any swelling anywhere in yur body?
Do u have any ulcers in yur mouth?
Do u have any other symptoms?
Do u have any cough?
Do u have any discharge anywhere in yur body?
Do u have any difficulty swallowing?
Has there been any change in yur mood?
D u have any sore throat?
Do u have any pain anywhere in yur body?
Whom do u live with?Do they support u?
I am going to ask u some questions about yur sexual health and practice?
R u presently sexualy active?
How many partners do u have?
R yur partners male,female or both?
Do u or ur partners use any kind of protection?

These r some of the questions which can be asked.

Counselling:
U need to counsel the SP about safe sexual practices.
U need to counsel the SP about having a nutritious diet.
U need to cousel him about whether he/she needs any support groups.
U need to counsel him/her about taking regular medications.
U need to counsel the SP about regular follow up visits and blood tests.
U need to counsel the SP regarding getting his/her sexual partners tested.


I hope it helps!
Good Luck!

Re: Step-2CS
bingousmle - 10-07-09 02:12

thats great... thanks..
can you put the counselling part in the actual statements to be made, cause i think thats the crux of the HIV diagnosed case

Re: Step-2CS
adonis123 - 10-07-09 03:00



Yes, that is indeed the crux of the HIV case.
The statements to be used should be:

"As there is a risk of HIV getting transmitted to yur sexual partners ,so in order to prevent the transmission u can use condoms as a type of protection or ask yur partner to use condoms."

"As HIV lowers one's ability to fight different diseases,so it would be very essential to take a nutritious diet , so as to increase yur immunity and maintain yur ability to fight various disease causing microbes."

"Do u have any kind of support.I would be very glad to offer u some information about various support groups which r available.These support groups can be very helpful in addressing and solving the various common problems which u may have."

"Taking medications at their right times is very important in controlling the progression of HIV.I would be glad to offer u an assistance and help with taking the medications at their right times.I will ask our social worker or nursing staff to contact u regarding this."

"It is very important to have a regular check-up and follow-up in order to know about any progression of symptoms or any new symptoms which may emerge.U need to have regular blood tests like CD-4 counts in order to know about the disease activity."

"In order to know whether yur sexual partners have been infected with HIV or not ,it would be very essential to test them and I would be very glad if u could convince them to get an HIV test done.If found positive , they will be able to get the treatment at the right time to prevent progression of their disease and they could use some type of protection to prevent the transmission of HIV to their current or future sexual partners."

I hope it helps!
Good Luck!

Re: Step-2CS
bingousmle - 10-07-09 03:39

yeah that surely helps, how about a counselling dialogue about a paediatric case, apart from convincing the mother to get the child to the hospital what could be a good closure dialogue?

Re: Step-2CS
usmlefever3 - 10-07-09 03:40

i just wonder whether time and tension permits to say that much stuff.......anyway it's very nice

Re: Step-2CS
usmlefever3 - 10-07-09 03:42



i think it depends on the case

Re: Step-2CS
bingousmle - 10-07-09 03:46



say it was a case of fever...

Re: Step-2CS
adonis123 - 10-07-09 04:03



That is where one's spontaneity in asking questions about the symptoms helps a test - taker.This case is not about diagnosis.It is about how u support and counsel the patient who has recently come to know that he/she is afflicted with the dreaded HIV.This is the communication aspect of the Step-2CS.This aspects tests how best u r able to relate to the patient.I always maintain that Step-2CS is about being with the patient,and so if anything takes u away from the SP then that thing is surely wrong.Also, one must never rush thro' an encounter.
If u r worried about the time aspect then u can shorten these statements according to how much time is available.But, if one prefers to do a full physical instead of counselling,then there is a lot of chance that he/she will fail this patient encounter.
Good Luck!

Re: Step-2CS
bingousmle - 10-07-09 04:13


so how about this scenario?

Re: Step-2CS
adonis123 - 10-07-09 04:43



In the case of fever in a child,the first thing u have to say to the parent or guardian of the child is to bring the child to the the hospital now.Never ask them to bring the child tomorrow or later.
U need to ask whether the parent has any means of transport available.If the parent or guardian says no then u have to arrange the one for them.U have to ask whether she has the money available to bring the child to hospital and u need to take care of that by contacting the social services department.These constraints cannot be allowed to become the reasons for the child not to be treated.
U need to tell the parent that u will be always there for their support.U need to tell them to keep on applying cold sponges to the child in order to bring down the child's fever.
U need to ask the parent if she needs anything else in the form of any other assistance,etc.
If the parent says that she/he cannot bring the child because they have some urgent work or have to go to the office,etc.then u have to tell them that if there is someone else in the house who is well aware of the child's symptoms and who can bring the child now.If the parent says there is none else there in the house who can bring the child,then u have to say that u understand the importance of the parent's work,etc but presently the safety of the child is very imperitive and too important.U need to tell the parent that u can write to their employer a letter about the parent's abscence from work if such a need arises.
Tell the parent that u r waiting to see them in the hospital or in the emergency room.
I hope it helps!