USMLE Review Blog Series: Step 2 CS Points – Part III

residency USMLE review series - 3

Now once you have written down a schedule and identified weak points to improve on, free up the time needed to dedicate to the following:

  1. Read FIRST AID for USMLE Step 2 CS, study it once more cover to cover. Now make notes. Review the notes. It is truly a fantastic resource. Almost identical to encounters on examination day with minimal variation over the past 10+ years. And consistent throughout all of the USMLE CS centers from California to Houston, TX to Atlanta, GA to Philadelphia, PA. Read the book just one more time if you don’t have it memorized yet.
  2. Download the mnemonics!

These are critical to success because it allows one to memorize a short, standard and simple format in order to have a systematic order in asking sets of questions to ALL PATIENTS on EVERY ENCOUNTER so that virtually 99% of the pertinent information is captured.

 Bonus Tip #1:

Asking system based questions after the initial H&P in regards to the complaint is very important. For example, if a patient’s chief complaint is shortness of breath, then ask pulmonary related questions like cough, sputum production, pleuritic chest discomfort, and hemoptysis. But doing a through H&P and FINISHING IT to the end would have included asking about occupation under social history. This would have delved into potential work related occupation pneumoconiosis causing respiratory problems into your broad outlook on differential diagnoses. Perhaps the patient has a history dealing with asbestosis/fibrosis/silicosis which could be at play from a mechanic/brake-lining engineer/shipyard worked/sand-blasters based career, etc.

Bonus Tip #2:

Documentation is KING!

And a significant portion of your grade to pass the exam.

NOT having a fever is just as important as HAVING a FEVER.


Because explicitly asking a patient and then documenting in the record NO FEVER/Afebrile decreases the likelihood of an infectious process on your differential diagnosis.

Remember that medicine is a fine art and one must initially have a broad outlook on ALL THE THINGS IT COULD BE. Then as you gather more information, conduct the exam, and organize the facts, your broad list is descaled to a narrow list and is then fine tuned to listing diagnoses from a most likely to least likely order (and this is important for the documentation and note at the end of the examination!!!).