w***n
发帖数: 9 | 1 我已经练了一段时间了，所以想找相同进度的一起练 ，
想把fa 的大case 小case能考前快速再练一遍，
最好是女生。skype上见
中部时间 上午十点到下午4点之间都availabe。 请 站内邮箱联系 | y*2
发帖数: 13 | 2 I WILL take the exam in Nov. IF YOU ARE AVAILABLE ,WE CAN PRACTISE TOGETHER.
my Skype:newliry0818 | F********1
发帖数: 151 | 3 今天和skype上两位学友谈到CS准备，我翻出自己以前写的CS总结，在这里贴一下仅供
参考。Hope it helps. 另外，我觉得面对面练习非常重要。希望大家一定要找同城考
友面对面练习。
1) Encounter may begin.
开始阅读doorway信息。last name, 性别，主诉，快速瞄一眼要不要求体检。然后快速
写下OCDFPPAAAGUWASFT PFHAMOSS, 女性把o改为OB/GYN。在AAA旁边写上2-3个鉴别诊断
名词，同时写上体检项目（心、肺、腹、神、头、甲）。同时，这些也是需要询问的大
系统。这一步40-50秒，争取不要超过1分钟。
2) 走到病人面前，微笑，建立眼神接触之后再说话，伸出手准备握手。Hi, Mr. Smith
, I am Dr. X, I am a physician in this hospital. I will be taking care of
you today. Very nice to meet you!
SP: Nice to meet you too.
Before we start, let me cover you up with this sheet to make you feel a
little bit more comfortable.
Now, tell me why you are here to see us today?
SP: I have pain in my belly.
I see. I will do my best to help you. I will need to ask you a few questions
and do a physical exam on you. Is that OK?
Yes.
Tell me more about your pain.
3) 按照字母表问，OLIQRAAACDFP。
注意：1. Paraphrase三次以上，边重述边写，不要沉默地写。
2.时刻不要忘记加上Empathy和Ressurance，主诉后一次，中间阳性症状说一次，结尾
closure说一次。
I can see you are having a difficult time because of this, I want to assure
you that I will do my best to help you to figure out what's going on.
It sounds pretty tough on you, we will do everything we can to help you.
关于Associated Symptoms，尽量每个问题都要问到点子上，不要随便乱问。一共4-5
mins一定要结束第一部分问诊，一定要有非常强烈的时间意识，各个系统的鉴别诊断问
最重要的两三个问题就好。
神经：Do you have any weakness anywhere in your body? Any numbness? Any
headache? Any change in your vision? Have you ever lost consciousness? Have
you ever fell down? Any injury to your head before?
呼吸：Do you have a cough? Does it bring up anything? What is the color? Any
blood? Do you have a runny nose? Any sore throat? Do you have any chest
pain? Does it change with your breathing? Have you ever had shortness of
breath? How many pillows do you use at night? Do you have any swelling in
your legs?
心脏：Did you feel heart racing? Do you have any chest pain? Have you had
shortness of breath? What do you think may have started your shortness of
breath?
消化：Do you have nausea? Did you throw up? What is the color? Any blood?
Any change in your bowel habits? Any belly pain?
甲状腺：Do you feel intolerant to coldness or heat? Do you have heart racing
? Do you feel shaking of your body anytime? Any change to your skin or hairs?
糖尿病：Any change in your vision? Any numbness anywhere? Any weakness in
your body? Any infection anywhere? Do you monitor your blood sugar level at
home? There is a medical test called HbA1c, which is glycated hemoglobin,
have you ever get it tested? When was the last time? What is the reading?
高血压：Any chest pain? Any shortness of breath? Any headache? Have you ever
lost consciousness? Any weakness in your body? Any numbness anywhere? Any
injury to your head before?
Depression: FACE SLIP feeling guilty? Appetite? Concentration level? Energy
level? Sleeping? Libido? Have you lost any interest in things you enjoyed
before?
儿童：OCDFPAAAGUWASFT + FBICD + PHAMFOSS : feeding, birth history,
immunization, check up (last check up), developmental milestones, day care?
Abuse: SAFE GARD: Do you feel safe at home? Are you afrid of your husband?
Any support from family and friends? Any Emergency plan? Gun at home?
Depression?
4) start PFHAMOSS. 按照字母表，不要跳来跳去容易遗漏问题。
Now Mr. Smith, I'd like to ask you about your general health. Have you ever
had this symptom before? Do you have any other major disease? Any high blood
pressure? High blood sugar? High cholesterol? 只有50岁以上才问，年轻人不问
这三个问题。
Family: Does anyone in your family have these diseases as I mentioned?
Anyone in your family has a similar symptom like you? Anyone in your family
has joint disease?
Have you ever been hospitalized before? Any surgeries?
Are you taking any medications now? Any over the counter ones?
Are you allergic to any medicaitons?
Mr. Smith, now I would like to ask you a few questions about your personal
life styles. These are routine questions I ask all my patients. Is that OK?
Do you smoke? How much do you smoke? For how long? Do you drink alcohol? How
much do you drink per week? Have you ever used recreational drugs?
在这里就顺便做戒烟戒酒的counseling，免得后面closure的时候忘记了。
Mr. Smith, you know that smoking is not good for your health. It increases
your risk of heart and lung diseases in the long term. Have you ever thought
of quitting smoking? I know it is difficult. Whenever you want to give it a
try, please let me know and I could be of help. We also have some excellent
programs in the hospital. I will give you the contact information if you
want.
Mr. Smith, now I would like to ask you a few questions about your sexual
life. These are routine questions too and it is confidential between us.
Are you sexually active? How many sexual partners do you have in the past
year? Do you use condoms all the time?
The reason why I ask this is because not following safe sex methods will put
you at a higher risk of getting sexually transmitted diseases. Therefore, I
must advise you to observe safe sex methods including using condoms
consistently. OK?
4) Mr. Smith, now I'd like to perform a brief physical exam on you. Please
excuse me. I am going to wash my hands.
利用洗手时间，在心中说出来，告诉自己，查什么？是否最相关最重要？先查什么，后
查什么？比如糖尿病，查眼底、carotid bruit、神经（上下肢运动、感觉，下肢感觉
分soft touch, vibration, position，查上下肢DTRs）。除非parkinson's不查小脑、
不查步态。除非dizziness，不查romberg。
Now Mr. Smith, let's start. I'd like to do a general examination on you
first, then look at your legs.
告诉自己，一个好的case首先是一个完成了的case，所以时间控制最重要，当机立断，
宁可少问、少检查，只查最必须的，多做Empathy + Reassurance + Counseling。体检
项目可以少，但是要非常认真，不要rush，要真的做检查。比如听诊器要停留足够时间。
Closure: 十分重要！
Mr. Smith, I have finished the physical exam. Thank you for your cooperation
. Let me summarize. You have c.c. for how long. 3 positive, 2 negative, 2
positive PE. Based on the information I have up to now, there are several
possibilities. There is a disease caused by lack of oxygen/inflammation/ a
disorder/some dysfunction in your organ, in the medical term it is called
XXX. There are some other possibilities, like normal aging or your mood
change may have lead to this, a inflammation in your other organ etc. I will
need to run some blood tests, take your urine/stool sample to have some
tests, and take a picture at your brain/chest/stomach by using some image
techniques. After your results come back, I will meet with you again to talk
about the final diagnosis and the best treatment plan that I will choose
for you.
Counsel Counsel Counsel!
急诊案例不让喝水、吃东西。健康宣教可以少做。但是Empathy Reassurance要尽量多
做一些！
In the meanwhile, I want to ask you to...
1. 戒烟戒酒带避孕套。这一部分在前面SH完成，后面不要重复。宁可Empathy +
Reassurance。
2. 特殊案例：糖尿病饮食控制、锻炼、按时服药，足部检查。I encourage you to
follow strict diet control, do regular exercise and take medications
following their instructions as you are doing now. They are very important
for managing your disease. And I also would like you to check your feet
carefully once a day for any cuts or infections and get it checked up as
soon as possible if anything happens.
安全（神经系统案例防止跌倒、Depression hurting yourself、Abuse emergency
plan）
Reassurance once before asking any questions!!!
I want to assure you that you are in good hands now. We will do everything
we can to give you the best care that we can provide.
Do you have any questions?
Challenge questions: I understand that you have the concern of/are in a lot
of pain/it is very frightening to think of the possibility of .... I won't
know for sure until I have all your test results back. It is for your safety
to have the tests done and let us figure out what is going on first. It is
not safe for you to have pain killers right now as it may hide up some
underlying disease. I want to assure you that we will get your tests done as
soon as possible. After they are back, I will be at a better position to
figure out what is really going on and choose the best treatment options for
you.
I understand that you are very concerned now. There are a few possibilities
to explain your symptoms and Parkinson's disease is only one of them. Right
now we are not sure what is exactly the reason until we have all your
results. And even if it is Parkinson's disease, it is a treatable disease. I
want to assure you that you are in good hands now. We have many treatment
options to manage the disease. There are also some clinical trials going on
for this disease and some of them have very promising results. Let's take
one step at a time and please do not worry too much at this stage.
Does that answer your question? Do you have any other questions?
然后 Reassurance More!
3. 其他一般信息。my contact information、counselor、support group。
I will leave my contact information with you and please feel free to call me
anytime if you want. Sometimes talking with a counselor will also help you
to deal with this difficult situation. They are very experienced in working
with patients with similar situation. If you want, I can set up an
appointment for you. We also have a support group in this area and if you
want I will give you the contact information.
Ok, I will see you again when your results are back. Thank you and take care!
总体策略：
1. 注意调整细节。站在45度角，说话咬字要清楚，嘴型稍微夸张一些。宁慢勿快。
2. 加强Empathy + Reassurance + Counseling！！！
3. 10分钟响铃的时候一定要开始体检一半了。
4. 1 + 4 + 3 + 4 + 2。每个案例争取提前1分钟出来。如果太快太早问完，则多问any
questions? Counseling, Reassurance，争取这方面的分数。
---- 写PN。
2分钟：鉴别诊断＋work up。DDx: 最有可能是什么？第二可能是什么？第三可能是什
么？后面随便乱写两个，不要多想。Workup：体检？血检？尿、粪、拭子培养，scans.
从最简单到最相关，然后到复杂不太相关。
6分钟：
C.C.
HPI - 第一句话描述主诉，OCDFPPAA
第二句话描述其他相关或者伴随的阳性体征。
第三句话描述特别相关的阴性体征。
ROS PMH PSH MEDS ALL SH FH OB/GYN
(儿科：Birth History, Check Up, Developmental History, Immunizations)
2分钟提醒的时候一定要开始写Physical exam了。
In no acute distress.
VS: WNL.
从上往下平均分布，先竖着写上所有必须写的检查系统。然后每一项先写上必须写上的
阳性／阴性体征。然后补充内容。 | e***5
发帖数: 106 | | F*****g
发帖数: 31 | 5 It is really helpful. Thank you very much. | a*****a
发帖数: 12 | 6 Thank you so much for sharing your experience! |
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