USMLE study report I

Today is the first day of David class. Practicing with my boyfriend and friends make me
have clear idea and focusing on my error easily . Therefore it is a good idea to informal practice with someone else before start with formal class. Mr.David is not only lively but also dedicate teacher. That's worth for 400 Baths per hour since he give me lot of effective way of communication.

FA case I : abdominal pain

Point1:
Can you " Tell" me more about your pain
; instead using "Describe" which difficult for Thai not to forget "b" end sound.
Does the pain "Move"to anywhere
; instead using "Travel"

Point 2:
Does anything make you feel better
..Anything make you fell worse
Do you have any nausea
...Any + N eg. Any vomiting ....Any rash

Point 3:
Use present simple if you need them recall things recently
= Is it constant or does it come and go
Do you have any allergies
Do you have any other health problems

Use present perfect if you need them recall back through life
= Have you ever been hospitalized
Have you ever had surgery

Point 4 :
Is "That"OK "with" you
not Is it OK to you

Point 5:
I would like to / I am going to / I need to...
not I will...
"I need to" is the most professional sense so it's suitable use in asking personal question
I need to ask you some personal questions
I need to do the rectal exam

Point 6:
May/Can I untie your gown
better than Let me untie your gown
I'd like to retie your gown

Point 7:
Can you turn this point ( indicate direction)
not turn your back esp when patient sit on the cough

Point 8:
Responding to worry question " Could I have pancreatic cancer?"
use "Yes But So" method
I understand your concern + but there are many possible causes for your pain + so we need to do some tests ( Tes's) that should help us have a conclusion.

Point 9:
Summary after history taking --make it easy
OK, you told me that you have..............for............and you also have............., is it correct?

Point 10:
Transition from Hx to PE
Thank you for your information Now, I would like to do a physical exam, is that OK with you?
All right ( next go to wash hand without asking permission!)

Point 11:
Transition from PE to closing
...Please sit up ( if patient lining down)
Thank you Mrxxx , From the information you gave me and the physical exam. It could be..............or....................or it could be something else. So we need to do some blood tests,
stool test, recal exam and ultrasound. Is that OK with you?

Point 12:
I am going to listen "to" your heart, please breath ( พลีสส - บรีทท) normaly
I am going to listen "to" your lungs, take a deep breath (ดีพ-เบร็ท)

Point 13
What do you do Mrxxx
Umm interesting -Do you enjoy your work?

Point 14
Touch (sensation) -> Feel (lymphnode) -> Press (Abdomen) ->Thump(Kidney)-> Pound (heart manual shock)
not use palpate

Point 15;
Rebound tenderness test;
Now, I am going to press and release
Please tell me - if it hurts more - when I press or when I release

Point 16;
Ultrasound explanation " It's like Xray but with sound wave"
not use word " imaging"

Point 17;
Do you have any questions or concerns ? --No
So we will talk again after the test results come back.