Lay man phrases for medical terms

Food regurgitation: Bringing up food.
Amaurosis fugax: Sudden loss of vision that is usually transient.
Palpate: Feel for.
Percuss: Tap.
ECG: Records the electric activity of your heart.
CT scan: Imaging the inside of your brain. It is like taking many X-rays and pooling them together.
MRI: Stands for magnetic resonance imaging. Basically takes pictures of the inside of your brain
Ultrasound: Looking at the inside of your belly (or the part in question) using a device on the surface of your body. The waves produced by the device are similar to sound waves and are totally harmless.
Appendicitis: Swelling and inflammation of the appendix.
Inflammation: Swelling due to irritation of the tissue due to a variety of reason.
Ovarian torsion: Twisting of the ovary on its stem.
Pneumonia: Infection of the lung.
Gastroenteritis: Infection of the stomach and the intestines.

Cholecystitis: Swelling and inflammation of the gall bladder.

Hepatitis: Swelling and inflammation of the liver.

USMLE Step 2 CS pass/fail rates

	2006-2007*		2007-2008*
	#Tested	%Passing	#Tested	%Passing
Examinees from US/Canadian Schools that Grant
MD Degree	17,256	97%	17,302	97%
1st Takers	16,769	97%	16,715	97%
Repeaters**	487	93%	587	92%
DO Degree	28	93%	48	88%
1st Takers	28	93%	47	87%
Repeaters**	0	N/A	1	†
Total US/Canadian	17,284	97%	17,350	97%
Examinees from Non-US/Canadian Schools
1st Takers	14,439	77%	13,787	72%
Repeaters**	2,379	68%	3,436	64%
Total non-US/Canadian	16,818	76%	17,223	70%

	2005-2006 Pass percentages			2006-2007
	ICE	CIS	SEP	ICE	CIS	SEP
All US/Canadian Schools	97	99	100	98	99	>99
All Non-US/Canadian Schools	85	87	99	86	81	92

Above data indicate that almost 1 in every 4 international graduates will fail the USMLE Step2 CS. Commonest reason for failing used to be ICE (Integrated Clinical Encounter) but more and more IMGs are now failing the CIS (Communication and Interpersonal Skills). Unlike the popular belief, English proficiency is an uncommon cause of failure. In 2005-2006 for example 99% of test takers passed in SEP. More students are failing in SEP now as compared to earlier however.

Patient Note

Importance of PNs in the USMLE Step 2CS is often underestimated. Many test takers score low on the data gathering because of a poor patient note. Here is a template that I suggest you use for every patient note. Make sure to include every heading. Even if you think it is not important in this particular case. I preferred writing down the Differential Diagnosis and Diagnostic Work Up part before writing the history and physical exam part but you can do either way that you feel comfortable.

History template

[Basic info] 30 yo female c/o [CC] pain in abdomen x 2 days. [ODP and CC description] Pain is in the lower half of her abdomen, colicky, 7/10 without any radiation. Pain started at rest and gradually worsened to present state. Has taken 2 tabs of Tums today morning with partial relief. There is no specific aggrevating factor. [Associated symptoms from the affected system] She has associated Nausea and Vomiting. She vomited 2 times today morning. Non bilious/non bloody. No diarrhea. [Review of other systems] No cough. No pain elsewhere in the body, No trauma, No urinary complaints.

[P]Past medical history is significant for asthma for which she takes [M] budesonide and albuterol. No previous surgeries. [A]Allergic to penicillin and sea food. [S]Is sexually active with her husband and uses condom for contraception. [O] Has one living child that was born vaginally at term 3 years ago. No pregnancy or delivery related complications. [H] That was her only hospitalization. LMP was 4 weeks back. Is normally regular every month and lasts 2-3 days. [S] Does not smoke or drink alcohol. Works as a teacher in primary school. [F]Family history significant for grandmother with ovarian cancer. No DM or HTN in family. [U and G were covered in the first paragraph]

Physical exam template

[General] Appears to be in pain but in no acute distress.

[Vitals] Vitals HR: 80/min, RR 20/min, BP 120/80mmHg, Temp 37 C

[GPE] No pallor or icterus. Neck supple.

[Sytemic Exam]Abdomen: Non distended, Normal bowel sounds in all 4 quadrants. Tenderness on palpation of thr right illiac fossa. No rebound tenderness. No masses or organomegaly.

Chest: Symmetric movements, Normal vesicular breath sounds bilaterally.

Heart: S1S2 normal. No murmur.

Differential diagnosis

1) Acute appendicitis

2) Ectopic pregnancy

3) Ovarian torsion

4) Pelvic inflamatory disease

5) 

[Remember to write the Differential in order or possibility]

Diagnostic Work Up

1) Pelvic exam

2) US abdomen and pelvis

3) CBC

4) Urine pregnancy test

5)

[Remember to write Pelvic and other such exams in your Diagnostic Work Up. Examples of commonly forgotten things include

Pelvic exam

Digital rectal exam

Orthostatic vitals

Minimental state exam

Pure tone audiometry]

What to take to the Step 2CS test center

The four things you need to take to the test center are as follows:

1) Stethoscope (If you forget they will provide one but it is generally recommended that you take your own)

2) White laboratory coat (If you forget they will provide one but it is generally recommended that you take your own. And of course make sure the pockets are empty!)

3) Scheduling permit

4) Photo ID [Acceptable forms of ID include the following forms of unexpired identification: passport, driver's license with photograph, national identity card, other form of unexpired government-issued identification, ECFMG-issued identification card. Your identification must contain both your signature and recent (no more than 10 years earlier) photograph. If it contains your photograph but not your signature, you can use another form of unexpired identification that contains your signature, such as a student/employee identification card or a credit card, to supplement your photo-bearing, governmentissued identification.]

Hardy–Weinberg equilibrium with example

The Hardy–Weinberg principle states that both allele and genotype frequencies in a population remain in an equilibrium (are constant) as long as no specific disturbing influences are introduced.

Those disturbing influences could be mutations, non-random mating, selection, limited population size, gene flow and random genetic drift. Because these influences are universal in real life Hardy-Weinberg principle is never absolutely accurate. Although it sounds more theoretical it can help predict things with reasonable error.

Take for example a single gene that could occur as either dominant allele (A) or recessive(a) and their frequencies are denoted by p and q respectively. Assuming population equilibrium, frequency of occurrence of AA(A homozygosity) is p^2 and frequency of aa (a homozygocity)is q^2. Similarly the frequency of Aa (heterozygous) should be 2pq. 

To better understand this consider an autosomal recessive mutation that causes sickle cell anemia in homozygous recessive children. The parents of a boy with this mutation wants to know the probability of their grandchildren inheriting the disease. In order to determine the chance that the child will reproduce with a carrier of the recessive mutation we can use the above equation.  In order to know this we should know the incidence of heterozygous girls with this mutation and this can be derived if the incidence of homozygous (disease) state is known.

Let us assume that the homozygous state occurs at the rate of 64 per 10,000 people. Hence the occurrence of aa (disease) is 0.0064 hence q^2 0.0064 Hence q = 0.08

p+q=1 hence p=1-q=1-.08=.92. According to this, AA is p^2, which is .8464. Heterzygotic frequency is 2pq, which is 0.1472

Hence the chance that the young boy will mate with a heterozygous girl are about 14% and half of all their kids will be homozygous hence the chance that their kids will have the disease is about 30%