These are the blue sheet, physical exam, diagnostic studies and differential diagnosis needed for a shoulder pain case in the USMLE Step 2 CS exam:
BLUE SHEET SHOULDER PAIN:
MNEMONIC FOR SHOULDER PAIN AND ANY OTHER JOINT PAIN:
Write just the initial letters on your blue sheet, then make notes depending on the information given by the SP (standardized patient).
COLD STERUM
Cold: Exposure (Raynaud’s)
S: Signs of inflammation (swelling, erythema, warmth, pain)
S: Stiffness (morning stiffness)
T: Tingling, numbness, weakness (usually you may ask them together)
T: Trauma (to the back)
E: Eye infections (reactive arthritis has conjunctivitis)
R: Rash – tick bite (Lyme’s disease)
R: ROM
U: Urinary symptoms (urethritis in reactive arthritis)
U: Ulcers in the mouth (SLE)
M: Menopause/HRT (risk for osteoporosis and pathologic fractures)
PHYSICAL EXAMINATION SHOULDER PAIN:
Always compare both sides of the extremities.
1. HEENT:
Neck: Inspection, ROM.
2. Lungs:
Auscultation
3. Heart:
Auscultation
4. Extremities:
Shoulders: Inspection, palpation (careful), ROM, impingement signs.
Peripheral pulses
5. Neurologic: Upper extremities
Motor: Strength
Sensory
DTR’s
POSSIBLE DIAGNOSTIC STUDIES:
- X-ray of the shoulder (indicate the side)
- MRI shoulder (indicate the side)
- Bone density scan
DIFFERENTIAL DIAGNOSIS:
- Shoulder dislocation.
- Rotator cuff tendinopathy or tear.
- Clavicular or humeral fracture.
- Osteoporotic fracture.
- Biceps tendon rupture.
- Frozen Shoulder Syndrome (Adhesive capsulitis).
Founder & Autor at Ecuadoctors.com
Hematology/Oncology Fellow at BUSM | Former Internal Medicine Residency/Chief Resident at UCONN | Website Developer & Author at Ecuadoctors.com
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