4/8/2014 https://www.usmleworld.com/Step2CS/Cs/csstart.aspx

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Time Elapsed (min:sec): 28:56

Interactive Pt Notes Print

Clinical Skills EvaluationPatient Note

HISTORYPatient is a 53yo male that presents with back pain that started 1 week ago whilemoving a large box. Pain is 8/10 and constant. it gets better when laying down on thebed and gets worse with movemrnt.Ut radiates to the left thigh and left leg. nofever,chest pain sob, weight loss. PMH: none PSH: none allergies: penicillins gives rashfamily: father died of heart attack Sh: smokes 1ppd for 18 years

PHYSICAL EXAMINATIONPatient is in acute distress due to pain in the lower back vitals: wnl cardio: s1 and s2normal, rrr. no mummur, gallops Back: Lower back tenderness to palpation, rom isabnormal for flexion, extension and abduction neuro: knee reflex is 4/4 bilateral,sensory is 5/5 bilateral on the both legs lungs: cta bilateral

Diagnosis #1: Lumbar strain

History Finding(s) Physical Exam Finding(s)

back pain tenderness on the lower back

moved some heavy boxes 1 week ago

construction worker

Diagnosis #2: disk herniation

History Finding(s) Physical Exam Finding(s)

back pain tenderness on the lower back

radiates to the thigh and leg

Diagnosis #3: metastasis carcinoma

History Finding(s) Physical Exam Finding(s)

h/o smoking for 17 years

back pain

Diagnostic Study/Studies

xr-backmri of the backcbc with differentialpsa level

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