Helpful Mnemonics for Step 2 CS

We have been asked quite a few questions about helpful mnemonics for Step 2 CS. We have compiled several of them here. If you find them helpful, consider jotting them down on a sheet of paper as you enter the standardized patient exam room so that you can use them while remaining calm. Here they are:


PAM HUGS FOSS (a mnemonic for past medical history)

P-revious history of smilar symptoms
A-llergies (medications, foods, over-the-counters, etc.)
M-edications (mediations the patient may be taking, including non-prescription meds)

H-ospitalization (previous hospitalizations for any illnesses or surgeries)
U-rinary changes (frequency, urgency, dysuria, hematuria, foul-smelling urine)
G-astrointestinal symptoms (nausea, vomiting, bowel habit changes, melena, etc.)
S-leep pattern (insomnia, early waking)

F-amily history (any illnesses in the family, particulary first-degree relatives)
O-b/Gyn history (last menstrual period, pregnancies, miscarriages, abortions, length of periods)
S-exual habits (STDs, male/female preference)
S-ocial history (smoking, alcohol, drugs, occupation)


LIQOR AAA (useful for asking about pain)

L-ocation of the symptom (abdomen, back, leg)
I-intesity (use a scale from 1-10)
Q-uality of the symptom (sharp, dull, crampy, burning)
O-nset of the symptoms (when did it start, what precipitated the pain?)
R-adiation of the pain (radiation to the back, arm, groin, etc.)
A-ssociated symptoms (nausea, dysuria, chest pain, shortness of breath)
A-lleviating factors (leaning forward, lying still, using a hot pack)
A-ggravating factors (moving, eating, physical effort)


PQRST (also helpful for asking about pain)

P-osition
Q-uality (sharp, dull, crampy, burning)
R-adiation (radiation of the pain to the back, arm, groin, etc.)
S-everity (use a scale from 1-10)
T-timing (worse with meals, bowel movements, time of day, etc.)


SODAS (useful for obtaining a detailed social history)

S-moking (cigarettes, marijuana, how much, how many years)
O-ccupation (what does the patient do for a living?)
D-rugs (what drug, how do they use it, any IV drug use?)
A-lcohol (whaty type of alcohol, how often, how much, consider doing a CAGE questionnaire)
S-exual history (number of partners, protection, STDs, pregancies, etc.)

All rights reserved worldwide. Copyright 2005, Theodore X. O'Connell, M.D.

Better than the MMSE

Some of the cases on the USMLE Step 2 CS require the test-taker to perform an evaluation of a patient's cognitive function. On some of the message boards, we have seen students asking about the mini mental status examination (MMSE). Our opinion is that there is a better alternative to the MMSE for the purposes of both this test as well as real-world clinical applications.

The MMSE is a multiple part test with a maximum score of 30. The MMSE can be cumbersome to administer, takes a fair amount of time (especially when the patient actually has some cognitive dysfunction), and usually requires that you have the test template in hand in order to administer the test. A newer test known as the Mini-Cog is a better test to use for the Step 2 CS, as well as for most primary care settings.

The Mini-Cog is a 3 minute instrument used to screen for cognitive impairment (most often dementia) in older adults. In several different studies, the Mini-Cog was as effective or more effective than the MMSE and other established screening tests. The Mini-Cog is able to screen for both memory and executive function.

In the Mini-Cog, the patient is told three items (such as apple, table, and penny) and is requested to repeat back and remember those three items. The patient is then asked to draw a clock face with all of the numbers, and then draw in the hands of the clock to indicate a certain time, such as 10:50. After the patient has drawn the clock face, he or she is asked to repeat back the three items that were previously stated.

That's it! The beauty of this test is its simplicity and quickness.

The test is scored as follows:
Recall of 0 items indicates dementia.
Recall of 1-2 items with an abnormal clock face indicates dementia.
Recall of 1-2 items with a normal clock face indicates no dementia.
Recall of all 3 items indicates no dementia.

Essentially, the clock face only comes into play when only 1 or 2 items are recalled. If zero items or 3 items are recalled, the diagnosis is clear-cut.


All rights reserved worldwide. Copyright 2005, Theodore X. O'Connell, M.D.