sign in sign up
<<
Home , Differential diagnosis, Eye examination, Weber test

COMPILED BY DR. VARSHIL MEHTA

CREDITS- WWW.MEDICAL-INSTITUTION.COM

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 1

SEXUAL ASSAULT

OTHER IMPORTANT QUESTIONS TO ASK: Assault Rape Mnemonic  Loss of consciousness, Dizziness  Weakness/Numbness  Vaginal bleeding  Changes in vision  Blood in urine/stool

PHYSICAL EXAMINATION for Assault Rape Mnemonic  Head & Neck exam: Inspection, Palpitation (Look for signs of head trauma)  Mouth exam: Inspection  Cardiovascular exam:  Pulmonary exam: Inspection, Auscultation, , . (Especially in a with SOB & Chest pain)  Abdominal exam: Inspection, Auscultation, Palpation  Neurologic exam: Mini Mental Status Exam, Cranial nerves (2-12), Gross Motor & Sensory  Musculoskeletal exam: Inspection, Palpitation (look for bruises and trauma)

DIFFERENTIAL DIAGNOSIS for Assault Rape Mnemonic  This section depends on patient’s . For example Chest pain, , Headache, Loss of consciousness and

ALWAYS include the following in your :  Sexually Transmitted Infection  Pregnancy

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 2

DIAGNOSTIC WORK UP for Assault Rape Mnemonic  Pelvic exam  Urine Beta-hCG  Wet mount, KOH prep, Cervical Culture, Vaginal pH  XR-Skeletal survey  HIV antibody, VDRL, HBV antigen  Chest X-ray\

IMPORTANT NOTE: Assault Rape Mnemonic  Make sure to show empathy.  If patient is crying offer her tissue & water and let her finish crying.  Support the patient by letting her know that you are here for her and that what happened to her was not her fault and could have happened to anyone.  Encourage her to report the incident to the police if she/he hasn’t already done so.  Offer her emergency contraceptives.  Let her know that you are going to let the social worker come and talk to her and provide her with phone numbers for support groups and other resources.

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 3

HEARTBURN

PHYSICAL EXAMINATION for Dysphagia Mnemonic  HEENT: Check throat for erythema and exudate  Neck exam: Check for , thyromegaly  Cardiovascular exam: Auscultation  Pulmonary exam: Auscultation  Abdominal exam: Inspection, auscultation, palpation, percussion.  Skin: check for signs of /CREST.

DIFFERENTIAL DIAGNOSIS for Dysphagia Mnemonic  Esophageal (Dysphagia starts with Solids and progresses to liquids. Hx of chronic alcoholism, smoking & weight loss )  Achalasia (Dysphasia for BOTH solid and liquids)  Esophagitis (Pain on swallowing. Immunocompromised ―e.g. HIV, Corticosteroids‖)  Systemic Sclerosis (Look for CREST )  GERD (Cough at nights, Hoarseness, sore throat)  Plummer-Vinson syndrome (Iron deficiency anemia, sore throat, craving ice, dirt, clay…)  Zenker diverticulum (Halitosis, regurgitation)  Pill-induced esophagitis (e.g. Bisphosphonates)  Mitral Stenosis (look for an immigrant or a pregnant female)

DIAGNOSTIC WORKUP for Dysphagia Mnemonic  CBC  Serum iron, ferritin, TIBC  Throat culture  HIV antibody and viral load, CD4 count  Chest X-ray  Barium swallow  Endoscopy  Esophageal manometry  Chest CT

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 4

ENURESIS

Differential Diagnosis for Enuresis mnemonic  Primary nocturnal enuresis (monosymptomatic)  Secondary enuresis (a/w stress such as: life or environmental changes, major illness or abuse)  UTI  Diabetes mellitus  Functional bladder disorder

Diagnostic Work up for Enuresis mnemonic  Genital Exam  Urinalysis  HbA1c  Urine culture  Renal Ultrasound

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 5

HEADACHE

PHYSICAL EXAMINATION for Headache Mnemonic  HEENT: Palpation of the Sinuses & Temporomandibular joints, Funduscopic exam, Nose, Mouth, Teeth & Throat  Neck Examination: Inspection, palpation  Cardiovascular exam: Auscultation  Pulmonary exam: Auscultation  exam: CN 2-12, Muscle strength, DTRs, Kernig’s sign & Brudzinski sign

DIFFERENTIAL DIAGNOSIS for Headache Mnemonic  headache  Tension headache   Pseudotumor cerebri   Temporal arteritis ()   Intracranial mass

DIAGNOSTIC WORKUP for Headache Mnemonic  CBC  ESR  CT of head  MRI  Lumbar puncture  CT of Sinuses

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 6

HEARING LOSS

PHYSICAL EXAMINATION for loss Mnemonic  HEENT: Test hearing by speaking with back turned, Rinne & Weber, Whisper test, Otoscopy, Funduscopic exam,  CV exam: Auscultation.  Pulmonary exam: Auscultation.  Neuro: CN 2-12, Sensation, Motor, DTRs, Cerebellar: Finger to nose, Heel to shin. 

DIFFERENTIAL DIAGNOSIS for Mnemonic   Cochlear N. damage due to loud noise   Ménière  Ototoxicity (Loops, Antibiotics & Aspirin in the History)

DIAGNOSTIC WORKUP for Hearing loss Mnemonic   Tympanography  Brain stem auditory evoked potentials  CT-Head  VDRL/RPR (r/o Meniere disease)

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 7

HEMATURIA

Physical Examination for Hematuria:  Cardiovascular exam: Auscultation  Pulmonary exam: Auscultation  Abdominal exam: Auscultation, Palpation, Percussion, Check for CVA tenderness.

Differential Diagnosis for Hematuria:  Nephrolithiasis  Bladder cancer  Coagulation disorder  BPH   Polycystic kidney disease  Renal Cell Carcinoma  Glomerulonephritis  IgA nephropathy   UTI

Diagnostic Work up for Hematuria:  Genital exam  Rectal exam (check for BPH or Prostate cancer)  Urinalysis  CBC, PT/PTT  Urine Culture  Urine cytology  Kidney ultrasound  BUN/Cr  PSA, IVP  Cystoscopy  CT abdomen / pelvis

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 8

HOARSENESS

PHYSICAL EXAMINATION for Hoarseness mnemonic  HEENT: Inspect conjunctivae, mouth, throat, lymph nodes and thyroid gland  Pulmonary exam: Auscultation  Cardiovascular exam: Auscultation  Abdominal exam: Auscultation, palpation  Extremities: Inspection, DTRs

DIFFERENTIAL DIAGNOSIS for Hoarseness mnemonic   Laryngeal cancer  Vocal cord polyps/Nodules   Mitral valve stenosis

DIAGNOSTIC WORKUP for Hoarseness mnemonic  CBC  TSH  Cardiac Echocardiogram  Laryngoscopy  CT scan of chest and neck

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 9

INSOMNIA

Physical Examination for (Sleeping Problem):  HEENT exam: Thyroid, Lymphadenopathy  CV exam: Auscultation  Pulmonary exam: Auscultation  Abdominal exam: Auscultation  Extremities: Check for tremor on outstretched fingertips & edema  Skin: Inspection for dryness  Neurologic: DTRs, Brisk reflexes

Differential Diagnosis for Insomnia (Sleeping Problem):  Anxiety  Caffeine-induced insomnia  Hyperthyroidism  Insomnia related to  Advanced Sleep phase disorder  Delayed sleep phase syndrome  Adjustment insomnia  Illicit drug abuse 

Diagnostic Work up for Insomnia (Sleeping Problem):  TSH, Free T4  CBC  Urine drug test  Polysomnography  ECG

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 10

JAUNDICE

PHYSICAL EXAMINATION for  HEENT: Inspect , Under tongue  Cardio vascular & Pulmonary: Auscultation  Abdominal exam: Inspection, Auscultation, Palpation, Murphy’s sign, Percussion  Extremities: Check for Asterixis, Edema  Skin exam: Spider nevi, Cutaneous telangiectasia, Palmar erythema,

DIFFERENTIAL DIAGNOSIS for Jaundice  Viral Hepatitis  Acetaminophen (Tylenol) toxicity  Alcoholic hepatitis  Primary biliary cirrhosis  Ascending cholangitis 

DIAGNOSTIC WORKUP for Jaundice  AST/ALT, Bilirubin, Alkaline phosphatase  CBC  Viral hepatitis serology  Abdominal Ultrasound  Abdominal CT  ERCP

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 11

KNEE PAIN

PHYSICAL EXAMINATION for Knee Pain  Mouth: Inspection (Look for ulcers to rule out SLE)  Musculoskeletal exam: Inspection, Palpation, ROM of both knees. Examine other joints (Wrist, shoulder, , hands, fingers, hip)  Hair & Skin exam: Inspection  Cardiovascular exam: Auscultation  Pulmonary exam: Auscultation  Abdominal exam: Inspection, Auscultation, Palpation, Percussion

DIFFERENTIAL DIAGNOSIS for Knee Pain   Pseudogout  Systemic erythematosus (SLE)   Gonococcal arthritis   Osteoarthritis

DIAGNOSTIC WORKUP for Knee Pain Mnemonic   Cervical culture  Knee aspiration & Synovial fluid analysis  XR of knees  CBC  ANA, Anti-dsDNA, Rheumatoid factor  Blood culture

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 12

MUSCULOSKELETAL PAIN

PHYSICAL EXAMINATION for Musculoskeletal Pain Mnemonic 1) Shoulder Pain:  Head and neck exam: Checked for bruises, neck movements and signs of head trauma  Exam of the arms: Compared both arms in terms of strength, range of motion (shoulder, elbow, wrist), sensation, DTRs,

2) Lower back pain:  Back exam:Inspection, palpation, range of motion  Extremities: Inspection, palpation of peripheral pulses, hip exam  Neuro exam: Motor, DTRs, Babinski sign, Gait (including toe and heel walking), passive straight leg raising, sensory exa

3) Calf Pain:  Extremities: Inspection, palpation; checked for Homans’ sign  Joint exam: Inspection, palpation, range of motion (knee, ankle, hip joint on both sides)  Neuro exam: Sensory and motor reflexes (knee, ankle)

4) Heel Pain:  Extremities: Palpation of medial calcaneal tuberosity, Achilles tendon, plantar fascia, retrocalcaneal bursa. Passive range of motion and general strength of ipsilateral knee and hip. Ankle dorsifl exion and great toe extension and passive range of motion; strength testing of ankle dorsifl exion and plantarflexion  Neuro: Checked sensation to touch for dermatomes of foot and ankle; assessed Achilles tendon reflex

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 13

DIFFERENTIAL DIAGNOSIS for Musculoskeletal Pain Mnemonic

1) Shoulder Pain:  Shoulder dislocation   Clavicular fracture  Humeral fracture  Osteoporosis  Elder abuse

2) Lower Back Pain:  Lumbar muscle strain  Disk herniation  Lumbar  Metastatic prostate cancer  Tumor in the vertebral canal  Vertebral compression fracture  Multiple Myeloma  Malingering  Ankylosing spondylitis

3) Calf Pain:  Deep venous thrombosis   Myositis  Rupture of Baker’s cyst  Hematoma  Spasm due to injury or

4) Heel Pain:   Calcaneal stress fracture   Retrocalcaneal bursitis  Tarsal tunnel syndrome  Foreign body  Ankle sprain

DIAGNOSTIC WORKUP for Musculoskeletal Pain Mnemonic 1) Shoulder pain:  XR of the shoulder and arm  MRI—shoulder  Bone density scan (DEXA)

2) Lower back pain:  Rectal exam  XR—Lower spine  MRI—Lower spine  PSA  CBC, calcium, BUN/Cr  Serum and urine protein electrophoresis

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 14

3) Calf pain:  Doppler U/S of the lower extremities  D -dimer  Hypercoagulability testing  CBC with differential  CPK and myoglobin level  CT venography  MRI

4) Heel pain:  XR—right ankle  Bone scan  MRI

ERECTILE DYSFUNCTION

DIFFERENTIAL DIAGNOSIS for Erectile dysfunction  Drug induced erectile dysfunction (eg. Beta-blockers, SSRI’s)  Hypertension induced erectile dysfunction  Diabetes mellitus induced Erectile dysfunction  Psychogenic Erectile dysfunction (eg. Depression)  Peyronie’s disease  Leriche syndrome

DIAGNOSTIC WORKUP for Erectile dysfunction  Genital examination  Urinalysis, Microalbuminuria  Serum glucose, HbA1c, BUN/Cr  CBC  Doppler ultrasound of penis  Nerve conduction studies

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 15

PSYCHOSIS

PHYSICAL EXAMINATION for Hallucinations Mnemonic

examination: Inspect and check for reactivity  Neurologic exam: Mini-Mental Status Exam, Cranial nerves (2-12), Motor exam, DTRs, Gait, Sensory exam  Pulmonary exam: Auscultation  Cardiovascular exam: Auscultation  Abdominal exam: Auscultation

DIFFERENTIAL DIAGNOSIS for Hallucinations Mnemonic

 Drug induced  Brief psychotic disorder  Schizophreniform   Schizoaffective

DIAGNOSTIC WORK UP for Hallucinations Mnemonic

 Mental status exam  Urine Toxicology  TSH  CBC  Electrolytes  Polysomnography

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 16

TREMORS

PHYSICAL EXAMINATION for Tremor: NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask permission before you start each physical exam. Make sure to use proper draping (don’t forget to tie back patient’s gown). Make sure to explain the physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.  Neurologic exam: Mini-Mental Status Exam, Cranial nerves (2-12), Muscle strength exam, Sensory exam, DTRs, Cerebellar, Gait.  CV exam: Auscultation  Pulmonary exam: Auscultation

DIFFERENTIAL DIAGNOSIS for Tremor:

 Parkinson’s disease (resting tremor)  (postural tremor ―tremor on outstretched arms‖, action tremor)  Physiologic tremor (postural tremor, action tremor) [eg, anxiety, caffeine, hypoglycemia…]  Hyperthyroidism (fine tremor + classic signs of hyperthyroidism)  Drug induced tremor [eg, Beta-agonist, nicotine, lithium, metoclopramide…]  Wilson’s disease (resting tremor, similar to Parkinson’s tremor)  Midbrain lesion

DIAGNOSTIC WORK UP for Tremor:

 CBC  TSH and Free T4  Heavy metal screens (eg, Arsenic or Mercury)  Brain MRI  for Kayser-Fleischer ring,  Serum Ceruloplasmin,  AST/ALT, Liver biopsy (Wilson’s disease work up)

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 17

FORGETFULLNESS

PHYSICAL EXAMINATION for Forgetfulness Mnemonic: NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping (don’t forget to tie back patient’s gown). Make sure to explain each physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.  Eye exam: Inspect pupils, Funduscopic exam.  Neck exam: Carotid Auscultation.  Neuro exam: Mini-Mental Status Exam, CN (2-12), Motor, Sensory, Gait, DTRs, Romberg sign.

DIFFERENTIAL DIAGNOSIS for Forgetfulness Mnemonic:

 Alzheimer’s disease  Vascular ―Multi-infarct‖  Pseudodementia (Dementia due to depression)  Hypothyroidism  Vitamin B12 deficiency  Subdural Hematoma

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 18

DIAGNOSTIC WORK UP for Forgetfulness Mnemonic:

 CBC  Electrolytes, Calcium, Glucose, BUN/Cr  Serum B12, TSH, PRP  CT of head  MRI of brain  EEG

COUNSELING for Forgetfulness Mnemonic

 If patient does not remember the name of his/her , ask for the list of the medication. Patient should have a Paper with the list of .  I would like to ask your permission to speak to your family and ask them a few questions.  I would like you and your family to meet with our social worker to assess home safety and supervision.

SMOKING CESSATION COUNSELLING

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 19

OB/GY CASE

PHYSICAL EXAMINATION for OBGYN History Mnemonic

 Pulmonary exam: Auscultation  Cardiovascular exam: Auscultation  Abdominal exam: Auscultation, palpation, percussion

DIFFERENTIAL DIAGNOSIS for OBGYN History Mnemonic

 All females in reproductive age  Pregnancy  Amenorrhea  ()  Domestic violence  Depression  Infertility  Sexually transmitted disease  Females who are going through menopause  Dyspareunia

DIAGNOSTIC WORKUP for OBGYN History Mnemonic

 Pelvic examination,  Urine Beta-hCG  Cervical culture  KOH prep, Wet mount, Vaginal pH,  TSH  Pelvic ultrasound

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 20

Child with Noisy Breathing (Stridor):

Differential Diagnosis for Child with Noisy Breathing (Stridor):

 Foreign body aspiration  Croups  Laryngitis  Epiglottitis  Retropharyngeal bascess   Peritonsillar

Diagnostic Work up for Child with Noisy Breathing (Stridor):

 ABG (Arterial Blood Gases)  Chest X-ray  Neck X-ray  CBC  Direct laryngoscopy  Bronchoscopy

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 21

CHILD WITH DIABETES MELLITUS

DIFFERENTIAL DIAGNOSIS:

 Type 1 Diabetes Mellitus  Mellitus  Cushing’s syndrome [Cushing’s syndrome Mnemonic]

DIAGNOSTIC WORKUP for Child with Diabetes Mellitus mnemonic

 Basic metabolic panel  HbA1c  Urinalysis/Microalbuminuria  Insulin and C-peptide level  Islet cell antibodies  24 hour urine cortisol

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 22

COUGH

Do NOT forget to

 Offer Cup of Water or a Tissue if the patient is coughing  If patient is holding a tissue make sure to ask her to show it to you to see if there is any blood.  Ask if tried quit smoking in past, if not educate.

Physical Examination for Cough:

 HEENT: Inspect Mouth, Throat, Lymph nodes  Cardiovascular exam: Auscultation  Pulmonary exam: Auscultation, Palpation, Percussion, Tactile fremitus  Abdominal exam: Auscultation, Palpation

Differential Diagnosis for Cough:

(with chronic history of smoking)  Lung abscess  Atypical  Typical pneumonia  COPD exacerbation  Wegener granulomatosis

Diagnostic Work up for Cough:

 PPD, Sputum gram stain, Acid Fast smear, CXR, CHEST CT  Bronchoscopy, Lung biopsy  CBC, Blood Culture, C-ANCA Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 23

DEPRESSION

PHYSICAL EXAMINATION for Depression mnemonic

 HEENT  Cardiovascular exam  Pulmonary exam  Neuro exam

DIFFERENTIAL DIAGNOSIS for Depression mnemonic

 Major depressive disorder  Adjustment disorder  Pseudodementia (Confusion/memory loss)  Domestic violence (Abuse)  Normal Bereavement   Dysthymic disorder  Cyclothymic disorder  Bipolar type 1  Bipolar type 2  Fatigue  Weight loss  Weight gain (atypical depression)  Sleeping problem (Sleepiness/Insomnia)  Erectile dysfunction  Dyspareunia (pain during sex)  Diabetes Mellitus

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 24

 Tremor  Amenorrhea  Cancer

DIAGNOSTIC WORK UP for Depression mnemonic

 Physical Exam  Mental Status Exam  Complete Blood Count (CBC)  Urine Drug test  TSH  HbA1c  Pelvic exam/Genital exam  CT of the head

DOMESTIC ABUSE

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 25

DIZZINESS

PHYSICAL EXAMINATION for Dizziness Mnemonic

 HEENT: Inspect for , Rinne & , Whisper test, Otoscopy, Funduscopic exam, Mouth & Throat.  Cardiovascular: Auscultation  Pulmonary: Auscultation  Neuro: Cranial nerves (2-12), Sensation, Motor, DTRs, Gait, Romberg test, Dix-Hallpike Maneuver.

DIFFERENTIAL DIAGNOSIS for Dizziness Mnemonic

Ask the patient whether they experienced ―sensation of room spinning‖ or Lightheadedness.  Ménière disease (Vertigo, , Hearing loss)  Orthostatic hypotension due to dehydration (Diarrhea, or Diuretic use. ―Presents with lightheadedness not vertigo)  Benign paroxysmal positional vertigo (Dizziness on changing position and Nystagmus)  (Recent URI, Hearing loss, Vertigo)  Vestibular neuronitis (Recent URI, NO hearing loss)

DIAGNOSTIC WORK UP for Dizziness Mnemonic

 Dix-Hallpike Maneuver  VDRL/RPR (to r/o associated with Ménière disease)  Tilt table test  Audiometry  MRI of brain,  Brain stem auditory evoked potentials

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 26

DIABETES F/U

PHYSICAL EXAMINATION for Diabetes Follow Up mnemonic

: Funduscopic exam  Neck exam: Carotid auscultation  Cardiovascular exam: Palpation, auscultation  Pulmonary exam: Auscultation  Abdominal exam: Auscultation, palpation, percussion  Extremities: Inspect feet for infection or ulcers, Check peripheral pulses  Neurologic exam: Motor, Sensation, DTRs, Babinski Reflex

DIFFERENTIAL DIANGOSIS ―DDx‖ for Diabetes Follow Up mnemonic

 In this case the DDx depends on the patient’s HPI and whether he/she has any other complains other than the request for refill prescription. For example if the patient is complaining of ―Chest pain‖ then you must do DDx for Chest pain, or if the patient is having problem with erection then you must do differential diagnosis for Erectile dysfunction and…

DIAGNOSTIC WORK UP for Diabetes Follow Up mnemonic

 Genital Exam (If patient complains of Erectile dysfunction -> Mnemonic)  Serum Glucose  HbA1c  Urinalysis  Urine Microalbumin (to check Kidney function)  BUN/Cr (to check Kidney function)  CBC

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 27

COUNSELING for Diabetes Follow Up mnemonic

Diabetes Mellitus & Hypertension Counseling –> MEDOWS  Medication (Regularity/Compliance)  Exercise (For obese/secondary life style)  Diet modification (Less Salty & Fatty food)  Ophthalmoscopic exam (EVERY Year ―annually‖)  Weight management  Sugar check up daily

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 28

ACKNOWLEDGEMENT  SPECIAL THANKS TO MEDICAL-INSTITUTION.COM AND OUR READERS WHO HELPED US WITH MNEMONICS  DR. VARSHIL MEHTA HAS COMPILED ALL THE INFORMATION FROM THE ABOVE MENTIONED SITE AND PRESENTED IN A SIMPLE WAY.  HE HOLDS NO RESPONSIBILITY FOR ANY ERRORS OR WRONG INFORMATION. HE HAS NOT WRITTEN ANYTHING OF HIS OWN, EVERYTHING IS FROM THE ABOVE MENTIONED SITE.  FULL CREDITS TO MEDICAL-INSTITUTION.COM.  ALL THE BEST FOR YOUR EXAMS.

Step 2 C.S. Made Easy - Compiled by Dr. Varshil Mehta 29