Physical Exam during Step 2 CS

[skk3]

Hey guys, I'm taking Step 2 CS pretty soon and I would love your input on a few things that I have trouble with.

First, what is the best way to approach a pediatric case? In FA, the questions are a jumble of all the milestones one is supposed to ask about, but to be honest, I won't know any of them. If the mother tells me her child is 3yo, I will have no idea which milestones are associated with that age. I know that there will be no actual baby in the room and only the mother will be there, so which questions am I supposed to ask, how do i do a PE, and how am I supposed to write a note??

Next, can you guys give me a some pointers on the neuro physical exam? My school told us that the mini-mental status exam is NOT memorized and that it is expected that you have the official MMSE question list with you during any patient encounter. Did any of you perform the MMSE? Also, can you please provide a detailed way to perform an adequate neurological physical exam? (For example, which reflexes did you check? Did you check all the cranial nerves? How did you check orientation? Did you get the patient to walk around on heel on toes? Romberg?)

Thanks!

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[MedicineMike]

x2 for this. If you do an abbreviated neuro exam in the room, can you put in your plan to do a full neuro work up?

 

[mercaptovizadeh]

Hey guys, I'm taking Step 2 CS pretty soon and I would love your input on a few things that I have trouble with.

First, what is the best way to approach a pediatric case? In FA, the questions are a jumble of all the milestones one is supposed to ask about, but to be honest, I won't know any of them. If the mother tells me her child is 3yo, I will have no idea which milestones are associated with that age. I know that there will be no actual baby in the room and only the mother will be there, so which questions am I supposed to ask, how do i do a PE, and how am I supposed to write a note??

Next, can you guys give me a some pointers on the neuro physical exam? My school told us that the mini-mental status exam is NOT memorized and that it is expected that you have the official MMSE question list with you during any patient encounter. Did any of you perform the MMSE? Also, can you please provide a detailed way to perform an adequate neurological physical exam? (For example, which reflexes did you check? Did you check all the cranial nerves? How did you check orientation? Did you get the patient to walk around on heel on toes? Romberg?)

Thanks!

For peds cases, I'm not sure milestones are so high yield. I would focus on questions oriented towards trauma, infection, etc. No PE here, just say deferred.

For neuro, cranial nerves, light touch, pinprick, vibration, reflexes,gait, pronator teres, rhomberg, finger-to-nose, heel-to-shin, alternating hand movements, extra ocular movements, etc.

I don't think you can bring in any forms like a memes template. Either memorize or stick to more generic lines of questioning.

 

[HarryPlopper]

x2 for this. If you do an abbreviated neuro exam in the room, can you put in your plan to do a full neuro work up?

If you did a focused neuro exam and it addresses what you are looking for, then you won't really have to do a full neuro work up. There is no harm to document further neuro evaluation but you don't want to be wasting time for something that wouldn't matter. Just to be clear though, do NOT document anything that you didn't do. You can be an idiot for much of the CS and pass, but a pattern of documenting illegally will guarantee failure.