USMLE a few random questions about CS

[cardiomegaly5]

I have a few questions about CS, if anybody can chime in, I'd really appreciate it!


Is it possible to dim the lights to do the fundoscopic exam?

If we were not able to do a part of the physical exam, do we put that in the workup? This is aside to the forbidden exams (rectal, genital, pelvic, breast).

Is it better to write ‘N/A’ under physical examination findings in the Differential Diagnoses section or leave it blank?

FA Case 21, 52 yo F ℅ yellow eyes and skin.
Under PE in the patient note:
HEENT: Sclerae icteric;
Skin: Jaundice, excoriations due to scratching, no spiders/telangiectasias/palmar erythema.

How do SPs illustrate icterus and jaundice? Or do we just assume that to be positive from the history and complaint and just write it in the patient note?


When we are given a diagnostic image on the tablet, what questions can I ask? I might be reading too much into this, but I just don’t want to be thrown off on exam day.

During the 10 minutes for writing the Patient Note, can I get up and look at the doorway information again?

Pt ℅ dizziness: What’s the best way to test orthostatic vital signs? How long does it take to repeat vital signs while patient is supine?

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[astlfriend]

Hi, I just took my exam few weeks back. Haven't got the results yet.

1. Yes you can dim the light. In my opinion it's not required. At least, that what Kaplan says. I looked at the reddish glow and moved on
2. You should definitely put additional physical exam in the workup if you want to (e.g. Dix-Hallpike or Orthostatic vital sign)
3. Leaving blank is fine. You don't get additional points for writing N/A

This is what I'd do.
Good luck

 

[Ismet]

I have a few questions about CS, if anybody can chime in, I'd really appreciate it!


1. Is it possible to dim the lights to do the fundoscopic exam?

2. If we were not able to do a part of the physical exam, do we put that in the workup? This is aside to the forbidden exams (rectal, genital, pelvic, breast).

3. Is it better to write ‘N/A’ under physical examination findings in the Differential Diagnoses section or leave it blank?

4. FA Case 21, 52 yo F ℅ yellow eyes and skin.
Under PE in the patient note:
HEENT: Sclerae icteric;
Skin: Jaundice, excoriations due to scratching, no spiders/telangiectasias/palmar erythema.

How do SPs illustrate icterus and jaundice? Or do we just assume that to be positive from the history and complaint and just write it in the patient note?


5. When we are given a diagnostic image on the tablet, what questions can I ask? I might be reading too much into this, but I just don’t want to be thrown off on exam day.

6. During the 10 minutes for writing the Patient Note, can I get up and look at the doorway information again?

7. Pt ℅ dizziness: What’s the best way to test orthostatic vital signs? How long does it take to repeat vital signs while patient is supine?

1. Yes, dim the lights. I believe when you turn off the switch, there's a small light that stays on so it's not pitch black.
2. If you forgot to listen to the heart, don't list "auscultate heart" or something. However there are certain maneuvers you can list (see previous post). If it's a maneuver you don't have time for such as orthostatic vitals, that's something you list on further workup. I wouldn't list something you didn't get to because you ran out of time in the room, though I doubt you'd lose that much if you do it.
3. Leave it blank.
4. I didn't have a jaundiced patient but I did have patients who had some basic special effects makeup that corresponded to their chief complaint. It wouldn't be that hard for someone to give their skin a yellow-ish tone with some makeup. They may also write it in the opening scenario (on the paper outside the room).
5. I can't answer that, I took it before the diagnostic images happened.
6. No. You'll get flagged if you get up when it's not time. The doorway information will be listed in a separate tab on the computer.
See: http://www.usmle.org/practice-materials/step-2-cs/patient-note-practice2.html
The above is exactly how the PN page will appear. The "examinee instructions" tab has the doorway information.
7. You won't have the time to adequately measure orthostatics (it takes more than 5 minutes). Write it in your diagnostic studies.

 

[sazerac]

When I took CS this year, dimming the lights was part of the orientation. It was also part of the practice area where we could play with equipment, before going to the testing area.

I took my test in September 2016 and I don't remember anything about images. If it is new it must be really new.

 

[cardiomegaly5]

Thanks guys!

 

[DisorderedDoc417]

Regarding images, I believe it will generally take what was a clinically vague diagnosis and narrow your differential. You should still be able to talk with and examine the patient per usual.