Auscultating on CS?

[Blesbok]

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a) How many points do you auscultate on the lung exam? Also, how many points do you do tactile fremitus and percussion?

b) How did you go about auscultating the heart and front pulm exam on a female? Did you do two points with them sitting up and then two points with them lying down?

Usually this isn't such a big deal, but since they make such a big deal about auscultating on the skin and also keeping them perfectly draped, I want to make sure that I don't mess up.

 

[agranulocytosis]

For the lung I did 8 points for auscultation, and 6 for percussion, no tactile or vocal fremitus crap. I just did 3 points for heart in the female patients. All skin contact and I passed with no problems.

EDIT: what I did for cardiac auscultation was to have them sit up and place the stethoscope through the neck of their gown after it had been slightly untied, and then right after that I'd go into lung auscultation with them untied but with the gown still on.

 

[Blesbok]

For the lung I did 8 points for auscultation, and 6 for percussion, no tactile or vocal fremitus crap. I just did 3 points for heart in the female patients. All skin contact and I passed with no problems.

EDIT: what I did for cardiac auscultation was to have them sit up and place the stethoscope through the neck of their gown after it had been slightly untied, and then right after that I'd go into lung auscultation with them untied but with the gown still on.

8 points on the back? Or six points on the back (3 left, 3 right) and two on the sides? Any lungs on the front?

Also, did you do orthostatics on anyone? I was reading the FA and in the minicases it makes it sound like orthostatics should be written in the diagnostic testing on the note, but in the full cases it makes it sound like it should be done during the exam.

 

[agranulocytosis]

8 points on the back? Or six points on the back (3 left, 3 right) and two on the sides? Any lungs on the front?

Also, did you do orthostatics on anyone? I was reading the FA and in the minicases it makes it sound like orthostatics should be written in the diagnostic testing on the note, but in the full cases it makes it sound like it should be done during the exam.

6 points on the back and the 2 on the sides for lungs, no lungs in front (although I do lungs in the front in real life on rotations when patients refuse to sit up or turn over, I don't think it's advisable to do this on the CS).

And I didn't do any orthostatics. If I felt there was an indication for it I put it in the patient note section as an order. I think time is too short in the patient encounter to be able to do a full orthostatic workup so I just wrote it in. In all honesty, the majority of my time in the patient encounters was with counseling and history-taking. The PE took approximately 5 minutes for each patient I was with.

 

[Blesbok]

6 points on the back and the 2 on the sides for lungs, no lungs in front (although I do lungs in the front in real life on rotations when patients refuse to sit up or turn over, I don't think it's advisable to do this on the CS).

And I didn't do any orthostatics. If I felt there was an indication for it I put it in the patient note section as an order. I think time is too short in the patient encounter to be able to do a full orthostatic workup so I just wrote it in. In all honesty, the majority of my time in the patient encounters was with counseling and history-taking. The PE took approximately 5 minutes for each patient I was with.

Cool. Somewhere I saw recommended doing like 8 on the back, 2 on the sides, and 4 on the front and I just wanted to make sure we didn't really need to do the front ones.

Did you do lachman's, drop test, or any of the actual tests that you would do if someone hurt their knee or shoulder? or did you just do palpation, active and passive rom, strength, and dtrs? It doesn't seem like FA really recommends doing lachmans and mcmurrays and all those things.

 

[Dogg1]

Time becomes an issue if you try to be complete. I had a patient that really needed a complete neuro exam but it's just not possible in that amount of time. Just try to do the basic tests that you think are needed, drape the pt, wash your hands, Provide closure at the end. If you have alot of time then consider going for completeness but I think you'll find time is tight

 

[OneFellSwoop]

In my honest opinion, it is just like kindergarten (and yes, I have taken and passed both kindergarten and Step II CS)
1)Place nice with others (ie patients: speak english, wash hands, drape and be polite)
2)Use your words (communicate your thoughts)
3)Know that 1+1 is 2 (have at least a remote clue of what is going on with the patient)

Anything beyond those three things, and I really think you are over preparing for the exam. So just relax, do some practice cases at the end of 1st aid, and then just treat it like another day in clinic in terms of H&P, except go a little heavier on the H.

 

[Blesbok]

One more thing. Is there a piece of paper outside the room that you can write on or do you have to wait until you are in the room?

 

[Dogg1]

They give you a piece of paper for each encounter at the beginning, along with two pencils and a clipboard. You can only write on the sheet of paper once they give you permission to begin the case (reading case on door & entering). After each case they collect the piece of paper used for that case. ( Your literally standing in front of the door like your ready to run a race & waiting until they give you the go ahead---its really very funny)

One thing for heads up. You can type or write your H + P note. If you type, it will only allow a limited amount of characters thus if you are too complete you will run out of room and have to erase stuff to make sure you get key points

 

[moinmoin]

Totally agree with Swoop. Play nice and you will be fine. I just got my score today (passed without issues) and I was freaking out a tiny little bit before hand. I NEVER auscultated more than 6 points anywhere on lung exam. I only listened to one quadrant of the abdomen every time. Never did orthostatics myself. Just make sure you leave time to counsel patients and tell them your assessment and plans.