Comlex 2 PE Questions

[Mdincorporated]

I have a couple of quick questions regarding the PE:

1. An OMM Structural exam needs to be done with every patient encounter correct? How do you jot it down in the Exam portion as "OMM:" or "T-Spine" . Assuming that my structural exam will be palpating the patient's back for TART .

2. Do we need to do any special tests for cases? For example if theres a patient with appendicitis - do I need to do the Rovsing sign test etc?

3. For OMM - how long do we spend on these treatments? My main treatments are myofacial release, rib raising, and some of the basic stuff. I saw some people mention spencers technique etc. but who has time for spencers with the allotted time?

4. Can anyone recommend what else we need to prepare for in terms of humanistic portion such as counseling, smoking cessation, and anything else that you can think of?

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[ninjaman22]

1. I did an OMM structural exam on every case as recommended by my school. Just a quick ROM of neck while you are doing the neck exam and palpation of the spine after you are done with the lung exam. That was basically my flow for the day. On my note I put it as OMM: hypertonic muscle in the Cspine and Tspine regions without any decrease in ROM

2. Absolutely. I basically did 4 sets of basic physical exam: head/neck, heart, lungs, OMM on everyone, and then case specific. If it's a neuro case do the full neuro exam, if it's an appendicitis case, then do the abdominal exam including the specialized tests. If someone's chief complaint was a cough, I added a HEENT exam to include the nose and throat plus added a specialized lung exam like percussion.

3. You will be fine with the basic treatments. I had three OMM cases: I did 2 soft tissue and 1 muscle energy. Don't spend more than 3-4 minutes on OMM. Make sure to re-check the dysfunctional region after you are done and make sure to note the improvement in your note. Like don't just ask them if the pain is improved. Actually, go through the motion of re-checking their ROM. If you decide to Spencer technique, just pick one technique based on your OMM exam. I think you will be fine with doing soft tissue, muscle energy, cranial, BLT, lymphatics, or rib raising.

4. My strategy for counseling was that I basically counseled everyone on the spot during the social history. If they said they smoke, I would tell them the risks and the options for quitting and ask them what they think. Some would say not today and some would say yes, they are interested. I would tell them we will bring them back for another visit to discuss further. Definitely put it in your note that you counseled them. Same with alcohol and drugs. Just do it during the social history, that way you won't forget at the end.

 

[Mdincorporated]

Thank you so muchhhh! <3 <3 Sorry I have mine coming up in a day and Im freaking out!!! My school hasnt prepared us at all for this stupid thing either!

Just a Couple of more last minute quick questions ...

1. Also for washing your hands what was your approach like - did you sanitize before and wash hands in the end?

2. And was there a clock or timer in the room?

3. Lastly, for the OMM aspect - let's say a patient came in with Ear pain- would you do lets say a structural OMM exam and point out T1 dysfunction and then proceed to treat it with an OMM Technique? Essentially, you diagnose with the OMM Structural as you said and then for tx it can be anything???

4. And did each OMM patient tell you they wanted OMM or did you have to dig it out of them?

5. Was there a patient that just wanted to talk about contraception or anything where it was just you and the patient talking and no PE - or does every patient have a PE?

1. I did an OMM structural exam on every case as recommended by my school. Just a quick ROM of neck while you are doing the neck exam and palpation of the spine after you are done with the lung exam. That was basically my flow for the day. On my note I put it as OMM: hypertonic muscle in the Cspine and Tspine regions without any decrease in ROM

2. Absolutely. I basically did 4 sets of basic physical exam: head/neck, heart, lungs, OMM on everyone, and then case specific. If it's a neuro case do the full neuro exam, if it's an appendicitis case, then do the abdominal exam including the specialized tests. If someone's chief complaint was a cough, I added a HEENT exam to include the nose and throat plus added a specialized lung exam like percussion.

3. You will be fine with the basic treatments. I had three OMM cases: I did 2 soft tissue and 1 muscle energy. Don't spend more than 3-4 minutes on OMM. Make sure to re-check the dysfunctional region after you are done and make sure to note the improvement in your note. Like don't just ask them if the pain is improved. Actually, go through the motion of re-checking their ROM. If you decide to Spencer technique, just pick one technique based on your OMM exam. I think you will be fine with doing soft tissue, muscle energy, cranial, BLT, lymphatics, or rib raising.

4. My strategy for counseling was that I basically counseled everyone on the spot during the social history. If they said they smoke, I would tell them the risks and the options for quitting and ask them what they think. Some would say not today and some would say yes, they are interested. I would tell them we will bring them back for another visit to discuss further. Definitely put it in your note that you counseled them. Same with alcohol and drugs. Just do it during the social history, that way you won't forget at the end.

 

[radsgrad]

Thank you so muchhhh! <3 <3 Sorry I have mine coming up in a day and Im freaking out!!! My school hasnt prepared us at all for this stupid thing either!

Just a Couple of more last minute quick questions ...

1. Also for washing your hands what was your approach like - did you sanitize before and wash hands in the end?

2. And was there a clock or timer in the room?

3. Lastly, for the OMM aspect - let's say a patient came in with Ear pain- would you do lets say a structural OMM exam and point out T1 dysfunction and then proceed to treat it with an OMM Technique? Essentially, you diagnose with the OMM Structural as you said and then for tx it can be anything???

4. And did each OMM patient tell you they wanted OMM or did you have to dig it out of them?

5. Was there a patient that just wanted to talk about contraception or anything where it was just you and the patient talking and no PE - or does every patient have a PE?

For what it is worth i only did an omm assessment on 3 or 4 patients and they were all clearly asking for omm treatment. They either say something along the lines of "last time a doctor did something with his hands and it helped" or " do you think there is anything you can do for me today" those are the patients you should do an assessment and treatment for.

1. I walked in, introduced and shake hands, and then used sanitizer. Didnt use at the end. I am confident if you use it once at all before the physical exam your good.
2. I cant remember seeing a clock, just the 2 minute warning anouncement.
3. Just find a omm dysfunction related to the area of concern and treat it with one or two techniques. Then reassess when you are done.
4. Like i said they almost always volunteer that they are seeking a treatment to feel better today.
5. You could have a patient like that or who wants some kind of preventive or screening test. Just do PE on any areas related to ehy they are there or if nothing else listen to heart and lungs.

 

[DocWinter]

1. An OMM Structural exam needs to be done with every patient encounter correct? How do you jot it down in the Exam portion as "OMM:" or "T-Spine" . Assuming that my structural exam will be palpating the patient's back for TART .

2. Do we need to do any special tests for cases? For example if theres a patient with appendicitis - do I need to do the Rovsing sign test etc?

3. For OMM - how long do we spend on these treatments? My main treatments are myofacial release, rib raising, and some of the basic stuff. I saw some people mention spencers technique etc. but who has time for spencers with the allotted time?

4. Can anyone recommend what else we need to prepare for in terms of humanistic portion such as counseling, smoking cessation, and anything else that you can think of?

1. Also for washing your hands what was your approach like - did you sanitize before and wash hands in the end?

2. And was there a clock or timer in the room?

3. Lastly, for the OMM aspect - let's say a patient came in with Ear pain- would you do lets say a structural OMM exam and point out T1 dysfunction and then proceed to treat it with an OMM Technique? Essentially, you diagnose with the OMM Structural as you said and then for tx it can be anything???

4. And did each OMM patient tell you they wanted OMM or did you have to dig it out of them?

5. Was there a patient that just wanted to talk about contraception or anything where it was just you and the patient talking and no PE - or does every patient have a PE?

1) Most encounters would benefit from a quick check of C/T/L spine or chapmans point check. Health maintenance encounters omit, OMT encounters certainly. Yes, OMT section, then specify your findings.

2) Yes, it would benefit you if you did appropriate and specific exams.

3) You will have enough time to do the appropriate treatment. These patients will have obvious MSK issues and may go as far as to blatantly ask you to treat them. You will not leave the encounter wondering "huh, maybe that was supposed to be a OMT case."
I believe it to be appropriate to shorten counterstrain by stating "usually I would hold this for 90 seconds, but I'm starting to feel a release."

4) Be prepared to council on smoking, excessive ETOH, drug use, and youth as well. It would be appropriate to ask about sexual practices and protection with younger patients. Acknowledge grief and difficulties patients express.

1) Sanitize before putting your hands on the patient. You do not need to repeat on leaving.

2) You will not watch the clock, believe me. Practice your timing before and be ready to close the encounter when you hear the 2 minute warning. This is a good time to talk about assessment and plan.

3) Yes. You have free reign on technique (exception of HVLA). Diagnose and treat as you see fit. Verbalize your findings and treatment as you go.

 

[ortnakas]

I have a couple of quick questions regarding the PE:

1. An OMM Structural exam needs to be done with every patient encounter correct? How do you jot it down in the Exam portion as "OMM:" or "T-Spine" . Assuming that my structural exam will be palpating the patient's back for TART .

2. Do we need to do any special tests for cases? For example if theres a patient with appendicitis - do I need to do the Rovsing sign test etc?

3. For OMM - how long do we spend on these treatments? My main treatments are myofacial release, rib raising, and some of the basic stuff. I saw some people mention spencers technique etc. but who has time for spencers with the allotted time?

4. Can anyone recommend what else we need to prepare for in terms of humanistic portion such as counseling, smoking cessation, and anything else that you can think of?

1. I didn't, and passed. I did a structural exam for anything where it seemed appropriate (mostly musculoskeletal cases).
2. Yes, if appropriate. Maybe not ALL the special tests, but at least some to demonstrate you're thinking about it.
3. Without going into details, I personally recommend fast techniques. Ain't nobody got 90 seconds for counterstrain or however long Spencer's takes.
4. Be a normal human. If a patient interrupts you to tell you something they're worried about or whatever, respond to it, don't just keep going with your H&P. And read through the cases in the Kauffman book and the USMLE CS book for ideas of "humanistic" things that might come up.

Thank you so muchhhh! <3 <3 Sorry I have mine coming up in a day and Im freaking out!!! My school hasnt prepared us at all for this stupid thing either!

Just a Couple of more last minute quick questions ...

1. Also for washing your hands what was your approach like - did you sanitize before and wash hands in the end?

2. And was there a clock or timer in the room?

3. Lastly, for the OMM aspect - let's say a patient came in with Ear pain- would you do lets say a structural OMM exam and point out T1 dysfunction and then proceed to treat it with an OMM Technique? Essentially, you diagnose with the OMM Structural as you said and then for tx it can be anything???

4. And did each OMM patient tell you they wanted OMM or did you have to dig it out of them?

5. Was there a patient that just wanted to talk about contraception or anything where it was just you and the patient talking and no PE - or does every patient have a PE?

1. I sanitized before. Make sure you use the sanitizer and not the soap or you'll be desperately making small talk wondering why the soap isn't drying. Not from experience or anything...
2. Don't think so.
3. Again, without going into details, this feels like overkill.
4. Scared the NBOME powers that be or the ghost of AT Still might smite me if I answer this, so skipping.
5. See #4.

 

[SpartanWolverine]

I have a couple of quick questions regarding the PE:

1. An OMM Structural exam needs to be done with every patient encounter correct? How do you jot it down in the Exam portion as "OMM:" or "T-Spine" . Assuming that my structural exam will be palpating the patient's back for TART .

2. Do we need to do any special tests for cases? For example if theres a patient with appendicitis - do I need to do the Rovsing sign test etc?

3. For OMM - how long do we spend on these treatments? My main treatments are myofacial release, rib raising, and some of the basic stuff. I saw some people mention spencers technique etc. but who has time for spencers with the allotted time?

4. Can anyone recommend what else we need to prepare for in terms of humanistic portion such as counseling, smoking cessation, and anything else that you can think of?

...

[5]. Also for washing your hands what was your approach like - did you sanitize before and wash hands in the end?

[6]. And was there a clock or timer in the room?

[7]. Lastly, for the OMM aspect - let's say a patient came in with Ear pain- would you do lets say a structural OMM exam and point out T1 dysfunction and then proceed to treat it with an OMM Technique? Essentially, you diagnose with the OMM Structural as you said and then for tx it can be anything???

[8]. And did each OMM patient tell you they wanted OMM or did you have to dig it out of them?

[9]. Was there a patient that just wanted to talk about contraception or anything where it was just you and the patient talking and no PE - or does every patient have a PE?

Didn't read all of the other posts, but here is my $0.02.
1. I did not do a structural exam with each patient encounter. In retrospect, I don't even remember if I put structural exam findings in for my OMT patients, actually...
2. Yes. Do special tests as indicated.
3. Not very long. A couple minutes, at most. Check, treat briefly, recheck.
4. Be ready to counsel patients on routine social history findings or at least recognize potential issues and address them in your plan.
5. Shook hands, sanitized. Sanitized again before leaving.
6. Don't recall. As the NBOME orientation information states, you will have audio prompts for starting an encounter, 2 minutes left in the encounter, time up for the clinical encounter, time up for documenting.
7. Sounds fine to me. I am not even close to proficient in OMM, so I did the bare minimum.
8. As with @ortnakas above, I'm not comfortable going into this much detail.
9. Could be within the realm of possibility. I always, for everyone, did at least heart and lungs though.

 

[TeddyBoomBoom]

I definitely did NOT do anything OMM-related for each patient. I only dove into the OMM world on the cases that were *clearly* OMM cases.

 

[jrlob91]

Don't do full structural exams on any patients!!! Not worth it. If it's neck pain, do a full hpi and then diagnose something randomly and do muscle energy or myofascial. No one fails this test if you at least seem the slightest bit competent.