OnMyWayThere

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I'm taking the COMLEX-PE next week and I haven't used or seen OMT for over a year. Is there any 1 or 2 types of treatments I can relearn that will get me by the OMT portion? The easiest ones that would work on most common complaints! I'm thinking soft tissue and muscle energy? Thanks!
 

Krazykritter

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Haven't taken the exam yet, but I'm in the same position as you...

You can't use HVLA so ST & ME are going to be the mainstay of any BS that I decided to use.
 

FutureInternist

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NBOME website states that you may be asked to do certain techniques by the patient. Their examples include Spencer (for shoulder), lymphatic drainage (Galbreath?) for sinusitis, & LBP
 
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TOXOSIS

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How do you guys manage time if we need to put aside 3-5 minutes for OMT? I had trouble getting through the entire OSCE in 14 minutes at my school and we didn't have to do OMM. So how do we pass all the aspects (humanistic, biomedical/biomechanical)? Seems difficult to do a complete history and pertinent physical exam and proper closing... all in 9-11 minutes now so we have time for OMM in those specific cases that require it? I've heard people complain the 14 minutes isn't enough for the USMLE CS and they don't have to do OMM... any advice on time management?
 

FutureInternist

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The people who ask for the OMT have pretty straightforward complaints w/o any significant PMHx, meds etc, so H&P goes by quick. Also, if you run out of time, you can always put the technique in the "Plan" portion of your note & still get some points.
 

FutureInternist

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Sorry....LBP is just "Low Back Pain". Just know two different ways to treat it (I used prone pressure w/ counter pressure & Still).
I guess you could use the same technique if 2 different pts ask you for it but I didn't want the ******** at NBOME to tell me I wasn't DO enough for them :D
 

Noodles4LIFE

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Also taking PE next week...and scared out of my mind! Lymph drainage for sinusitis...would submandibular percussion be the best technique? or inhibitory pressure of trigeminal nerve? I thought Galbreath was more focused towards Otitis Media...? Anyone have any last minute tips on how to successfully pass this thing? :(

Another thing..
Are structural exams expected on all patients? Or just the ones that blatantly ask for OMT (musculoskeletal complaints)? I have heard people doing both...but like mentioned earlier, can't imagine having nearly enough time to pull all of that off in 14 minutes...

*scared ****less*:scared:
 

FutureInternist

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Anyone have any last minute tips on how to successfully pass this thing? :(

Once they tell you to start
you can stand outside the door for as long as you want looking at their vitals etc & forming a differential. I found that if I already had a list of Qs in my head it just goes that much smoother. (This time DOES come off your 14 minutes total). I would also take this time to transcribe the VSs onto the O part of my note since I forgot to do that if I waited till after I got done with the patient.

Make sure you only put that stuff in your SOAP note that you actually did. If you think of a test that you should have done or a Q you should have asked, after you have exited the room....too late. Just take the hit rather than put it down. Our Dean was told that most ppl who failed, did so for this reason.

Also make sure you start your re-cap the moment you hear the 2 minute warning. No use getting 90% on your SOAP writing & interview skills only to fail the humanistic portion. All you need is 1% over whatever their passing grade is (but you need that in EACH category)

Whenever you transition from asking Qs to performing exam or doing the recap, just say a little something that tells them what you're about to do.

Washing hands & draping patients is essential. Draping is always a Q...I just put the cloth over them (level with their ASISs) & then pulled the gown up. This way you are in no danger of sneaking a peek at their "delicates". When auscultating anything make sure the stethoscope is on the skin and NOT on the gown. Ask & then untie the gowns from the back to get all the lung zones, while from the front you can kind of sneak you hand over the top & get it done since I was not sure about asking females to untie from the front.

When doing your HPI, I would say something to the effect that even though you are writing stuff (hence looking down) you are still paying attention to them (Gotta get as many of those "Are you DO enough points" :laugh:)

In my physicals, I did everyone's heart, lungs & abdomen & then moved on to the specific complaint (Just what I was taught in my FP rotations) but ofcourse you don't want to do that at the risk of running out of time for the actual complaint related exam.


 

TOXOSIS

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Thanks FI! Do you recommend learning the MMSE or practicing a full neuro exam w/ cranial nerves (any quick ways to assess CN II-XII?) ? This time constraint worries me if we are expected to these in addition to possible OMM!
 

FutureInternist

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Learning both is a good idea since you do not know what the scope of the patient's problem will be.
As for cranial nerves, there really isn't a quick way to test them, that I know of. Ofcourse in practice if the patient follows you with their eyes, is talking & looking sad, you pretty much got the big ones covered. I did not have to do a CN exam so if someone else has hints please post.
 

LadyGrey

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How to pass -- just chill out. :) I'm sure I lost the most points on my first case, where I was still a little anxious, and missed some obvious bad stuff that should've been on my differential but that I didn't think of until driving home. Once I calmed down and got into the groove, it was almost fun. (But I'm a sick person who kinda likes standardized tests).

There was maybe one case where I felt pressed for time. I was almost always out before the two minute warning, and done writing early, too. Time isn't really an issue if you've been in the hospital/clinic, as we all have been, and are used to being efficient. It's kind of a magical clinic where everything is on your side -- these are fake patients who answer direct questions with direct answers. They don't ramble at length. They're not drunk, high, or malingering. They're not struggling with English, nor are you struggling in their language. They are not chained to their beds with two officers guarding them.

Do you have the First Aid book? Maybe two reads through that, with a very quick perusal of Savarese, was good enough for me. I didn't actually practice the cases with real people or anything, so timing was what I was a little concerned about going in, but like I said, not an issue.

As for OMT -- I am no OMT superstar, and I still passed. You will know who needs OMT.

Finally, I had one patient where a MMSE was relevant, and I just put it in my plan. I think I did do some CN testing, reflexes, strength, etc., but an MMSE is too damn long and easy to screw up.

Also, for anyone reading this who is a third year still working on their fourth year schedule, I took this near the end of an ER rotation, which I'd highly recommend. It gets you used to working up a broad range of complaints with broad differentials, and used to being super efficient. I think family medicine might be good, too, but the Big Bad Things wouldn't be as fresh in your mental differentials.
 

BMW19

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Just a suggestion to those of you that are worried about time because it is probably the biggest issue on this test (not the OMM contrary to popular belief). The OMM ones are the easy ones! They will ask for it and you can pretty much just jump right to it after ruling out some cardio complaints if its chest pain vs. rib with hx and a brief physical etc.

When you get to your SOAP note you may want to immediately put down 3-4 Assessments and 3-4 plans before even doing family hx, CC etc.

This is JUST MY OPINION- and I did pass.....
When you are freaked out on the test it is easy to get caught up in trying to write down a full family hx, allergies, social hx etc. 9 mins is NOT long time as you will see. In my humble opinion if you forget/run out of time and don't put down family hx or allergies they might take off some points. But if you run out of time and saved the A/P (the bread and butter) for the last min and you put down one thing or nothing- that is not good! I would imagine that is major point deduction NO DX and NO TX plan!

So if you come out of the room and immediately write down:
1) Appendicitis
2) GB
3) Pancreatitis etc. and then your plan to work each one up i.e. CT, US, HIDA, LFTs etc. at least you will get the bread and butter points.

My friends and I used this strategy and we passed....