Common sense COMLEX PE Q's...

[BMW19]

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Some Q's about COMLEX PE that may seem like common sense but you never know with these tests! And some of us have no 4th years to ask yet....

1) How many DDx are acceptable/warranted? every step 2 CS book I have seen has only listed 4 or 5 DDx and the same for workup.

2) Step 2 books always say to document pertinent positive and negative findings. Obviously the SP is not a real patient so it should be assumed that if they don't say it and it is not on the door then it is a negative finding?

3) In your work up can you just write CXR on a line or does it have to be
Chest x-ray to rule out pneumonia vs. Plural effusion etc. with long explanations for why you are ordering the test.

4) Is it appropriate to order consults i.e. GI, Neuro.... In the real world if this patient has a _____ Dx you might order a consult but I have not seen that in any step 2 CS book

5) Is it appropriate to order treatments? If a kid has OM of course you would give AB's but in no step 2 book have I seen any treatments ordered. Just diagnostic tests

6) This Q is about OMM- If the patient is complaining of neck pain and you do your whole H and P then decide you are going to do OMM. Do you have to do a specific technique? Or can you pick whatever you want (not HVLA I know).
Once done do you document in your notes that the patient had a C3 Rot L SB L etc. or just write that you found a somatic dysfunction and fixed it.

Thanks. I know these Q's are common sense but for those of us getting ready for the exam that have had no feedback about it it may not be.

 

[Taus]

bump....I'm taking mine soon also and have no idea either....

 

[jrf331]

Remember there is really no instruction as to the specifics so most of this comes from experiences of mine and others.

questions
1. There is are five spaces to write DDX and Plan so yo u can use all of them to be safe. I didn't use them all each time. I tried to do at least 3 per pt. Some of those were very weak like Tobacco dependence and obesity.

2. You do need to document pert + and pert -, but don't assume that it is a negative if they don't say anything. If you don't ask them about it you cannot document it. If you do document something you didn't ask then you will fail the test.

3. Just write the test you don't have to explain why. It is the assumed that the plan is used to rule out DDXs

4. Yes you can order consults if you think it appropriate
5. yes you can order tests/treatments
6. About OMM--if you dont find a specific SD you don't have to be specific as to the side bending and rotation components you can just document what you find, like hypertonicity or tissue texture changes or decreased ROM, but you need to document what treatment you use. And you can pick any treatment but HULA. I just did the easy crap like soft tissue. You don't have to think about that crap.


Good luck this test is a bunch of crap. Enjoying being graded by a bunch of SP's

 

[BMW19]

Thanks for the response jrf....I'm sure we might have a few more Q's in the next few weeks

Remember there is really no instruction as to the specifics so most of this comes from experiences of mine and others.

questions
1. There is are five spaces to write DDX and Plan so yo u can use all of them to be safe. I didn't use them all each time. I tried to do at least 3 per pt. Some of those were very weak like Tobacco dependence and obesity.

2. You do need to document pert + and pert -, but don't assume that it is a negative if they don't say anything. If you don't ask them about it you cannot document it. If you do document something you didn't ask then you will fail the test.

3. Just write the test you don't have to explain why. It is the assumed that the plan is used to rule out DDXs

4. Yes you can order consults if you think it appropriate
5. yes you can order tests/treatments
6. About OMM--if you dont find a specific SD you don't have to be specific as to the side bending and rotation components you can just document what you find, like hypertonicity or tissue texture changes or decreased ROM, but you need to document what treatment you use. And you can pick any treatment but HULA. I just did the easy crap like soft tissue. You don't have to think about that crap.


Good luck this test is a bunch of crap. Enjoying being graded by a bunch of SP's

 

[CorpuSpongiosum]

Do I even need to study for this thing? Or can i just wing it?

 

[BMW19]

So if you have an SP that you think may be having an MI are you really going to do an osteopathic structural exam?

Remember there is really no instruction as to the specifics so most of this comes from experiences of mine and others.

questions
1. There is are five spaces to write DDX and Plan so yo u can use all of them to be safe. I didn't use them all each time. I tried to do at least 3 per pt. Some of those were very weak like Tobacco dependence and obesity.

2. You do need to document pert + and pert -, but don't assume that it is a negative if they don't say anything. If you don't ask them about it you cannot document it. If you do document something you didn't ask then you will fail the test.

3. Just write the test you don't have to explain why. It is the assumed that the plan is used to rule out DDXs

4. Yes you can order consults if you think it appropriate
5. yes you can order tests/treatments
6. About OMM--if you dont find a specific SD you don't have to be specific as to the side bending and rotation components you can just document what you find, like hypertonicity or tissue texture changes or decreased ROM, but you need to document what treatment you use. And you can pick any treatment but HULA. I just did the easy crap like soft tissue. You don't have to think about that crap.


Good luck this test is a bunch of crap. Enjoying being graded by a bunch of SP's

 

[DOanesthesia]

So if you have an SP that you think may be having an MI are you really going to do an osteopathic structural exam?

No. You don't need to do a structural exam on most of the SPs. I only did them on the patients that specifically asked for OMM. It is very obvious who needs structural exams/treatments.

If you did well w/ SPs at your school, the PE should not be a problem. All cases were pretty straightforward. Overall, it is an easy exam. Minimal to no prep required.

 

[jrf331]

Agree minimal to no prep

No. You don't need to do a structural exam on most of the SPs. I only did them on the patients that specifically asked for OMM. It is very obvious who needs structural exams/treatments.

If you did well w/ SPs at your school, the PE should not be a problem. All cases were pretty straightforward. Overall, it is an easy exam. Minimal to no prep required.

 

[Amy B]

So if you have an SP that you think may be having an MI are you really going to do an osteopathic structural exam?

Yes.. and follow that with the pedal pump to cure all that ails that patient

 

[jrf331]

Yes.. and follow that with the pedal pump to cure all that ails that patient

But you forgot CV4

 

[Old_Mil]

2) Step 2 books always say to document pertinent positive and negative findings. Obviously the SP is not a real patient so it should be assumed that if they don't say it and it is not on the door then it is a negative finding?

This is the real catch with SPs vs real patients. Real patients - those who aren't psychiatric patients or motivated by secondary gain - will try and partner with you to find an answer to what ails them. On the other hand, a SP exists to test your ROS questioning capability.

Asking a question like "So, have you had any problems voiding?" has a reasonable shot of getting "Well doc, it burns when I go" or "Well doc, my pee was pink" with a real patient.

An SP, on the other hand, will conceal symptoms and answer "no." If you asked the same patient "Do you have hematuria?" He'll say yes. So to adequately cover GU with such a patient you have be the doc in the last frame on the bottom...

http://theunderweardrawer.homestead.com/Id_ER_02.html

I'm not sure if this was the intent of educators when the standardized patient was dreamt up, but this is the way it seems to work in real life.