CS: Do a "full" exam?

[NewYorkDoctors]

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I mean doing a FULL examination for each organ system whenever the organ system is indicated?

For instance:

If this is SOB, obviously do a full lung exam (inspection for accessory muscle use, percussion of lung fields, measuring chest excursion, auscultation on 8 places on the back, 6 on the front, and both sides, with the patient upright and leaning forward.. all the while appreciating the length of inspiratory and expiratory cycles and noting the nature of breath sounds (bronchial, vesicular, etc.) and a full heart exam (PMI, JVD, palpation for heaves and thrills, auscultation while upright, supine, and in LLD)

But if the case does not explicitly indicate the respiratory or CV system, just take a listen?

Is this pretty much the way it should go?

VS

Just auscultation all the way through?

 

[VenusinFurs]

I mean doing a FULL examination for each organ system whenever the organ system is indicated?

For instance:

If this is SOB, obviously do a full lung exam (inspection for accessory muscle use, percussion of lung fields, measuring chest excursion, auscultation on 8 places on the back, 6 on the front, and both sides, with the patient upright and leaning forward.. all the while appreciating the length of inspiratory and expiratory cycles and noting the nature of breath sounds (bronchial, vesicular, etc.) and a full heart exam (PMI, JVD, palpation for heaves and thrills, auscultation while upright, supine, and in LLD)

But if the case does not explicitly indicate the respiratory or CV system, just take a listen?

Is this pretty much the way it should go?

VS

Just auscultation all the way through?

If it was a lung exam I pretty much just auscultated and percussed. I don't think there's really time to do all the PE stuff that you never do in real life anyway.

 

[septoplasty]

The DDx for a respiratory symptom (in your example) are many, and you'll be stumped if you try and do a full lung / cvs exam. Do everything superficial, for any presenting symptom.

Ex. GERD presenting as paroxysmal cough. Pointless to do full lung exam in this case, so just auscultate.

They will give you many different signs / symptoms so you can come up with a wide array of dx, so just do it superficial to keep up.

GLuck!

 

[gametown19]

FYI I took the old exam. I just listened to CV, Lung, Abd unless there was a specific complaint that required more investigation. For example if abd pain then auscultation, percussion, palpation, Murphy's or rebound based on what the complaint was and then a quick auscultation of Lung and CV. I focused more on trying to be helpful to the pt when they are lying down or getting up, keeping them covered, telling them what I was about to do (I am going to listen to your lung). There is very little time and questioning, rapport, politeness, empathy needs more attention than PE. At least that is what I did to pass. Good Luck on your exam.

 

[NewYorkDoctors]

good to know thanks everyone


Btw:

For the life of me, I cannot auscultate physiological split S2.

On careful reading, it seems it is best heard in younger individuals...


Anyone actually been able to haer physiological split S2?

 

[septoplasty]

good to know thanks everyone


Btw:

For the life of me, I cannot auscultate physiological split S2.

On careful reading, it seems it is best heard in younger individuals...


Anyone actually been able to haer physiological split S2?

You'll never see it in the exam, chill bro.

I barely even put my steth on the chest to even listen to the sound, S1 Heard => end of my heart exam lol.

 

[shan564]

good to know thanks everyone


Btw:

For the life of me, I cannot auscultate physiological split S2.

On careful reading, it seems it is best heard in younger individuals...


Anyone actually been able to haer physiological split S2?

The only time I've heard it was when I was auscultating myself with deep inspiration. I guess I'm still young enough?

 

[MossPoh]

I rarely seemed to get any relevant physical exam findings, but they always seemed non-contributory to the differential. It was really really communication centered.

 

[shan564]

I'm more concerned about the checklist than the actual possibility of real physical exam findings. I know I won't find any peripheral stigmata of infective endocarditis in most patients, but will I get marked off if I didn't look for them as part of my cardio exam?

 

[septoplasty]

I'm more concerned about the checklist than the actual possibility of real physical exam findings. I know I won't find any peripheral stigmata of infective endocarditis in most patients, but will I get marked off if I didn't look for them as part of my cardio exam?

Idea is to ask relevant questions. So for Infective Endo (I dont think they would even have that, refer to FA for cases), they would give you many different signs / symptoms that would suggest multiple dx, so the idea is to develop a ddx, rather than a single dx.

By asking the standard Pain protocol questions like Freq,Onset,Radiation,Duration etc. you have enough info to develop a ddx. then you ask the other stuff like past medical hx, surgical hx etc etc. This will cover atleast 80% of the "check list".

I agree with MossPoh, i think the idea is more about patient interaction rather than asking all the relevant symptomology questions. I think I asked all the relevant stuff, but wasn't so good in the Professional manner and rapport (lowest score), because of the fact I was trying to meet the "check list".

Nevertheless, the exam design is terrible, so glad I don't have to go through it again.

 

[MossPoh]

I usually knew what it was by history and then did a few maneuvers at the end to humor them. Even faking a proper physical exam takes more than 7 or so minutes you'd have.