CS Physical Exam Question

[Thaitanium]

Hey-

So, how in depth do we have to be when it comes to the P/E? I'm going over a lower back pain case now where the diagnosis is most likely disc herniation. When we inspect, do we have to move to the patient's side and look at the spinal curvature or can we just get by with looking at the patient's back from right behind the patient. For a motor exam, do you have to test motor strength in fingers, wrist, legs, arms? All these maneuvers in addition to several more as listed in FA...I find it tough to complete in 3-5 mins.

Don't mean to sound so picky and all but kinda wondering how thorough we have to be considering we only have 3-5 mins to perform the physical. Trying to save as much time as possible whenever possible.

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[manning18]

The cases are typically set up such that the PE should not take that long anyway. The examinee receives 15 minutes for the entire encounter, so how in depth one can afford to go depends on how he/she is doing with regards to timing. There's no harm in being more thorough, although it may cause problems with time. I never had trouble completing the face-to-face encounter in 15 minutes or writing up my note in 10 minutes.
As for what to test, you should test whatever will help you come up with the best Dx and workup in the time allotted. Keep the chief complaint in mind and test those things that relate to it. For the motor strength, you can test motor strength in multiple areas is the pt complained of deficits in each of them.
If you make sure to get all the freebie points (knocking, addressing pt by name, introduing yourself, washing your hands, asking to start the PE, counseling pt about substance abuse, summarizing your findings, social Hx, family Hx, substance use, medications, allergies, etc) and hit the high points in terms of History and Physical, you should do well!

 

[OBJen]

I think first aid gives all of the ideally tested PE manuevers but from my friends that have passed--as long as you test strength in the arms, hips, knees, ankles for example--leaving out hands/fingers should be fine. Like you say--you only have 3-5min. so just start with the most pertinent PE areas and stop in time to counsel for a minute or 2 at the end.

 

[8744]

http://pandabearmd.blogspot.com/2006/03/usmle-step-2-clinical-skills.html

That's right. It's all on my humble blog.