Forgot to do physicals in a few cases

[999nineninenine]

Hey guys. I recently took Step 3. Did well on practice tests and have done well on previous steps. During the CCS I got so into it that I forgot to go back and do physicals on about 5 cases because after initial lab workup the diagnosis was clear and the patient was stable. The cases quickly ended and I finished most cases in <7 minutes with the final diagnosis.

How is the test scored in terms of "automatic failure" for not doing physicals. I did full physicals on 3 patients and partial ones on 2. None on 4.

Thoughts? Has aonyone done this and still passed?

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[carrigallen]

I don't see the utility of checking labs before doing the physical exam.
I think it might be helpful to do the cases in a more organized fashion. I would start every case by reading the history carefully. Then do a physical - basically every physical should include vitals/heart/lung/abdomen.
At this point you should already have 3-4 top diagnoses in your mind (one will probably stand out). Jot them down on the marker board as you read along.
I had a order set for almost every ED patient which i would write down to make sure I didn't miss them.

1. Oxygen (if needs)
2. TSH (if applicable)
3. Type and cross (anything life-threatening/surgical)
4. Counseling (this brings up a list of options; invariably at least one will apply to your patient)
5. NPO (when in doubt npo)
5. Chest xray (if applicable)
6. EKG (if warranted)
7. IV fluids
8. vitals qX, pulse ox once

Go for things which are fast and non-invasive. You cannot get points docked for doing an interal history (how are you?) and it only uses a minute.