NJWxMan

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In short, I have my NBOME PE (COMLEX) coming up in a few weeks. There's little direction in whether students are supposed to put treatments under the Plan Section. If you read First Aid and Kaplan for the USMLE CS, they clearly state that ONLY workups/tests are to be placed in the Plean Section. What are NBOME PE test takers to do? Per the completed SOAP on the NBOME site, the note has numerous treatments and tests ordered including prescribing a quinilone. Any suggestions would be greatly appreciated.
 

Old_Mil

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In short, I have my NBOME PE (COMLEX) coming up in a few weeks. There's little direction in whether students are supposed to put treatments under the Plan Section. If you read First Aid and Kaplan for the USMLE CS, they clearly state that ONLY workups/tests are to be placed in the Plean Section. What are NBOME PE test takers to do? Per the completed SOAP on the NBOME site, the note has numerous treatments and tests ordered including prescribing a quinilone. Any suggestions would be greatly appreciated.
First Aid is a good resource for the test. If they say workups/tests, don't include treatments (the obvious exception being any OMM treatments that you actually perform).
 

FutureInternist

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One of our instructors grades the PE exams and he said that you must try to put at least one somatic dysfxn in the Dx section & its corresponding tx (you can just put HVLA, ME, Still). Then he recommends putting smoking cessation counseling (even though you already did it) & "follow-up" in "x weeks" depending on what lab tests you ordered. That leaves you with just 2 plans that need to be unique to each patient (since 11 of the 12 pts that I had, smoked). Other students have said that they even put referrals under their plan section. For medications, under the Plan, you do not need to get specific (cephalosporin is enough, no need to say 'ceftriaxone')

Just be careful that you don't put anything in the Assessment that you did not do. The dean of our school said that the NBOME stated that most failures was d/t this.


 
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NJWxMan

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Can you put something in the plan or ddx if you didn't state it to the patient? IE, you think of Pancreatitis last minute while writing the SOAP note but never told the patient that it was a possibility?

Also, I head that this is NOT an OMM exam and that you only check for somatic dysfunction in the patients that say "I once had a DO that did OMT on me...". So many rumors. I think that these inconsistencies is why people fail. So in the end, I now wonder; should I do a OMT exam real quick on each patient?
 

FutureInternist

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Yes you can. While going over what you think is wrong with the patient is encouraged, if time limitations or lack of thinking of it during the patient encounter kicks in, you can write a Dx that you did not mention. What you do NOT want to do is write down a physical exam finding etc that backs up your Dx when you never did it. I had a patient w/ HA & photophobia & of course went down the migraine pathway. It was only when I left the room that I saw he had a 103 temp & then remembered he was a college student :eek: (oops). Needless to say I put Meningitis as my # 1 assessment & LP as # 1 Plan even though I never mentioned them to the patient. And I of course did not put Kerning or Brudnizki findings in my Objectives. After that patient, luckily my first, I stayed at the door for approx a full minute after they told us to go in to read all the VSs & get a good line of Qs in my head 'cos once that old grandma is staring at you with those sad eyes you kind of lose track. (This time IS taken off from the alloted time of 14 mins but is NOT cause for them giving you a lower score)

As for OMM, you are right when you say they will ask you for it. For all others I tried to link a SD finding with their complaint, if I had the time, o/w there was usually enough other Dx that I didn't feel the need to force an OMM exam. The NBOME website mentions several techniques (& I got asked all of them). I would at the very least know 2 ways to tx LBP, Spencer technique for shoulder & Lymphatic drainage (Galbreath?) technique for sinusitis. They will ask you to do this tx at random times during the exam so best thing to say is "Let me finish my Qs so I can get an accurate pic of what is going with you & at the end if I feel the tx is warranted I will do it"

As for the lack of direction &/or inconsistencies....Well this wouldn't be a proper NBOME sanctioned COMLEX exam if they didn't have it like that :laugh:
 
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