How to auscultate lungs and heart for step 2 CS?

[Ruban]

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Hi all,
At my school's OSCE, we had to auscultate the lungs in a ridiculous number of locations (4 anterior, 12 posterior). For the cardio exam, we had to listen in the 4 major areas + listen with the bell in the left lateral decub position.

It takes a very long time to auscultate at so many spots. Is this necessary for CS? What is the minimum we need to do to get credit?

Thanks!

 

[gutonc]

Listen to 4-6 posterior lung fields (and not over the scapulae, they'll ding you for that) and 3 or 4 heart areas, at least one of them w/ the bell (not in LLD...you don't have time) and don't spend long doing it. You probably won't hear anything unusual anyway.

 

[salmonella]

Listen to 4-6 posterior lung fields (and not over the scapulae, they'll ding you for that) and 3 or 4 heart areas, at least one of them w/ the bell (not in LLD...you don't have time) and don't spend long doing it. You probably won't hear anything unusual anyway.

For pulmonary exam, is it necessary to do percussion, tactile fremitus, egophony and check for bilateral chest expansion? Are they going to fail us if we didn't do that?

 

[DrMom]

For pulmonary exam, is it necessary to do percussion, tactile fremitus, egophony and check for bilateral chest expansion? Are they going to fail us if we didn't do that?

no

 

[gutonc]

no

Unless of course someone's CC is 4 days of fever, malaise and cough productive of purulent yellow sputum, in which case a little egophony or tactile fremitus would be a good idea. Otherwise as above.

As in life (and this is perhaps the only useful thing about that stupid test) adjust you physical exam to suit the setting. If someone presents w/ sudden onset of left facial droop and right-sided weakness, looking for hepatomegaly, no matter what you learned in your physical diagnosis class, will be remarkably low yield.

 

[salmonella]

Unless of course someone's CC is 4 days of fever, malaise and cough productive of purulent yellow sputum, in which case a little egophony or tactile fremitus would be a good idea. Otherwise as above.

As in life (and this is perhaps the only useful thing about that stupid test) adjust you physical exam to suit the setting. If someone presents w/ sudden onset of left facial droop and right-sided weakness, looking for hepatomegaly, no matter what you learned in your physical diagnosis class, will be remarkably low yield.

What's going to happen if someone with that CC and I didn't do egophony or tactile fremitus? What about forgetting to wash hands? Is that enough to fail? Are they that detail when it comes of physical exam grading?

 

[robotsonic]

Here's what I did for the cardiopulm exam on every patient:
Listened for heart sounds in 2-3 locations. Beating? No absurdly obvious murmurs? Check.
Placed the stethoscope on 4 locations on the back (upper lobes and lower lobes). Pretended to listen. Check.

The abdominal exam, for a patient with no abdominal pain, consisted of a cursory push on the belly.

You don't have time for a detailed exam and it usually isn't necessary. Do a focused exam. Don't worry if you forget parts of the exam.

On one patient I forgot to wash my hands.

I passed.

 

[Mumpu]

I forgot to auscultate the bowel sounds on all of my patients (belly auscultation is part of my chest exam, so when doing a focused abdominal exam it didn't even come into the equation until I walked out of the room... again and again and again). I passed.

 

[Mattchiavelli]

Good god that's too many lung fields- I never listened to that many, even on a patient that required a lung exam and I passed. If your school is like mine, they over-do it on the OSCE just so when you take CS there's no way you won't pass, similar to training for a race with a parachute before actually running it. Don't forget there is an inspection aspect to everything and the best way to let the SP know you're inspecting it is to say it. It will be very unnatural but then CS is pretty unnatural and mainly looking to weed out the blatantly incompetent.

Oh, and wash yo' hands, don't be nasty

 

[Winged Scapula]

Moving to Step 2 forum

 

[Buzz Me]

I tend to listen to the heart and lungs the same way:

(1) (Standing on the patient's right) Listen to AV, PV, TV, MV
(2) (On patient's back) Listen to R upper lung, L upper lung, L lower lung, R lower lung