Physical exam for Step 2 CS

[medblazer21]

Do you have to tell them step by step everything that you are doing in detail so they will give you credit?

For example, did you tell them that you were assessing their jugular venous pressure, or did you just tell them you were looking at their neck?

Did you do the same thing with percussing the liver, palpating spleen, etc? Or just be more vague about it and say "I'm going to tap on your belly" etc?

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[MeowMix]

I told them what I was doing and why (plain and medical language)

 

[Marigold]

OK, here's another question about the CS physical exam...

How do we handle documenting physical findings? I know, for example, that if the pt has pneumonia they may fake a wheeze when you auscultate...but how about, say, retinopathy in a longtime very poorly-controlled diabetic? You can't fake that. So do we document what we SAW, or what we would expect to see in such a patient?

 

[arthrodisiac]

OK, here's another question about the CS physical exam...

How do we handle documenting physical findings? I know, for example, that if the pt has pneumonia they may fake a wheeze when you auscultate...but how about, say, retinopathy in a longtime very poorly-controlled diabetic? You can't fake that. So do we document what we SAW, or what we would expect to see in such a patient?

document what you see. its malpractice to document something that isn't there. furthermore, there are very few medical students good enough at opthalmologic exams to diagnose any retinal disease without dilation. i had a case where the woman had a specific complaint unrelated to lungs, but had a definite wheeze, so i documented it.

 

[Arsenic]

OK, here's another question about the CS physical exam...

How do we handle documenting physical findings? I know, for example, that if the pt has pneumonia they may fake a wheeze when you auscultate...but how about, say, retinopathy in a longtime very poorly-controlled diabetic? You can't fake that. So do we document what we SAW, or what we would expect to see in such a patient?

document what you see but also document pertinent negatives. ie, "PERRLA, fundi appear normal bilaterally without evidence of retinopathy or hemorrhage". that way even if the finding wasnt there you show the grader of the note that you looked for it. there is no need to make stuff up, just mention pertinent negatives in the physical instead and you'll do fine.

 

[Marigold]

Good to know. I'm taking it on Tuesday, and these threads about AMG's who failed are making me a bit nervous. But nerves are good motivation to study tomorrow!

 

[lord_jeebus]

I explained very few of the things that I did.

I did make comments like "your lungs sound healthy" and such, as I would normally do.

 

[jpro]

If we are supposed to treat this like a normal pt interaction then why are we explaining everything. "this is a stethascope, we can hear things with it" I studied for about three days for this test. I did not practice doing the notes or performing physical exams. What I did study was being able to identify the appropriate questions and physical exam for each CC given. On the real test I felt short on time for the note writing. I would often leave the room quite early just so I could complete a concise note. The only way I could leave early was to rush the physical exam.

This test is so unrealistic. In a real situation you don't get the pt CC and VS 1sec before entering a room. In reality you are able to look up the pts EMR and go in with a much better idea of what there past medical/surgical hx is along with prior imaging, labs, and interventions. Also, when a pt comes into see you because they are concerned about a specific issue they will usually explain this too you in detail along with info that does not relate to the CC. On the CS you have to drag info out of people that most pts would tell you with an open ended question. This test is a complete waste of time I hope I don't have to take it again.

 

[NuMD97]

retinopathy in a longtime very poorly-controlled diabetic? You can't fake that. So do we document what we SAW, or what we would expect to see in such a patient?

Most likely the patient would tell you that there is retinopathy. If you are uncomfortable with that you can just report it "as per patient" reporting the patient's physician's findings, but that your findings were normal. This at least acknowledges what the patient is telling you, but that your findings did not bear that out.

Hope that helps.