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Questions regarding the Step 2 CS exam

Discussion in 'Step II' started by surgicel, May 15, 2014.

  1. surgicel

    surgicel 2+ Year Member

    Jul 18, 2013
    Had a couple of questions

    1. Is it bad to cut off pts. after the first open ended question if you feel they are too slow? Can you lose points on that?

    2. If you remember questions after the physical exam can you still ask those questions or is it bad to ask questions after the PE, before the closure if you’re still unsure about the diagnosis?

    3. Are we allowed to bring a non-digital watch to the exam, to keep track of time?

    4. If you leave 1 min early and forget an important question can you enter the room again to ask that question or is it once you leave you can’t enter again?

    5. Is there any cross check with the SP check list and doctor reading the PN for example if the pt. denies any tobacco use but you put down the pt. used tobacco as a mistake, will you be penalized?

    6. How do you examine the chest, in females to check for PMI in the CVS exam do you bring the whole gown down below the costal margin exposing the pt. with a bra on or is that wrong?

    7. Is it ok to write during the PE after completing each system to make sure you get the PE noted correctly?

    8. If you forgot to do a major PE exam during closure can you do still tell the pt. you would like to check one more thing and perform the maneuver or is it bad to go back?

    9. Do you have to tell the pt. every single test you will be doing? What if you think of a test later while writing down the PN but didn’t tell the pt. will you get points off?

    10. If he dx is clear- cut such as Herpes Zoster do you just write one diagnosis or should you always put down a second dx such as Small Pox, Measles, Cox Sackie, etc.
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  3. thehundredthone

    thehundredthone 5+ Year Member

    Aug 20, 2012
    A lot of your questions are answered in the information booklet and the orientation video. I suggest going through them thoroughly.

    1. Yes.

    2. You can. Just transition into it properly, by saying something like, "Before I sit down and talk to you, I have a couple more questions." They will answer, and your ICE score will be the better for it if it is relevant.

    3. No. Your coat and your stethoscope is all you can have on your person. There are clocks on the walls.

    4. Once you step out, you're done. It will happen more than once, just move on.

    5. The physician will have an idea about the case history. So be honest in your note.

    6. Untie the gown, bring it down, bra will stay on. Ask them to lift the breast and then auscultate/check for PMI. You will likely check PMI in a recumbent position in which case you can possibly lift the gown further up during your abdominal exam and perform the maneuver.

    7. For the most part you won't really be able to go system wise because patient comfort is paramount. This means that all examination in seated position should take place at once, similarly standing/recumbent/torso exposed etc. As a personal opinion, these are outpatient cases and you should be able to remember pertinent positive findings (and pertinent negatives should be in your head already since the entire exam is a potential pertinent negative).

    8. As long as you communicate the requirement effectively, you can revisit any issues. Be advised though, as in 7., patient comfort is paramount, so try not to forget maneuvers that require change of position/exposure of the relevant part.

    9. The patient has a checklist for PE maneuvers, so it's possible you'll still get the mark for doing it, but as far as possible, explain everything you do as you go about the examination.

    10. You should have a second differential at the very least at least based on the history if not examination as well, unless the standard of diagnosis of that disease is clinical and absolute in your case.

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