Step 2 CS- gowning and grading

[mossyfiber12]

1) how do you gown a female patient for cardiac and lung exam for CS?
2) how are you graded in this exam?
3) other than washing my hands and making eye contacts, what other essential gestures is a must for every patient?
4) did you volunteer your thought during closure or did you wait for the patient to ask a question before giving them any extra info.

Thanks. I haven't studied at all so I am slightly worried

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[Green Grass]

1) how do you gown a female patient for cardiac and lung exam for CS?
2) how are you graded in this exam?
3) other than washing my hands and making eye contacts, what other essential gestures is a must for every patient?
4) did you volunteer your thought during closure or did you wait for the patient to ask a question before giving them any extra info.

Thanks. I haven't studied at all so I am slightly worried

1. They are wearing a patient gown. Simply untie it in the back and listen to the lungs and lower it slightly to listen to the heart.
2. Communication, Proficiency of the English Language, History Taking/Note Writing
3. Smile!
4. Summarize at the end and state your plans for diagnostic tests to be done

Good luck.

 

[bostampa2007]

1. They are wearing a patient gown. Simply untie it in the back and listen to the lungs and lower it slightly to listen to the heart.
2. Communication, Proficiency of the English Language, History Taking/Note Writing
3. Smile!
4. Summarize at the end and state your plans for diagnostic tests to be done

Good luck.

cardiac exam on female pt:
do you put your stethoscope on top of their gown or sweep your hand under the gown or lower the gown one breast at a time for better exposure?

Breast exam: do we do it?

what about pelvic exam?

what about rectal exam?

prostate exam?

testicular exam?

 

[LouisianaDoctor]

cardiac exam on female pt:
do you put your stethoscope on top of their gown or sweep your hand under the gown or lower the gown one breast at a time for better exposure?

Breast exam: do we do it?

what about pelvic exam?

what about rectal exam?

prostate exam?

testicular exam?

Female cardiac:

Ask permission to untie top of gown, ask the patient to lower it. Listen to first two heart sounds. Raise gown. Then tell them "I'm going to finish listening to your heart from the side" and then go in the side of the gown. Ask the patient to lift her left breast and finish listening. That's how I did it. It takes a little more time, but I feel much more comfortable doing it that way than exposing too much of the patient. I've had feedback from SPs saying they felt more much comfortable this way.

For the other exams, no you don't do those. You order those. You really need to buy a copy of First Aid Step 2 CS. It covers all these points. People fail this exam because they don't know the rules. It's an easy test, but the rules are stupid and you have to play their game. And the encounters go by very, very quickly. You need to know exactly what you are going to do at each step in the game. Get First Aid Step 2 CS, it will tell you all the rules.

 

[DrVanNostran]

On a side note, is wearing gloves permissible instead of hand washing? I clearly haven't gone through anything lol.

 

[LMarie_MD2b]

On a side note, is wearing gloves permissible instead of hand washing? I clearly haven't gone through anything lol.

Yes, you may wear gloves instead of soap-and-water washing before the exam. They had medium and large gloves in the Atlanta testing center.

 

[DrVanNostran]

Yes, you may wear gloves instead of soap-and-water washing before the exam. They had medium and large gloves in the Atlanta testing center.

Thanks for the heads up

 

[DrVanNostran]

Is the doorway information available when we are typing our notes?

 

[LMarie_MD2b]

Is the doorway information available when we are typing our notes?

Yes--you may stand and re-evaluate the doorway info during the 10 minute PN session for each encounter.

There is also a copy of the doorway information in the exam room for each encounter.

 

[DrVanNostran]

Yes--you may stand and re-evaluate the doorway info during the 10 minute PN session for each encounter.

There is also a copy of the doorway information in the exam room for each encounter.

Nice thank you very much!

 

[bostampa2007]

Nice thank you very much!

few more questions:

1. is it okay if i wash hands first thing upon entering the room? that way i don't have to do it before starting physical exam?

2. so the pts will be already wearing hospital gown by the time i enter the room? so the additional drape that will be provided (just a plain piece of cloth) , is just for some extra privacy right?

 

[LMarie_MD2b]

few more questions:

1. is it okay if i wash hands first thing upon entering the room? that way i don't have to do it before starting physical exam?

2. so the pts will be already wearing hospital gown by the time i enter the room? so the additional drape that will be provided (just a plain piece of cloth) , is just for some extra privacy right?

1) I'm not entirely sure about this. The rooms are set up in such a way that this would be a little awkward. You will want to get your history started ASAP, and this would mean you're talking to the patient with your back turned. I think it's best to do it just before your exam, or wear gloves. (Anyone else have thoughts on this??)

2) Yes, they will be wearing gowns and underwear before you enter the room. The female patients will also be wearing bras. You are given a flat sheet for draping, which you MUST provide to every patient. It's placed on your chair or stool, so it's best to just unfold it most of the way and hand it to the patient for draping their legs. Move it during your exam to minimize exposure.

 

[arielred]

I washed my hands just before the physical exam. Gave me a moment to organize things in my head and to idly chitchat. I suppose you could wear gloves though most people I know didn't.

 

[Green Grass]

I had patients that didn't require the drape (only did heart, lungs, and extremities), so I never gave it to them. I don't think giving the drape to EVERY patient is required. But if you are evaluating the abdomen or performing a straight leg test, you should have the patient draped appropriately.

 

[jeesapeesa]

1) how do you gown a female patient for cardiac and lung exam for CS?
2) how are you graded in this exam?
3) other than washing my hands and making eye contacts, what other essential gestures is a must for every patient?
4) did you volunteer your thought during closure or did you wait for the patient to ask a question before giving them any extra info.

Thanks. I haven't studied at all so I am slightly worried

consult FA CS book.

1. the patient will have a gown on when you get in the room. (for cases requiring a PE). i placed the drape right after my introduction. for the cardiac and lung exam, i politely asked if i can perform them, asked if i can untie the gown in the back, and performed the lung exam first. i then asked them if they can lower the front part of the gown for the cardiac exam. if it looks like they're having trouble doing that, then i politely ask if they need my assistance.
2. graded by: data gathering/history taking, pt note, professionalism/empathy, speaking clearly, etc.
3. smile when you enter the room, have a firm handshake, have empathy, look them in their eyes, always look like you know what you're doing. i NEVER washed my hands, just used GLOVES (SAVES TIMEEEEEEE)
4. no, you must summarize after getting the history and ask if you missed anything or if there is any information that is wrong. consult after the PE. for challenge questions, they usually ask by themselves and can occur ANYTIME during the encounter.

 

[jeesapeesa]

I had patients that didn't require the drape (only did heart, lungs, and extremities), so I never gave it to them. I don't think giving the drape to EVERY patient is required. But if you are evaluating the abdomen or performing a straight leg test, you should have the patient draped appropriately.

drape every patient to pass, trust me; it takes 2 seconds.

 

[Green Grass]

drape every patient to pass, trust me; it takes 2 seconds.

I will let you know in a month or so.

 

[RapidReview]

some of you guys really need to read the first aid cs intro sections. honestly, if you passed 3rd year in the US, and you spend 2 hours reading the introductory sections of fa cs (everything except for the cases), you will pass this exam. the book tells you exactly what you should do, how you should allocate you time, examples of "difficult questions" every patient will ask you, etc. after reading how a regular encounter goes in that book, nothing will be a surprise to you. although i'm still unsure how to get the asterisk for "language proficiency" lol

 

[kingkenny]

If you have open wounds on your hands, you NEED to use gloves.

I did not have any, but it was so much quicker to just use gloves instead of having to wash your hands and then dry them and on top of that, make sure they're warm. This is especially when you have long Neuro exams to do.

 

[rad0nc]

Isn't the patient sitting down when you enter the room? How do you drape them while they are sitting?

 

[jeesapeesa]

Isn't the patient sitting down when you enter the room? How do you drape them while they are sitting?

There will be a drape on the sitting stool. Unfold it and cover the patient's lap.

 

[rad0nc]

There will be a drape on the sitting stool. Unfold it and cover the patient's lap.

Cool. Thanks

 

[Green Grass]

I will let you know in a month or so.

Passed. You don't have to drape every patient to pass. Drape them accordingly.

 

[hidoc]

This isn't in FA...

When examining the female patient (cv/pulm) in sitting position, is the right way to auscultate to untie the gown and:

1. listen to the aortic, pulm, tricuspid from the top of the gown (have pt hold top of gown afteer untying)
2. listen to mitral from the side of the gown (not top of gown as above) and ask them to move their bra over or whatever...

 

[dowhot]

drape every patient to pass, trust me; it takes 2 seconds.

I plan on doing this, i don't see a downside to draping everyone. I am taking it pretty late so no room for errors.

 

[DrBowtie]

This isn't in FA...

When examining the female patient (cv/pulm) in sitting position, is the right way to auscultate to untie the gown and:

1. listen to the aortic, pulm, tricuspid from the top of the gown (have pt hold top of gown afteer untying)
2. listen to mitral from the side of the gown (not top of gown as above) and ask them to move their bra over or whatever...

We were taught never to auscultate through the gown.

 

[Jimmy B]

PASSED-I used gloves in each encounter and draped every patient. I probably didn't have to drape everybody but the SP's didn't mind (unless you have an encounter where you only take a history).

 

[username456789]

I took CS about a week ago, and have done a good job not thinking about it, until now. I keep thinking about the patient I forgot to ask about meds, the diagnoses I may have forgotten about, the patient I forgot to counsel about smoking cessation, and the leading questions I probably asked regularly. I really hope I don't fail. I feel like I did very well with eye contact, making friendly conversation, and hopefully data gathering. But there are all these things I either forgot to do/ask, or things I forgot to even consider beforehand (like avoiding leading questions). I really approached the thing as an afterthought, and I hope that doesn't come back to bite me.

 

[Mortal_Lessons]

I worried about all these things 2 months ago when I took the exam. I made many mistakes including forgetting to obtain certain components of the history, not listening to all cardiac areas, etc. Today I obtained my score back and passed. Thanks goodness, it is such a relief. I realize it is another thing once you've passed the exam, but be comforted by the fact that an overwhelming majority of US med students pass the exam and that it is rare to fail.

 

[SB100]

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