Step 2 CS Physical Exam

[Nabin]

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I wanted some help regarding the PE portion. I have my CS scheduled in a month. Thank you in advance.

1. I spend about 10 seconds just doing a brief head, eye, tongue, hands and feet examination before going into the main organ system (other than HEENT) . Is that fine?

2. Is it necessary to listen to the lungs and heart in every case even if its not relevant? I understand they would be vital systems to check in any case. Is it okay to save time that way? For example, in a RLQ abd pain case, I'd just spend the 10 seconds mentioned above and then make the patient lie down and examine their belly and conclude the PE. Okay to do that?

3. How do I go about listening to the mitral area of a female patient?

4. I hope its okay to use the hand sanitizer instead of gloves or washing hands. (of course, after letting the hand dry up)

5. How do I finish a dementia case on time? I just can't seem to do it with so many questions to ask followed by the MMSE and neuro exam.

Any suggestion would be greatly appreciated.

 

[Ismet]

I wanted some help regarding the PE portion. I have my CS scheduled in a month. Thank you in advance.

1. I spend about 10 seconds just doing a brief head, eye, tongue, hands and feet examination before going into the main organ system (other than HEENT) . Is that fine?

2. Is it necessary to listen to the lungs and heart in every case even if its not relevant? I understand they would be vital systems to check in any case. Is it okay to save time that way? For example, in a RLQ abd pain case, I'd just spend the 10 seconds mentioned above and then make the patient lie down and examine their belly and conclude the PE. Okay to do that?

3. How do I go about listening to the mitral area of a female patient?

4. I hope its okay to use the hand sanitizer instead of gloves or washing hands. (of course, after letting the hand dry up)

5. How do I finish a dementia case on time? I just can't seem to do it with so many questions to ask followed by the MMSE and neuro exam.

Any suggestion would be greatly appreciated.

1. You don't need to do any more than what's indicated. If you suspect a PTX or PNA why would you waste time doing a "tongue" exam or a foot exam? This is a focused physical exam.

2. It's not necessary to listen to the heart and lungs if you don't think it's pertinent.

3. The same way you would on a regular patient?? Explain that you want to listen to the bottom of the heart and ask if she can lift up her left breast for you. This is most easily and modestly done when you have them lying at 45 degrees, as they should be if you're doing a full cardiac exam, expose their abdomen (+/- abdominal exam) and listen to the mitral area.

4. Read the CS manual. Hand sanitizer = washing hands = wearing gloves.

5. Ask fewer questions. The SP isn't grading you on the history questions you're asking, and you have limited space in the HPI section anyway, so you reach a point of diminishing returns if you ask a ton of questions. MMSE shouldn't take you more than a couple minutes, and do an efficient neuro exam.

 

[Nabin]

1. You don't need to do any more than what's indicated. If you suspect a PTX or PNA why would you waste time doing a "tongue" exam or a foot exam? This is a focused physical exam.

2. It's not necessary to listen to the heart and lungs if you don't think it's pertinent.

3. The same way you would on a regular patient?? Explain that you want to listen to the bottom of the heart and ask if she can lift up her left breast for you. This is most easily and modestly done when you have them lying at 45 degrees, as they should be if you're doing a full cardiac exam, expose their abdomen (+/- abdominal exam) and listen to the mitral area.

4. Read the CS manual. Hand sanitizer = washing hands = wearing gloves.

5. Ask fewer questions. The SP isn't grading you on the history questions you're asking, and you have limited space in the HPI section anyway, so you reach a point of diminishing returns if you ask a ton of questions. MMSE shouldn't take you more than a couple minutes, and do an efficient neuro exam.

Thank you for your response. It clears things up.