Step 2 CS Physical Exams

[Hemichordate]

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A couple questions..

1) Do you have to ask for permission for every little step of every exam you perform? For example, can you just say "I'm going to listen to your lungs" and then palpate and percuss during the same exam without saying those, or would you need to say it specifically?

2) For some exams, I don't check everything..for example, I often don't check cranial nerve 8 (hearing) when doing the CN exam, but still report it as normal on notes. Is this acceptable on CS?

 

[discerdude]

I don't know if you want to take my advice because I don't have my score back yet, but...

1) I asked permission if it was something that involved exposing the patient. I also asked permission to start the PE in general. I highly doubt that you are required to ask permission for every little thing. I just did it where I thought it might be appropriate.

2) I hope so...I usually consider the patient being able to hear me a + for CN8. I would probably check hearing formally on the exam (with a whisper or tuning fork test). I didn't though. I'll let you know if I pass...

 

[Phloston]

Agree with discerdude that it's probably only necessary when appropriate (i.e., you don't need to ask permission for every little thing).

However over-asking, rather than under-asking, will likely establish good rapport. This exam is about the impression you give, not your actual clinical skills. I'd bet the mock patients probably maintain the mentality of asking themselves if they'd want you as their actual doctor. You would never lose points for being a doctor who's really polite. There was some other poster on here a while ago who mentioned that he'd make small chat when washing his hands, instead of using it as awkward downtime. It's just a whole acting session for building rapport and showing you're not unsafe.

 

[Hemichordate]

I see. Thanks for the responses.

Also, when listing the diagnostic tests, do we list what we would do initially or everything that we would want done?
In first aid, they would list all the tests (like both MRI and CT), while in actuality only one would likely be done initially.