Step 2 CS questions

[tacoman2493]

1) How many of the special signs did you try to elicit on physical exam? (murphy, tinnel, obturator, psoas, etc). Did you use those signs as a consistent part of the physical exam or only when you had a very high suspicion for a particular disease (i.e. did you do murphys for a person with LLQ pain)?

2) If a lady says she is monogamous with her husband, did you ask in detal about # of lifetime partners, men vs women, or just drop it and assume that there are no sexual risk factors in play?

3) During the physical exam, did you explain in detail every part of it? Or did you just say "i'm listening to your lungs now" etc. The SPs are supposed to check off a list for physical exam stuff, but if you dont tell them that you are doing the obturator sign, they might not check it off?

4) For women, for lung exam did you completely take off the top part of the gown and leave them sitting there in a bra or did you stick the stethoscope underneath the gown to listen?

5) For neuro complaints like headache, did you really do a FULL neuro exam, including vibration, position sense, sharp touch, light touch, etc or just focus more on cranial nerve stuff, Romberg, etc?

6) Did you do a real mini-mental status exam with all the questions, or did you just ask the standard alert/orientation questions? For what kind of patients did you do this? For example, did you do this for patients with depression?

7) Did you include the soup to nuts 10 million dollar workups that First Aid lists? Its ridiculous they want every patient with a cough to get a bronchoscopy and lung biopsy! I've never seen a doctor work up patients like that and its NOT the standard of care to order so many tests for such routine complaints!

---

Members don't see this ad.

 

[lord_jeebus]

1. only when i'd do it in real life

2. drop it (unless the chief complaint is strongly related)

3. didn't explain anything. did make comments like "your heart sounds healthy"

4. untie the back of the gown and leave it on

5. I did a fairly comprehensive neuro exam when indicated, but you really don't have time for testing sharp touch, dull touch, vibration etc. in all extremities

6. "where are we" and "what is the date," in situations when I'd do it in real life

7. just ordered what i would actually want to get

 

[Putrescine]

1. Only if I thought of the differential diagnosis in which the special test would be warranted based on what the patient was telling me in the history.

2. Yeah, I pretty much dropped the issue too, although I think i might have went as far to ask about contraceptive methods on a couple of them, but I dont think that was necessary.

3. I usually told the patient right before I was going to examine them: Im going to check your heart, lungs, abdomen, etc. I made comments about normal findings in the heart and lungs as I was doing the exam. I did not ask for permission to perform physical exam maneuvers (which I think is what first aid suggests).

4. I untied the back of the gown and listened by placing the stethoscope directly on the skin, moving the gown aside as needed, but I did not lower it to expose the patient's bra. Although during the cardiac exam, i'd have the women and men lower the left half of their gown down. I'd listen to the aortic, pulm, tricuspid regions, and then i'd do the mitral when the patient was lying down for an abdominal exam - mentioning that I would need to place my stethoscope on their lower chest to listen to the bottom of the heart.

5. I did a pretty good neuro exam for headache - CN II-XII, muscle tone and bulk, strength, sensation to light touch, pinprick (no stereognosis, graphesthesia or crap like that), coordination with rapid alternating movements and hell to shin, position sense. Kernig and Brudzinski signs. By no means was my sensory exam on every dermatome. It was really crude, a few spots on each extremity then move on.

6. I did a more fuller MMSE on patients who had memory loss complaints. I did not do it on patients with depression.

7. I ordered what I thought would be able to rule in or rule out my differentials the best first. If it included an expensive procedure, so be it, I wrote it down.

 

[Lauraaa]

Did you guys write on the note for the differential or in the work up section the reason for including diagnoses and tests or did you just list them like in First Aid?

Thanks...

 

[Lauraaa]

Did anyone get the CD that was going to be sent out in the orientation manuel? I didn't get one. Did they stop doing that? Is it the same videos that are posted online?

 

[Putrescine]

Did you guys write on the note for the differential or in the work up section the reason for including diagnoses and tests or did you just list them like in First Aid?

Nope, just listed them.

I also never received a CD, I watched both videos posted online prior to the test and I felt well prepared about the basics of how the day was going to be run. Plus, they showed us exactly the same video on the day of the exam.

 

[Lauraaa]

Hmmm. Maybe they stopped sending the CDs to people. I thought the video on the CD was supposed to be an example of a clinical encounter. Perhaps they don't send them anymore. That's cool, thanks for your input!