Step II Step 2 CS RUQ pain vs epigastric pain workup

[zlatansays]

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I had a question for the workup of this complaint. If a patient complains of abdominal pain and it is in the epigastric/RUQ region, would it be alright to do a workup that consisted of a RUQ U/S, EGD and amylase/lipase. Or can you really localize the pain that well if it is in the epigastric region and exclude something like the U/S?
Thanks!

 

[Bully Ball]

I had a question for the workup of this complaint. If a patient complains of abdominal pain and it is in the epigastric/RUQ region, would it be alright to do a workup that consisted of a RUQ U/S, EGD and amylase/lipase. Or can you really localize the pain that well if it is in the epigastric region and exclude something like the U/S?
Thanks!

Focus on the history. Don't forget your pain mnemonic (mine was SOCRATES). They should give you enough in the history to narrow it down before you get to the physical exam/workup/note. There were very few positive physical exam signs on my CS, if they are told to act it, they'll be trained well enough to act it when you press/tap at the right location. Getting a good history is 90%+ of the CS because it will guide your physical exam, it's used to asses your CIS/SEP scores and it's all you have to go off of in the note/diagnosis/workup sections