Step II Step 2 CS, specialized physical exam tips?

[mercaptovizadeh]

Do you perform a full mini MSE on demented patients? this seems like it would take 2-3 minutes of precious exam time?

Do you do orthostatics on patients who need it, or order it as a diagnostic procedure? Doing orthostatics properly requires waiting 3 minutes after the patient stands up from supine position, also a huge time waster.

What are the rules of auscultating, i.e. do you turn the patient into left lateral decubitus and use the bell? Do you listen under the gown or over it (I would think they might be picky with that)?

 

[helvetica]

Took CS, passed. This is the advice I received/followed. I would recommend reading the beginning of First Aid for Step 2 CS for quick tips, as I found a lot of them to be helpful on test day.

1. You can ask a few questions in a brief amount of time to get a gauge, and then in your note you can mention performing a full mini-mental.

2. As above-- pretty sure you can document that you want to do orthostatics without having to actually do them in the room.

3. You have to listen under the gown I believe to get credit for auscultation. Just keep modesty in mind. You can position the patient in whatever way is appropriate for the exam. I'm not sure how the bell policy would work since some stethoscopes do not have a separate bell, but rather tune out higher or lower frequencies based on the amount of pressure you use (a lot of the Littmann's have the tunable diaphragm).

 

[Stellar Clouds]

Don't waste precious time doing orthostatics, just order them in your note.

Don't listen through the gown. Diaphragm alone is fine.

 

[naseeha]

Also, don't rush the PE. Listen to the heart for a few secs and listen to full ins and exp.

 

[LaCasta]

Are you supposed to score the MSE?