Struggling to adapt to the new CS format

[SlaveOfTCMC]

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I am currently using the latest UWorld for preparation of CS. However, they have not yet modified their materials to reflect the new format.

As I practice, I begin to realize just how few physical exam findings I can actually write down.

For instance:

A case of impotence... based on Hx it could be medication based, primary, diabetic neuropathy...

But what physical findings could I possibly find on a mock patient in whom I cannot do a genital exam?

Perhaps he may feign claudication of the hips and buttocks on the real test and that could help. But I am at a total loss.

A psychiatric case may find very few physical findings if it is a non-organic etiology.


Other cases are far easier if one can feign pain related to the CC


However, it appears to me that at times I am going to have to put in the bare minimum of inputs for physical exam findings and history items.


Any thoughts on this?

 

[septoplasty]

I am currently using the latest UWorld for preparation of CS. However, they have not yet modified their materials to reflect the new format.

As I practice, I begin to realize just how few physical exam findings I can actually write down.

For instance:

A case of impotence... based on Hx it could be medication based, primary, diabetic neuropathy...

But what physical findings could I possibly find on a mock patient in whom I cannot do a genital exam?

Perhaps he may feign claudication of the hips and buttocks on the real test and that could help. But I am at a total loss.

A psychiatric case may find very few physical findings if it is a non-organic etiology.


Other cases are far easier if one can feign pain related to the CC


However, it appears to me that at times I am going to have to put in the bare minimum of inputs for physical exam findings and history items.


Any thoughts on this?

Impotence will never be the primary CC for any patient you'll encounter. It would be on of the things they'll mention when you do RoS / Ask them for ADR from meds they've been taking for HTN or DM etc.

So CC being HTN / DM Followup, or something that you CAN do a PE for.

Now i'm sure you can come up with PE exam for those two at the very least.

Just like the psych cases, but those don't really require you to do like an ABD exam or something (unless patient has complaints), do as much of a Neuro focused exam as you could + heart / lungs.

Key to this exam is asking FOCUSED questions and doing a FOCUSED PE. Time will fly if you aren't organized or are asking irrelevant questions.

 

[SlaveOfTCMC]

Correct I am asking focused questions when I practice and it fits the scoring rubric with each case. I understand using a test prep source's rubric is not 100% precise for the real thing.

Nonetheless, when it comes down to putting down my 3 DDx and the supporting findings, I usually wonder what I can put down.

For a HTN/DM case, I can obviously put down elevated BP (as indicated by the vital signs on the sheet) for a physical finding.. possibly I can put down decreased sesnation to dull/sharp/temperature/vibration if the patient cooperates on that aspect... possibly visual difficulty on the Snellen chart..

But unless the patient gives me any more prompts, I do not what else to put down because I obviously cannot put down findings consistent with the Dx but are NOT found on the SP.


Perhaps I am just overthinking this. The CS instruction manual has a few examples and at times they do not list more than 1 or 2 history findings in certain cases.


In real life in my clerkships it is a far easier task because of real findings.


Perhaps the bottom line of my concern is that:

How many actual findings will there be? If there are not supposed to be many pertinent physical findings (as in the psych cases), then would putting down the bare minimum of supporting findings be acceptable?

P.S. I am referring more to the "add supporting history and physical findings under the DDx" as opposed to the PE write up section.

 

[septoplasty]

For a HTN/DM case, I can obviously put down elevated BP (as indicated by the vital signs on the sheet) for a physical finding.. possibly I can put down decreased sesnation to dull/sharp/temperature/vibration if the patient cooperates on that aspect... possibly visual difficulty on the Snellen chart..

But unless the patient gives me any more prompts, I do not what else to put down because I obviously cannot put down findings consistent with the Dx but are NOT found on the SP.


Perhaps I am just overthinking this. The CS instruction manual has a few examples and at times they do not list more than 1 or 2 history findings in certain cases.


In real life in my clerkships it is a far easier task because of real findings.


Perhaps the bottom line of my concern is that:

How many actual findings will there be? If there are not supposed to be many pertinent physical findings (as in the psych cases), then would putting down the bare minimum of supporting findings be acceptable?

P.S. I am referring more to the "add supporting history and physical findings under the DDx" as opposed to the PE write up section.

You recognized the problem, you're over thinking it.

Think of the encounter just like your clerkships, the SP's are told to give characteristic PE findings of the disease entity that they are trying to convey. This means, yes if the case is DM, then they will show decreased sensation etc., and you will be use those findings when writing the diagnosis or putting down the workup.

 

[SlaveOfTCMC]

All right good to hear. Thanks for your input.