What about REAL (not simulated) PE findings in Step II CS ??

[Still Kickin]

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So, I'm skimming through my 1st Aid for my CS which is in a couple days.

It says the patient will say "hush-hush" to simulate bruits, murmurs, etc. Then there is also a section that says not to be surprised if we actually do come across some REAL findings (scars, nevi, HEART MURMURS, etc.)

So - I'm wondering - if I have a SP with a REAL heart mumur - did they intentionally pick someone who has a mumur to be the SP in a case where that would be a relevant finding? Or am I supposed to ignore it & only count it as a murmur if the patient says "hush-hush"?

(Or, perhaps the murmur really has nothing to do with the differential, etc. for the case AT ALL, and it's totally random that my SP has a REAL murmur, but now that I've heard it, I have to document it?)

Also - that business about patients tensing up their abs to mimic "abdominal rigidity". I had an SP on an OSCE at my school who kept tensing up like that, and I took it to mean I had to keep trying to find ways to get him to relax his abs for the exam. Now I'm wondering if he had "rigidity". If someone has tense abs, do I just call it "rigidity" and move on? Or try to get them to relax further?

And all this draping business. I don't think I've EVER draped someone's legs if I was just doing a HEENT exam, etc. But is *is* required for *every* patient, correct?

 

[Still Kickin]

1 more question:

So at my school, they always make a big deal that we must always represent ourselves as a STUDENT (ie, student doctor, medical student, whatever...) and must not mis-represent ourselves as a "real" full-fledged "doctor". This typically applies to our OSCE's, too, unless the door info has been written in a way that makes it clear that for this particular case you really have been "promoted" to full "doctor".

The First Aid gives an example of introducing oneself to the patient that is something like "Hi, I am Dr. Jones". Are they EXPECTING us to call ourselves "Dr." in these encounters? (Either way - I don't want to get points off for failing to be the "DOCTOR" if that's what I'm supposed to be; but I also don't want to get points off for mis-representing myself...) Anyone know what they are looking for?

 

[2oRadio]

1. I'd drape every patient.

2. I think any simulated findings would be outstandingly obvious. I breezed through my physical exams and didn't even bother trying to elicit any subtle findings. Passed without a hitch. Remember the name of the game is efficiency. I'm pretty sure coming up with cohesive assessments/plans and being a professional at all times (see: draping) will outrank what physical findings you can document on the note.

 

[Gibbles]

As per above, if you note a particular finding, it's pretty obvious that you can pass. However, if you hear a murmur and you mention it, the SP will either say that it's not part of case, that they weren't aware of it, or they will probably ask what a murmur is in the first place.

Enjoy the frustration. I know that I did.

 

[ForeignBody]

Just call yourself Dr. ________

For all they know you actually are one. There are many FMG's taking the exams who are Dr.'s.

All of the proctors will call you Dr. "last name" the whole day. At least they did at my site.