trishue
Forum Elite
Topics: 24
Posts: 156
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Regarding the Pre-employment PE and Hx, I wouldn't need to write an Patient note for it if they give me a form right? What if the form contains Weight and Height, do we ask the patient? or is there a weighing scale in the PE room? thanks... my exam is in two days, really anxious right now...
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| CSobsessed
Forum Senior
Topics: 6
Posts: 144
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trishue, I did not see any scale in PE room. What I know though is that they say that preemployment PE is the luckiest of all the cases. There will be a form which you suppose to fill out. All points will be for the physical exam. You do exactly what they ask you to do in the form. You can look at the form all the time, so you do not forget what is you asked to do.Regarding weight and height... just pay attention to the opening scenario and write down height and weight if it is there... If it is on the form and you do not know-- you can ask the patient. DO NOT FORGET TO WASH HANDS. Because they say that people are so glad that they do not have to ask anything that they forget to wash hands. Though there will be no history you still very briefly ask him about general health, high blood pressure, high sugar,high cholesterol, allergies and medications, does he excersise or not, any diet? In the end you wish him well with his new job, shake hands and say that a filled out form will be waiting for him at the front desk. I think you worry over nothing in this case. Good luck.
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| kgyi2003
Forum Senior
Topics: 18
Posts: 68
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how about writing case notes for this sceanerio? can u give me some advices please ?
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| CSobsessed
Forum Senior
Topics: 6
Posts: 144
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kgyi2003, in the form they give you they specify what exactly you have to do.
For example, you will be asked:
1. Percuss the lungs. 2. Measure blood pressure. 3. Assess reflexes in lower extr.
I do not know how much would be to check but you've got the point. So, you check exactly what you were asked and then you write on the form which is waiting for you on the desk after you left the room:
1. Lungs: (-) dulness to percussion B/L or lungs are resonant B/L;
2. BP: 120/80 supine B/L
3. reflexes 2+ B/L patellar, Achilles.
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| doctor1998
Forum Newbie
Topics: 8
Posts: 20
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do we have to check BP for pre-emp case even if we have BP written on doorway?
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| CSobsessed
Forum Senior
Topics: 6
Posts: 144
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Yes, if their instructions directly tell you to measure BP. I can think of only this case when you measure BP. In ALL other cases( HTN case, HTN-refill case are included) it is unjustified to measure BP because it takes too long and you have so much more to do and to ask. You'll get 1 point for BP and meanwhile miss 5 ( or whatever) other points. Just look up information on the door and assume that that information is true.
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| doctor1998
Forum Newbie
Topics: 8
Posts: 20
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thanks CSobsessed,
if we have to examine pt's chest and abdomen ,with history relevant to both,do we make the pt lie down and check heart and lungs,then make him sit up for the back of chest exam and then again make him lie down for abdomen exam?please i'm confused about making pt lie down 2 times.
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| jedi
Forum Senior
Topics: 28
Posts: 73
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In continuation with what doctor1998 asked,I would like to ask if it is neccessary to examine heart in 2positions-ie,sitting as well as supine or is just a supine position is enough(unless the patient has a valvular heart disease?) -jedi
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| CSobsessed
Forum Senior
Topics: 6
Posts: 144
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doctor1998, we do not check lungs when patient is supine... But you are on the right track about not making a patient moving up and down unnecessary. So, while he is sitting up you check peripheral pulses, check nails, dependent edema, check lungs back and front and listen to the heart, then you ask him to lie down, pull the rest leg out, auscultate heart again and palpate for PMI, costochondral tenderness, then you cover up his chest with the gown( remember, you untied it so cover chest part) and ask the patient to pull out his gown up while you are moving sheet so only area from subcostal edge to the upper edge of his undewear exposed. Then you examine abdomen. After that you ask the patient whether he is comfortable while laying down or wants to sit up. If the patient wants to sit up, you help him and make sure to tie his gown back. Though, as much you want to do everything, I doubt you will have time to do full examination of three systems. At least I could not manage to do everything I wanted to do.You usually fully examine one plus some points from other systems. For example,you suspect aortic abdominal aneurism. You would have to do heart, lungs, abdomen. I would do full cardiovascular ( heart itself sitting and supine, periph. pulses,JVD, dependent edema), but only auscultation of the lung, and only auscultation of the abdomen to assess for brui.
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| CSobsessed
Forum Senior
Topics: 6
Posts: 144
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jedi, I think it depends on what you suspect. For example, the guy with a chest and left arm pain and MI is very high on your dif.diagnosis list. You do full CV and auscultation of the heart sitting and supine as a part of it. OR, the guy is coughing the hell out of him,has chest pain and fever. So, the lung disease is a priority here. So, you do full pulmonary plus auscultate the heart only while sitting. OR the female has insomnia, hot all the time...so you auscultate the heart sitting only and check periph.pulses as a part of her thyroid problem. If you HAVE time, by all means do everything you think is necessary. Just remember, you must leave about 2 minutes for a nice closer. If you consistenly do not do closure-- it is much worse than if you miss something on PE.
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| CSobsessed
Forum Senior
Topics: 6
Posts: 144
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doctor1998, sorry I forgot to meantion that in cases when you do not measure BP but you think BP is relevant-- order it on the first line of the work-up part of the patient note, so nurse will do it. Something like measuring BP supine B/L X3.
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| doctor1998
Forum Newbie
Topics: 8
Posts: 20
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thanks CSobsessed,
I saw some physical exam video where the doc was doing lung exam with pt in supine position.I think it was vocal fremitus and percussion of chest.
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| CSobsessed
Forum Senior
Topics: 6
Posts: 144
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doctor1998, I am a pediatrician so examined babies's lungs while they laying down a lot
Unfortunately my Swartz CD with PE does not want to work for some reason... Anyway, while examining lungs you must compare not level to level on one side but SIDE to SIDE on the SAME level. I think when patient is sitting up it is much easier to achieve it with less discomfort to the patient... Of course, if the patient playing really sick and say he can not sit up, you do not make him sit up.
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| doctor1998
Forum Newbie
Topics: 8
Posts: 20
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thanks CSobsessed,
did u already take your exam?
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| CSobsessed
Forum Senior
Topics: 6
Posts: 144
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doctor1998, yes, I've already taken my exam in Phil. and got my ECMFG Certificate today.
Come to think of it, the best days are over Taking exams is much easier than to find a spot for externship or something. I'd rather take chance with a computer than write a Personal Statement But that off-topic... I do not know where you are going to take your CS. People in Phil. were very friendly. The patients have no intention to screw you and all I can say about cases is what on USMLE CD itself: they are common cases.
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| jedi
Forum Senior
Topics: 28
Posts: 73
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Thanks a lot Csobsessed and good luck to you!! -jedi
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