drmamu
Forum Elite
Topics: 43
Posts: 188
| | 09/30/05 - 07:51 PM
2 of 2 forum leaders found this post helpful
| #1 |
hai guys,
I dont have many posts in this forum. But i was a regular reader of the site. I came to know the step 2 cs results. I passed. I was reasonably confident when i gave the exam. But then i opened the forum and came to know that one of our very confident fellows had failed. So i did not have the courage to tell about my experiences in the exam at that time. I bought a cd from the web that contained 140 cases and their sample patient notes and patient check list. I used to read them and pretended to ask them as if there was a real patient. I also read a book on clinical examination. But that was not really useful. I studied for at least 3 weeks. Towards the last forteen days my wife used to pretend as the patient. I used to do this 1 or 2 cases a day. Have the habit of asking the history in a sequence, at a moderate pace and without skippimg any topic. Later i came to know that usmle world also had the same materials that i had studied from the cd, but it was much more expensive. Its is not only important to to practise asking questions, but also you must be able to the examination in a flow that is comfortable to you and the patient. One that i found useful is this. Most of the time you wil find the sp sitting on the examination table. After introduction, drape the patient.Take a history as fast as possible. But cover all headings. Most sp will ask a question in between. Take time and explain it in a diplomatic manner without commiting anything. At the end, also remember to tell that you wil keep the question in your mind and that you will give a definite answer as fast as possilbe. Not only tell the sp what you are going to examine but also tell him what you are going to ask him next eg, about family, social life, etc Its the same as a transition statement. I did not find talking during washimg hands very useful. I started by examining the scalp, eye, nose, mouth, throat and then the ear. With finish cranial nerve examination also. Examine the thyroid from behind. ask the patient to swallow. Examined the upper limbs- check the pulse, strength and reflexes.Now ask permission to untie the gown. Now percuss, auscultate and check for vocal fremitus and chest expansion. Look for Cva tenderness and examine the spine and your examination in the back is over. Now you can ask the patiet to lie down. Slip the gown down and do upper chest exam. Recover the part now. Gently pull the gown from underneath the drape nad do lower chest and abdomen exam. Tel the sp to flex the hip and knee.Superficial followed by deep palption. Its better to auscultate abdomen first if you remember. I never did. Then examine the lower limbs-pulses, reflex and strengthNow ask the patient to get up- pull foot stool and offer to help.Ask the pateient to walk and do romberg sign. THis sequence worked well with me. If you make tha patient lie down with out untying the gown, you are in trouble. You wont be able to untie it with oatient lying supine. It will be very very difficult to pull up the gown without untying it. You may have to ask the patient to change position many times which may be very uncomfortable and time consuming. Finish the history and hand washing by 7-8 minutes. Finish the examination by at least one minute after the anouncement that two minutes are left in the encounter. Tell the patient to take a comfortable position and tell her that we will sit and talk. Summerise the history, tell some thing about your examination (that it is normal.) Now tell somethimg about the main test you will do and that we will sit and talk about it after the test results come. Offer to answer any question that she may have. Try to use all the time you have. I have more thing to tell that i think is useful. If anybody find it use ful i will send one more mail about things i learned. Its not a very difficult exam, Buttake it seriously and you will be fine.
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| ghcristina
Forum Newbie
Topics: 4
Posts: 18
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That's very thorough and very organized. Great job, drmamu!!
How long did it take to receive your result?
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| drmamu
Forum Elite
Topics: 43
Posts: 188
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hai ghcristina,
thanks for the compliments. i got my results in exactly 4 weeks. Bets of luck for your exams . If you need to know anything more feel free to ask me. bye
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| drvic
Forum Elite
Topics: 10
Posts: 181
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hey that was great flow of examination. covers almost everything except a few things here and there. there is no mention of CVS examination, which needs to be done in both sitting and lying down position. the one in lying down position can be done in the abovementioned sequence along with anterior upper chest exam, but the one done in sitting position could possibly be done before asking the patient to get off the table and walk. but then u will need to untie the gown once again...any tips to make this better?
but for the routine, its very good...hats off to you, man for making it look so simple....
what was the second useful thing u had mentioned? please share it with us....
also would you recommend any changes if the patient is already lying down when u enter the room...?
Edited by drvic on 10/03/05 - 10:48 AM
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| drmamu
Forum Elite
Topics: 43
Posts: 188
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hai drvic
I have always felt comfortable examining the chest and CVS together. I feel that most of the anterior chest and heart examination can be done in the supine position. Some like diaphregmatic excursion are not worth spending the time they require. Once you untie the gown in sitting position, you must tie it only at the end of the examinations i.e. just before you tell her to standup and walk. If you have any specific examination maneuvers in mind that can be done only in sitting position, please let me know and we will think of something.
Its always better to consider all patient as females during the process of physical examination. This will help you better to respect their privacy.This is more important when you are practising. Try to practise on female patients and yiu will do better on male patients.
When patient is already lying down, you should be careful as you may be dealing with a sick patient. In yhay case, do the bare minimum and come out. If the patient is not in any acute condition, you can ask if its alright for her to get up and sit.
I feel that you should tie or at least offer to tie the patients gown at the end of examination. You may be in great embarassment if the patient gets up with the gown untied and he/she has to catch it suddenly to prevent it from falling off.
Edited by drmamu on 10/03/05 - 12:56 PM
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| drvic
Forum Elite
Topics: 10
Posts: 181
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i guess you're right....since the UW videos recommend CVS examination in both sitting and lying down position, so i was wondering whether we would lose any evaluation points if we don't do the CVS exam in sitting position...that was the only concern. other wise the abovementioned schema of examination is just about perfect...
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say what you mean... and mean what you say...
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