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Prep4USMLE » USMLE STEP 2 CS Forum » USMLE Step 2 CS Cases » Comments on Underwear


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DrVirgo

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May 23, 2007 - 9:20 AM       #1

We are told not to auscultate through the gown, but what if we have to auscultate the lower abdomen and the patient's underwear is covering that area. Do we ask him/her to lower it a little or do we auscultate over the undergarment.

Same question for women and bras... do we auscultate over it if it's in the area we need to listen to? Or does the steth have to be on the skin?





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kity

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May 23, 2007 - 10:26 AM       #2

yes you have to ask them to lower it a bit, in women you could say to lift it up a bit. but auscultation has to be done on skin not cloths


CocaCola

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May 23, 2007 - 10:55 AM       #3

yes we have to allways auscultate on skin...

when ausculataing the heart in a female patient with a bra - just ask the patient if you could place the steth underneath the bra at the desired area... thats what i did during the exam and it wasn't a problem...



DrVirgo

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May 23, 2007 - 6:35 PM       #4

Thanks. thats what I thought as well...

Also when auscultating the lungs from behind, we have to first ask if its ok if we untie the gown, patient says ok, then untie it, and then ask the patient to lower it (we shouldn't lower it ourselves). -this is the correct method.



CocaCola

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May 23, 2007 - 6:38 PM       #5

yes ask the patient... i lowered the gown but also ask to do so...



DrVirgo

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May 23, 2007 - 6:43 PM       #6

If you are moving from chest exam to abdominal exam, do you continue asking the patient to LOWER the gown? OR do you ask to put the gown back up, and then raise the gown from the bottom?

In other words, for the abdominal exam, do you ask to lower the gown from the top, or raise the gown from the bottom?




CocaCola

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May 23, 2007 - 6:47 PM       #7

chest exam - lower gown from top
Abdominal exam - raise gown from bottom with drape over pelvis and thighs, and leg extension to support lower legs...



DrVirgo

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May 23, 2007 - 6:48 PM       #8

ok, so when going from chest exam to abdomen, we have to re-tie the robe at the neck?


CocaCola

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May 23, 2007 - 6:49 PM       #9

Yes...


DrVirgo

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May 23, 2007 - 6:52 PM       #10

Excellent. Thanks. smiling face





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