Step 2CS All You Need to Know: Difference between revisions
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===Review of Systems (ROS)=== | ===Review of Systems (ROS)=== |
Revision as of 12:32, 11 July 2013
Type chapter name here Microchapters |
Physical Examination |
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Patient Note |
Differential Diagnosis |
Step 2CS All You Need to Know On the Web |
Study Guide
For study purposes the patient will be called Wiki and the Dr. is Romero
Overview
Watch the USMLE website video first to get an overall idea of the examination
Test Structure
Please help Wikidoc add content
Interviewing Process
Doorway Information
-Mr/Mrs
Age BP HR RR Temp
- Comes due to symptom (back pain/ sore throat)
- Write down on given paper Name/Last-name, Age, Altered vitals, chief complaint
- If possible write quickly 3 differential diagnosis for the chief complaint
- Knock the door and enter the room
Introduction to Wiki-Patient
- Hello Mrs/Mr Wiki-patient (Shake hands with the patient)
- I am Dr. Romero I will be your doctor today, I will ask you some questions and perform a brief physical exam on you. Is that OK with you?
- Is the room OK for you? (Dim light or adjust temperature if possible)
- Let me make you more comfortable
- How would you like to be addressed? (Wiki-patient says he/she likes to be called Wiki)
- How may I help you today? (Wiki-patient describes chief complaint)
- I am sorry to hear that. I will do my best to help you.
Asking About Chief Complaint
LIQORAAA for Pain
OCPDFAAA for Non-Pain
Review of Systems (ROS)
LIQORAAA (for pain) OCDPF ROS (IF PERTINENT) PAMHITSFOSS
Counseling
- Immediately when the patient gives you the information
- When washing your hands
- During closure
Challenging Questions
Physical Exam
Performance
History
- HPI
- ROS
- ALL
- MED
- PMH
- PSH
- OBGYN
- FH
- SH
Patient Note
Avoid using medical terms when interviewing. Use Layman terms instead.
HPI
LIQORAAA (for pain) OCDPF ROS (IF PERTINENT)
PAMHITSFOSS ROS: negative except as above PMHx: previous symptoms like this or major medical condition Hipertension, Diabetes, MI. HOSP. NKDA, Medics: prescribed and OTC PSHx: TRAUMA, SURGERY FHX: none (only pertinent) OB-GYN Hx FMP, LMP, Period every 30 days, lasts 5 days, tampons/pads, GPA (gestation, pregnancy, aborption) SHx: Occupation. . Occupation. Support (SAFE). SEXUAL: active with. multiple Men/wome/both. Condoms every time. No STDs. HIV test. smoking (PPD: 1pack per day for 30 years, EtOH (CAGE 0/4), Illicit drugs, Travel history.
PAM HUGS FOSS WA FOR KIDS ON CALL IDIOT: onset number cry asociated sxs listless liquid (urine) inmunization diet, dehydration, daycare infection/ill contacts ORS:Oral rehydration solution Travel
Physical Examination
- Unable to examine due to pain
- NAD (hydrated, afebrile, tired, flat affect, tired, speech, movement)
- VS: WNL except: BP RR HR Temp.
- HEENT (head, eyes, ears, nose, throat)
Head: AT, NC (atraumatic, normocephalic) Eyes: EOMI, PERRLA, normal eye funds. No conjuctival pallor Nose: no nasal congestion. Throat: No tonsillar erythema, exudates or enlargement. Mouth: moist mucous membranes, good dentition
- Neck: Supple, no JVD, no carotid bruits, no cervical LAD, normal thyroid. (CAT ORGAN: Carotid, Abdomen, Thyroid)
- Chest/Lung: no tenderness, clear to percussion bilaterally, tactile fremitus normal, clear breath sounds bilaterally. (No wheezes, crackles, rhonchi, rubs)
- Heart: PMI not displaced, RRR,normal S1/S2 WNL, no M, G, R.
- Abdomen: ND, BS +, Soft, NT. (NO Murphy, McBurney, Rovsing, CVA tenderness, psoas/obturator sign "just one"). No Hepatosplenomegaly/ organomegaly.
- Extremities: No edema +2 +3, clubbing, cyanosis, hairless, asterixis, skin changes. Peripheral pulses (don't write it radial, brachial, dorsal is pedis, posterior tibilalis) 2+ and symmetric. No bruises. ROM (limited passive/active "abduction/adduction/flexion/extension/external rotation" MRS (motor, reflexes, sensation)
- Neuro
Mental Status: A & O x3, spells backward, recalls 3 objects. CN 2-12 WNL/grossly intact. Rinne WNL, AC> BC?. Weber not lateralized. Motor: strength 5/5 in all limbs except DTRs: 2/4 except (normal) absent ankle jerks. Babinksy - Left or right. Sensation: intact to pinprick and soft touch (sharp and dull). Vibration and position normal Gait: normal Cerebellar: finger to nose normal (dysmetria, diadococinesia) Romberg -.
- Skin: preserved turgor.
- Mental Status exam
Pt speaks slowly No hostile behavior toward interviewer Blunt affect with poor aye contact Inattentive to interviewer 3/3 registration, 3/3 recall at 3 times Distant memories are impaired Oriented to person, date and place Completed 3 step command Right handed 1/5 on serial 7s Poor judgement
Reporting Physical Exam Briefly
HEENT:
- NC/AT: normocephalic / atraumatic
- Ø LAD: no lymphadenopathy
Cardiac exam (CV):
- Ø M/G/R: no murmurs, gallops, rubs
- 2+ PT/DP B: 2+ posterior-tibial and dorsalis pedis pulses bilaterally
- Ø JVD: no jugular venous distension
- Ø LE edema: no lower extremity edema
Lung exam:
- CTA B: clear to auscultation bilaterally
Abdomen exam:
- NT/ND: non-tender, non-distended
- Ø HSM: no hepatosplenomegaly
- + BS: bowel sounds present
Back exam:
- Ø CVAT: no costovertebral angle tenderness
Neuro:
- EOMI / PERRL: extraocular mvmnts intact / pupils equal, round, reactive to light.
Differential Diagnosis
Give 3 to 5 differential diagnosis with pertinent positives or negatives from HISTORY AND PHYSICAL EXAM
Diagnostic Workup
- Specific physical examination (rectal, pelvic, breast, genital) if applicable
- CBC and electrolytes
- Cultures
- Imaging