Physical exams on Step II CS

[CNphair]

Ok, I am 12 days from the CS exam...just started reviewing the Kaplan II CS book. I have been breezing through it so far, but I have run into a problem on the practice cases...what are they expecting for the "focused" physical exam?

This is what I have gathered...you pretty much always do a cardiac, lung, and abdomen exam...and then add on anything else you need. But how detailed do you get? If a patient has gout, is it ok to just listen to the lungs at 2 levels or do you always have to do a fully pulmonary exam? Do you always listen to the 4 points on the heart exam, or are 2 ok?

I know what I usually do on the wards...but something tells me that won't quite cut it for the test.

Thanks for the help!

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[ttumed]

Well you could argue that you could just quickly place your steth @ all 4 places... they can't tell what you did or didn't hear. Just be quick about you know. Did your school do an OSCE to help you prepare... very useful imo

 

[Stinger86]

Of my 12 stations, I think I listened to only the heart and lungs on probably 8 of them. Heart exam -- listened to four places with the diaphragm. Lung exam -- auscultated 3 levels on both sides, so 6 spots. That's it, even on cases with CC's of pulmonary or cardiac origin. The only time I EVER did anything beyond those two maneuvers was when it was obviously relevant to the chief complaint -- for example, ortho, neuro, abdominal exam. Otherwise, nah.

Of course, as far as i know I could've made up for my crummy physical exam with a strong history in the checklist department, so take this as you will.

I still think you're more heavily graded on talking the patient through the physical exam and explaining findings, than actually performing all the maneuvers, though.

 

[CNphair]

Thanks, guys. That is good to know. It easy to get worked up by the recommendations of Kaplan and First Aid...HEENT, lung, CV, ext, and neuro exam on every pt with fatigue.

Casey