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  #1  
Old 02-26-2012
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Help Need answers for these 5

Could someone help me with these answers?

(1)During PE of heart do we need to do it both in sitting and supine position?In case we need to do it in both positions,do we first do both heart and lung examinations in sitting position and then ask the SP to lie down or do we do heart completely 1st and then ask the SP to sit again to examine the lungs?

(2)During your introduction to SP,do u mention your designation in that clinic or ER?I mean could anyone tell me what exactly u mention your designation as?

(3)In a paediatric case,do we just ask the parent if development is normal or do we ask the individual milestones the child should have attained at that age?

(4)Do we need to check the vital signs for any case like suspected Aortic dissection or COA?The VS we document in patient note are the ones shown to us on the doorway information or the ones we should take on our own?

(5)Suppose the case is Infectious Mononucelosis with LUQ pain do we still need to check for spleenomegaly ?We should not repeat painful maneuvers right?So once we check for tenderness we should not go back again to check for spleenomegaly?Does the same apply for RUQ tenderness and liver span?

Sorry to bother with silly doubts but would be happy if someone could answer these for me
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  #2  
Old 02-26-2012
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1) Do both heart and lung in sitting,ask him to lie down and do heart palpation and stuff. Dont ask him to lie and then sit up too many times.

2) "hello, I am Dr X, I am the physician in the office today, may I know wat brought u to the hospital/clinic today"

3) "Did he/she have any developmental delays or was the development normal" tis is enough no need to ask each and everything.

4) those on the door way r the ones u should consider, even if u measure it again, so just don measure, u can put it in the worp up plan as "repeat BP" or whatever.

5) Yes once painful never touch that part again.
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  #3  
Old 02-27-2012
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thanku so very much for your reply.
it really helped me.
good luck
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  #4  
Old 03-02-2012
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1) only if it is a full CVS you do both, if it is a secondary symptom then you just auscultate
2)you dont need to mention ER or clinical since the patient will be lying down for an ER case usually and they will be sitting for a clinic case.
3) ask about milestones for developmental history
4)unless if it is a htn followup case, which probably will never happen, you should just rely on the VS on the front of the door,
5)avoid painful areas, stop immediately
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  #5  
Old 03-14-2012
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1. you can do both in sitting position. make sure that you auscultate the chest at alteast 6 places (3 on each side) and wait for one breath cycle. Dont make the SP lie down and sit up very often, as it wastes time and makes them irritable.

2.If in the doorway information your designation has been specified, then you use that...otherwise you are free to you use any designation "doctor on duty", "resident on duty", etc

3. You should inquire about individual milestones relevant for that age. In a phone case you have a lot of time at your disposal, so make full use of it.

4. BP should be checked in the following cases if you have time
- acute chest pain
- hypertensive followup
- diabetic followup
- suspecting postural hypotension
- CVA

5. Dont repeat any painful procedure again. Please apologize if you cause the patient pain. In infectious mononucelosis make sure tell the patient to avoid contact sports.
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