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Old 10-09-2012
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Hammer and Otoscope Focused Physical Exam

Hey guys. A lot of resources (including Kaplan book and CS information booklet on the website) say that we should perfrom FOCUSED physical. And it is generally accepted by forum people that FA and CSE video have very extensive physicals.
Do you guys think that perfroming only focused exam (i.e. only examining joints in knee pain case) is a way to go? Or do we still need to try and at least auscultate heart and lungs in every case in addition to doing the relevant system exam?
I was trying to do a lot of physical in every case when practicing, but now I start thinking that maybe I should avoid it to feel more comfortable with closure and even maybe to leave couple extra minutes for PN? Does anyone know how much value the "not so relevant" system exam has on the SP checklist?

Recent test takers help is greatly appreciated.
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Old 10-09-2012
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Default I get my results tomorrow....

I will let you know more tomorrow but I did a general exam on almost everyone unless I had no time.

Example:

Looked at conjunctivae, checked pharynx and mouth. Looked at hands and lower extremities then auscultated heart and lungs... After that, I would do focused exam.

This would take me a couple of minutes. In a few cases where the patients were in serious pain I would check the focused area first and then do the general.

My 0.02
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Old 10-10-2012
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It is much better to start with a general examination of the patient
and then do ur systems exams. General exam can be very revealing and sps will think ur a good physician for doing it
gl
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Old 10-23-2012
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I would do gen exam at the end . If done at the beginning it should be really quick.
From the patients' perspective, Focussed exam is better because after he tells you about his backache and how it is giving him problems he would expect you to look onto his back first rather than look into his conjunctiva!
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Old 10-23-2012
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Default

Quote:
Originally Posted by Lotsahope View Post
Hey guys. A lot of resources (including Kaplan book and CS information booklet on the website) say that we should perfrom FOCUSED physical. And it is generally accepted by forum people that FA and CSE video have very extensive physicals.
Do you guys think that perfroming only focused exam (i.e. only examining joints in knee pain case) is a way to go? Or do we still need to try and at least auscultate heart and lungs in every case in addition to doing the relevant system exam?
I was trying to do a lot of physical in every case when practicing, but now I start thinking that maybe I should avoid it to feel more comfortable with closure and even maybe to leave couple extra minutes for PN? Does anyone know how much value the "not so relevant" system exam has on the SP checklist?

Recent test takers help is greatly appreciated.
you will get the most points on the SP checklist (the checklist that grades you) If you do a focused physical examination of the system you think is involved.


WHY TO DO ONLY A FOCUSED PHYSICAL EXAM?
because it will give u extra time to close and counsel the patient.
the most important thing on the new pattern is the CIS.

yes you can check stuff like -- pulse, pallor (both by examining the hands)

but personally i would advice against wasting time doing any other systems or general stuff -- it will get you maybe 2-3 extra points on the checklist.. but if you spend the time on counseling/summing up ur impression of the patient... you will hit more points on the checklist


save the time for counseling.





WHAT ALL TO COUNSEL ON? WHY DO I NEED EXTRA TIME


counsel on
1- workup - explain tests u will do
2 - explain the diagnosis
3- guide the patient thru smoking cessation/ alcohol cessation/ support groups/ exercise etc etc
4- Hidden concerns

EVERY patient will have something APART from the obvious case that u can counsel on... having time to go about that will get u the stars on the CIS part which is the hardest to pass.



WHAT IF MY PHYSICAL ISNT UPTO THE MARK?
you can still cover up in the patient note -- write a good history, good differentials, fill up all the stuff for the tests you will order etc.

if you lack a few check points in the physical exam.. you can still cover up for it in the Patient note.

however if u for some reason lack check marks in the CIS, there is no way to cover it up... so while with the SP - give it the MOST importance.
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Old 10-23-2012
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Default My Exam

Sorry cannot give you advice on what happens when you don't do heart and lung auscultation because I too did them on every one of my patients.
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