When to order HIV test; BP required in CV problem?; Tilt test? - USMLE Forums
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Old 06-09-2013
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Question When to order HIV test; BP required in CV problem?; Tilt test?

Hey everyone,

I had a few questions for CS exam.

1. I see in cases like multiple sexual partners, we ARE supposed to ask about history of STD's. I saw in one case of FA that we are also supposed to ask if they have been tested for HIV. My question is, should we offer every patient with multiple sexual partners (like 4-5 the last year, or being promiscuis) an advise to get HIV test i.e their consent for it while closing? When we should counsel them to get one?

2. I know we are not supposed to take BP in any of the cases. But what if the patient has a chest pain, and you are suspecting dissection. Are we supposed to take BP in both arms?

3. In cases of Dizziness/vertigo, FA mention to do P/E for Tilt test, and then orders up in workup the Dix-Hallipke test. Aren't they the same thing? And are we supposed to do the Dix or Tilt test in cases of vertigo/dizziness or just order them in workup?

4. One more thing. A patient has 0/4 on CAGE, but he says he doesn't keep a count on his alchol, and drinks heavily on weekends. Are we suppose to councel him on Alcohol? I.e should we counsel even if CAGE is 0/4 ?

Thanks a ton!
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Old 06-09-2013
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1- yes you should ask and advise for hiv test especially if patient not used condoms.
2- just mention it to patient and record it in follow up tests
3-no just put it in follow up tests.
4- sure councel such case even cage 0/4. do not councel in cage 0/4 and patient drink only one or so wine in weekend
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Old 06-10-2013
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Thanks for the answers.

Just one more thing. I get confused in the cases for Mental Status Exam(not Mini Mental Status Exam). Like in the case of Psychoses or other mental illness, are we supposed to evaluate the affect/mood/judgement/thought etc? That is like a whole half an hour discussion, and I think we should just order it up, right?

And in such cases only MMSE is enough?
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Old 06-10-2013
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Quote:
Originally Posted by Smashingdude View Post
Thanks for the answers.

Just one more thing. I get confused in the cases for Mental Status Exam(not Mini Mental Status Exam). Like in the case of Psychoses or other mental illness, are we supposed to evaluate the affect/mood/judgement/thought etc? That is like a whole half an hour discussion, and I think we should just order it up, right?

And in such cases only MMSE is enough?
Yes MMSE should be enough. Infact unless there is something gravely wrong with the patient, the SP will respond to the initial orientation questions correctly and you can simply document that. If you are running out of time, make sure you atleast ask them the AAOx3 questions. However, if the case is clearly about confusion/memory loss then i would go ahead and do everything including asking them to hold a piece of paper (maybe you can use a tissue, but definitely don't use the blue sheet they give you as they are numbered), fold it and keep it on the ground. You can always order the Mental Status Exam as part of your workup. Hope that helps!
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Old 06-10-2013
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Thanks once again. Just one more question, and I promise I won't ask anymore

Every patient above 50, are we supposed to ask for health maintenance? I.e screening with colonoscopy/rectal exam in males, and mammography/pap in females?
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