Painful Area Examination in the CS - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CS Forum > USMLE Step 2 CS Prep Tips > USMLE Step 2 CS SP Challenges

USMLE Step 2 CS SP Challenges Challenging situations presented by the Standardized Patient (SP) during the the USMLE Step 2 CS Encounter.


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 04-23-2011
USMLE Forums Newbie
 
Steps History: 1 + CK
Posts: 6
Threads: 2
Thanked 2 Times in 2 Posts
Reputation: 12
Hammer and Otoscope Painful Area Examination in the CS

Guys, would you answer the following questions about examination of a painful area:

1. If SP has tenderness during anterior chest palpation (i.e. costochondritis), should we move on and perform anterior chest lung auscultation? I bet, SP will experience pain taking deep breath...

2. If SP is lying down on a couch on his side in acute pain, should we turn him supine to examine his abdomen or leave him in a such position?

3. If before abdominal exam SP tells you he has RLQ pain, Should we start abdominal palpation from LLQ? Right? And should we press on the RLQ to elicit pain? Than... should we check rebound tenderness in RLQ?
Reply With Quote Quick reply to this message



  #2  
Old 04-23-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 3,317
Threads: 170
Thanked 4,880 Times in 1,808 Posts
Reputation: 4933
Default

Quote:
Originally Posted by GVVdoc View Post
1. If SP has tenderness during anterior chest palpation (i.e. costochondritis), should we move on and perform anterior chest lung auscultation? I bet, SP will experience pain taking deep breath...
Tell the SP that you will be doing auscultation and that you will be very gentle and that you will try to avoid the tender areas.
If the SP insists that you don't do it, then skip the examination and mention the patient note that exam was not done due to severe tenderness.

-
-
Reply With Quote Quick reply to this message
The above post was thanked by:
cool_atomic (04-24-2011), Dr.Lacune (02-22-2015), drsrb (03-20-2014), GVVdoc (04-24-2011), kingjehu (02-26-2014)
  #3  
Old 04-23-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 3,317
Threads: 170
Thanked 4,880 Times in 1,808 Posts
Reputation: 4933
Default

Quote:
Originally Posted by GVVdoc View Post
2. If SP is lying down on a couch on his side in acute pain, should we turn him supine to examine his abdomen or leave him in a such position?
You ask the SP gently to try to lay flat on his/her back. Explain that abdominal examination cannot be performed unless the patient lies flat. Say something like "Is there anything I can do to make you more comfortable" / "I will definitely prescribe for you treatment to ease your pain but we have to find out the cause of your problem".

If the SP insists (which is very unlikely) then you skip the exam and mention in the patient note that the abdominal examination was not possible due to severe pain and tenderness.

-
-
Reply With Quote Quick reply to this message
The above post was thanked by:
cool_atomic (04-24-2011), Dr.Lacune (02-22-2015), GVVdoc (04-24-2011), meilocat (05-17-2014)
 
  #4  
Old 04-23-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 3,317
Threads: 170
Thanked 4,880 Times in 1,808 Posts
Reputation: 4933
Default

Quote:
Originally Posted by GVVdoc View Post
3. If before abdominal exam SP tells you he has RLQ pain, Should we start abdominal palpation from LLQ? Right? And should we press on the RLQ to elicit pain? Than... should we check rebound tenderness in RLQ?
Ask the SP if it's OK to try to examine the RLQ, if the SP insists that you don't do it (very unlikely) then you skip the RLQ and you don't touch it and you mention in your patient note that RLQ palpation and rebound tenderness were not attempted because of extreme tenderness.

PS- Appendicitis and others should still be in your differential diagnosis, you should not drop them just because you did not do the rebound tenderness.

-
-
Reply With Quote Quick reply to this message
The above post was thanked by:
Dr.Lacune (02-22-2015), GVVdoc (04-24-2011)
  #5  
Old 04-24-2011
USMLE Forums Newbie
 
Steps History: 1 + CK
Posts: 6
Threads: 2
Thanked 2 Times in 2 Posts
Reputation: 12
Default

Quote:
Originally Posted by Sabio View Post
Tell the SP that you will be doing auscultation and that you will be very gentle and that you will try to avoid the tender areas.
If the SP insists that you don't do it, then skip the examination and mention the patient note that exam was not done due to severe tenderness.
Thank you.
What are appropriate actions if SP shows silent grimace during lung auscultation? (because deep breathing causes pain in costochondritis)
Reply With Quote Quick reply to this message
  #6  
Old 04-24-2011
USMLE Forums Newbie
 
Steps History: 1 + CK
Posts: 6
Threads: 2
Thanked 2 Times in 2 Posts
Reputation: 12
Default

Quote:
Originally Posted by Sabio View Post
You ask the SP gently to try to lay flat on his/her back. Explain that abdominal examination cannot be performed unless the patient lies flat. Say something like "Is there anything I can do to make you more comfortable" / "I will definitely prescribe for you treatment to ease your pain but we have to find out the cause of your problem".

If the SP insists (which is very unlikely) then you skip the exam and mention in the patient note that the abdominal examination was not possible due to severe pain and tenderness.

-
-
It is totally clear! Thanks!
Reply With Quote Quick reply to this message
  #7  
Old 04-24-2011
USMLE Forums Newbie
 
Steps History: 1 + CK
Posts: 6
Threads: 2
Thanked 2 Times in 2 Posts
Reputation: 12
Default

Quote:
Originally Posted by Sabio View Post
Ask the SP if it's OK to try to examine the RLQ, if the SP insists that you don't do it (very unlikely) then you skip the RLQ and you don't touch it and you mention in your patient note that RLQ palpation and rebound tenderness were not attempted because of extreme tenderness.

PS- Appendicitis and others should still be in your differential diagnosis, you should not drop them just because you did not do the rebound tenderness.

-
-
If SP says OK you may examine RLQ. In such a case I have to elicit pain by initial superficial palpation in spite of knowing that RLQ hurts, right? And rebound maneuver will be repeated painful maneuver in RLQ which is prohibited, right?
Reply With Quote Quick reply to this message
  #8  
Old 04-28-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 3,317
Threads: 170
Thanked 4,880 Times in 1,808 Posts
Reputation: 4933
Default

Quote:
Originally Posted by GVVdoc View Post
If SP says OK you may examine RLQ. In such a case I have to elicit pain by initial superficial palpation in spite of knowing that RLQ hurts, right? And rebound maneuver will be repeated painful maneuver in RLQ which is prohibited, right?
Yes, that's right.
Reply With Quote Quick reply to this message
The above post was thanked by:
GVVdoc (05-02-2011)
  #9  
Old 04-28-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 3,317
Threads: 170
Thanked 4,880 Times in 1,808 Posts
Reputation: 4933
Default

Quote:
Originally Posted by GVVdoc View Post
Thank you.
What are appropriate actions if SP shows silent grimace during lung auscultation? (because deep breathing causes pain in costochondritis)
You can say something like that
"I can see you are hurt with deep breathing, I will make sure to ease your pain once we finish the examination"

Note that it is very important to say that sentence, otherwise they will score you negatively for not paying attention and for not empathetic
Reply With Quote Quick reply to this message
The above post was thanked by:
GVVdoc (05-02-2011), meilocat (05-17-2014), mle guy (05-15-2012), nepb (11-11-2012)
  #10  
Old 01-22-2014
USMLE Forums Scout
 
Steps History: ---
Posts: 14
Threads: 6
Thanked 1 Time in 1 Post
Reputation: 11
Default

are we going to check ROM in pt who is having severe arm pain? what about reflexes in this case? i think its difficult to do? any answers for this!!
Reply With Quote Quick reply to this message



Reply

Tags
CS-Challenge, CS-Physical-Exam

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Painful Breast Lump? mosallam USMLE Step 2 CK Forum 10 02-20-2011 10:19 AM
examination of painful area in abdomen hedihav_x USMLE Step 2 CS Forum 1 01-26-2011 05:32 PM
I want to know how to change the area of Examination? stepsdreamer General Topics Forum 1 10-05-2010 07:38 AM
Painful Vesicle Yallah USMLE Step 1 Forum 2 06-25-2010 07:25 PM
Moving a painful limb Adamu2010 USMLE Step 2 CS Forum 2 03-13-2010 11:40 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)