USMLE Forum Archives - USMLE Step 2 CS - STP 2CS PE DOUBTS
STP 2CS PE DOUBTS
drkims - 09-16-09 14:36
I urgently need help.Exam next week.Will leave for Chicago after 1day.
I have some doubts in Physical Examination:
1.THYROID EXAMINATION:1 method :to stand behind patient & palpate for each lobe &I dont ask him to swallow.
2nd way:stand in front of him & ask him to swallow each time you palpate a lobe.Also to ask if will need water to swallow.
Which is the method followed?2nd takes time.
2.RINNE TEST:done on affected side only or both sides?
3.During Babinski & ACHILLES reflex we touch patients sole.Do we need to again wash hands after these tests if there are other examinations to be done?It takes time.
4.Is it acceptable if we check motor,DTRs,sensation of upper limb & then do all these on LOWER LIMB.This way can do BABINSKI last & avoid washing hands.
5.During exam do examinees actually wash hands with soap & water?OR just run the tap water without wetting hands.I take quite sometime to dry hands using the tissue provided.Also SPs complained that my hands were very cold.I
did rub my hands nicely.
6.Is it acceptable to check muscle strength of both Rt & Lt upper limbs simultaneously?Same for both lower limbs?
7.If pt with say knee pain c/o pain when we check m.strength & DTRs?What to say? should we proceed withthe tests?
drkims - 09-16-09 14:36
I urgently need help.Exam next week.Will leave for Chicago after 1day.
I have some doubts in Physical Examination:
1.THYROID EXAMINATION:1 method :to stand behind patient & palpate for each lobe &I dont ask him to swallow.
2nd way:stand in front of him & ask him to swallow each time you palpate a lobe.Also to ask if will need water to swallow.
Which is the method followed?2nd takes time.
2.RINNE TEST:done on affected side only or both sides?
3.During Babinski & ACHILLES reflex we touch patients sole.Do we need to again wash hands after these tests if there are other examinations to be done?It takes time.
4.Is it acceptable if we check motor,DTRs,sensation of upper limb & then do all these on LOWER LIMB.This way can do BABINSKI last & avoid washing hands.
5.During exam do examinees actually wash hands with soap & water?OR just run the tap water without wetting hands.I take quite sometime to dry hands using the tissue provided.Also SPs complained that my hands were very cold.I
did rub my hands nicely.
6.Is it acceptable to check muscle strength of both Rt & Lt upper limbs simultaneously?Same for both lower limbs?
7.If pt with say knee pain c/o pain when we check m.strength & DTRs?What to say? should we proceed withthe tests?
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#1
Re: STP 2CS PE DOUBTS
drkims - 09-16-09 14:55 Hope somebody will help me clear my doubts.
1CVS exam :do we need to do in both sitting & lying.Will sitting position only be enough?
2.Should the pt close eyes while spreading hands for tremor?
3.to test CN9& 10:ask pt to say 'ah'.Correct ?plz correct if wrong.
4.What to say before looking for JVD?
& also what to say after pt clenches jaw ie,before touching TMJ area.
#2
Re: STP 2CS PE DOUBTS adonis123 - 09-16-09 20:29 
posted by drkims on 09-16-09 14:55
Hope somebody will help me clear my doubts.
1CVS exam :do we need to do in both sitting & lying.Will sitting position only be enough?
2.Should the pt close eyes while spreading hands for tremor?
3.to test CN9& 10:ask pt to say 'ah'.Correct ?plz correct if wrong.
4.What to say before looking for JVD?
& also what to say after pt clenches jaw ie,before touching TMJ area.
Hope somebody will help me clear my doubts.
1CVS exam :do we need to do in both sitting & lying.Will sitting position only be enough?
2.Should the pt close eyes while spreading hands for tremor?
3.to test CN9& 10:ask pt to say 'ah'.Correct ?plz correct if wrong.
4.What to say before looking for JVD?
& also what to say after pt clenches jaw ie,before touching TMJ area.
Yes, sitting position is enough most of the times.
No, there is no need to ask the patient close his/her eyes while checking for tremor in hands.
Yes, it is correct to make the patient say 'Ah'.
Before looking for JVD, ask the patient that u r going to check vessels in her /his neck.
Last but not the least,always resort to a brief and a focussed physical exam.
Good Luck!
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