Physical exam component of CS

[deleted113029]

I know we're supposed to do a focused exam, BUT:

a complete neuro exam without an MMSE exam (alone takes ~3.5 minutes) takes me about 2-3 minutes and that doesn't include a CV or Pulmonary auscultation exam. I was reading in First Aid Step 2CS about what they write up in their practice cases and they do at times a quite extensive phys. exam. Not to mention the 30-40 questions they ask just for the History.

Is FA going a little overboard in their practice cases? Am I to assume if one does everything FA does, one should ACE the exam and that if you do 1/2-2/3of what FA then you should be fine? Please help.

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[Leukocyte]

The neuro exam is the longest PE that you will do, but it should not take you more than 3 minutes.

Be very very very brief and focused (upper ext. vs lower ext vs. cerebellum) depending on the CC.

The neuro exam is divided into 7 components (You do not have to do them all, pick and choose depending on the CC)

1) CN
check the ones that are relevant to the CC

2) Motor
Check strength in upper AND/OR lower ext. (depending on the CC). You need to check strength by one modality only, bilateraly (unless you think the pt. needs a more detailed exam).

3) Sensation
Check sensation in upper AND/OR lower ext. (depending on the CC). You need to check sensation by two modalities only, bilateraly - "sharp/dull" and "is your toe now pointing up or down" (unless you think the pt. need a more detailed exam.)

4)DTR
Check ONE reflex in the upper ext. and ONE reflex in the lower ext., bilateraly (unless you think the pt. needs a more detailed exam)

5)Gait
If needed. Please walk to the door and back.

6)Cerebellum
Nose to finger
Romberg

7)Mental Status
Alert and Oriented x 3 (Very rarely will you need to do a full mental status).

Good Luck.

 

[deleted113029]

Thanks a ton leukocyte.

(i was just concerned because FA does EVERYTHING for the neuro.)

 

[jojo14]

definitely nit picking here, but i would add babinski to the list. i used it on step 2 cs. that's a pe finding that they can fake quite easily.

i also agree you don't have to do everything