Saturday, March 2, 2013

STEP 2 CS-EXAMINATION ROOM AND EQUIPMENT.

ORIENTATION TO THE EXAMINATION ROOM AND ITS EQUIPMENT.
                                  


Being oriented to time place and person itself is extremely important for an examinee appearing for Step 2 CS! If you are someone like me who has never seen an examination room setting in USA before appearing for this exam,this will definitely help you.I still would recommend you all to personally go and see a typical examination room in USA be it through an Elective rotation/Observership or simply requesting any doctor to shadow him/her in the clinic for a day and try to get a hands on experience on each and every part of the examination room equipment.You definitely would not want to be confused during that day as time runs very quickly during the exam.

This is how a standard examination room looks like!




THE EXAMINATION TABLE-There are only a few things you need to know about the use of the examination table to make the patient feel comfortable.
1) The Step on the pull out extension at the bottom of the table-This is for the patient to rest his/her leg comfortably while in sitting position.You should tuck away the step after you make the patient lie down on the examination table and pull it out every time you make the patient get up from the examination table.All these things matter.This is a part of the interpersonal skills and will show your respect for the patient.

2)Extension at the foot end of the table-You must pull out the foot extension for the patient every time you make the patient lie down for examination and tuck it away if the patient wants to sit up.Using these extensions should be like a reflex activity for you.So please do not forget this.

3)Lever to manipulate the head end of the table-You should be comfortable enough to use the lever at the head end of the table to move it up or down according to the need of the examination.Please do not try to move it too fast,do it slowly.It once happened that one of my friend applied too much pressure on the lever to bring the head end down to the flat position and it went down suddenly with a Bang!..hurting the patient's head.



STETHOSCOPE-You can use any model of Littmann stethoscope.Any ways you are most likely not going to hear any pathologic heart sound,so it does not matter.But the key is please do not forget to bring your own.Now centers may have extra ones but who knows they only have limited stock.

OPTHALMOSCOPE,OTOSCOPE AND BLOOD PRESSURE INSTRUMENT.

These instruments you will see either on the wall at the head end of the examination table or one of the side walls depending on the structure of the examination room.In any case they will be placed in a way that it is comfortable for you to pick them up from the wall to examine the patient.


THE OPTHALMOSCOPE-Use it only when indicated that is if the patient has a history of Hypertension,Diabetes or any other specific complain in the eye.You do not need to know the technical details of this instrument.All you need to do is switch on the instrument(in most cases it will automatically switch on as soon as you lift it from the wall,if it does not, you have to manually do it.You have to be a good actor pretending to use the instrument like a professional.Just make sure you look into the patients right eye holding the opthalmoscope if front of your right eye,same goes for the left eye.


THE OTOSCOPE-This instrument should be used when there is any complain pertaining to the ear.Again the light will automatically turn on as soon as you pick the otoscope from the wall.If it does not,You have to manually switch it on.Please remember to cover the examining tip of the otoscope with a disposable specula provided along with it,which you will also find on the wall.This is to ensure you do not hurt the patient.Again you have to pretend to do the examination correctly.But you have to be extremely gentle while doing it.Do ask the patient if it is hurting him/her.Just Gently pull the auricle upward and backward.Hold the little finger on the tragus acting as a support so that you do not hurt the patient if he/she moves the head.Do not apply a lot of pressure!

WASH BASIN!-The wash basin will be placed in such a way that the patient is able to see you while you are washing your hand.Please wash your hand in a way the patient is able to see you doing so.One serious advice...Water in USA is extremely soft so it is  difficult to remove soap while washing. .So please do not use a lot of soap or you will spend millions of years washing your hands.This is what happened to me!.I had a hard time removing the soap off my hands because I applied too much.It will only waste your time.Do wipe your hands thoroughly with paper towels provided alongside the basin.




COTTON BALL,ALCOHOL JAR,SWABS AND STICKS-These are provided on the side table in the room.Make sure you clean your stethoscope using alcohol swab.You might earn an extra point! Cotton will be of use when you have to do superficial skin sensation.Make sure you only touch the cotton on the skin while doing it.It once happened that a patient told the examinee"Doctor I can feel your finger more than the cotton on my skin" So please take care of that!





GLOVES-They will be provided in the examination room,but I personally was not comfortable with using gloves,so I preferred to wash my hands,instead of using gloves.







TUNING FORKS-Tuning forks will be provided to you in the examination room.Remember for hearing test use the 512 Hz one and for Vibration sense use the 128 Hz tuning fork.













REFLEX HAMMER-A reflex hammer will also be provided!..In case of old patients just be careful not to hit them very hard while trying to elicit reflexes.It happened to me while I was trying to do it and the old lady said "Ouchhh"








So friends all you need to get of your own is Stethoscope and White coat. Even Pen will be provided!

This was all about the examination room and its equipment.Feel free to comment.If you have any thing additional to be included do let us know,we will be happy to update that in the post.
Thank you!





1 comment:

  1. What instrument are we supposed to use for pupillary reflex? Otoscope without disposable caps on?

    Thanks!

    ReplyDelete

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