Cse Exam

Front 1

Patient Interaction & General Communication Skills

Back 1

1. ____ Greets the patient, confirm name & age
2. ____ Introduce yourself and your role
3. ____ Uses appropriate questioning skills
4. ____ Uses facilitating non-verbal communication skills
5. ____ Maintains appropriate eye contact
6. ____ Avoids or explains medical jargon
7. ____ Demonstrates empathy and sensitivity for the patient’s concerns
8. ____ Organizes patient interview appropriately
9. ____ Paces patient interview appropriately
10. ____ Uses transition statements in patient interview

Front 2

Chief Complaint

Back 2

11. ___ Asks open ended question (e.g.“What brings you here today?”)
12. ___ Asks a second open-ended (facilitation) question (e.g. “Can you tell me about your ___”)

Front 3

History of Presenting Illness (HPI)

Back 3

Asks about each of the following:
13. ____ Quality of symptom
14. ____ Location of symptom (“free” point for non-location symptoms)
15. ____ Severity of symptom
16. ____ Duration & onset of symptom
17. ____ Frequency of symptom and change with time
18. ____ Presence or severity of symptoms today
19. ____ Radiation of symptom
20. ____ Aggravating factors
21. ____ Alleviating factors

Front 4

Previous History

Back 4

22. ____ Asks about history of similar symptom
23. ____ Asks about previous history of ____ (student’s probable diagnosis):

Front 5

HPI Review

Back 5

30. ___ Summarize information for patient
31. ___ Survey of problems – Is there anything else?
32. ___ Ask what patient thinks might cause symptoms (general or specific)
33. ___ Find out how illness has impacted patient’s daily function, wellbeing, etc.

Front 6

Past Medical History

Back 6

Asks about each of the following:
34. ___ general question about health or medical problems
35. ___ any 4 specific illnesses (from the list below, or others)


• high blood pressure
• heart attack
• stroke
• diabetes
• cancer
• thyroid disease
• kidney disease
• liver disease
• stomach ulcers/peptic ulcer
• asthma/emphysema/COPD


36. ___ any history of surgery
37. ___ any hospitalizations
38. ___ prescribed medications
39. ___ over the counter medications
40. ___ herbals or vitamins taken
41. ___ medication allergies
42. ___ how patient reacts to medication allergies

Front 7

Family History

Back 7

43. ___ Asks if any illnesses are common or “run in the family”
44. ___ Asks general question about parents’ age or health status
45. ___ Asks about father’s and mother’s history of diseases (4 from list below, or others)

• high blood pressure
• heart attack
• stroke
• diabetes
• cancer

• thyroid disease
• kidney disease
• liver disease
• stomach ulcers/peptic ulcer
• asthma/emphysema/COPD
46. ___ Asks about status of siblings, e.g. health conditions, alive / dead

Front 8

Psychosocial History

Back 8

Life & Work
47. ___ Asks who lives at home with the patient
48. ___ Asks about marital status & marital history
49. ___ Asks if the patient has any children (how many, ages)
50. ___ Asks what is the patient’s work/job
51. ___ Asks about level of education

Lifestyle & Risk Factors
52. ___ Asks if the patient smokes
53. ___ How much and for how long
54. ___ Asks if the patient uses alcohol
55. ___ How much, how often
56. ___ Asks if the patient uses (or has used) any illicit drugs

Stressors
57. ___ Asks if any stressors at work or home

Front 9

Physical Examination

Back 9

Preliminary/General

58. ___ Washes hands before starting examination (in front of patient)

Vital Signs

59. ___ Blood pressure (sitting or supine acceptable)
60. ___ Heart rate
61. ___ Respiratory rate

Patient Interaction/Communication

62. ___ Explains to patient what will occur prior to conducting each part of physical exam
63. ___ Uses appropriate draping
64. ___ Verbally checks with patient to make sure comfortable as conducting exam
65. ___ Attends to patient comfort – minimizing movement and re-positioning during exam
66. ___ Attends to patient comfort – equipment use
67. ___ Made eye contact with patient throughout exam

System Exam

68. ___ system exam step 1
69. ___ system exam step 2
70. ___ system exam step 3
71. ___ system exam step 4
72. ___ system exam step 5
73. ___ system exam step 6
74. ___ system exam step 7

Symptom-Specific Exam Steps

75. ___ specific exam step 1
76. ___ specific exam step 2
77. ___ specific exam step 3
78. ___ specific exam step 4

Front 10

Assessment

Back 10

Most likely diagnosis

79. ___ ______________________________________

List two likely competing “differential diagnoses”

80. ___ ________________________________________
81. ___ ________________________________________

List 3 reasons from history and physical why your "most likely diagnosis" is probably correct (can list positives, e.g. “rectal bleeding,” or negatives, e.g. “no chest pain”)

Front 11

plan

Back 11

List any ONE additional diagnostic step (may be any of the following: additional physical examination step, blood tests, X-ray or other radiographic study, or other diagnostic test)

85. ___ ________________________________________

List any TWO management or treatment steps (may be any of the following: medication to start or change*, lifestyle change or preventive measure, consultation or referral, other treatment step)
* for medications: may list two separate medications to count as two answers; try to indicate specific drug: not just “antibiotic” or “pain medication,” etc.

86. ___ ________________________________________
87. ___ ________________________________________

Indicate appropriate follow-up action (may be hospital admission, follow up in specified time period, etc.)

88. ___ ________________________________________

Front 12

back pain diagnosies

Back 12

lumbar disc herniation
pyelonephritis
low back strain

Front 13

back pain system exam?

Back 13

musculoskeletal

Front 14

shortness of brea diangosis

Back 14

congestive heart failure
COPD
cardiac angina

Front 15

shortness of breath system exam

Back 15

chest/thorax

Front 16

faintness diagnosis?

Back 16

dehydration (gastroenteritis)
transient ischemic attack (TIA)
cardiac valvular disorder (aortic stenosis)

Front 17

faintness exam

Back 17

cardiovascular

Front 18

abdominal pain diagnosis

Back 18

appendicitis
chronic constipation
UTI (cystitis)

Front 19

abdomenal pain exam?

Back 19

abdomen

Front 20

headache diagnosis?

Back 20

migraine headache
tension headache
sinusitis

Front 21

headache exam

Back 21

head and neck

Front 22

back pain ROS?

Back 22

1. fever
2. radiation to posterior leg (sciatica)
3. leg weakness
4. pain or burning with urination
5. blood with urination
6. loss of bladder control

Front 23

Shortness of breath ROS

Back 23

1. cough
2. sputum production
3. dyspnea worse when supine
4. fatigue with activity
5. chest pain
6. leg swelling

Front 24

Faintness ROS

Back 24

1. palpitations
2. shortness of breath
3. chest pain
4. vomiting or diarrhea
5. vertigo
6. speech or vision changes

Front 25

Abdominal pain ROS

Back 25

1. nausea or vomiting
2. fever
3. change in character or frequent of bowel movements
4. pain worse with meals
5. weight loss
6. pain with urination

Front 26

headache ROS

Back 26

1. visual symptoms or scotomata (lights)
2. focal neurologic symptoms (arm or leg weakness, etc.)
3. pain improved with dark or quiet
4. nausea or vomiting
5. facial pain or sinus congestion
6. nasal discharge

Front 27

back pain PE speacial

Back 27

1. CVA tenderness (percuss bilaterally, ulnar side of fist, over kidneys)
2. knee reflexes bilaterally
3. ankle jerk (Achilles) reflexes bilaterally
4. distal light touch sensation lower legs bilaterally

Front 28

shortness of breath speacial PE

Back 28

1. auscultate cardiac valves (all 4 areas, diaphragm of stethoscope)
2. assess jugular venous pulsations (right side or bilaterally, head turned slightly, patient 30°)
3. palpate apical impulse
4. palpate upper extremity pulses (brachial, ulnar and radial, bilaterally)

Front 29

faintness speacial PE

Back 29

1. orthostatic BP and HR (both BP and HR, sitting or standing, 30 sec after checking supine)
2. carotid auscultation (upper & lower carotids, bilaterally)
3. cranial nerve exam (at least 4 different cranial nerves, bilaterally)
4. gait examination (walk, tandem, toes, Romberg)

Front 30

abdominal pain speacial PE

Back 30

1. CVA tenderness (percuss bilaterally, ulnar side of fist, over kidneys)
2. suprapubic tenderness
3. cardiac auscultation (all 4 areas, diaphragm of stethoscope)
4. pelvic (female) or digital rectal (male) examination (asks for card)

Front 31

headache speacial PE

Back 31

1. retinal/fundoscopic exam (correct fundoscopic technique, focus on retina, bilaterally)
2. cranial nerve exam (at least 4 different cranial nerves, bilaterally)
3. peripheral nerve exam (at least 4: any strength, sensation, or coordination, done bilaterally)
4. gait examination (walk, tandem, toes, and Romberg)

Front 32

muskuloskeletal exam

Back 32

1. percuss thoracic and lumbar spine (with ulnar side of hand, at least 6 areas total)
2. palpate lumbosacral area for tenderness (lower back, lateral to lumbar spine, bilateral)
3. test cervical spine range of motion (all directions)
4. test lumbar spine range of motion (flex, extend, lateral flexion, rotation both ways)
5. straight leg raise (supine or sitting, bilaterally)
6. passive hip range of motion (flexion, internal & external rotation, bilaterally)
7. lower extremity strength (knees and ankles, flexion and extension, bilaterally)

Front 33

Chest/thorax exam

Back 33

1. use stethoscope correctly, advise patient to take deep breaths with mouth open
2. listen throughout inspiration and expiration
3. check chest expansion bilaterally
4. percuss posterior lungs/thorax (at least 3 areas each side)
5. auscultate posterior lungs/thorax (at least 3 areas each side)
6. auscultate lateral lung fields bilaterally (at least 2 areas each side)
7. examine for leg edema (pressure with thumb, at least 2 locations below mid-calf, bilaterally)

Front 34

cardiovascular exam

Back 34

1. inspect jugular venous pulsations (right side or bilaterally, head turned slightly, patient 30°)
2. palpate cardiac apical impulse
3. auscultate cardiac valves (all 4 areas, diaphragm of stethoscope)
4. palpate upper extremity pulses (brachial, ulnar and radial, bilaterally)
5. palpate carotid pulses
6. palpate lower extremity pulses (posterior tibial pulses and dorsalis pedis pulses, bilaterally)
7. examine for leg edema (pressure with thumb, at least 2 locations below mid-calf, bilaterally)

Front 35

abdomen exam

Back 35

1. use appropriate examination technique (patient 0, observe patient’s face, adequate exposure)
2. auscultate for bowel sounds (all 4 quadrants, 5-10 seconds per site)
3. percuss for localized tympany or dullness (all 4 quadrants)
4. palpate lightly for tenderness (all 4 quadrants)
5. palpate deeply for tenderness (at least both lower quadrants)
6. palpate liver edge
7. examine for rebound tenderness

Front 36

head and neck exam

Back 36

1. examine auditory canals and tympanic membranes using otoscope
2. inspect nasal vault and septum (use otoscope with clean speculum)
3. palpate frontal sinus for tenderness
4. palpate maxillary sinus for tenderness
5. inspect tongue, posterior pharynx (back of throat)
6. palpate cervical lymph nodes
7. palpate submandibular lymph nodes

Front 37

Steps of the CSE exam process

Back 37

Step 1: Patient interaction and general communication skills(greeting and manners)

Step 2: obtain chief complaint

Step 3: HPI

Step 4: Previous history of similar condition/symptoms

Step 5: complain specific ROS

Step 6: Review HPI'

Step 7: past medical history

Step 8: Family history

Step 9: Psychosocial history

Step 10:Physical exam
-vitals
-patient
interaction/commnication(manners)
-System exam
- symptoms specific exam

Step 11: Assessment

Step 12: Plan

Front 38

indicators for lumbar disk disease

Back 38

reduced reflex responses
reduced sensation
leg weakness
loss of bladder control

Front 39

indicators for pyelonephritis?

Back 39

bloody urination
painful urination
fever
painful percussion of low back

Front 40

indicators for low back strain

Back 40

history of recent injury/overuse

absent fever/painfull percussion/painbloodurine

absent weakness/loss of bladder control/reduced reflexes

Front 41

indicators congestive hearfailure

Back 41

dullness on back percussion
crackles heard on inspiration
elevated JVP
Signes of aortic stenosis
leg edema

Front 42

indicators COPD

Back 42

wheezing heard on expiration
hyperressonant percussion
cough with sputum production

Front 43

indicator cardiac angina

Back 43

absent crackles
absent JVP
absent edema

absent cough w/ sputum
absent wheezing

history of athrosclerosis
history of heart disease
history of chest pain
obsecity
high cholesterol

Front 44

indicators dehydration

Back 44

dizziness when standing
low BP
elevated HR
positive orthostatics
vomiting or diarrehia

Front 45

indicators TIA

Back 45

speech or vision changes
decreased cranial nerves signs
gait disturbances

history of arrythmia/palpitation
histroy of valve issue
carotid buit

Front 46

indicators aortic stenosis

Back 46

shortness of breath
systolic murmor heard in carotids
elevated JVP
edema
systolic murmur
diminished pulses

Front 47

indicators of apendicitis

Back 47

fever
RUQ pain
nausea
rebound tenderness

Front 48

indicators of chronic constipation

Back 48

decreased frequency of BM
absent/decreased bowel sounds
dullness on percussion

Front 49

indicators of UTI

Back 49

painful urination
painful back percussion
painful suprapubic palpation
fever

Front 50

migraine indicators

Back 50

visual symptoms
scomatota

pain relieved in darkness and quiet

history of reccurent severe headaches with some sort of aura

nausea/vomiting

Front 51

sinusitis indicators

Back 51

sinus/facial pain

sinus discharge

congestion

Front 52

tension headache indicators

Back 52

absent aura/prodrome

frontal or occipital location

doesn't recede in quite dark room

Front 53

diagnostic step,2treatment, follow up for lumbar disc disease?

Back 53

MRI

morphine/ibuprofin

referral for sugical assessment.

Front 54

diagnostic step,2treatment, follow up for pyelonephritis

Back 54

UA

penicillin/cephelosporin

If mild have pt return for follow up after finishing antiboitic course
If severe or comorbid serious conditions are present considere hospitalization.

Front 55

diagnostic step,2treatment, follow up for low back strain

Back 55

low back radiographs

cold applications/ibuprofen

outpatient follow up 3 weeks.

Front 56

diagnostic step,2treatment, follow up for dehydration

Back 56

electrolyte studies

oral fluids/ ondansetron if caused by vomiting, antibiotic is caused is thought to be bacterial

inpatient rehydration is severe/if not as severe and family that can be trusted to support is present outpaitient is fine.

Front 57

diagnostic step,2treatment, follow up for TIA

Back 57

Brain MRI

warfarin if caused by clot/aspirin.

admit to hospital for treatment, possible surigical intervention.

Front 58

diagnostic step,2treatment, follow up for aortic stenosis

Back 58

echocardiogram

valve replacement/diuretics if not hypotensive thiazide

Front 59

diagnostic step,2treatment, follow up for congestive heart failure

Back 59

echocardiogram

thiazide/ weightloss increased excesise

follow up outpatient unless severe shortness of breath then hospitalize

Front 60

diagnostic step,2treatment, follow up for COPD

Back 60

Spirometry testing

smoking cessation/albuterol

outpatient unless severe

Front 61

diagnostic step,2treatment, follow up for Cardiac angina

Back 61

EKG

aspirin/atenolol

inpatient assessment for risk of heart attack.

Front 62

diagnostic step,2treatment, follow up for apendicitis

Back 62

WBC

appendectimy/morphine

inpatient referral to surgury

Front 63

diagnostic step,2treatment, follow up for chronic constipation

Back 63

abdominal X-ray

metamucil/ lactalose

outpatient if no obstruction/dehydration is present

Front 64

diagnostic step,2treatment, follow up for UTI

Back 64

UA urine culture

ciprofloxin, amoxicillin

out patient unless signs of sepsis

Front 65

diagnostic step,2treatment, follow up for migraine

Back 65

CT scan of head

sumatriptan/ Valproic acid

outpatient follow up in 3 weeks

Front 66

diagnostic step,2treatment, follow up for tension headache

Back 66

Head CT

Ibuprofin/ relaxation therapy

follow up outpatient 1 month.

Front 67

diagnostic step,2treatment, follow up for sinusitis

Back 67

CT of sinus cavity

penicillin/phenylephrine nasal spray

outpatient follow up after treatment runs course.