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Kai1111
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May 2008 MCCQE II
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05.05.08 (5 months ago)
#1
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I will post the cases I recall (most of them), but....I need to know if it is allowed by the MCC and if one can get into trouble for this?
I feel deflated.....I have a hole in my gut.....can't imagine how I could have been better prepared.....the stress somehow stymied my thought processing and I found myself jumping around in my hx taking.....the 5 minute stations felt like 30 seconds..... Here is an example:
asked to demonstrate a pulmonary exam on a man with severe pleuritis/splinting R sided CP, assoc w fever and cough w production of green sputum. Wanted to ask for pain medication first, but there was no nurse present at the station. It felt ridiculous to be checking for CW expansion in someone with so much pain and a temp of 38.5, cough w prod green sputum. The examiner wouldn't confirm that there were any chest findings....just a stone cold blank stare.....not even a 'won't offer you that information'...so I had to assume no rales, wheezes, bronchophony, ecophony ...... by the time I got to whispered pectoriloquy I felt like an idiot. There was no CW pain....I felt moronic checking cap refill and clubbing on a man with a probable pneumonia.....anyway, that case serves to share one of the many frustrations with this test.....in real life, I would have taken care of this man's pain, then proceeded with a more thorough exam, (if there was little doubt about the cause; i.e. prob pna).....the PEP at this 5min station showed a clear cut R middle lobe infiltrate(this infiltrate was dense and there is no way you'd have normal chest findings besides pleuritis) and you had to prescribe a medication to treat his condition. I mean, for something this basic, you would think that I would leave the station feeling good about my work...I didn't. Anyone who has a more positive way of looking at this, might be able to help me to quell the angst I'm feeling.
Hope everyone else feels better than I do.
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Kai1111
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05.05.08 (5 months ago)
#2
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I meant to say "checking cap refill in an otherwise healthly guy with pink cheeks, no cyanosis or palor....also his Sat was 95% and he spoke in full sentences." In a way its interesting, that as we evaluate people in 'real life' there is so much going on in our interpretation of their behavior that is subtle and building on an impression and action. The weakness of these 'test situations' is the attempt to compartmentalize and standardize behavior that has millions of variations....in a way, I think putting someone like this through a thorough physical exam before getting pain meds and CXR is a little inhumane. I thought we were supposed to 'relieve suffering' and 'first do no harm?' If that is the case, then why put this poor patient through the rigors of a tedious exam that won't change his treatment and prolong his suffering. I may be way off course, but these are just thoughts that are shooting out of my mind that is currently going a mile a minute in question and frustration...
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vanjik
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I think ...
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05.07.08 (5 months ago)
#3
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Actually, I've got this station before...
But, the acting of the SP was not as good as before...^^...
previous SP acted as real situation.
we might have to do tactile vocal fremitus, bronchophony, egophony and whispered pectoriloquy as well
I also did peripheral vascular sign and Homan sign.
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hla
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05.08.08 (5 months ago)
#4
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Can you pls tell us more about the exam and how it was
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Kai1111
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05.09.08 (5 months ago)
#5
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I need to know if publically sharing the experience of the exam is 'allowed.' I haven't the time to research this....if someone can do this for me, then, I will post my recalled questions (I immediately recalled around 13 stations and have them written down). I'm too busy to do the leg work of figuring out if I could get into trouble for this, etc.
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bush5
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05.09.08 (5 months ago)
#6
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no sharing legally
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baloo
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06.22.08 (3 months ago)
#7
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email me questions from may exam please.
i will be appearing this fall
any prep material will be appericiated
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