| | PREEMPLOYMENT EXAMINATION
Doorway information about patient
The patient is a 25 -year-old man who comes to the clinic for a pre-employment evaluation
Vital signs
. Temperature:37’C
. Blood pressure : 117/80 mmHg
. Pulses : 64/min
. Respirations : 12/min
Approach to the patient
Pre-employment medical evaluations generally fall into one of a few categories:
. To assess fitness in a worker whose job is unusually strenuous or in whom a medical condition could put the public at risk (eg,truck drivers, air traffic controllers)
.To provide aggressive preventive care for a high-level employee in whom unexpected absences could jeopardize the company at large (“executive physical “)
.To screen for substance abuse or other mental health disorders (often requires as a condition of employment for an individual with a history of substance abuse)
.To provide general preventive care as a non monetary benefit for the employee(“wellness examination”)
In most cases , patients coming to the office for a pre-employment visit have explicit instructions (often on a preprinted form)listing what must be done during the visit . If the patient requires additional examinations , You may do those as time permits , but the required services should be complete first .If the patient dose not provide specific instructions , conduct a routine preventive visit.
HISTORY AND PHYSICAL EXAMINATION
The pre-employ,meant visit should address the following topics :
. Past medical , family , and social histories , include medications , drug allergies , and tobacco/alcohol/illicit drug use
. Occupational history
. Age-appropriated history
. Vaccine history
. Occupational health exposures(eg,toxins, blood-borne pathogens)
. Personal protective equipment(as appropriate)
. General multi system examination, including vital signs
if the form asks you to measure blood pressure , perform the measurement yourself . This differs from most other encounters in the USMLE Step 2 CS exam , in which you should rely on the vital signs provided in the Doorway information .
Closing the encounter
If the patient has given you a form to complete and time is short , advise the patient that you will fill out the form after leaving the room and mail it to the patient’s home. Note in your documentation if the patient has an obvious disqualification for the job that would put the patient or the public at risk or if the patient is unable or unwilling to use personal protective equipment or follow appropriate safety practices.
Diagnostic testing
The patient will usually notify you want diagnostic tests are required. common test include :
. Fasting glucose
. Lipid panel
. Urine toxicology(drug test)
. Tuberculin skin test
The patient should also be offered age-appropriate screening tests. Additional tests(eg, blood counts , serum chemistries ) are recommended only of the patient encounter reveals specific indications for them or the patient has certain high-risk exposures (eg, chest x-ray and pulmonary function tests for patient with inhalation exposure to hazardous particulate).
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2018/05/24 09:38pm 
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