Tips on the COMLEX PE

First, COMLEX Level 2-PE review book by JB Review is available.

MOST OF THE FOLLOWING INFORMATION IS TAKEN FROM THE NBOME.ORG WEBSITE PER
DR. DAYBERRY

There are two aspects to the COMLEX PE the humanistic aspect and the
biomedical/biomechanical aspect.
For the Humanistic side, Dr. Dayberry likes the mnemonic LEGREP to remember all the
things you need to cover in the humanistic side:
L: listening
E: eliciting info
G: giving info
R: respectful
E: empathetic
P: professional
Humanistic = 11 out the 12 students that failed the COMLEX PE from TCOM failed this
portion.
Biomedical/Biomechanical = 2 failed here (one person failed both) both of these
individuals attributed their failure to a lack of preparation
The COMLEX PE is geared toward primary care, because Osteopathic medicine is geared
toward primary care. Even if you just spent 3 months doing rotations in specialty medicine,
you need to review your primary care stuff for this thing!
Professionalism: you will have cameras on you as soon as you walk in the door, NOT just
when you are taking your test. Be on your best professional behavior at all times when in
the building. Have your white coat pressed and laundered, business professional dress (ex:
shirt, tie, dress pants, dress shoes)(women -conservative top - no cleavage , no stiletto
heels, closed toe shoes).
There are three settings in which the encounter can occur: 1. Family medicine clinic, 2.
Primary care clinic or 3. Emergency room. It is very likely that upon entering the
emergency room, the patient could have some level of anxiety. Have a canned speech
prepared for this (ex: Youre in the ER right now, it is the best possible place for you. We
have all the things here to do whatever you need. However, we need to focus on getting
some information so we know exactly what we need to do for you)
Address patient as Mr.__________ or Ms.____________
Before you begin to interview, ask them if they mind if you take some notes. This covers
the respectful aspect, and involves the patient in their own care.
Chief complaint well I see you are here for ________________
Start with an open-ended question right off the bat. For example, Tell me about
____________.
When they tell you about their headaches, for example, say something like, My, that
sounds terrible. Im sorry you feel that way. This covers the empathy aspect.
Do a quick review of systems by starting at the head and working your way down. Tell
them, Im going to start asking you about other organ systems. I will start at the head
and work my way down. Stop me if you have any problems with any of these areas. Do
you have any problems with you scalp? Do you have headaches or seizures? Do you have
blurry vision or loss of vision? Do you have difficulty hearing or ringing in your ears? Do
you have recurrent sinus infections, etc.
 Also do a complete past medical history, allergies, medications, surgical hx, and social hx.
Ask about things like LMP/menarche if they are female (any female from 10 to 55 years if
you plan to treat).
In the social history, include ETOH, tobacco, drugs, diet, and exercise. Be prepared to
counsel on diet and exercise. Remember the preventative aspect of osteopathic medicine.
If they are a smoker, have a canned smoking speech prepared. Ex: Do you know that
smoking is bad for you? It can cause things like lung cancer, vascular disease, increased
risk of heart attack and stroke, etc. Ask them if they are ready to quit smoking. If they say
yes, then have plan ready, (ex: medication, counseling, support groups, etc.). If no, give
them an out later if they change their mind, (ex: Well if you change your mind, please call
the office and set up an appointment and we will get you in a support group and start
some medications)
Before you start your physical exam, say Please let me know if at any point you feel
uncomfortable.
Always drape the patient.
Dont listen through clothes. Listen on skin. Slide stethoscope down robe after asking for
permission.
While examining, tell the pt what you are finding. This covers giving information. Ex: Your
heart is RRR, with evidence of murmurs, etc. Your lungs sound clear, etc.
Upon finishing the history and physical sit down, look your patient in the eye and tell
them
Based on the information you have given me and my physical exam, I think you have
this, this, or this. You must give three differentials for the chief complaint and another one
may be somatic dysfxn. With chronic diseases as 5 and six unless uncontrolled. HTN,
DM2 then they may be dx 4, 5 etc.
Always check for thoracic viscerosomatic reflex (go down T-spine and ask what hurts)
LEARN THE VISCEROSOMATIC REFLEX TABLE. ASK THE PATIENT BEFORE YOU PALPATE TO
TELL YOU IF THEY FEEL ANY PAIN.
Only document what you find, not what you expect to find. Documenting something that
you did not perform will result in automatic failure.
If they say Thats rough doctor. Thats your cue that what you are doing is painful.
Apologize and change your technique.
Document somatic dysfxn in objective portion.
Ask permission for ordering labs.
No HVLA is allowed.
Have two OMM treatments prepared for each part of the body (seven stages of spencer,
sibsons fascia) and for some of the most common ailments (ex: asthma, pneumonia,
abdominal pain, sinus infections etc.) fabere test anterior posterior drawer, apley grind
etc.

WHEN YOU GET READY TO LEAVE THE ROOM

CLOSING THE ENCOUNTER- canned speech WELL BASED ON WHAT YOU TOLD ME AND
WHAT I FOUND ON PHYSICAL EXAM, I BELIEVE YOU HAVE __________ OR _________ OR
__________. WITH YOUR PERMISSION I WOULD LIKE TO ORDER ____________(LABS BE
SPECIFIC),________________XRAY(BE SPECIFIC)___________WRITE A PRESCRIPTION FOR ?
(DRUG NAME, DOSAGES NOT REQUIRED, If writing a rx be sure to again ask for allergies
after you tell them what drug. I know you told me you are allergic to ______ but I want to
write a prescription for ___________ and I want to make sure you are not allergic
to__________)
If you order a CT or MRI ask patient if they know what ct or mri is and have canned speech
to explain( it is like an xray but gives us a much more detailed view of the internal parts of
the body. U will lay down on a table and the table moves through the machine while the
pictures are being taken. )

Health promotion (education over 50 c-scope, obesity- lipid labs, mammograms, paps)
Then ask Do you have any questions for me? Give them an opportunity to answer then
state something like the nurse will be in with the Lab slip ( or the prescription or whatever
you decide).

I WOULD LIKE TO SEE YOU IN THE OFFICE IN ONE WEEK (OR 3 DAYS OR WHATEVER) IF IN
THE ER GO THROUGH THE SAME CLOSING IF YOU ARE DISCHARGING PATIENT BUT SAY I
WOULD LIKE FOR YOU TO FOLLOW UP WITH YOUR PRIMARY CARE PROVIDER WITHIN 1
WEEK. If admitting ask if they have a physician that takes care of them in the hospital, if
not we will have you admitted to the (internal medicine service, family med. Service etc)