1 Flashcards
The components of the health history include all of the following except which one?
A) Review of systems
B) Thorax
C) History of present illness
D) Social history
B
The following information is recorded in the health history: “The patient has had abdominal pain for 1 week. The pain lasts for 30 minutes at a time; it comes and goes. The severity is 7 to 9 on a scale of 1 to 10. It is accompanied by nausea and vomiting. It is located in the mid-epigastric area.”
Which of these categories does it belong to?
A) Chief complaint
B) History of present illness
C) Social history
D) Review of systems
B
The following information is recorded in the health history: “I feel really tired.”
Which category does it belong to?
A) Chief complaint
B) History present illness
C) Social history
D) Review of systems
A
A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?
A) Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.
B) Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding.
C) Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.
D) Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.
C
Mr. Larson is a 42-year-old widowed father of two children, ages 4 and 11. He works in a sales office to support his family. Recently he has injured his back and you are thinking he would benefit from physical therapy, three times a week, for an hour per session. What would be your next step?
A) Write the physical therapy prescription.
B) Have your office staff explain directions to the physical therapy center.
C) Discuss the plan with Mr. Larson.
D) Tell Mr. Larson that he will be going to physical therapy three times a week.
C
You are growing fatigued of performing a maneuver on examination because you have never found a positive and are usually pressed for time. How should you next approach this maneuver?
A) Use this test when you have a higher suspicion for a certain correlating condition.
B) Omit this test from future examinations.
C) Continue doing the test, but rely more heavily on laboratory work and diagnostics.
D) Continue performing it on all future examinations.
A
You have recently returned from a medical missions trip to sub-Saharan Africa, where you
learned a great deal about malaria. You decide to use some of the same questions and maneuvers in your “routine” when examining patients in the midwestern United States. You are disappointed to find that despite getting some positive answers and findings, on further workup, none of your patients has malaria except one, who recently emigrated from Ghana. How should you next approach these questions and maneuvers?
A) Continue asking these questions in a more selective way.
B) Stop asking these questions, because they are low yield.
C) Question the validity of the questions.
D) Ask these questions of all your patients.
A
You are interviewing an elderly woman in the ambulatory setting and trying to get more information about her urinary symptoms. Which of the following techniques is not a component of adaptive questioning?
A) Directed questioning: starting with the general and proceeding to the specific in a manner that does not make the patient give a yes/no answer
B) Reassuring the patient that the urinary symptoms are benign and that she doesn’t need to worry about it being a sign of cancer
C) Offering the patient multiple choices in order to clarify the character of the urinary symptoms that she is experiencing
D) Asking her to tell you exactly what she means when she states that she has a urinary tract infection
B
Mr. Q. is a 45-year-old salesman who comes to your office for evaluation of fatigue. He has come to the office many times in the past with a variety of injuries, and you suspect that he has a problem with alcohol. Which one of the following questions will be most helpful in diagnosing this problem?
A) You are an alcoholic, aren’t you?
B) When was your last drink?
C) Do you drink 2 to 3 beers every weekend?
D) Do you drink alcohol when you are supposed to be working?
B
Mr. W. is a 51-year-old auto mechanic who comes to the emergency room wanting to be checked out for the symptom of chest pain. As you listen to him describe his symptom in more detail, you say “Go on,” and later, “Mm-hmmm.” This is an example of which of the following skilled interviewing techniques?
A) Echoing
B) Nonverbal communication
C) Facilitation
D) Empathic response
C
Mrs. T. comes for her regular visit to the clinic. She is on your schedule because her regular provider is on vacation and she wanted to be seen. You have heard about her many times from your colleague and are aware that she is a very talkative person. Which of the following is a helpful technique to improve the quality of the interview for both the provider and the patient?
A) Allow the patient to speak uninterrupted for the duration of the appointment.
B) Briefly summarize what you heard from the patient in the first 5 minutes and then try to have her focus on one aspect of what she told you.
C) Set the time limit at the beginning of the interview and stick with it, no matter what occurs in the course of the interview.
D) Allow your impatience to show so that the patient picks up on your nonverbal cue that the appointment needs to end.
B
When you enter your patient’s examination room, his wife is waiting there with him. Which of the following is most appropriate?
A) Ask if it’s okay to carry out the visit with both people in the room.
B) Carry on as you would ordinarily. The permission is implied because his wife is in the room with him.
C) Ask his wife to leave the room for reasons of confidentiality.
D) First ask his wife what she thinks is going on.
A
A 15-year-old high school sophomore and her mother come to your clinic because the mother is concerned about her daughter’s weight. You measure her daughter’s height and weight and obtain a BMI of 19.5 kg/m2. Based on this information, which of the following is appropriate?
A) Refer the patient to a nutritionist and a psychologist because the patient is anorexic.
B) Reassure the mother that this is a normal body weight.
C) Give the patient information about exercise because the patient is obese.
D) Give the patient information concerning reduction of fat and cholesterol in her diet because she is obese.
B
A 55-year-old bookkeeper comes to your office for a routine visit. You note that on a previous visit for treatment of contact dermatitis, her blood pressure was elevated. She does not have prior elevated readings and her family history is negative for hypertension. You measure her blood pressure in your office today. Which of the following factors can result in a false high reading?
A) Blood pressure cuff is tightly fitted.
B) Patient is seated quietly for 10 minutes prior to measurement.
C) Blood pressure is measured on a bare arm.
D) Patient’s arm is resting, supported by your arm at her mid-chest level as you stand to measure the blood pressure.
A
A 49-year-old truck driver comes to the emergency room for shortness of breath and swelling in his ankles. He is diagnosed with congestive heart failure and admitted to the hospital. You are the student assigned to do the patient’s complete history and physical examination. When you palpate the pulse, what do you expect to feel?
A) Large amplitude, forceful
B) Small amplitude, weak
C) Normal
D) Bigeminal
B
A 25-year-old type 1 diabetic clerk presents to the emergency room with shortness of breath and states that his blood sugar was 605 at home. You diagnose the patient with diabetic ketoacidosis. What is the expected pattern of breathing?
A) Normal
B) Rapid and shallow
C) Rapid and deep
D) Slow
C
Mr. Curtiss has a history of obesity, diabetes, osteoarthritis of the knees, HTN, and obstructive sleep apnea. His BMI is 43 and he has been discouraged by his difficulty in losing weight. He is also discouraged that his goal weight is 158 pounds away. What would you tell him?
A) “When you get down to your goal weight, you will feel so much better.”
B) “Some people seem to be able to lose weight and others just can’t, no matter how hard they try.”
C) “We are coming up with new medicines and methods to treat your conditions every day.”
D) “Even a weight loss of 10% can make a noticeable improvement in the problems you mention.”
D
Jenny is one of your favorite patients who usually shares a joke with you and is nattily dressed. Today she is dressed in old jeans, lacks makeup, and avoids eye contact. To what do you attribute these changes?
A) She is lacking sleep.
B) She is fatigued from work.
C) She is running into financial difficulty.
D) She is depressed.
D
You are seeing an older patient who has not had medical care for many years. Her vital signs taken by your office staff are: T 37.2, HR 78, BP 118/92, and RR 14, and she denies pain. You notice that she has some hypertensive changes in her retinas and you find mild proteinuria on a urine test in your office. You expected the BP to be higher. She is not on any medications. What do you think is causing this BP reading, which doesn’t correlate with the other findings?
A) It is caused by an “auscultatory gap.”
B) It is caused by a cuff size error.
C) It is caused by the patient’s emotional state.
D) It is caused by resolution of the process which caused her retinopathy and kidney problems.
A
Despite having high BP readings in the office, Mr. Kelly tells you that his readings at home are much lower. He checks them twice a day at the same time of day and has kept a log. How do you respond?
A) You diagnose “white coat hypertension.”
B) You assume he is quite nervous when he comes to your office.
C) You question the accuracy of his measurements.
D) You question the accuracy of your measurements.
C