Ch1 notes

Question 1

essential elements of clinical care

Answer 1

empathetic listening; the ability to interview patients of all ages, moods, and backgrounds; the techniques for examining the different body systems; and the process of clinical reasoning

Question 2

When do you conduct a comprehensive assessment?

Answer 2

For all patients you are seeing for the first time

Question 3

When is a focused or problem oriented assessment appropriate?

Answer 3

For patients you know well who are returning for routine office care or for patients with specific “urgent care” concerns

Question 4

Subjective data

Answer 4

what the patient tells you

Question 5

Objective data

Answer 5

what you detect during the examination

Question 6

The components of comprehensive adult health history

Answer 6

Identifying data and source of the history/reliability; chief complaint(s); family history; present illness; personal and social history; past history; review of systems

Question 7

identifying data

Answer 7

age, gender, occupation, marital status

Question 8

source of history

Answer 8

usually the patient, but can be a family member or friend, letter of referral, or the medical record

Question 9

reliability

Answer 9

varies according to the patient’s memory, trust, and mood

Question 10

chief complaint(s)

Answer 10

the one or more symptoms of concerns causing the patient to seek care

Question 11

present illness

Answer 11

amplifies the chief complaint; describes how each symptom developed. It includes the patient’s thoughts about the illness and pulls in relevant portions from the review of system. It may include medications, allergies, and habits of smoking and alcohol.

Question 12

past history

Answer 12

lists childhood illnesses; lists adult illnesses with dates for at least four categories (medical, surgical, obstetric/gynecologic, and psychiatric); includes health maintenance practices such as immunizations, screening tests, lifestyle issues, and home safety

Question 13

family history

Answer 13

outlines or diagrams age and health or age and cause of death of siblings, parents, and grandparents; documents presence or absence of specific illnesses in family, such as hypertension or coronary artery disease

Question 14

personal and social history

Answer 14

describes education level, family of origin, current household, personal interests, and lifestyle

Question 15

review of systems

Answer 15

documents presence of absence of common symptoms related to each major body system

Question 16

seven attributes of a symptom

Answer 16

location, quality, quantity or severity, timing (onset/duration/frequency), the setting in which it occurs, factors that have aggregated or relieved the symptom, and associated manifestations

Question 17

medical illnesses in past history

Answer 17

diabetes, hypertension, hepatitis, asthma, and HIV; hospitalizations; number and gender of sexual partners; and risky sexual practices

Question 18

childhood illnesses in past history

Answer 18

measles, rubella, mumps, whooping cough, chicken pox, rheumatic fever, scarlet fever, polio, and chronic illnesses

Question 19

surgical information in past history

Answer 19

dates, indications, and types of operations

Question 20

obstetric/gynecologic in past history

Answer 20

obstetric history, menstrual history, methods of contraception, and sexual function

Question 21

psychiatric information in past history

Answer 21

illness and time frame, diagnoses, hospitalizations, and treatments

Question 22

family history questions

Answer 22

ask about hypertension, coronary artery disease, elevated cholesterol levels, stroke, diabetes, thyroid or renal disease, arthritis, tuberculosis, asthma or lung disease, headache, seizure disorder, mental illness, suicide, substance abuse, and allergies; ask about any history of cancer; ask about genetically transmitted diseases

Question 23

tangential lighting

Answer 23

tangential lighting is optimal for inspecting structures such as the jugular venous pulse, the thyroid gland, and the apical impulse of the heart. It makes contours, elevations, and depressions more obvious.

Question 24

Organize your assessment around three goals

Answer 24

maximize the patient’s comfort, avoid unnecessary changes in position, enhance clinical efficacy

Question 25

cardinal techniques of examination

Answer 25

inspection, palpation, percussion, and auscultation

Question 26

inspection

Answer 26

close observation of the details of the patient’s appearance, behavior, and movement such as facial expression, mood, body habitus and conditioning, skin conditions such as petechiae or ecchymoses, eye movements, pharyngeal color, symmetry of thorax, height of jugular venous pulsations, abdominal contour, lower extremity edema, and gait

Question 27

palpation

Answer 27

tactile pressure from the palmar fingers or fingerpads to assess areas of skin elevation, depression, warmth, or tenderness, lymph nodes, pulses, contours and sizes of organs and masses, and crepitus in the joints

Question 28

percussion

Answer 28

use of the striking or plexor finger, usually the third, to deliver a rapid tap or blow against the distal pleximeter finger, usually the distal third finger of the left hand laid against the surface of the chest or abdomen, to evoke a sound wave such as resonance or dullness from the underlying tissue or organs. This sound wave also generates a tactile vibration against the pleximeter finger

Question 29

auscultation

Answer 29

use of the diaphragm and bell of the stethoscope to detect the characteristics of the heart, lung, and bowel sounds, including location, timing, duration, pitch, and intensity. Auscultation also permits detection of bruits or turbulence over arterial vessels

Question 30

sample physical examination order

Answer 30

1. general survey
2. vital signs
3. skin
4. head/eyes/ears/nose/throat
5. neck
6. back
7. posterior thorax and lungs
8. breasts, axillae, and epitrochlear nodes
9. anterior thorax and lungs
10. cardiovascular system
11. abdomen
12. lower extremities
13. nervous system
14. additional examinations (ie rectal or genital)