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Intro to Clinical Skills > Class Presentations > Flashcards

Class Presentations Flashcards

1
Q

When should you tell the patient bad news?

A

Once the diagnosis is certain.

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2
Q

How should you break bad news to a patient?

A

In a Private, Comfortable setting, with Support of Family or Friend.

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3
Q

What is the Protocol for giving bad news (Acronym, and Steps)?

A

SPIKES (Setup, Perception, Invitation, Knowledge, Emotions, Strategy).

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4
Q

Things to Avoid when giving bad news?

A

Don’t tell them over the phone, without support present, in a public space, and Don’t say it will be okay or give false hope (be supportive, but always be honest).

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5
Q

When is the best time to discuss end-of-life preferences (living will, DNR, etc)?

A

Early!

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6
Q

What is the Chief Complaint?

A

CC = the Reason for the Visit, in the Patient’s Own Words!!

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7
Q

What is the Format of the HPI section?

A

1st Para = Story (with LQDMASCOT, if app),
2nd Para = Pertinent Positives,
3rd Para = Pertinent Negatives (diff. diag.).

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8
Q

What is the 1st sentence of the HPI?

A

Patient info (name, age, gender), with onset/duration, and restated CC.

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9
Q

What is LQDMASCOT?

A

Description of Pain = Location, Quality, Duration, Modifiers, Associated, Severity, Context, Onset, Timing.

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10
Q

Risk Factors for MI?

A

SMOKING, Hypertension, Hyperlipidemia, Family Hx of Premature <60, Diabetes, Central Obesity, Male.

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11
Q

What info do you include about Medications?

A

Name, Dose, Route, Frequency, Reason.

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12
Q

How do you list Pregnancy History?

A

G_P_ _ _ _ (Gravida #, Para #, with TPAL = Term, Preterm, Abortions, Living).

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13
Q

How do you list an Allergy?

A

Name, Reaction (eg Anaphylaxis), and Year.

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14
Q

Painless but itchy inflammatory skin reaction after an exposure?

A

Contact Dermatitis.

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15
Q

Painless but itchy inflammatory skin reaction worsened by stress, and presents on face, head, and hairy areas?

A

Seborrheic Dermatitis.

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16
Q

Painless but itchy inflammatory skin reaction worsened by stress, and presents on head, elbows, knees, buttocks, penis?

A

Psoriasis.

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17
Q

Sudden diffuse rash after new med?

A

Drug Rash.

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18
Q

Very painful rash in dermatome pattern?

A

Herpes Zoster.

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19
Q

Wheal?

A

Hives

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20
Q

Bulla?

A

Large fluid-filled skin vesicle.

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21
Q

What are the Red Flags of Skin Cancer?

A

ABCDE = Asymmetry, Borders are irregular, Color is dark, Diameter is large, Evolution/changing over time.

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22
Q

Generally bad Red Flags:

A

Fever/chills, Weight loss, Age of Child or Senior, Loss of Function/Sensation, Pain during Night or At Rest, Hx of Cancer.

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23
Q

Warning signs of drug abuse seeker?

A

Hx of any substance abuse, inconsistencies in story/record, new unknown patient, impatience, over/under-familiarity with medical terms, impatience, praising/sweet-talking the provider.

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24
Q

How is biology affected by stress?

A

“Mind-body connection” is real.

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25
Q

Patient Suspects people are Exploiting or Deceiving them?

A

Paranoid Personality Disorder (stay professional, empathetic, do not challenge).

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26
Q

Patient shows unstable extremes with frantic Fear of Abandonment?

A

Borderline Personality Disorder (set clear limits).

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27
Q

Patient shows extreme Attention-Seeking and Drama?

A

Histrionic Personality Disorder (stay professional and objective).

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28
Q

Patient shows arrogance and entitlement with lack of empathy?

A

Narcissistic Personality Disorder (channel pt’s skills/energy into strategy).

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29
Q

Patient shows rigid control, order, organization?

A

Obsessive Personality Disorder (focus on objective findings).

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30
Q

Indications likely of Distress rather than Disease?

A

elaborate descriptions, non-specific, unsupported by exams, unresponsive to treatment, does not make clear “sense”.

31
Q

Patient feels “need to be sick”?

A

Somatic disorder.

32
Q

Patient fixates on a specific severe illness and strongly convinced they have that particular disease?

A

Hypochondriac disorder.

33
Q

Patient exhibits a sudden unexplained loss of function (esp after emotional trauma)?

A

Conversion disorder.

34
Q

Patient intentionally fakes/pretends to be ill or makes someone else ill?

A

Fictitious disorder (munchausen’s or munchausen’s-by-proxy).

35
Q

Term for intentionally deceiving medical professional for personal gain (disability comp, get out of work, etc)?

A

Malingering.

36
Q

Cause of psychiatric illness?

A

Usually combination of genetics and environment/stress.

37
Q

Symptoms of depression?

A

Depressed mood/anhedonia for at least 2 weeks, with SIGECAPS (= Problems with: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal thoughts).

38
Q

Factors that improve likelihood of good outcome?

A

Support of a family member, Spiritual support.

39
Q

4 questions to assess Substance Abuse?

A

CAGE (=Cut down failure, Angered/Annoyed, Guilty, Eye-opener.)

40
Q

Indicators of Worse Outcome for Suicidal risk?

A

Have clear plan, have tried before, won’t promise to call if close to attempting.

41
Q

What is PTSD?

A

Acute Stress Disorder that lasts more than a month.

42
Q

A more mild but more persistent, long-term form of depression that lasts 2+ yrs?

A

Dysthymia.

43
Q

Alternating periods of depression and manic episodes?

A

Bipolar disorder.

44
Q

Term for psychotic symptom of making up words?

A

neologism.

45
Q

Term for psychotic symptom of suddenly stop talking in middle of thought?

A

blocking.

46
Q

Term for psychotic symptom of repeating a phrase or response over and over again?

A

perseveration.

47
Q

Term for psychotic symptom of repeating what another person says over and over?

A

echolalia.

48
Q

Term for psychotic symptom of repeating words based on sound such as rhyming?

A

clanging.

49
Q

Delirium Versus Dementia?

A

Delirium = Sudden/acute impaired cognition with sudden organic cause (infection, drug, electrolyte imbalance, fever), Vs. Dementia = gradual decline in cognition over time (esp with age).

50
Q

What is sundowning?

A

symptoms get worse later in the evening, indicative of dementia.

51
Q

Paresis?

A

Muscle Weakness (partial paralysis).

52
Q

Ataxia?

A

Loss of muscle control.

53
Q

Paresthesia?

A

Tingling sensation.

54
Q

Headache Red Flags?

A

“Worst ever”, wakes patient up, exertional/cough, hyperemesis.

55
Q

Headache with photophobia, phonophobia, and is usually unilateral and accompanied by a pre-aura?

A

Migraine headache.

56
Q

Headache that is like a dull tight band around head, esp near eyes, and is worse in pm?

A

Tension headache (stress).

57
Q

Headache that is sharp,stabbing pain and occurs around the same time each day and is usually worse in the am?

A

Cluster headache.

58
Q

Headache that is found in older women with elevated ESR and can lead to permanent blindness?

A

Temporal Arteritis.

59
Q

Headache that is worse with cough or sneeze, is accompanied with Papilledema, and can cause death?

A

Increased Intracranial Pressure (ICP).

60
Q

Loss of Consciousness:

Syncope Vs. Seizure?

A

Syncope = Fainting then regain (embarassed), Seizure = LOC followed by Post-Ictal State (disoriented)!!!

61
Q

Controllable risk factors for Stroke?

A

HTN, Hyperlipidemia, Diabetes, Tobacco; also weight, lack of exercise, and heavy alcohol use.

62
Q

Two types of Cerebro-Vascular Accident (CVA/Stroke)?

A

Thrombotic (dry, ischemic, blockage) OR Hemorrhagic (intracranial bleeding, Sudden and Painless)!

63
Q

Signs of Stroke?

A

“Recognize a Stroke FAST”: (Facial droop, Arm drift, Speech slurred, Time to call 911).

64
Q

What is necessary to approach a pediatric patient well?

A

An understanding of child development; must work with parents and tailor interaction based on developmental stage.

65
Q

How does child development proceed?

A

Child development proceeds along a predictable pathway, but with wide range variations.

66
Q

Childhood Development Milestones

A 
(all are variable, +or- a few months each way)
Roll over @ ~ 6 months,
Crawl @ ~ 9 months,
Cruise @ ~ 12 months,
Walk @ ~ 14 months.
67
Q

Things that hurt Teenagers?

A

Themselves! Risky behaviors: Sex, Drugs, Alcohol, Tobacco, etc.

68
Q

Things to remember when working with elderly patients?

A

elderly tend to Under-report symptoms.

69
Q

Symptoms of heart failure?

A

DOE, Orthopnea, Tired, Edema (if R-sided, backs up).

70
Q

Asthma treatment?

A

Need albuterol inhaler AND pulmonary Anti-inflammatory.

71
Q

Blood in Stool:

Hematochezia Vs. Melena

A 
Hematochezia = red, bleed from lower GI;
Melena = dark, tarry bleed from upper GI.
72
Q

What are SOAP notes?

A

Essential “meat&potatoes” of notes (leaves out anything unnecessary for current visit)
= Subjective, Objective, Assessments, Plans.

73
Q

What is the format of Assessments in SOAP notes?

A

Give number for each diagnosis (new and past chronic), or if not sure yet of new Dx then put “[CC] r/o [short DDx list]”.

74
Q

What is the order of Assessments for SOAP notes?

A 
#1 is CC of this visit,
#2 - #x = remaining chronic conditions (inc substance abuse)
#last = Health Maintenance.

Intro to Clinical Skills (4 decks)

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