Class Presentations Flashcards by Matthew Linder

When should you tell the patient bad news?

Once the diagnosis is certain.

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How should you break bad news to a patient?

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

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

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

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Things to Avoid when giving bad news?

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

Early!

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What is the Chief Complaint?

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

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What is the Format of the HPI section?

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

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What is the 1st sentence of the HPI?

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

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What is LQDMASCOT?

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

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Risk Factors for MI?

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

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What info do you include about Medications?

Name, Dose, Route, Frequency, Reason.

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How do you list Pregnancy History?

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

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How do you list an Allergy?

Name, Reaction (eg Anaphylaxis), and Year.

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Painless but itchy inflammatory skin reaction after an exposure?

Contact Dermatitis.

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

Seborrheic Dermatitis.

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

Psoriasis.

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Sudden diffuse rash after new med?

Drug Rash.

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Very painful rash in dermatome pattern?

Herpes Zoster.

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Wheal?

Hives

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Bulla?

Large fluid-filled skin vesicle.

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What are the Red Flags of Skin Cancer?

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

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Generally bad Red Flags:

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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Warning signs of drug abuse seeker?

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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How is biology affected by stress?

“Mind-body connection” is real.

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Patient Suspects people are Exploiting or Deceiving them?

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

Patient shows unstable extremes with frantic Fear of Abandonment?

Borderline Personality Disorder (set clear limits).

Patient shows extreme Attention-Seeking and Drama?

Histrionic Personality Disorder (stay professional and objective).

Patient shows arrogance and entitlement with lack of empathy?

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

Patient shows rigid control, order, organization?

Obsessive Personality Disorder (focus on objective findings).

Indications likely of Distress rather than Disease?

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

Patient feels "need to be sick"?

Somatic disorder.

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

Hypochondriac disorder.

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

Conversion disorder.

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

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

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

Malingering.

Cause of psychiatric illness?

Usually combination of genetics and environment/stress.

Symptoms of depression?

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

Factors that improve likelihood of good outcome?

Support of a family member, Spiritual support.

4 questions to assess Substance Abuse?

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

Indicators of Worse Outcome for Suicidal risk?

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

What is PTSD?

Acute Stress Disorder that lasts more than a month.

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

Dysthymia.

Alternating periods of depression and manic episodes?

Bipolar disorder.

Term for psychotic symptom of making up words?

neologism.

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

blocking.

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

perseveration.

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

echolalia.

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

clanging.

Delirium Versus Dementia?

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).

What is sundowning?

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

Paresis?

Muscle Weakness (partial paralysis).

Ataxia?

Loss of muscle control.

Paresthesia?

Tingling sensation.

Headache Red Flags?

"Worst ever", wakes patient up, exertional/cough, hyperemesis.

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

Migraine headache.

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

Tension headache (stress).

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

Cluster headache.

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

Temporal Arteritis.

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

Increased Intracranial Pressure (ICP).

Loss of Consciousness: | Syncope Vs. Seizure?

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

Controllable risk factors for Stroke?

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

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

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

Signs of Stroke?

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

What is necessary to approach a pediatric patient well?

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

How does child development proceed?

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

Childhood Development Milestones

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

Things that hurt Teenagers?

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

Things to remember when working with elderly patients?

elderly tend to Under-report symptoms.

Symptoms of heart failure?

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

Asthma treatment?

Need albuterol inhaler AND pulmonary Anti-inflammatory.

Blood in Stool: | Hematochezia Vs. Melena

``` Hematochezia = red, bleed from lower GI; Melena = dark, tarry bleed from upper GI. ```

What are SOAP notes?

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

What is the format of Assessments in SOAP notes?

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]".

What is the order of Assessments for SOAP notes?

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