Clinical Assessment and Reasoning

Question 1

Why take a history?

Answer 1

Gather information to solve a problem

Also:
- Communication skills
- Build rapport and trust
- Identify a problem
- Make a plan

Question 2

Whats the three stages of taking a history?

Answer 2

1. Introduction
2. Information gathering
3. Explore and exclude differentials
   (cheeky 4). Problems, plan and present.

Question 3

Whats the basic framework of taking a history?

Answer 3

1. Presenting complaint
2. History of presenting complaint
3. Past medical history
4. Meds, allergies and other drugs
5. Social history
6. Family history
7. Systems enquiry

Question 4

What are the methods for dealing with difficult patients?

Answer 4

1. The defence; Have lines to use to put the focus back on the patient.
2. Have boundaries and know your vulnerabilities
3. Know what personally offends you vs is professionally relevant.
4. Validate colleagues; i.e share, be open, be supportive
5. Learn to be assertive, learn to be supportive.

Question 5

Whats the point of examination?

Answer 5

To gather information (Again)
- Include or exclude relevant physical findings
- To confirm, refute or suggest diagnosis.

Question 6

What are key skills for examination?

Answer 6

• Language is everything i.e dont use feel and use confident body language.
• Do not cause pain
• Know the routine
• Explore the abnormal

Question 7

What is the five step basic exam technique?

Answer 7

1. Gel hands
2. Endofthebedogram
3. Fingers to face
4. Relevant routine; IPPA, ITPCRS or cranial nerves, look-feel-move
5. Complete rest of body but do not to bedside tests.

Question 8

What does IPPA stand for?

Answer 8

Inspect
Palpate
Percuss
Ascultate

Question 9

Whats the chapman 6?

Answer 9

6s’s

Size
Shape
Symmetry
Skin inc. colour, lesions texture
Scars
Specific extra

Question 10

What does ITPCRS stand for?

Answer 10

Inspection
Tone
Power
Coordination
Reflexes
Sensation

Isolate joints to test, compare between limbs

Question 11

After you perform an exam what are the next steps?

Answer 11

1) Order: Make sense, present
2) Analyse: ID issues, problem list
3) Action: Plan, what to do next.

Question 12

Whats the goal of a written presentaiton?

Answer 12

Communication with all clinical staff a complete detailed documented. Medicolegal purpose.

Question 13

What is a goal of an oral presentation?

Answer 13

Communication between DRs.

Question 14

What are the steps of an oral presentation?

Answer 14

• Opening statement
• Follow framework
• Relevant +ives and -ives
• Close with statement

i.e Opener, Problems, Plan

Question 15

What are the key aspects of an opening statement?

Answer 15

1. Name, age, gender, ethnicity
2. Presenting symptom, diagnosis if known.
3. Major and relevant PMH
4. Functional status

Question 16

What are the potential types of plans? Differ Pts and stages of care

Answer 16

1. Investigations and treatments (straightforward)
2. Problem by problem (multifaceted)
3. Acuity focused (Now, today, tomorrow, before discharge etc)

Question 17

Whats the goal of the closing statement?

Answer 17

Summary, problem presentation.

i.e

-Opener
-ddx (diagnosis?)
-initial investigations and Tx
-issues, immediate and important