Day 3: HPI

Question 1

Elements of the HPI

Answer 1

Onset
Timing (constant, intermittent, waxing/waning)
Location (where is discomfort)
Quality (sharp, dull, ache)
Severity (mild, mod, severe, 0-10)
Modifying factors (what makes better/worse?)
Associated Sx
Context (anything else important that relates)

Question 2

Formula for writing the HPI

Answer 2

1. age/sex pt
2. chief complaint/onset
3. quality, location, timing
4. modifying factors
5. associated sx
6. list pertinent negs
7. other important context related to the CC

Question 3

Trauma HPI: 4 things

Answer 3

LOC
Head injury
Back Pain
Neck Pain

Question 4

HPI for MVA

Answer 4

1. were you driver or passenger
2. were you wearing a seatbelt
3. how fast were you moving
4. what part of the car was hit
5. did it hit a stationary object or another moving vehicle
6. did the airbags deploy
7. did you lose consciousness
8. did you hit your head
9. did you get injured
10. how much damage was done to your vehicle
11. is the car drivable
12. did you self-extricate (get out of the vehicle)
13. were you able to ambulate on the scene
14. did you require EMS treatment?

Question 5

ROS is a checklist of sx the pt ____ or ______ have.

Answer 5

does or does not

Question 6

If a complete ROS is unable to be obtained write:

Answer 6

A complete ROS is unobtainable due to the pt’s condition

Question 7

ROS: the 14 body systems

Answer 7

constitutional (fever, weight loss, sweats)
eyes
ENT
CV
Respiratory
GI
GU
MS
Integumentary
Neuro
Psych
Endocrine (polyuria, polydipsia)
Hematologic/Lymph
Immunologic (HIV/AIDS, splenectomy)

Question 8

Complete ROS contains ____ elements

Answer 8

10, or 2

Question 9

CP Major DDX, Minor DDx

Answer 9

Major DDx: MI, PE, Aortic Dissection, PTX

Minor DDx: chest wall pain, costochondritis, pleural effusion, GERD

Question 10

CP, SOB: MI risk factors

Answer 10

CAD, HTN, HLD, DM, Smoking, FHx CAD <55 yo

Question 11

CP, SOB: PE risk factors

Answer 11

Hx DVT/PE, known DVT, recent surgery, immobilization, A-fib, cancer, pregnancy/birth control

Question 12

SOB: Major DDx, Minor DDx

Answer 12

Major DDx: CHF, COPD, Asthma, PNA. (also consider MI or PE

Minor DDx: bronchitis, URI

Question 13

Abdominal Pain: Major DDx, Minor DDx

Answer 13

Major DDx: appy, cholecystitis, diverticulitis, pancreatitis, SBO, GI bleed, AAA
Minor DDx: UTI, Gastroenteritis, Gastritis, Constipation

Question 14

Diarrhea Risk Factors

Answer 14

recent foreign travel, recent camping, bad food exposure, sick contacts, recent antibiotics, recent hospitilization

Question 15

Female lower abdomen pain Major DDx, Minor DDx

Answer 15

Major DDx: appendicitis, ovarian torsion, ectopic pregnancy

Minor DDx: ovarian cyst, UTI, STD

Question 16

Female abdominal pain risk factors:

Answer 16

possible pregnancy, unprotected sex, history of STD

Question 17

Low back pain: Major DDx, Minor DDx

Answer 17

Major DDx: spinal cord injury, cauda equina, spinal abscess, AAA
Minor DDx: musculoskeletal back pain, back strain, sciatica

Question 18

Bak pain risk factors:

Answer 18

recent trauma, hx of IVDA, spinal hardware

Question 19

Dizziness/HA Major DDx, Minor DDx

Answer 19

Major DDx: hemorrhagic CVA, Sub Arachnoid Hemorrhage (SAH), Ischemic CVA, meningitis
Minor DDx: dehydration, benign positional vertigo (BPV) migraine HA, tension HA, sinusitis

Question 20

CVA risk factors:

Answer 20

HTN, HLD, DM, smoking, FHx CVA, Hx TIA/CVA, Afib

Question 21

Syncope Major/Minor DDx

Answer 21

Major DDx: Sz, CVA, MI, PE, cardiac arrythmia

Minor DDx: vasovagal syncope, dehydration

Question 22

AMS Major/Minor DDx

Answer 22

Major DDx: sepsis, CVA, meningitis, hypoglycemia, drug overdose
Minor DDx: UTI (if elderly), EtOH abuse, Narcotic abuse, Drug abuse

Question 23

AMS risk factors

Answer 23

Dementia/Alzheimers, DM, psychiatric history, substance abuse

Question 24

Trauma Major/Minor DDx

Answer 24

Major DDx: Hemorrhagic CVA, Subdural hematoma, Cervical/Thoracic/Lumbar spinal cord injury, PTX, Cardiac contusion, Splenic laceration, Liver laceration, Compound fracture
Minor DDx: closed head injury, simple fracture, dislocation, strain/sprain, laceration

Question 25

Trauma risk factors

Answer 25

blood thinners (coumadin/warfarin, Plavix, ASA), Severe Mechanism of Injury

Question 26

Review Common PMHx

Answer 26

General: HTN,HLD,CA,DM
Cardiac: MI, CAD, Angina, CHF, AFib
Pulmonary: PE, PNA, COPD, Asthma
Abdominal: GERD, AAA, Pancreatitis, Hepatitis, Diverticulitis
GU: Kidney Stones, UTI, renal insufficiency/failure
Neuro: CVA, TIA, Epilepsy/Sz, Migraines, Dementia, Alzheimers
Psych: depression, anxiety, bipolar, schizophrenia
Other: DVT, MRSA, RA, CBP

Question 27

Review Common PSHx

Answer 27

ENT: tonsillectomy, adenoidectomy, PE tubes
Cardiac: CABG, Coronary Stents, Pacemaker, AICD, Catheterization, Angioplasty, Valve replacement
Abdominal: appendectomy, cholecystectomy, Herniorrhaphy, Gastric Bypass, Colectomy, Colostomy
GU: Hysterectomy, C-section, Oophorectomy, Salpingo-oopherectomy, Tubal Ligation, TURP
Ortho: AKA/BKA, Hip Arthroplasty
Neuro: Carotid Endarterectomy, Craniotomy, VP shunt
Other: mastectomy, PICC line
Nephrectomy: kidney removal

Question 28

G/P/A convention:

Answer 28

G: total number of times pt has been pregnant
P: number of live births
A: number of miscarriages or elective abortions