Exam 1 Flashcards
What are some of the components of effective communication in a patient interview?
Active listening, open-ended questions, empathy, being aware of cultural perspectives
What is paralanguage?
Speech-patterns
- A warm and soft tone soothes patients
-Your pitch and volume should be low
What are kinesics in patient speech patterns?
Their body language
- be aware of facial expressions, eye contact, defensive barriers, etc
- BE CAREFUL w Touch
How should you be starting your interviews?
Start with open ended questions and then move towards more focused questions
- DO NOT use accuasatory or leading questions
Symptoms vs signs
Symptoms: What the patient feels, subjective
Signs: What the examiner finds, measurable
(Wheezing and pain are both a sign and a symptom)
Can a patient history be subponeaed?
Yes
What does the complete history include?
CC
HPI
PMH/Psx
SH
ROS
What are some considerations that we should take with geriatric patients?
- ADL’s, nutrition/cognitive/psych assestment, medications, falls
What are some questions we can ask about nutritional status?
- Eating throughout the day (what/how often)
- Weight change (loss or gain, intentional or not)
-Diets
-Deficiencies (Vitamin C deficiency=scurvey, alcoholism leads to folate deficiency, Vitamin B- Pellagra)
What does the HPI describe
information relevent to the CC
- Every 1st sentence of the HPI should be: “age of patient, gender, pmh, CC”
What is the acronym for Social History?
HEADDSSS
- Home, Education, Employment, Activities, Diet, Drugs, Sexuality, Safety, Support
What is the pack years formula?
PPD x years
i.e. 1/2 a pack per day over 20 years is 10 pack years
1 pack per day over 20 years is 20 pack years
What is included in the SOAP note
-Problem focused, short
S: Subjective (CC, HPI, PMH and ROS, meds/allergies)
O: Vital signs, PE findings, lab data, imaging results
A: Diagnosis and differential diagnosis
P: Further testing, therapy, referrals, pt education
Steps to building rapport
eye contact, ask questions about their life, open communcation, mirroring
What is one of the most important things NOT to do when transitioning from history closure to PE
- DO NOT ANCHOR on a diagnosis
How to deliver bad news?
Ensure adequate time and privacy
use eye contact
use touch only if appropriate
communicate well, use laymans terms
active listening
Difference between health and wellness
Health: State of being (physical, mental, social)
Wellness: State of living a healthy lifestyle (aims to enhance well-being)
What part of the patient interview do the majority of diagnoses come from?
The history and physical exam
How do you perform percussion
on drums
(Im kidding)
Use middle finger, tap DIP
What do the different sounds indicate during percussion
COPD: high pitched sound
Pnumonia: Have a thudding sound (indicates mucus)
What does the state of nutrition include in the inspection
Homeless, drug addict, kekectic or obese, small, etc
What are neck and renal bruits
constricted arteries, whooshing sounds. Indicate plaque buildup
Normal range for temperature
97F (36.1 C) to 99F (37.2C)
Fever is 100.4 (38C)
When do you use a rectal temperature
when the patient is hypothermic or in heat stroke and you need an extremely accurate body temperature
What is a fever of unknown origin typically caused by
In adults: infections (25-40% of cases) or cancer (25-40% of cases)
In children: Infections (30-50% of cases) and rarely in cancer (5-10% of cases)
Autoimmune disorders contribute to 10-20% for both adults and children
What do you not use to measure a pulse
your thumbs (silly gooses)
What are the characteristiscs of a pulse
rythym, amplitude (0-4)
What can cause bradychardia
Infections, hypothyoridism, beta blockers, inflammatory diseases
What can cause tachychardia
High blood pressure, thyroid disease, alcohol use, emotional stress
Charachteristics of respiratory rate
Rythym, rate, character
What is apnea?
cessation of breathing
What is hyperpena
increased depth of breathing, usually associated with metabolic acidosis
What are cheyne-stokes respirations
crescendo-decresendo pattern
Caused by stroke/CNS injury/actively dying patients
What are kussmal respirations
deep, rapid breathing
seen in DKA
What one-time measurement of BP indicates treatment?
> 160/100
What orthostatic measurement is significant when taking BP
When the patient goes from sitting to standing, the systolic should not decrease more than 20, and the diastolic should not decrease more than 10, the HR should not increase by 20 or more.
What is a short description of general survey
WDWN (well developed, well nourished)
What is a macule papule
macule: <1cm, papule: superficial, raised, <1cm
What is the difference between a primary and secondary leasion
Primary arises first, secondary arises from the changes to the primary leasion (i.e. scratch itchy mole and it create scales, the scales are secondary)
Elevated lesions classifications
Plaque: >1cm
Papule: <1cm
Nodule: deeper, solid, >1cm
Elevated lesions with fluid classifications
Cyst: Fluid filled papule or nodule
Postule: pimple
Vesicles: Superficial, fluid filled, <1cm (herpes virus)
Bullae: >1cm (blister/burn)
What is excoriation a fancy word for
a scratch
What is an ulcer
a loss of skin below the dermis
What is blanching
when you touch a lesion and it turns white
What are the 3 red/purple lesions
Petechiae- nonblanching, <.5cm
-Pupura- nonblanching, >.5cm
Ecchymosis: Nonblanching, various size
What does keratotic mean
horny thickening (like warts)
What condition appears in a linear-line shape
poision ivey, linear postules/bullae
What appears in a multiform shape
chicken pox
What are papulosquamous?
Papules or plaques with scaling
What appears in a zosteriform arrangement
shingels
How does chicken pox appear
Macular papula rash
What is impetigo
postules on kids mouth from staph infection
What are psoriasis classified as
plaques (bigger than 1cm and riased)
How does tinea corporis appear
anular, accruate, target lesion
What are examples of contact dermatitis
allergy from rings, eczema
Most common type of skin cancer
Basal cell carcinoma
Presentation of squamous cell cancer
non-healing, ulcerated, firm, progressive, crusted
Which skin cancer are you at a risk for if you are immunocompromised
squamous cell
Bulla, >1cm, fluid filled, blister/burn
macule, circular flat, <1cm
Nodule, circular elevated, solid, >1cm
Patch, flat, >1cm
Papule, superficial solid and elevated, <.5cm
Plaque>1cm
Vesicle, vesicle containing fluid
Papule (circular collection of free fluid, <1cm)
Wheal, plaque, may last a few hours (commonly from injecting anesthetic)
Scales, flakes or plates
Fissure - crack or split
Excoriation (linear erosion)
its literally just a scratch lol
Erosion (superficial loss of epidermis)
Dorsal recumbent- good for pts who cannot lie flat due to back pain
Fowlers- used for pts who have cardio issues/difficulty breathing/NG tube
Lithotomy
Time for a pap smear!
used for OB/GYN procedures and childbirth
Left lateral recumbent- take off pressure on vena cava for pregnant women or hypertensive patients
Proctologic
rectal exams (potentially?)
Reverse trendelenburg
-venous air embolism, pulmonary asperation prevention
Sims position
Enemas, perineal exams, comfort during pregnancy
I fear i do not need to include a description for sitting
supine
also called recumbent
Trendelenburg
OBGYN procedures, abdominal surgeries, central line placement
Here for reference
