Exam 1 Asterisked Slides

Question 1

Comprehensive physical

Answer 1

Complete, expanded, for a new patient. Get to know a patient, develop provider-patient relationship. Identify or rule out physical causes related to CC. Baseline for future assessments. Platform for health promotion. Demonstrats profiency in the essential skills of the physical examination

Question 2

Focused Physical

Answer 2

Problem oriented, basic. Comprehensive has been done in the past. Established patient, urgent care or sick care, focused concerns or symptoms. Restricted to a specific body system. Examination methods relevant to assessing the concern or problem

Question 3

Question Types

Answer 3

Open Ended, Direct/Closed, Graded Response, Leading, Multiple

Question 4

Open-Ended Question

Answer 4

Best when seeking general information. Beginner interviewer

Question 5

Direct or Closed Question

Answer 5

If seeking specific facts. Outlined CC and past history. Brief sentence

Question 6

Graded response Question

Answer 6

A question with multiple possible answers: A, B, or C?

Question 7

Leading Question

Answer 7

Risky. Limits information. Avoid those with answer or suggested response.

Question 8

Multiple Question

Answer 8

Used by novice interviewers. Pt will only answer the last thing they heard. Ex “Do you have a history of high BP, cancer, or stroke?”

Question 9

Interview Techniques

Answer 9

Facilitation, Reflection, Clarification, Reassurance, Empathy, Confrontation, Interpretation, Validation, Summarization, Transitions

Question 10

Facilitation

Answer 10

Verbal and/or nonverbal. Encourages pt. to say more. Ex: nodding, moving in closer, eye contact, “and?” etc. OR cutting in

Question 11

Reflection

Answer 11

Repeat what the patient said to reinforce/make sure they know you were listening/get them to continue

Question 12

Clarification

Answer 12

Get a definition of specific cultural terms. “What do you mean by…?”

Question 13

Reassurance

Answer 13

Good to give patient reassurance in face of bad news, but do not lie or give false hope

Question 14

Empathy

Answer 14

Exists both verbally and nonverbally. Nonverbal exists on a per-patient basis.

Question 15

Confrontation

Answer 15

In response to disturbing behavior

Question 16

Interpretation

Answer 16

Restate and confirm

Question 17

Validation

Answer 17

Acknowledgement of what the pt said and affirm its legitimacy

Question 18

Summarization

Answer 18

Summarize what pt has told you

Question 19

Transition

Answer 19

Transition between areas of visit

Question 20

CAGE

Answer 20

Screen for Alcohol consumption. Concern (your own or someone else’s drinking, felt need to cut down on your drinking), Annoyed (Criticism of your drinking), Guilty (Felt guilty about your drinking), Eyeopener (A drink first think in the morning).

Question 21

TACE

Answer 21

Another, almost identical screen for alcohol consumption. Take (How many drinks does it TAKE to get you buzzed?), Annoyed (criticism of your drinking), Cut (Do you feel you should cut down on your drinking), Eye opener (Drink first thing in the morning)

Question 22

CRAFFT

Answer 22

Screen for adolescents for illicit drugs. Car (Have driven under the influence/been in the car with someone under the influence), Relax (do you use drugs to relax), Alone (do you use drugs alone), Forget (Do you ever forget things you do under the influence of drugs), Family (does your family have problems with your drug use/think you should cut down on your drug use), Trouble (Have you gotten in trouble while you were using drugs)

Question 23

Comprehensive Note

Answer 23

Complete, expanded. Usually for new patients.

Question 24

Inventory Note

Answer 24

Related to complete but not as detailed

Question 25

Focused Note

Answer 25

Problem oriented, basic. Focused on reason for visit

Question 26

Interim Note

Answer 26

Chronicles events since last visit

Question 27

General Guidelines for SOAP Note

Answer 27

Legal document. Important for health care payment. Brief notes. Must be accurate, well organized, clear and concise. Organized in a manner representative of the examination. Never document something you did not do. EXCEPTION: VITAL SIGNS. If something was deferred or omitted, state reason. Completion of note: Signature on paper, enote will be digitally signed on closure. Do not use abbreviations outside of approved list. Words to avoid: Normal, poor, good.

Question 28

Subjective

Answer 28

Information, Absence/Presence of Symptoms, Patient Offered information

Question 29

Objective

Answer 29

Findings, Direct observations: See-Hear-Touch-Smell

Question 30

Assessment

Answer 30

“What you think”. Diagnostic Possibilities. Ongoing problems. Health maintenance

Question 31

Plan

Answer 31

Develop a plan for each problem. Tests. Treatments. Educations. Newly prescribed meds will go here.

Question 32

Chief Complaint

Answer 32

Reason for seeking care. Placed in quotes: “CC”. Brief statement. Patient my have several concerns; list according to severity or urgency. AVOID phrasing: problem or complaint*

Question 33

Medication

Answer 33

List every medication: Prescription, OTC, herbal, supplement, vitamin. Must haves: Name, dose, # of tablets, route, frequency, last dose taken.

Question 34

4C’s that patients look for in a Pt/Doctor Relationship

Answer 34

Courtesy, Comfort, Connection, Confirmation

Question 35

Ask me 3

Answer 35

Encourage patient to understand: What was the main problem, what do I need to do, and Why is this important for me?

Question 36

Teach Back

Answer 36

Ask patient to restate what you told them (medication instructions, health information, etc)

Question 37

4Cs

Answer 37

Call (what do you call your problem), Cause (What do you think causes your problem), Concern (what concerns you the most about your problem), Cope (what are you doing to cope with your problem)

Question 38

Note important tips (again…)

Answer 38

Note is a legal document. Patient name/headings. For handwritten note: Black and blue ink. LEGIBLE!!! Never skip a line. Error correction: single line through, initial and date. Addendum: Note and date. Signature with title

Question 39

Goals of Sports Physical

Answer 39

Make sure athlete is healthy. What is the athlete’s present fitness level? Identify conditions that could interfere with ability to participate in a sport. Health problems that could increase risk (i.e. Sickle Cell). Lead to selection of an appropriate sport. Ultimate goal: ensure safe participate without restricting unnecessarily

Question 40

Sports Medical History

Answer 40

Standard forms, previous disqualifications, heat illness/muscle cramps, focus detection of previous and current issues, viral illness (mononucleosis, fever (absolute contraindication), sickle cell trait, hospitalizations or surgeries, Medications, Allergies, Special Equipment, Absence of paired organs, Immunizations, Height/Weight/BMI

Question 41

Female Athlete Triad (KNOW THIS)

Answer 41

Disordered eating, amenorrhea, and osteoporosis. Triad is seen in females participating in sports emphasizing leanness or low body weight. Energy deficit occuring bc calorie expenditure exceeds calorie intake. May see primary amenorrhea, secondary amenorrhea, or oligomenorrhea. Could present as osteopenia or osteoporosis

Question 42

Temperature Differences between the Routes

Answer 42

Normal Oral: 37C, 98.6F. Axillary is .6C Lower/1.0F Lower than Oral. Rectal is 0.4-0.5C Higher or 0.7-0.9F Higher than Oral. Tympanic is 0.8C or 1.4F higher than oral. When recording, record the route used. If you record the route used, do not correct. If you do not include route, oral assumed.

Question 43

What’s the best way to take the temperature of elderly and critically ill children and why?

Answer 43

Rectally and because they do not spike temperatures readily.

Question 44

Afebrile

Answer 44

Not fever. 97F-100.4F/36C-38C Rectal

Question 45

Febrile

Answer 45

≥100.4F/38C Rectal.

Question 46

Fever/Pyrexia

Answer 46

Condition of elevated body temperature (100.4)

Question 47

Hyperpyrexia

Answer 47

Super duper pyrexia. ≥106F/41.C

Question 48

Hypothermia

Answer 48

Below 95F/35C

Question 49

Accessory Muscles

Answer 49

Used during respiratory distress. Nasal flaring, intercostal retraction, and positioning in children

Question 50

Eupnea

Answer 50

Standard breathing. 12-20 breaths per minute

Question 51

Bradypnea

Answer 51

<12 per minute. Athletic conditioning, hyperthermia, depressant medications.

Question 52

Hypernea/Hyperventilation

Answer 52

≥20 per minute WITH DEEP BREATHS. Causes: Pain, respiratory distress, acidosis, hysteria

Question 53

Tachypnea

Answer 53

≥20 per minute. Causes; fever, exertion, acidosis, anxiety, fear, CO poisoning

Question 54

Standard precautions

Answer 54

Do not recap needle (unless you can do 1 handed technique). PPE: Personal protective equipment (gloves et. Al.) Hand hygiene: after contact with fluids, immediately after removing gloves, and between patients wash hands thoroughly. Respiratory hygiene and cough ettiquette: any patient with cough at initial point of contact.

Question 55

Examination Technique

Answer 55

Keep patient covered: draping (keep gown/clothes covered over everything except relevant area). Ask pt to move clothing and retie.

Question 56

Examination technique for Supine

Answer 56

Lies on back, will want to drape chest to knees or toes

Question 57

Examination technique for Prone

Answer 57

Patient is lying on stomach, will want to cover torso

Question 58

Examination technique for Dorsal recumbent

Answer 58

Used to examine genital or rectal areas, supine knees bent and feet on table

Question 59

Examination technique for Lateral Recumbent

Answer 59

Used to measure heart sounds, side lying legs extended or flexed. Looks like the fetal position.

Question 60

Examination technique for Lithotomy

Answer 60

Pelvic, dorsal recumbent, legs in stirrups

Question 61

Examination technique for Sims

Answer 61

Rectum or temperatures, lateral recumbent, top leg flexed at hip or knee, bottom leg flexxed slightly

Question 62

Palpation

Answer 62

Best done using palmer surfacesof fingers/finger pads. Can also use Ulnar surfaces of hand and fingers/dorsal surface of hand. Light: up to 1cm depth. Deep: up to 4cm depth. Do not have long nails!

Question 63

Percussion

Answer 63

One object hitting/vibrating against another. Direct: palpate and percuss directly over the area of interest (ie a sinus) Indirect: place a finger over the area of interest and percuss the finger. Listening for different sound waves –> resonance.

Question 64

Auscultation

Answer 64

On skin. Bell used for low frequency. Diaphragm for high frequency.