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Health Assessment > Exam 1: intro to HA > Flashcards

Exam 1: intro to HA Flashcards

1
Q 
Objective data would include all except: 
A- BMI
B- Chief complaint
C- Ophthalmic examination
D- EKG results
A

B- Chief complaint (bates p 7)

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2
Q 
Mrs Gomez presents today reporting “I have a UTI”. This is an example of what kind of data:
A subjective
B objective
C assessment
D impression
A

A subjective (bates p 7)

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3
Q

Cardinal techniques for examination begin with:

A observation of standard and universal precautions
B draping the patient appropriately to visualize one body part at a time
C inspection
D interview

A

Inspection (bates p 18)

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4
Q

Your pt reports that taking ibuprofen 200 mg 2 tabs TID has helped with his ankle pain. This information would fall under what category of OLDCART?

A

Relieving factors (bates p 79)

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5
Q

You’re 23-year-old female presents with complaints of pelvic cramps, menorrhagia, headaches and feeling bloated. Your next course of action would be:

A complete symptom analysis including ROS
B perform physical exam, including pelvic exam
C order diagnostics including HCG, pelvic and vaginal ultrasound
D obtain FH, particularly assessing for any +FH of ovarian cancers

A

A complete symptom analysis including ROS (bates ch 3)

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6
Q

You’re 31-year-old male patient presents for his annual comprehensive exam. This is your first time meeting this patient. It is appropriate to ask him about his sexual history.

True or false

A

True (bates p 95)

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7
Q 
You note that your patient is dressed in a turtleneck sweater and heavy overcoat which seems incongruent with today’s weather of 71°. This information would go under what section of your notes? 
HPI
impression
ROS 
PE
A

PE (bates p 121)

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8
Q

An appropriate opening statement or questions to elicit further information from your patient would be:

A “ I see you are concerned you might have bronchitis”
B “ what concern can I help you with today?”
C “ are you having cough and cold symptoms?”
D “ were you exposed to anyone with similar symptoms?”

A

B “ what concern can I help you with today?” (Bates p 81)

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9
Q

The seven attributes of a symptom include location, associated manifestations, quality, remitting or exacerbating factors, quality, onset, and ______.

A duration
B characteristics
C timing
D site

A

C timing (bates p 79)

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10
Q

The onset in the seven attributes of a symptom refers to when the symptom began:

True or false

A

False (bates p 79)

Onset refers to the setting in which symptom occurs. Include environmental factors, personal activities, emotional reactions, or other circumstances that may have contributed to the illness.

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11
Q

Geriatric syndrome include all except:

A increased age
B incontinence
C delirium
D Falls

A

A increased age (bates p 967)

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12
Q

The FNP is performing a history on a patient who has presented with abdominal pain. The patient has reported that the pain is in the upper right side and she describes the pain as stabbing. The patient began as she was eating dinner last night. The pain worsens when she takes a deep breath, but is better when she lies down. The patient reports nausea that accompanies the pain. When evaluating the attributes of a symptom, which would the FNP need to inquire about?
A Quality and remitting / exacerbating factors
B onset and quantity / severity
C Quality and timing
D timing and quantity / severity

A

D timing and quantity / severity (bates p 79)

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13
Q

What is subjective data?

A

Information the patient tells you.

The symptoms and history, from chief complaint through review of systems

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14
Q

What is objective data?

A

What you detect during the examination, laboratory information, and test data.
All physical examination findings, or signs.

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15
Q

What are the seven attributes of a symptom?

A

1 Location (where is it/does it radiate?)

2 Quality (what is it like?)

3 Quantity or severity (how bad is it? Pain: scale 1-10)

4 Timing, including onset (when did/does it start), duration (how long it lasts), frequency (how often does it come)

5 Onset (the setting in which symptom occurs)

6 Remitting or exacerbating factors (what makes it better/worse?)

7 Associated manifestations (anything else that accompanies it?)

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16
Q

Where should major health events discovered during the ROS be moved to in your write up?

A

Present illness or past history

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17
Q

what are the steps in preparing for the physical examination?

A

1 reflect on your approach to the patient
2 adjust the lighting and the environment
3 check your equipment
4 make patient comfortable
5 observe standard and universal precautions
6 choose the sequence, scope, and positioning of the examination

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18
Q

What are the 4 cardinal techniques of examination?

A

Inspection
Palpation
Percussion
Auscultation

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19
Q

What are the 5 steps for generating clinical hypotheses?

A

1 select the most specific and critical findings to support your hypothesis
2 match your findings against all the conditions that can produce them
3 eliminate the diagnostic possibilities that fail to explain the findings
4 weigh the competing possibilities and select the most likely diagnosis
5 give special attention to potentially life-threatening conditions (always include “the worst case scenario”

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20
Q

How can the family history be recorded?

A

As a diagram or a narrative. The diagram is more helpful for tracing genetic disorders.

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21
Q

The process of diagnostic reasoning begins with the ______.

A

History.

As you learn about your patient, you will start to develop a differential diagnosis.

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22
Q

What is sensitivity?

A

The probability that a person with disease has a positive test.

AKA the true positive rate

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23
Q

What is specificity?

A

The probability that a non-diseased person has a negative test.

AKA the true negative rate

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24
Q

What does SnNOUT stand for?

A

a Sensitive test with a Negative result rules OUT disease

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25
Q

What does the acronym SpPIN stand for?

A

a Specific test with a Positive result rules IN disease

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26
Q

What type of questions should Review of Systems be?

A Open ended questions
B Close ended questions
C Yes/no questions

A

C Yes/no questions

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27
Q

The head to toe assessment generally is done on the ____ side of the patients body

A

Right

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28
Q

What is validity?

A

Does the test accurately identify whether the patient has the disease?

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29
Q

What is the gold standard?

A

The best measure of whether a patient has disease.

30
Q

What is the positive predictive value (PPV)?

A

The probability that the person with the positive test has disease

Ex: In prostate cancer screening, where a man with a PSA value greater than four has only a 30% probability of having prostate cancer found on biopsy.

31
Q

What is negative predictive value (NPV)?

A

The probability that a person with a negative test does not have disease.

Ex: among men with a PSA level of four or below, 85% are found to be cancer free on biopsy.

32
Q

What is primary prevention?

A

interventions designed to prevent disease

33
Q

What is secondary prevention?

A

Screening test designed to find disease or disease processes at an early, stage

34
Q

What is selection bias?

A

Occurs when comparison groups have systematic differences in their baseline characteristics that can affect the outcome of the study

35
Q

What is performance bias?

A

Occurs when there are systematic differences in the care received between the comparison groups (other than the intervention)

36
Q

What is detection bias?

A

Occurs when there are systematic differences in the efforts to diagnose or ascertain an outcome

37
Q

What is attrition bias?

A

Occurs when there are systematic differences in the comparison groups in the number of subjects who do not complete the study

38
Q

What are some skilled interviewing techniques?

A

Active listening, empathetic responses, guided questioning, nonverbal communication, validation, reassurance, partnering, summarization, transitions, empowering the patient

39
Q

What type of question do you ask to elicit the chief complaint?

A

Open ended question

40
Q

What are two mnemonics that help pursue the seven attributes of a symptom?

A

OLD CARTS
Onset, location, duration, character, aggravating/alleviating factors, radiation, and timing

OPQRST
Onset, palliating/provoking factors, quality, radiation, site, and timing

41
Q

In general, ask what kind of questions to elicit the patients story?

A

Open-ended

42
Q

What are the three dimensions of cultural humility?

A

1 self awareness
2 respectful communication
3 Collaborative partnerships

43
Q

What is the single most important rule when discussing sensitive topics?

A

To be nonjudgemental

your role is to learn from the patient and help the patient achieve better health acceptance is the best way to reach this goal.

44
Q

What is tolerance?

A

A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drugs effects overtime

45
Q

What is physical dependence?

A

A state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and or administration of an antagonist

46
Q

What is addiction?

A

A primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continue to use despite harm, and craving.

47
Q

What is the most widely used screening questions for alcohol?

A

The CAGE questions

Cutting down
Annoyance when criticized
Guilty feelings
Eye-openers

48
Q

The National Institute of Alcohol Abuse and Alcoholism defines drinking at low risk for developing an alcohol use disorder.

What are they for men, women, healthy adults >65 and not taking meds?

A

Men: no more than 4 drinks on a single day or 14 drinks a week

Women: no more than 3 drinks on a single day or 7 drinks a week

Healthy adults over age 65 years and not taking medications: no more than 3 drinks on a single day or 7 drinks a week

One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits

49
Q

What is nonmalficence?

A

“First, do no harm “

In the context of the interview, giving information that is incorrect or not really related to the patients problem can do harm. Avoid relevant topics or creating barriers to open communication can also do harm.

50
Q

What is beneficence?

A

Is the dictum that the clinician acts in the best interest of the patient.

51
Q

What is autonomy?

A

Reminds us that informed patients have the right to make their own clinical decisions.

52
Q

What is confidentiality?

A

As a clinician, you are obliged not to repeat what you learn from or know about a patient.

53
Q

What are the Tavistock principles? And give examples.

A

These principles construct a framework for analyzing healthcare situations that extend beyond our direct care of individual patients to complicated choices about the interactions of healthcare teams and the distribution of resources for the well-being of society.

They include: 
rights
balance 
comprehensiveness 
cooperation 
improvement 
safety 
openness
54
Q

Fatigue is a nonspecific symptom with many causes. What can cause fatigue?

A

Depression and anxiety, infections (such as hepatitis, infectious mono, TB); endocrine disorders (hypothyroidism, adrenal insufficiency, DM); heart failure; chronic disease of the lungs, kidneys, or liver; electrolyte in balance; moderate to severe anemia; malignancies; nutritional deficits; and medications.

55
Q

Weakness, especially if localized in a neuroanatomical pattern, suggest possible ____ or _____.

A

Neuropathy or myopathy

56
Q

What does recurrent shaking chills suggest?

A

More extreme swings in temperature and systemic bacteremia

57
Q

Night sweats occur in what two conditions?

A

TB and malignancy

58
Q

In immunocompromised patients with sepsis, what happens to the patient’s temperature?

A

Fever may be absent, low-grade, or dropping low normal (hypothermia)

59
Q

Rapid changes in weight over a few days suggest changes in what?

A

Bodily fluid (not tissue)

60
Q

Edema from extravascular fluid retention is visible in what conditions?

A

Heart failure, nephrotic syndrome, liver failure, and venous stasis

61
Q

How do you calculate tobacco use in pack years?

Give example

A

of PPD x # of years smoking = pack years

1 pack = 20 cigarettes

Or include the date the pt quit and PPD for how long.

EX:
1/2 PPD x 10 yrs = 5 pack yrs

1 PPD x 15 yrs = 15 pack yrs

Pt smoked 2 PPD for 10 yrs and quit in 2015.

62
Q

What is important when using an interpreter? (3)

A

1- Ask the interpreter to translate everything, not to condense or summarize.
2- Make sure your questions are clear, short, and simple.
3- Speak directly to the patient.

63
Q

What is capacity?

A

A clinical designation and can be assessed by clinicians.

64
Q

What is competence?

A

Is a legal designation and can only be decided by a court.

65
Q

Tolerance

A

A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drugs effects over time.

66
Q

Physical dependence

A

A state of adaptation that as manifested by a drug class- specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and or administration of an antagonist.

67
Q

Addiction

A

A primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over her drug use, compulsive use, continue to use despite harm, and craving.

68
Q

What is the CAGE screening?

A

To assess alcohol and illicit drug use.

Cutting down
Annoyance when criticized
Guilty feelings
Eye openers

69
Q

What are five developmental aspects to assess at every visit?

A

Physical (maturation, growth, puberty)

Motor (gross and fine)

Cognitive (milestones)

Emotional (mood, temperament, etc.)

Social (integration family, peers, community)

70
Q

What are geriatric syndromes?

and give examples

A

A multi factorial condition that involves the interaction between identifiable situation specific stressors and underlying age related risk factors, resulting in damage across multiple organ systems.

Falls
Delirium/cognitive impairment
Functional dependence
Urinary incontinence
Pressure ulcers
71
Q

What does the acronym INTERPRET stand for?

A 
Introductions
Note goals
Transparency
Ethics
Respect beliefs
Patient focus
Retain control
Explain
Thanks

Health Assessment (13 decks)

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