General

Question 1

Consultation Framework/Calgary-Cambridge Skills Guide stages

Answer 1

•Initiation •Gathering information •Structuring •Physical examination •Building the doctor-patient relationship •Explanation and planning •Closing

Question 2

Gathering information-Biomedical perspective

Answer 2

WWQQAA=>Where; When, Quality; Quantity; Aggravating/Alleviating factors; Associated manifestations

Question 3

Gathering information-Patient’s perspective

Answer 3

ICEEF=>Ideas and beliefs; Concerns; Expectations; Effects on daily living; Feelings

Question 4

Problem solving according to personality types

Answer 4

S=>N=>T=>F

Facts=>Possibilities=>Logic=>People

Question 5

Six Basic Emotions

Answer 5

Disgust, Happiness, Sadness, Anger, Fear, Surprise

Question 6

Influences on the actions of the doctor

Answer 6

•Own knowledge/ideas/belief systems •Ideas/stances/traditions/preferences of the patient •What is best for the community as a whole •Norms and standards according to the HPCSA •Constitution/laws of the country •What is morally good

Question 7

Models of Dr-Pt Interactions

Answer 7

• Paternalistic-One way, Dr tells Pt
• Informative-Dr supplies info, Pt has to choose
• Deliberative-Dr acts as counsellor to try and better behaviour/habits/understanding
• Interpretative-Shared responsibility, Dr facilitates consideration of all alternatives

Question 8

Principles of professionalism

Answer 8

• Beneficence
• Non-maleficence
• (Respect for) Autonomy
• (Distributive) Justice

Question 9

Responsibilities of the Dr

Answer 9

Use effective Hx and phys exam to reach Dx, psycho-educate, answer questions, advocate for the best (EBHC) Tx, motivate and support, informed consent, follow-up availability

Question 10

Responsibilities of the Pt

Answer 10

Ask questions, make informed decisions, take ownership of illness, participate in Tx, esp change of lifestyle

Question 11

Opportunities to take a spiritual history

Answer 11

• social crisis/time of loss
• at registration/during health check-up
• in the peri-operative period
• dying/suffering form terminal/major illness

Question 12

Components of a spiritual history-taking

Answer 12

• Beliefs, incl what is important in life
• Practices, incl praying
• Support from ex faith community

Question 13

Symptom-analysis to gain particulars/details about a leading symptom

Answer 13

SOCRATES

Site; Onset; Character; Radiation; Alleviating factors; Timing; Exacerbating factors; Severity/scale of intensity

Question 14

Define Systems Review (SR)/Systemic Enquiry (SE)

Answer 14

A checklist to screen other systems of the body not covered by the MC for clinically relevant S+S
General; Eyes and ENT; CVS; Resp; GIT; Breasts and genitourinary system; NS; Musculoskeletal system

Question 15

SR-General

Answer 15

fatigue, malaise, sleep disturbances
fever, rigors, night sweats
change in appetite/weight
skin-rashes and bruising

Question 16

SR-Eyes and ENT

Answer 16

eyes-itch, redness, secretions, swelling, blurred vision
ears-itch, pain, discharge, tinnitus
nose-congested, runny, secretions-clear, yellow, green
throat-pain, hoarseness, difficulty swallowing

Question 17

SR-CVS

Answer 17

chest pain, palpitations, ankle oedema
shortness of breath-activity, dressing, exercise
orthopnoea-SOB when lying flat
PND-paroxysmal nocturnal dyspnoea

Question 18

SR-Respiratory system

Answer 18

pleuritic chest pain, wheezing
cough, shortness of breath
haemoptysis-sputum colour and quantity

Question 19

SR-GIT system

Answer 19

abdominal pain-incl nature and region
N+V-incl haematemesis
dysphagia, indigestion, dyspepsia (heartburn)
flatulence, belching
change in appetite/weight
change in bowel action, constipation
diarrhoea-presence of blood/mucous

Question 20

SR-Breasts and Genitourinary system

Answer 20

urgency and frequency of urination
dysuria, polyuria, oliguria, nocturia, haematuria
urinary incontinence
M-prostatic symptoms
F-menstruation-reg/irreg/during pregnancy, post-menopausal bleeding, vaginal discharge

Question 21

SR-Nervous system

Answer 21

headaches, dizziness, fits, loss of memory
fainting, loss of consciousness
anxiety, depression, personality change
weakness, numbness, tingling sensations

Question 22

SR-Musculoskeletal system

Answer 22

pain, swelling of limbs/joints
stiffness of joints/back muscles
able to wash, dress, climb stairs

Question 23

Past medical history-Chronic illnesses

Answer 23

DEARTHHH and surgical procedures (type, time, place, complications)
Diabetes, Epilepsy, Asthma, Rheumatic fever, Thyroid, Hypertension, Heart disease, Hypercholesterolaemia (incl Dx, Tx and check-up)

Question 24

Describe two methods of performing hand hygiene

Answer 24

• Hand rub with an alcohol-based formulation; preferred for routine hand hygiene if hands are not visibly soiled; fast, effective and better tolerated by hands.
• Wash with soap and water; when hands are visibly soiled or after contact with body fluids and after using the toilet; also preferred during outbreaks of Clostridium difficile.

Question 25

What is the duration of a proper hand rub and hand wash respectively?

Answer 25

• Hand rub-20-30 seconds

* Hand wash-40-60 seconds

Question 26

Name the five moments for hand hygiene at the bed side

Answer 26

• Before touching a patient.
• After touching a patient.
• After touching patient surroundings.
• Before an aseptic procedure.
• After body fluid exposure risk.

Question 27

Describe The Glove Pyramid

Answer 27

•Gloves not indicated-taking BP, temp and HR; SC and IM injections; bathing, dressing, transporting patient; caring for eyes and ears (without secretions); any vascular line manipulation in absence of blood leakage; using the telephone; writing in the patient chart; giving oral medications; distributing or collecting patient dietary trays; removing and replacing linen for patient bed; placing non-invasive ventilation equipment and oxygen cannula; moving patient furniture.
•Examination gloves indicated-contact with blood, mucous membranes and non-intact skin; potential presence of highly infectious/dangerous organism; epidemic or emergency situations; IV insertion and removal; drawing blood; discontinuation of venous line; pelvic and vaginal examination; suctioning non-closed systems of endotracheal tubes; emptying emesis basins; handling/cleaning instruments; handling waste; cleaning up body fluid spills.
•Sterile gloves indicated-any surgical procedure;
vaginal delivery; invasive radiological procedures;
performing vascular access and procedures (central lines);
preparing total parental nutrition and chemotherapeutic agents.