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Q1 > HAPE exam 1 > Flashcards

HAPE exam 1 Flashcards

1
Q

what does the clinical interview need to incorporate?

A

both the clinican and patients views of reality, disease, and illness

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2
Q

describe the general structure and sequence of the clinical encounter

A
  1. Initiating the encounter
    -setting the stage/preparation
    -greeting the patient and establishing initial report
  2. gathering information
    -initiate information gathering
    -exploring patients perspective of illness
    -exploring biomedical perspective of disease including relevant background and context
  3. performing the physical examination
  4. explaining and planning
    -provide correct amount and type of info
    -negotiate plan of action
    -shared decision making
    5.closing the encounter
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3
Q

if this is your first time seeing a patient what should you explain?

A

your role, your status as a student, and how you will be involved in their care

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4
Q

what kind of language should you use when referring to patients with disabilities?

A

“people first” language

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5
Q

what is a good way to establish the agenda for the patient ecounter?

A

begin with open ended questions that allow full freedom of response: ex; “what are your special concerns today”

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6
Q

how should you invite the patients story?

A

encourage patients to tell their stories in their own words, using an open ended approach

train yourself to follow the patients lead

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7
Q

what is a mnemonic that explores the patients perspective of disease?

A

FIFE
f- the patients feelings
i-the patients ideas about the nature and cause of the problem
f-the effect of the problem on the patients function
e-the patients expectations of the disease

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8
Q

what percentage of patients in primary care practice have anxiety and depression?

A

30-40%

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9
Q

responding to emotional cues using nurse statments

A

N-name “that sounds like a scary experience”
U- understand “its understandable that you feel that way”
R- respect “youve done better than most people would do with this”
S- support “I will continue to work with you on this”
E- explore “how else were you feeling on this”

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10
Q

what is teach back?

A

it is NOT a test of the patients knowledge, but rather a test of how well you explained things in a manner your patient understands

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11
Q

steps of the teach back method/ how to use it and get comfortable with it

A

-plan your approach
-chunk and check (dont wait until end of visit)
-clarify and check again
-start slowly and use consistently
-practice
-use the show me method
-use handouts along with teach back

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12
Q

what is the pinnacle of patient centered care? what is the 3 step process

A

shared decision making;
1- introducing choices and describing options
2-exploring patient preferences
3- moving to a decision or giving pt more time if needed

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13
Q

why should you do self reflection after closing the encounter with a patient?

A

self reflection is a continual part of professional development in clinical work. it brings a deepening personal awareness to our work with patients.

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14
Q

what are the disparities in health care?

A

social determinants of health, racism and bias, cultural humility

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15
Q

what are the social determinants of health?

A

neighborhood and built environment, health and health care, economic stability, education, social and community context

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16
Q

skills and practices to migrate bias in your clinical encounters

A
  1. reflect on patterns of emotion and behavior
  2. pause before starting an encounter and prepare for potential triggers of bias
  3. generate alternative hypotheses for bias anchored in behavior
  4. practice universal communication and interpersonal skills
  5. explore your patients identities
  6. explore your patients experiences of bias
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17
Q

what are the 3 dimensions of cultural humility?

A

1- self awareness
2- respectful communication
3- collaborative partnerships

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18
Q

what are the 5 Rs of cultural humility

A

Reflection
Respect
Regard
Relevance
Resiliency

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19
Q

guiding questions in assessing the role of spirituality in your patient

A

-what values guide your patients healthcare decisions?
-how do patient spiritual beliefs and practices influence how they cope with their illness and care for themselves?
-does your patient have spiritual struggle or distress and need a referral to a chaplain?

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20
Q

what are the core values of medical ethics?

A

1-nonmaleficence
2-beneficence
3-respect for autonomy
4-decisional capacity
5-confidentiality
6-informed consent
7-truth telling
8-justic

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21
Q

what are the elements of decisional capacity?

A

Patients must have the ability to:
1-understand info about diagnosis or treatment
2-appreciate their situation
3-use reason to make a decision
4-communicate their choice

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22
Q

skilled interviewing technique

A

active or attentive listening, guided questioning, empathetic responses, summarization, transitions, partnering, validation, empowering the patient, reassurance, appropriate verbal communication, appropriate nonverbal communication

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23
Q

how do you express empathy?

A

you must first recognize the patients feelings, then actively move toward and elicit emotional content

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24
Q

what are techniques for empowering the patient?

A

1 evoke the pt persepctive
2convey interest in the person
3 follow the pt lead
4 elicit and validate emotional content
5 share info with the pt
6 be transparent with clinical reasoning
7 reveal limits of ur knowledge

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25
Q

what does appropriate verbal communication include?

A

using understandable and nonstigmatizing language

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26
Q

what are examples of nonverbal communication

A

body orientation, gaze orientation, head nodding, posture, tone of voice, use of silence, use of touch

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27
Q

guidelines for broaching sensitive topics

A

be nonjudgmental, explain why you need to know, find opening questions, conciously acknowledge whatever discomfort you are feeling

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28
Q

SPIKES (6 step protocol for delivering bad news)

A

S- setting up the interview
P-assessing pt perception
I-obtaining the patients invitation
K-giving knowledge to pt
E-emotions and empathetic responses
S-strategy and summary

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29
Q

SBAR (a tool to facilitate interprofessional communication)

A

S-situation
B-background
A-assessment
R-reccomendation

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30
Q

when treating a deaf patient it is important to:

A

learn whether they belonged to the deaf culture or the hearing culture when the hearing loss occured

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31
Q

what factors should you keep in mind when adjusting the scope of your history and physical examination?

A

magnitude and severity of pt problems, the need for thoroughness, clinical setting, primary or specialty care, and time

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32
Q

subjective vs objective info

A

subjective- symptoms the pt tells you
objective- info from the physical examination that you detect

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33
Q

what should you do when documenting the chief complaint?

A

make every attempt to quote the pt own words especially if unusal or unique

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34
Q

what is the hpi?

A

most basic story of pt problem and task of oral and written organization is yours

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35
Q

oldcarts

A

onset, location, duration, character, aggravating or alleviating factors, radiation, timing, setting

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36
Q

pertinent negatives vs pertinent positives

A

negatives-expected symptoms or signs that are not present
positives-symptoms or signs that you would expect to find if a possible cause for patients problem were true

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37
Q

what are two validating questions for depression?

A

1- over the past two weeks have you felt down, depressed, or hopeless?
2- over the past two weeks have felt little interest or pleasure doing things?

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38
Q

gravida and parity

A

G- number of pregnancies
P-number of delivers (term, preterm, abortions)

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39
Q

allergy vs side effect

A

allergy-adverse drug reaction mediated by an immune response
side effect- expected and known effect of a drug that in not the intended theraputic outcome

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40
Q

what should be included when documenting medications?

A

name, dose, route, frequency of use

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41
Q

basic ADLS

A

ambulating, feeding, dressing, toileting, bathing, transferring

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42
Q

instrumental ADLS

A

using the phone, shopping, preparing food, housekeeping, doing laundry, using transportation, taking medicine, managing money

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43
Q

sample questions to ask about pt sexual orientation or gender identity

A

-how would you describe ur sexual orientation
-how would you describe your gender identity
-what is the sex on your original birth certificate

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44
Q

what is the CAGE questionarre used for?

A

used to detect alcohol abuse
cuttting down
annoyance when criticized
guilty feelings
eye openers

2 or more is positive

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45
Q

pack years

A

calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the pt has smoked

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46
Q

the five Ps of sexual history

A

1-partners
2-practices
3-protection from STIs
4-past hx of stis
5-pregnancy plans

47
Q

FICA spiritual tool

A

faith or beliefs, importance and influence, community, address (how to address these issues in your healthcare)

48
Q

what are the steps in beginning the physical examination

A

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

49
Q

the following fluids are considered potentially infectious

A

blood, semen, vaginal secretions, csf, synovial, pleural, peritoneal, pericardial, and amniotic fluids

49
Q

what are the 4 classic techniques the physical examination relies on?

A

inspection, palpation, percussion, and ausculation

49
Q

what part of the exam should the room be darkened for?

A

the ophthalmoscopic exam bc it promotes pupillary dilation and improved visibility of the fundi

50
Q

when does close observation being during a head to toe physical exam?

A

begins at the outset of the patient encounter and continues throughout the exam

51
Q

how should you exam the neck?

A

move behind the sitting pt to feel the thyroid gland and to examine the back, posterior thorax, and lungs

52
Q

is the pt sitting or standing when inspecting the breasts and axillae?

A

sitting

53
Q

what position is the female pt in when palpating the breasts?

A

supine and you are on the right side of the pt bed

54
Q

what is the position of the pt and exam table for the cardiovascular examination?

A

pt is supine and ELEVATE HEAD OF EXAM TABLE TO -30 degrees adjusting as necessary to see the jugular venous pulsations

55
Q

what is the position of pt and exam table for abdominal exam?

A

pt supine and lower bed to flat position

56
Q

what position is pt in when palpating femoral pulses as well as lower extremity exam

A

supine

57
Q

how should the pt be positioned when examing the musculoskeletal system?

A

standing to look at aligment of spine, legs, rom

58
Q

basic structure of clinical reasoning process

A

gathering initial info, organizing and interpreting info, testing hypothesis, planning diagnositc and treatment stragety

59
Q

what is a problem representation?

A

a clinicians evolving sense of the clinical picture

60
Q

what do the elements of an illness script include?

A

diseases pathophysiology, epidemiology, time course, salient symptoms and signs, diagnostics, and treatment

61
Q

what should you always include in your differential diagnosis?

A

worst case scenario to make sure things have been ruled out based on your finding and patient assessment

62
Q

what is evidence based medicine?

A

exists at the intersection of the best available evidence, clinician judgement, and patient values

63
Q

common types of clinical cognitive errors

A

anchoring bias, availability heuristic, confirmation bias, diagnostic momentum, framing effect, representation error, visceral bias

64
Q

suggested rules for good decision making

A

slow down, be aware of base rates for ur differentials, consider what data is truly relevant, actively seek alternative diagnosis, ask questions to disprove not approve your hypothesis, remember you are often wrong

65
Q

examples of semantic qualifiers

A

acute, chronic, constant, diffuse, localized, sharp, dull, young, old, mild, severe

66
Q

what is a summary statement?

A

chief complaint placed in context of patients overall health status, includes pertinent party of hx, physical, and labs, no more than 2-3 sentences, demonstrates clinical reasoning, should make a case for a diagnosis, distillation of ur understanding of the case

67
Q

patient problem list

A

documented pt problems, list the most active and serious problems first. This helps you individualize a pt care

68
Q

what are the guidelines for an oral presentation?

A

opening statement, source (if no comment pt assumed to be reliable), present illness, other history, physical examination, labs/data, synthesis, enumerated problem list

69
Q

constitutional symptoms

A

patient concerns that accompany many disease processes

70
Q

what symptoms should you ask your pt about when doing the ‘general’ portion of the review of symptoms

A

ask about fatigue and weakness, fevers, chills, night sweats, weight change, pain

71
Q

what is fatigue a common symptom of?

A

depression and anxiety but also infections, endocrine disorders, heart failure, chronic disease of lungs, kidneys, or liver, electrolyte imbalance, anemia, medications

72
Q

what does weakness suggest?

A

especially if a neuroanatomical pattern, suggest possible neuropathy or myopathy

73
Q

what does recurrent shaking chill suggest?

A

suggests more extreme swings in temperature and systemic bacteremia

  • hot and sweating can also accompany menopause
    *night sweats occur in tuberculosis and malignancy
74
Q

what can be possible causes of weight gain?

A

changes in body fluid, edema in pt with heart failure, nephrotic syndrome, liver failure, and venous stasis, medications

75
Q

what can be possible causes of weight loss

A

GI diseases, endocrine disorders, chronic infections, malignancy, chronic cardiac, pulmonary or renal failure, depression, anorexia

76
Q

what can cause weight loss with high food intake suggest?

A

diabetes, hyperthyroidism, malabsorption

77
Q

how do you perform a general survey?

A

notate pt appearance, apparent state of health, skin colorm dress, odors, grooming

78
Q

what is a stadiometer?

A

device specifically designed for accurate measure of height

79
Q

how do you calculate bmi

A

weight in kg/ height in m2

80
Q

what happens to pt bp if the cuff is too small and too narrow

A

too small- bp will read high
too large- bp will read low

81
Q

orthostatic hypotension

A

sustained reduction in SBP of at least 20 mm Hg or in DBP of atleast 10 mm Hg within 3 min of standing

82
Q

what should you notate about pulse?

A

rate, rythym, strength (weak or strong)

83
Q

what should be notated about respiration?

A

rate, rythym, depth, and effort

84
Q

what are causes of fever

A

infection, malignancy, drug reactions, immune disorders

85
Q

define pain

A

unpleasant sensory and emotional experience

86
Q

somatic pain

A

linked to tissue damange, can be acute or chronic, dull pressing pulling throbbing

87
Q

neuropathic pain

A

direct consequence of a lesion or disease affecting the somatosensory system, ex cns or spinal chord injury

88
Q

what are things that can have significant effect son patients experience of pain?

A

arthritis, hiv, substance abuse, sickle cell, psychiatric disorders

89
Q

use consistent methods to assess pain (there are 3 common tools)

A

visual analog scale, numeric rating scale, wong backer faces

90
Q

list important topics for health promotion and counseling

A

screening for hypertension, blood pressure and dietary sodium, optimal weight, nutrition and diet, exercise and physical activity

91
Q

what are the regulatory functions of serotonin and norepinephrine?

A

helps regulate mood, arousal, and cognition

*low serotonin w high norepinephrine= anxiety

92
Q

what are the regulatory functions of dopamine?

A

helps regulate mood, arousal, cognition, and motor control
*too much dopamine w low serotonin- psychosis and mania

93
Q

what are the regulatory functions of acetylcholine?

A

regulate sleep, arousal, and attention (low concentration levels can cause dementia)

94
Q

what are common or concerning mental health symptoms?

A

anxiety or excessive worrying, depressed mood, memory problems, medically unexplained symptoms

95
Q

list common risk factors in patients with anxiety

A

fam hx of anxiety, personal hx of anxiety or mood disorder, being female, chronic illness, behavioral inhibition

96
Q

screening questions for anxiety

A

1- over the past two weeks have you been feeling nervous, anxious, or on edge?
2- over the past 2 weeks have you been unable to stop or control worry?
3- over the past 4 weeks have you had an anxiety attack?

97
Q

what are common comorbid conditions that accompany excessive or uncontrollable anxiety?

A

hyperthyroidism, cardiopulmonary disorders, and TBI

98
Q

what diseases would you consider in an older pt with one sided hand tremor and difficulty starting mvmts? what about a young pt?

A

parkinsons and huntingtons

99
Q

lewy body dementia vs frontotemporal dementia

A

lewy body- visual hallucinations
frontotemporal- personality changes

100
Q

list the key components of the mental status exam

A

assess appearance and behavior, assess speech and language, assess mood, assess thoughts, assess insight and judgement, assess cognition

101
Q

what are the levels of conciousness?

A

alertness, lethargy, obtundation, stupor, coma

102
Q

obtundation vs stupor

A

obtundation- opens eyes when tactile stimulus is applied and looks at you but responds slowly and is confused
stupor- arouses only after a painful stimuli, verbal responses are slow or absent and pt lapses into an unresponsive state when the sitmulus ceases

103
Q

what characteristics should you look at when observing speech in a mental status exam?

A

quantity, rate and volume, articulation of words, fluency

104
Q

broca aphasia vs wernicke apashia

A

broca- pt can comprehend but not form fluent speech
wernicke- pt can speak but not comprehend

105
Q

what are some variations and abnormalities in thought processes?

A

blocking, circumstantiality, clanging (ex rhyming), confabulation (making things up), derailment, echolalia (repitition of words), flight of ideas, incoherence, neologisms, perservation

106
Q

abnormalities of thought CONTENT

A

anxieties, compulsions, delusions, depersonalization, derealization, obsessions, phobias

107
Q

abnormalities of perception

A

hallucinations and illusions

108
Q

mental health important topics for health promotion and counseling

A

screening for depression, assessing for suicide risk, screening for dementia and delirium, screening for substance abuse disorders

109
Q

when neurologic disease is suspected? what two complimentary questions should guide your assessment?

A
  1. what is the localization of the responsible lesion in the nervous system?
  2. what is the underlying pathophysiology that explains the pt symptoms and neurological findings?
110
Q

what are concerning neurological symptoms?

A

headache, dizziness, weakness, numbness, fainting, seizures, tremors

111
Q

migraine is present if 3/5 POUND features are present

A

Pulsatile or throbbing
One day duration
Unilateral
Nausea or vomitting
Disabling

112
Q

headache warning signs

A

frequent or severe over 3 month period, head trauma, cancer or hiv, change in pattern, over 50 years old, aggravated or relieved by change in position, weight loss, night sweats, neck stiffness

Q1 (15 decks)

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