History-Taking for Wellness Exams, Episodic Visits, and Chronic Care Management

Question 1

What does the scope and degree of detail in history-taking depend on?

Answer 1

the chief concern
complexity of the medical condition
clinician’s goals for the visit

Question 2

What is the purpose of a wellness exam?

Answer 2

preventing illness, disease, and health problems

detecting problems at an early stage

Question 3

General components of a wellness exam

Answer 3

• comprehensive, culturally sensitive history and physical
• anticipatory guidance
• addressing risk factors
• motivational interviewing to reduce identified risk factors
• ordering appropriate immunizations and laboratory/diagnostic procedures

Question 4

How does a wellness exam differ from a episodic visit or chronic care management visit?

Answer 4

wellness exams are focused on risk factors NOT a presenting problem

Question 5

What should PMH include for a wellness exam?

Answer 5

• past medical conditions, hospitalizations, surgeries, injuries
• medications or supplements be observant of opiate use
• allergies

Question 6

PMH for women should include

Answer 6

• menstrual history
• gynecological history
• sexual history
• obstetric history

Question 7

Who should be included in a family history?

Answer 7

patient’s grandparents, parents, siblings, and children

Question 8

What should be asked during a menstrual history exam?

Answer 8

age of menarche, length and frequency of cycle, type and amount of flow, associated symptoms, FDLMP, menopause, any hormone replacement therapy

Question 9

What should be asked during a gynecological history exam?

Answer 9

last pap smear and results, abnormal vaginal discharge, dryness, lesions

Question 10

What should be asked during a sexual history exam?

Answer 10

• sexual history: number of partners, preference, abuse history, safety, STI, contraception method

Question 11

What should be asked during a obstetric history exam?

Answer 11

GPA or TPAL, complications during pregnancy or labor, vaginal, induced, or c-section, fertility

Question 12

What should be reviewed during a family history of a wellness exam??

Answer 12

health status of family members, pattern of disease(s), cause of death

Question 13

What is included in a social history of a wellness exam?

Answer 13

age and gender appropriate review of: 
marital status
living arrangement
home conditions
social support
occupational history
drug use
alcohol intake
smoking/tobacco history
religious/spiritual ideals
cultural preference
sexual history

Question 14

What is the purpose of a ROS?

Answer 14

to gather essential information on current or potential disease processes that may otherwise go unnoticed

Question 15

What is important to consider when obtaining a history on a patient with a disability?

Answer 15

The patient is the expert.

Question 16

What are special considerations for older adults during a wellness exam?

Answer 16

medication appropriateness
functional assessment (ADLs, fall risk, home safety)
cognitive function
advanced directives/POAs
risk for depression

Question 17

What is an example of a screening tool for medication appropriatenss?

Answer 17

AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

Question 18

What are some examples of a model used to assess fall risk for older adults?

Answer 18

Hendrick II Fall Model

Fall Prevention Checklist for Older Adults

Question 19

What is an example of a cognitive assessment tool for older adults?

Answer 19

Mini-Cog

Question 20

PHQ-9 or PHQ-2

Answer 20

A depression screening tool (patient health questionnaire-9 or 2)

Question 21

Where can you find recommendations on preventative care services?

Answer 21

www. uspreventiveservicestaskforce.org/Page/Name/grade-definitions
https: //epss.ahrq.gov/PDA/index.jsp

Question 22

What letter grade warrants the highest certainty for net benefit in regards to preventive services?

Answer 22

Grade A

Question 23

What type of visit accounts for the majority of visits to a clinician?

Answer 23

episodic visit

Question 24

What is the general framework for history taking during an episodic visit?

Answer 24

Chief concern (CC)
History of present illness (HPI)
Past medical history (PMH)
Family history (FH)
Social history (SH)
Review of systems (ROS)

Question 25

How should the HPI begin?

Answer 25

with the chief concern (CC)

Question 26

What is the most helpful component of developing a differential diagnosis list?

Answer 26

the HPI

Question 27

What are the 8 key elements of the HPI?

Answer 27

1. location 2. quality 3. severity 4. duration 5. timing 6. context 7. modifying factors 8. associated signs and symptoms

Question 28

What is OLD CARTS?

Answer 28

A mnemonic to help remember the 8 key elements of HPI. | Onset, Location, Duration, Character, Aggravating factors/associated symptoms, Relieving factors, Timing, Severity

Question 29

How is the ROS performed during an episodic visit?

Answer 29

1. problem-pertinent ROS 2. extended ROS 3. complete ROS

Question 30

What type of physical exam should be performed during an episodic visit?

Answer 30

problem-focused expanded problem-focused detailed comprehensive

Question 31

What body areas should be included in a physical examination?

Answer 31

``` head/face neck chest abdomen genitalia, groin, buttocks back/spine extremities ```

Question 32

What reference should be utilized when considering laboratory and diagnostic testing?

Answer 32

choosingwisely.org

Question 33

What are among the leading causes of death and disability?

Answer 33

chronic conditions

Question 34

What are some examples of chronic conditions?

Answer 34

``` heart disease cancer chronic lung disease stroke alzheimer's disease diabetes chronic kidney disease ```

Question 35

What should chronic care management include?

Answer 35

BOTH face-to-face and non-face-to-face visits

Question 36

What should be the focus of chronic care management?

Answer 36

patient's relationship with the healthcare TEAM establishing AND achieving health goals coordination of community and social services medical, functional, and psychosocial assessment preventive care

Question 37

What should the treatment plan include for chronic care management?

Answer 37

lifestyle modifications pharmacological interventions self-management support education

Question 38

What is a chronic care management visit MOST focused on?

Answer 38

lifestyle modifications and counseling

Question 39

What are potential benefits of team-based care?

Answer 39

clinician delegation improvement in quality of care reduction in healthcare cost more patient-centered

Question 40

How would a clinician document HPI during a chronic care visit?

Answer 40

By utilizing 6 elements: SDT CMA 1. Severity 2. Duration 3. Timing 4. Context 5. Modifying factors 6. Associated S/S

Question 41

How is a PMH, FH, and SH obtained during a chronic care visit?

Answer 41

same as wellness and episodic visits