History Taking/Temporal Profile/Analysis of Symptoms (trans 2)

Question 1

REMEMBER

Comprehensive Assessment

 Is appropriate for new patients in the office or hospital

 Provides fundamental and personalized knowledge about the patient.

 Strengthens the clinician-patient relationship

 Helps identify or rule out physical causes related to patient concerns.

 Provides baselines for future assessments

 Creates platform for health promotion through education and counseling.

 Develops proficiency in the essential skills of physical examination.

Answer 1

Focused Assessment

 Is appropriate for established patients, especially during routine or urgent care visits.

 Addresses focused concerns or symptoms.

 Assesses symptoms restricted to a specific body system.

 Applies examination methods relevant to assessing the concern or problem as precisely and carefully as possible.

Question 2

What are the fundamental objectives in history taking

Answer 2

1. motivating the patient to communicate
2. Controlling the interaction
3. Measuring and communicating

Question 3

REMEMBER

Avoid pitfalls by beginning with brief “check-in”. Too much small talk may lead to displaced time for examining more complicated problems

Answer 3

Patient-Physician dependent:

How the physician interacts with the patient helps in establishing rapport and, in turn, leads to more concise information from the patient.

Question 4

What are the INTERVIEWING MILESTONE

Answer 4

1. Taking time for self-reflection
2. Reviewing the medical record
3. Setting goals
4. Reviewing clinical behavior and appearance
5. Adjusting the environment
6. Taking notes

Question 5

Characteristics of symptoms analysis (SOCRATES)

Answer 5

1. site
2. onset
3. character - Described by adjectives (e.g. sharp/dull, burning, tingling, boring/stabbing, crushing, tugging)
4. radiation - referred by a shared neuronal pathway to a distant unaffected site

5 associated symptoms

6 timing - Duration, course, pattern since onset; Episodic or continuous

7. Exacerbating and relieving factors
8. severity

Question 6

7 Cardinal Features of Symptoms

Answer 6

1. Onset and chronology
2. Position and radiation
3. Quantification
4. Quality
5. Related symptoms
6. Setting
7. Transforming factors

Question 7

TECHNIQUES ON BUILDING A RELATIONSHIP

Answer 7

 Active listening

 Guided questioning

 Nonverbal communication

 Empathic responses

 Validation

 Reassurance

 Partnering

 Summarization

 Transitions

 Empowering the patient

Question 8

ADAPTING TO SPECIFIC SITUATIONS

The silent patient:

Answer 8

 Be attentive and respectful, encourage patient to continue when he or she is ready

 Watch for nonverbal cues

Question 9

ADAPTING TO SPECIFIC SITUATIONS

The confusing patient:

Answer 9

 Focus on symptom context, emphasize patient’s perspective, and guide interview into a psychosocial assessment.

Question 10

ADAPTING TO SPECIFIC SITUATIONS

A patient with impaired capacity

Answer 10

Consider mental health condition; determine whether the patient has decision-making capacity characterize by: The ability to understand information, the ability to make medical choices, ability to declare treatment preferences

Question 11

ADAPTING TO SPECIFIC SITUATIONS

The talkative patient:

Answer 11

 Give patient time to talk for the first five to ten minutes.

 Focus on what seems important to the patient

 Do not show impatience.

 Set a time limit and schedule a second meeting to carry-over other concerns.

Question 12

ADAPTING TO SPECIFIC SITUATIONS

The Angry or Disruptive Patient:

Answer 12

o Avoid joining in their hostility. Validate their feelings without agreeing with the reasons.

o Maintain safe environment if the angry patient becomes out of control

Question 13

Kulber-Ross’ 5 stages in response to loss/ anticipatory grief of impending death:

Answer 13

(1) Denial and isolation
(2) Anger
(3) Bargaining
(4) Depression/sadness
(5) Acceptance

Question 14

FORMAT OF HISTORY

Answer 14

1. Patient profile
2. source and reliability
3. Chief compliant
4. History of present illness (HPI)
5. recording the history
6. six point checklist
7. past health history
8. Family history
9. review of sytems
10. temporal profile diagram

Question 15

History of present illness components:

o Restatement of chief complaint, with elaboration

o History of present problem from time of onset

o Full description of current status of the patient

o Summary of all significant positive and negative information

o Includes patient’s thoughts and feelings about the illness

o May include medications, allergies, and habits of smoking and alcohol, which are frequently pertinent to the present illness

Answer 15

History of present illness phases:

1. Obtain an account of the symptoms as patient experiences them; use open-ended neutral questions
2. Obtain a detailed analysis of symptoms described by the patient; use closed-neutral question and some direct questions
3. Test diagnostic possibilities by inquiring about other symptoms or events
4. Review of systems to reveal other symptoms

Question 16

SIX POINT CHECKLIST

Answer 16

 Are all components present?

 Is the sequence correct?

 Are the temporal relationships correct?

 Is the analysis of symptoms done?

 Are time holes plugged?

 Is the review of systems thorough?

Question 17

In temporal profile diagram, what is the representation of the height of the symptom curve from the baseline?

Answer 17

Severity of the symptom

Question 18

True or false In temporal profile diagram, there can be more than 3 symptoms of the illness presented

Answer 18

False - 2 to 3 only

Question 19

REMEMBER In intermittent type of temporal profile diagram the symptom curve rises and returns to the baseline in a wave-like pattern

Answer 19

In remittent, continous type of temporal profile diagram, the symptom curve also display a wave-like pattern but does not completely return to the baseline

Question 20

REMEMBER

In recurrent pattern of temporal profile diagram the total episode repeats itself at various intervals of time – hours or days. For example, afternoon fever every 2 or 3 days

Answer 20

REMEMBER

In periodic pattern of temporal profile diagram the episode occurs in cluster of time in periods of days/weeks/months with symptom-free period longer than the symptomatic period.

Question 21

Answer 21

Gradual onset, progressively worsening

Question 22

Answer 22

Acute onset, unrelenting course up to admission

Question 23

Answer 23

Intermittent (occurring and ceasing)

Question 24

Answer 24

Remittent, continuous

Question 25

Answer 25

Acute episodes, remittent and periodic.

Question 26

Answer 26

Recurrent pattern

Question 27

Answer 27

Periodic.

Question 28

Answer 28

Gradual onset, continuous