Intro to Physical Exam and Instruments

Question 1

What is a fundoscopic exam?

Answer 1

eye exam looking at retina

Question 2

When do you use the medium light on your ophthalmoscope?

Answer 2

in a dark, non-dilated pupil

Question 3

what must you include when documenting an allergy?

Answer 3

The reaction

Question 4

What is a useful mnemonic for spirituality and religion questions?

Answer 4

FICA

faith and belief

importance

community

address in care

Question 5

How long should you scrub your hands when washing them?

Answer 5

at least 20 seconds

Question 6

What is low-risk drinking for men?

Answer 6

no more than 4 drinks on a single day and no more than 14 drinks per week

Question 7

What are the CAGE questions?

Answer 7

Has anyone ever suggested you Cut back?

Are you ever Annoyed when people talk about your drinking?

Do you ever feel Guilty about your drinking?

Do you ever need a drink in the morning to steady your nerves (an Eye opener)?

Question 8

When checking the ear of a child > 12 months or an adult, how do you pull the ear back?

Answer 8

hold otoscope in same hand as ear you are viewing and use free hand to pull ear up and back

Question 9

For women and those over 65, what is low-risk drinking?

Answer 9

no more than 3 drinks on any single day and no more than 7 drinks per week

Question 10

What is the CAGE questionnaire useful for?

Answer 10

to screen pts who drink more than one drink daily OR who drink a lot on the weekends

can open door to conversation about getting help

Question 11

How should you angle the tip of the otoscope when performing an exam?

When should you stop?

Answer 11

slightly toward the pt’s nose to follow ear canal

Stop at any sign of increased pain

Question 12

In a child <12 months, how do you pull the ear back during an ear exam?

Answer 12

down and back

Question 13

How long do you measure a regular pulse?

How long do you measure an irregular pulse?

Answer 13

30 seconds –> multiply number by 2

full 60 seconds

Question 14

What are the 5 ways you can measure temperature?

Answer 14

orally

rectally (0.5-0.7 degrees higher than mouth)

axillary (usually 0.3-0.4 degrees lower than mouth)

ear

skin

Question 15

How is bp written?

Answer 15

systolic/diastolic

Question 16

What are the 3 types of sphygmomanometers used to measure bp?

What is the gold standard of reading bp?

Answer 16

mercury, aneroid, and digital

gold std = auscultation

Question 17

If bp is elevated, what should you do?

Answer 17

measure 2 additional times, waiting a few minutes btw measurements

Question 18

What do you ask a pt to do when examining their eyes with an ophthalmoscope? Where do you put your hand?

Answer 18

look over your shoulder - pick a spot Put your hand on pt’s forehead

Question 19

What can cause falsely high bp?

Answer 19

brachial artery below heart

cuff too small/narrow

cuff too large/wide on a large arm

Question 20

What is the 5 step approach to pt-centered interviewing?

Answer 20

1. Set the stage for the interview
2. Elicit chief complaint and set agenda for visit
3. Open the HPI
4. Continue pt-centered HPI
5. Transition to the clinician-centered process

Question 21

When do you use the bell of a stethoscope?

Answer 21

low pitched sounds (bruits)

Question 22

What are the 5 parts of a physical exam?

Answer 22

inspection auscultation palpation olfaction percussion

Question 23

What do you set the lens selector to on your ophthalmoscope?

Answer 23

“o”

Question 24

For men that have ever smoked at least 100 cigarettes in lifetime, what is recommended?

Answer 24

One-time screening for abdominal aortic aneurysm

Question 25

What are the AUDIT-C questions and scoring?

Answer 25

How often do you have a drink containing alcohol? How many drinks containing alcohol do you have on a typical day when you are drinking? How often do you have six or more drinks on one occasion? Score: max is 12, greater than or equal to 4 = above recommended levels for men; above 2 = above recommended levels for women

Question 26

When do you use the diaphragm of a stethoscope?

Answer 26

for high-pitched sounds (breath sounds and hear tones)

Question 27

Where is the arm supposed to be when measuring bp?

Answer 27

at heart level

Question 28

In what case is lung cancer screening recommended?

Answer 28

annual screening w/ low-dose computed tomography in adults aged 55-80 who have **30 pack-year smoking history and currently smoke or have quit within the past 15 yrs**

Question 29

What is the accronym to remember social history?

Answer 29

FEDTACOS food exercise drugs tobacco alcohol caffeine occupation spirituality and sexual relationships

Question 30

Among the 7% of women who reported same-sex sexual relationship, what percent still identify as heterosexual?

Answer 30

50%

Question 31

What is the gold standard technique for hand hygiene? When is the other technique preferred?

Answer 31

hand rubbing with an alcohol-based hand rub washing with soap and water - when visibly dirty; after using toilet; when exposed to potential spore-forming pathogens is suspected

Question 32

What is the metal part of the stethoscope attached to the eartips called?

Answer 32

biaural spring

Question 33

What is the ausculatory gap? What is its clinical significance?

Answer 33

period of diminished/ absent korotkoff sounds during measurement of bp can get confused by this and underestimate systolic or overestimate diastolic

Question 34

What are the 5Ps of the sexual history?

Answer 34

Partners Practices Prevention of Pregnancy Protection from STIs Past History of STIs

Question 35

What is an ophthalmoscope used for?

Answer 35

to visualize inner aspect of eye - retina, vascular supply, optic nerve, etc.

Question 36

What percentage of women who report same-sex sexual behavior have had/still have male sex partners?

Answer 36

50-97%

Question 37

when do you use the half light on your ophthalmoscope?

Answer 37

if pupil is partially obstructed (cataracts) half circle can be used to pass light through only the clear portion to avoid reflection

Question 38

What is the AUDIT questionairre useful for?

Answer 38

better sensitivity that CAGE more questions, somewhat difficult to score

Question 39

If you are looking at a pt's right eye, which of your eyes do you use to look through the ophthalmoscope?

Answer 39

your right eye - use the same eye to examine the pt's eye

Question 40

Who and what should you include in family history?

Answer 40

first degree relatives things that run in the family

Question 41

When should you wear gloves?

Answer 41

if there is obvious blood or body fluid (wash hands before and after wearing gloves)

Question 42

According to the KCU SOAP note template, how do you start your note?

Answer 42

with the chief complaint

Question 43

What is normal temperature?

Answer 43

97.8-99 degrees F

Question 44

What is the pneumoic on how to be empathetic in a pt encounter?

Answer 44

NURSE: name understand respect support explore

Question 45

When do you use the small light on your ophthalmoscope?

Answer 45

when the pupil is very constricted; well-lit room w/ no dilator used

Question 46

How many times do people try to quit smoking before success?

Answer 46

7-8 times

Question 47

When do you use the large light on your ophthalmoscope?

Answer 47

when you use mydriatic eye drops to dilate

Question 48

What is percussion?

Answer 48

taping over an area to differentiate air, fluid or solid underneath surface

Question 49

What are the 7 key active listening skills?

Answer 49

1. be attentive 2. ask open-ended questions 3. Ask probing questions 4. Request clarification 5. Paraphrase 6. Be attuned to and reflect feelings 7. Summarize

Question 50

What can cause falsely low bp

Answer 50

brachial artery above heart cuff too large/wide on a small arm

Question 51

How high should you inflate the bp cuff?

Answer 51

180 mmHg or roughly 30 higher than estimated systolic pressure

Question 52

According to the Joint Commission, what % of accidental deaths and injuries and linked to communication failures?

Answer 52

70%

Question 53

what percentage of patients walk out of a doctor's office not knowing what they were told or what they are supposed to do?

Answer 53

50%