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FA - STEP 2 CS Cases > Kaplan Intro — History > Flashcards

Kaplan Intro — History Flashcards

1
Q

What to do if time runs out?

A

“Well, Doctor, I think it’s safe to tell you. My problem is …”

“This encounter is now over.”

“I’m sorry; I have to answer this emergency page. I’ll be back as soon as I can.”

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2
Q

Eye contact is also important during what …?

A

The physical exam!

Observe the patient’s face when palpating and percussing to see if there are any simulated physical findings of abdominal pain.

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3
Q

If you don’t look at the patient during your writing, you should …

A

Nod up and down slightly ==> Gives the impression you are still listening.

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4
Q

When do you need to interrupt your patient?

A

When he is rambling and talking about unimportant, perhaps tangential, issues.

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5
Q

Example of patient interruption:

A

How can I help you today?

Oh, Doctor, thank you so much for seeing me today. I called the office and your nurse was so nice.

Thank you. I see mu nurse wrote that you have a sore foot. Can you tell me about it, please?

I had a dog once with a sore leg. Spot was her name. I’ll get a picture and show you.

(Interrupting) I’m sorry, I need to interrupt. I know you want to show me the picture but I would like to focus on you today. Please point and show me exactly where it hurts.

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6
Q

If the pt mentions that he lost weight, then an appropriate response would be …

A

Have you been on a diet?

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7
Q

Examples of empathy:

11

A
  1. Make the pt as comfortable as possible.
  2. Check that the drape is always protecting the pt’s modesty.
  3. Pull out the leg rest before a pt lies back.
  4. Assist the pt when he/she needs to change position during the physical exam.
  5. Offer water when a pt is thirsty or when you do a thyroid exam.
  6. Offer to dim the room lights if the pt is photophobic.
  7. Offer a tissue to a pt who is crying.
  8. Be attentive to making a painful exam as brief as possible while explaining the need for the maneuver.
  9. If the pt is hard of hearing, always stand in front of him so he can read your lips.
  10. Stand behind the pt if he seems dizzy and about to fall.
  11. Sit in silence for a couple of seconds when a pt is emotional.
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8
Q

Verbal empathy examples:

A
  1. Tell me more.
  2. The more you tell me, the better I’ll be able to help.
  3. Remember, I’m here to help.
  4. I want to be sure I understand. You told me (paraphrase here). Is that correct?
  5. I imagine that must be hard/sad/frustrating/painful.
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9
Q

Pt is pacing back and forth in the exam room as you enter. Before you can even say hello, the patient speaks angrily.

A

What took you so long?

(Showing great empathy) I can see that you’re upset. I’m sorry I took so long to see you.

(Who was expecting an excuse and is pleasantly surprised by the simple apology) Oh, that’s okay.

Let me introduce myself. My name is Dr. …

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10
Q

Even if the pt is portraying a physician who is a patient, …

A

DO NOT USE MEDICAL JARGON.

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11
Q

Before the PMH, say …

A

Now, I’m going to ask you about your health in the past/in general.

Do NOT use “Past medical history”.

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12
Q

Before starting the Ob/Gyn, sexual, and social histories:

A

I’m going to ask you some personal questions. Everything we talk about is confidential.

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13
Q

Do NOT reassure the pt about whether he’s going to be ok.

You’re better off reassuring the patient that you:

(5)

A
  1. Understand his concerns.
  2. Will do everything you can to make him feel better.
  3. Will do everything you can to find out what is wrong.
  4. Will get him the best treatment available.
  5. Will remain his doctor and will always be available to help.
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14
Q

If the pt says it’s the worst sore throat of his life, think …

A

Adult epiglottitis + peritonsilar abscess.

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15
Q

Intensity of a symptom other than pain?

Ask:

A

How is this X (eg weakness) affecting your life?

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16
Q

Another way to measure the intensity of a symptom is to ask questions about the FUNCTIONAL IMPAIRMENT:

(Especially useful with chronic problems such as dementia, depression, PD)

A

DEATH questions:

Dress
Eating
Ambulate
Toilet
Hygiene
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17
Q

DEATH questions — Examples:

A

Are you having problems getting dressed?

Are you able to prepare your own food and eat it?

Are you having any falls?

Any problems getting off and on the toilet?

Are you able to bathe or shower by yourself?

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18
Q

1 teaspoon is …

A

5cc

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19
Q

1 TABLEspoon is …

A

15cc.

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20
Q

1 cup is …

A

8oz = 240cc

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21
Q

If a symptom has a volume, what we really want to know for intensity is the …

A

QUANTITY.

“How much has this been happening?”

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22
Q

Symptoms with volume?

A
  1. Vaginal bleeding.
  2. Sputum.
  3. Emesis/diarrhea.
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23
Q

Onset questions that are sometimes very revealing are the following:

A
  1. When did it begin?
  2. What were you doing when it started?
  3. Did it come on slowly? Suddenly?
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24
Q

For patients who are not sure when a chronic symptom began, try the following:

A

When were you last completely well?

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25
Q

Onset questions also include:

A
  1. Duration ==> How long does the pain last? Does the pain ever go away? When was the last time you didn’t have pain?
  2. Frequency ==> How often does it happen?
  3. Course ==> Is it getting better or worse? Does the pain come and go?
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26
Q

Radiation — Sometimes, depending on the case, the SP may ask you for more specific information.

For example:

A

Does the pain move anywhere?

Like where?

How about your arms?

No.

Neck?

No.

Back?
…

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27
Q

The 4 categories of allergy are:

A
  1. Medications.
  2. Foods.
  3. Plants and animals.
  4. Environmental sources.
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28
Q

If the case might be that of an allergic reaction — a more detailed allergy history is indicated:

A
  1. Do you have any allergies to prescription medication?
  2. How about any bad reaction to OTC pills?
  3. Any bad reactions to food?
  4. Do you have any allergies to animals or plants?

+ ANYTHING ELSE you can tell me about allergies?

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29
Q

Medications — the three categories:

A
  1. Prescription.
  2. OTC.
  3. Vitamins and herbs.
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30
Q

For medication’s name, use …

A

Whatever name the pt gives you.

Trade name or generic name is acceptable.

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31
Q

If the pt seems to be having a hard time remembering the names of his meds, ask if …

A

He has the BOTTLES with him.

If he does, you can simply read the labels.

32
Q

What should be specifically asked about the medications?

A

COMPLIANCE

Classic is CHF worsening after non compliance with meds

33
Q

Any herbal medications?

A
  1. Saw palmetto ==> BPH.
  2. Cranberry ==> Urinary tract infection.
  3. Echinacea ==> URI.
  4. Ginseng ==> Stress and memory.
  5. St. John’s Wort ==> Depression.
34
Q

Common meds and their names — NSAIDs:

A
  1. Motrin.
  2. Ibuprofen.
  3. Naproxen.
35
Q

Common meds and their names — Diuretics:

A
  1. Lasix, furosemide.
  2. HCTZ.
  3. Bumex.
36
Q

Common meds and their names — Digoxin?

A

Digoxin, lanoxin.

37
Q

Common meds and their names — Beta blockers:

A
  1. Atenolol.
  2. Metoprolol.
  3. Toprol XL (anything that ends in “-ol”).
38
Q

Common meds and their names — ACEIs/ARBs:

A
  1. Lisinopril.
  2. Captopril.
  3. Avapro (irbesartan).
  4. Enalapril.
39
Q

Common meds and their names — SSRIs:

A
  1. Fluoxetine.
  2. Prozac.
  3. Paxil.
40
Q

Common meds and their names — Statins:

A
  1. Atorvastatin (Lipitor).

2. Simvastatin (Zocor).

41
Q

PMH — 4 parts:

A
  1. Hospitalizations.
  2. Major illness.
  3. Significant trauma.
  4. Surgical history.

HITS

42
Q

In questioning adult pts about RFs, ask about specific diseases individually:

A
  1. Have you ever had high BP?
  2. Have you ever had high blood sugar?
  3. How about high cholesterol?
43
Q

Trauma — If there is a mental-status-change case, ask about …

A

Head trauma.

44
Q

Occasionally, during the physical exam you will find a surgical scar you did not expect.

Ask the pt the following:

A

(Pointing to or touching the scar) “What is this scar from?”

45
Q

3 systems for the ROS:

A
  1. GI.
  2. GU.
  3. Sleep.
46
Q

Urinary ROS questions:

6

A
  1. How often do you urinate?
  2. How many times do you get up at night to urinate?
  3. Do you have any burning with urination?
  4. Any blood?
  5. Is the stream weak?
  6. Do you ever have any accidents?
47
Q

GI ROS questions:

2

A
  1. Has there been any recent change in your weight?

2. Are you on any special diet? ==> Uncovers vegans with B12 deficiency.

48
Q

DDx for weight gain:

A
  1. Depression.
  2. Eating disorders.
  3. Hypothyroidism.
  4. Cushing.
  5. Edematous states ==> Liver failure, heart failure, nephrotic syndrome.
49
Q

DDx for weight loss:

A
  1. Depression.
  2. Eating disorders.
  3. Cancer.
  4. Hyperthyroidism.
  5. Amphetamine use.
  6. Other chronic diseases.
50
Q

Sleep ROS questions:

A

Has there been any change in how much you sleep?

51
Q

Increased sleep DDx:

A
  1. Depression.
  2. Hypothyroidism.
  3. Sleep apnea.
  4. Drugs.
52
Q

Decreased sleep DDx:

A
  1. Depression.
  2. Hyperthyroidism.
  3. Mania.
  4. Drug use.
53
Q

Express condolences if …

A

The death was less than a year ago OR

If the pt’s facial expression suddenly becomes sullen.

54
Q

OB/GYN — How to determine a pt’s GPA status:

A

G — How many times have you been pregnant?

P — How many times have you given birth?

A — Have you had any miscarriages or abortions?

55
Q

Gyn Hx — 8 things to ask:

A
  1. Regularity — Length of period — LMP.
  2. Cramps.
  3. Flow.
  4. Cycle length.
  5. Age of menarche/age of menopause.
  6. Spotting — Postcoital — Dyspareunia.
  7. Vaginal discharge.
  8. Last Pap smear.
56
Q

Standard sexual history questions include:

7

A
  1. Are you sexually active?
  2. Do you use contraception?
  3. How many sexual partners have you had in the last 6 months?
  4. Are your partners men, women, or both?
  5. Have you ever been tested for HIV?
  6. Have you ever had a STD?
  7. Do you have any concerns about sexual function?
57
Q

Ask the CAGE when …

A

If a man says he has >2 drinks a day.

If a woman says she has >1 drink a day.

58
Q

The correct way to ask about recreational drugs is the following:

A

Do you use recreational drugs?

Yes

What do you use?

Cocaine, when I can get it.

How do you take it?

I smoke it.

When did you last use?

About 20min ago.

59
Q

When asking about drugs, stay away from using the term …

A

ILLICIT drugs, as it is considered judgmental.

60
Q

Common names for recreational drugs — Alcohol:

A

Booze
Brews
Brewskis

61
Q

Common names for recreational drugs — Amphetamines:

A

Speed
Crank
Crystal meth

62
Q

Common names for recreational drugs — Cannabis:

A 
Hash
Hashish
Dope
Pot
Reefer
Bud
Ganja
Weed
Grass
63
Q

Common names for recreational drugs — Cocaine:

A 
Blow
Coke
Toot
Nose candy
Crack
64
Q

Common names for recreational drugs — Downers:

A

Generic street name for benzos/barbs.

65
Q

Common names for recreational drugs — Heroin:

A

Horse
Brown sugar
Smack

66
Q

Common names for recreational drugs — Phencyclidine:

A

PCP

Angel dust

67
Q

Common names for recreational drugs — Roids:

A

Anabolic steroids in general.

68
Q

Questions about home life:

A
  1. Who do you live with?

2. Is there any stress at home?

69
Q

Pediatric history consists of 6 subparts:

A
  1. Prenatal.
  2. Birth.
  3. Neonatal.
  4. Feeding.
  5. Development.
  6. Routine care.
70
Q

Prenatal history questions:

A
  1. How was your health during pregnancy?
  2. Did you get regular prenatal checkups?
  3. Did you smoke or drink during the pregnancy?
  4. Were there any problems with swelling or high blood pressure? (Preeclampsia)
71
Q

Birth history questions:

A
  1. Was the baby full-term?
  2. Did you have a CS?
  3. Were there any problems with your labor?
  4. How much did the baby weigh at birth? (All mothers know this information)
72
Q

Neonatal history questions:

A
  1. How long did you and the baby stay in the hospital after delivery?
  2. Did the child have any medical problems when she was born?
  3. Any problems with breathing?
  4. Any problems with feeding, having bowel movements, or infections?
  5. Any problems with yellow skin?
73
Q

Feeding history questions:

A
  1. Was the child breast-fed or bottle-fed?

2. Are you having any problems breastfeeding?

74
Q

If the newborn is bottle-fed, get more details:

A
  1. What formula are you using?

2. How many ounces does the baby drink? How often? What is the feeding schedule?

75
Q

If the child is a bit older, ask about his eating habits:

A
  1. When did the child start eating solid foods?
  2. How is her appetite?
  3. Is she taking a pediatric multiple vitamins?
  4. Does she have any food allergies?
76
Q

Developmental history:

A
  1. Has you child been gaining weight normally?

2. Has there been any sudden gain or loss of physical growth?

77
Q

Routine care — 2 questions:

A
  1. Are the child’s immunizations up to date?

2. Is the child getting routine checkups?

FA - STEP 2 CS Cases (50 decks)

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