L1: Foundations of Health Assessment 1

Question 1

What is the best type of question type to start off with when meeting your pt?

Answer 1

• Open ended, followed by closed if needed.

Question 2

What is the screening acronyn for partner violence/domestic violence?

Answer 2

• HITS o H: hurt o I: insult o T: threaten o S: scream

Question 3

What skills are on the listening skills checklist?

Answer 3

• Non-verbal cues - Watch for and respond to clues - Collaborate - Avoid repeating questions - Legitimize concerns

Question 4

When assessing for illicit drug use/abuse, what are the acronyms to keep in mind?

Answer 4

• CAGE: o C: concern o A: annoyed o G: guilty o E: eye opener - CRAFFT: o C: car (been in car driven by someone under influence?) o R: relax (used to relax?) o A: alone (use alone?) o F: forget (while using?) o F: family/friend (ever asked you to cut down?) o T: trouble (gotten into?)

Question 5

When is an inventory history used?

Answer 5

related to complete history, but not as detailed

Question 6

Explain the ‘4 Cs’ method of assessing pt-clinician communication.

Answer 6

• Call: What does the pt call their problem? - Cause: What does the pt think caused/contributed to their problem? - Concern: What concerns the pt the most that needs to be addressed? - Cope: What is the pt currently doing to cope with their problem?

Question 7

What are the various history types that can be obtained?

Answer 7

• Comprehensive (complete, expanded, new patient) - Focused (aka problem oriented, basic) - Inventory - Interim

Question 8

Explain the ‘Ask Me 3’ method of assessing pt-clinician communication.

Answer 8

• Encourages pt to understand: - What their main problem is - What they need to do - Why it is important for them to do that

Question 9

Characteristics of Leading question

Answer 9

• risky for of questions (can loose out / limit on information returned by pt) - to be avoided

Question 10

Different questionnaires:

Answer 10

• Challenging pt - Sexual history - Mental health history - Alcohol, rx and illicit drugs - Partner violence / domestic violence - Death and dying

Question 11

When is a focused history used?

Answer 11

• used with established pt (previously comprehensive exam done) - urgent/sick care - focused concerns or symptoms - restricted to a specific body system - exam methods relevant to assessing the concern/problem

Question 12

Types of interview questions:

Answer 12

• Open-ended - Direct or closed - Graded response - Leading - Multiple

Question 13

When is a complete history used?

Answer 13

• used with new pt - for getting to know the pt - to develop provider/pt relationship - identifying / ruling out physical causes related to chief complaint - baseline for future assessment - platform for health promotion - proficiency in essential skills of PEX

Question 14

When assessing for alcohol abuse, what are the acronyms to keep in mind?

Answer 14

• CAGE: o C: concern o A: annoyed o G: guilty o E: eye opener - TACE: o T: take (how many drinks to feel buzzed?) o A: annoyed (by other ppls criticism) o C: cut o E: eye opener

Question 15

What are the various interview techniques that can be used during history taking?

Answer 15

• Facilitation: verbal, non verbal, encourages pt to say more (nodding, mmm) - Reflection: repeat what pt said - Clarification: what do you mean? - Reassurance: without false hope - Empathy: verbal or non-verbal - Confrontation: if pt exhibits disturbing behavior - Interpretation: restate and confirm - Validation: acknowledge and legitimize - Summarization - Transitions

Question 16

Explain the Alcohol, rx and illicit drugs questionnaire

Answer 16

• understanding if pt has addiction, physical dependence or tolerance to etoh, rx and / or illicit drugs - use acronyms: CAGE, TACE, MAST, ACEDIT, CRAFFT - CAGE: o C: concern o A: annoyed o G: guilty o E: eye opener - TACE: o T: take (how many drinks to feel buzzed?) o A: annoyed (by other ppls criticism) o C: cut o E: eye opener - CRAFFT: (used to determine abuse by adolescents) o C: car (been in car driven by someone under influence?) o R: relax (used to relax?) o A: alone (use alone?) o F: forget (while using?) o F: family/friend (ever asked you to cut down?) o T: trouble (gotten into?)

Question 17

What skills are on the verbal skills checklist?

Answer 17

• Clear and appropriate volume (lower voice for pts with hearing loss) - Avoid medical jargon - Start with open-ended questions, closed if needed - Redirect as needed

Question 18

What is a medical history?

Answer 18

• An organized method of data collection using the presenting concern and past history to help develop a differential diagnosis

Question 19

Characteristics of Graded response question

Answer 19

answer has multiple defined responses that are typically quantitative

Question 20

Characteristics of Multiple questions

Answer 20

used by novice, avoid as pt typically only remembers the last thing asked (run risk of limiting information returned by pt)

Question 21

Explain the Death and dying questionnaire

Answer 21

• questions to ask pt about EOL, advanced directives, living wills, POA, DNR, health proxy

Question 22

How do you show empathy during an interview/pt encounter?

Answer 22

• Be compassionate and sympathetic - Make eye contact - Listen - Show interest - Be concerned - Consider pts current life situation and impact on what is being discussed on their life

Question 23

Explain the ‘Teach Back’ method of assessing pt-clinician communication.

Answer 23

• Involves having the pt what was explained to them in their own words - Checks for understanding with pt through their own verbalization - Promotes adherence, quality and safety

Question 24

Explain the Mental health history questionnaire

Answer 24

• asking pt if they have had problem with emotional mental illness(es), if they have been seen by counselor or therapist, if they or anyone if their family has been treated / hospitalized for emotional or mental health problem, if pt has depression / thought disorders then a careful history should be taken – used acronym SIGECAPS: - S: sleep change, I: interest loss, G: guilt feeling, E: energy loss, C: cognition/concentration change, A: appetite decline leading to weight loss typically, P: psychomotor ie. Anxiety, lethargy, S: suicidal thoughts

Question 25

What are 3 methods to assess pt-clinician communication?

Answer 25

• Ask me 3 - Teach back - 4 Cs

Question 26

What are things to consider about regarding professionalism to a pt encounter?

Answer 26

• Dress/appearance - Concern for pt - Compassion, kindness - Confidence, not arrogance - Confidentiality (HIPAA) - Ethics - Practice what you preach

Question 27

Characteristics of open-ended question

Answer 27

• used when seeking general information - beginner interviewer uses this style

Question 28

Explain the need for partner violence/domestic violence questionnaire

Answer 28

• if there are clues to phys/sexual abuse seen, such as: unexplained injuries, delayed treatment, history of repeated accidents, etoh/drug use in pt or partner, dominates visits, pregnancy at young age/multiple partners, infections/STIs, trouble walking/sitting indicative of possible genital / anal pain, vaginal lacerations/bruises, fear of pelvic exam/physical contact, fear of leaving exam room - use HITS acronym to screen o H: hurt o I: insult o T: threaten o S: scream

Question 29

Explain the Challenging patient questionnaire

Answer 29

• pt is: silent, confusing, altered, talkative, is crying, is angry/disruptive, language barrier, lower literacy (including health literacy), hearing loss, impaired vision, limited intelligence, personal problems, is seductive

Question 30

When is an interim history used?

Answer 30

• means to chronicle events bw visits - pt hasn’t seen provider in a while, used as fill-in

Question 31

Explain the sexual history questionnaire

Answer 31

• asking pt about when they were last physically intimate, if contact included intercourse, if they have sex with men, women or both, number of sexual partners in the past x timeframe, if they use protection, if they have concerns about HIV/AIDs and other STDs?

Question 32

Characteristics of Direct or closed question

Answer 32

• used when seeking specific facts - outlines chief complaint and past history for basis of question

Question 33

What are the four Cs of communication?

Answer 33

• courtesy - comfort - connection - confirmation

Question 34

What is the best acronym to assess illicit drug abuse in adolescents?

Answer 34

• CRAFFT: o C: car (been in car driven by someone under influence?) o R: relax (used to relax?) o A: alone (use alone?) o F: forget (while using?) o F: family/friend (ever asked you to cut down?) o T: trouble (gotten into?)

Question 35

What are things to pay attention to during the interview to show respect?

Answer 35

• Unbiased encounter with pt - Politeness - Introduce self, title and role - Greet pt - Address pt appropriately - Shake hands - Be kind - Ask permission - Respect pt’s rights - Respect differences (cultural and background)

Question 36

Goals of interview/history: Why perform a history?

Answer 36

• Collect info about pt and their illnesses - Establish contract of care with pt - Understand pt’s environment - Develop a problem list - Develop a problem-solving plan

Question 37

What skills are on the humanistic skills checklist?

Answer 37

• Verbal - Listening - Respect - Empathy - Professionalism - Handling sensitive topics appropriately