[Lecture] Complete H&P [Tyler]

Question 1

4 Components of a complete H&P

Answer 1

History

ROS

PE

Documentation (SOAP)

Question 2

What components of a complete H&P might be overlooked in a focused H&P? (it’s just stuff we don’t like to do in SPEs, just be aware)

Answer 2

Immunizations

Preventative health

Reproductive/sexual

Blood transfusions

Advanced Directives

Question 3

How many systems in ROS?

Answer 3

14

Gen, Skin, HEENT, Breasts, Respiratory, CV, GI, GU, Reproductive, MSK, Neuro, Hematologic, Endocrine, Psychiatric

Question 4

What are the 3 steps in a reasonable approach to gathering H&P?

Answer 4

Information gathering

Interview

PE

Question 5

What are the 4 cardinal techniques in a PE?

Answer 5

Inspection

Palpation

Percussion

Auscultation

Question 6

What 3 processes are key to making an accurate diagnosis?

Answer 6

Pattern recognition

Illness Script

Application of science

Question 7

Clinical reasoning should when in an encounter?

Answer 7

At the beginning

Question 8

Steps to making a hypothesis

Answer 8

1. Make the most specific and critical findings
2. Match findings against conditions that can produce them
3. Eliminate diagnostic possibilities that fail to explain the findings
4. Weigh the competing possibilities and select the most likely diagnosis
5. Give special attention to potentially life-threatening conditions