M1 Ch 2-5 Flashcards

1
Q

A 20yr Old patient presents to the office for a wellness exam. The clinician assesses the patient’s use of seat belts. Which component of the wellness exam is assessed?

a. HPI
b. PMH
c. assessment and plan
d. Anticipatory guidance

A

d. Anticipatory guidance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which of the following is NOT an element of history taking?

a. CC
b. Fam hx
c. Physical examination
d. HPI

A

C. physical examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
Patient presents to the office with shoulder pain. Pain is constant, burning, and reported worse at night. During the patient interview, the Clinician asks the pt "Can you tell me what you have been doing for your shoulder pain" The clinician is asking info about?
a. Modifying factors
b. quality
c associated signs and sx
d. health promotion
A

a. modifying factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What id the difference b/w an open-ended question and a closed-ended question?

a. OE question are answered with yes or no. CE are answered with more detail
b. OE questions have more details than simple yes or no answers
c. OE questions refer only to the physical exam section of CE questions refer only to the history collection
d. The only difference b/w the two is the timing of when the questions are asking

A

B. Open-ended questions have more details than simple yes or no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A set of EB recommendations for preventative services were developed by which agency?

a. U.S Agency of Health and Human services?
b. U.S Institute of Medicine Task Force
c. U.S Preventative Services Task Force
d. U.S Center for Health and Wellness

A

c. U.S Preventative Services Task Force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

An established pt presents for a f/u visit for her stable HTN. During this visit, the clinician can update the ROS, PMI, Fam hx and social hx by simply stating the info was reviewed and updated from the previous encounter.

a. true
b. false

A

a. true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What vaccines would you recommend for a 70 year old pt to receive at a wellness exam?

a. varicella, TD, zoster, pneumococcal
b. TD. zoster pneumococcal
c. flu, zoster. Tdap, pneumococcal, zoster
d. Nasal flu mist, TD, varicella

A

c. flu, zoster, tdap, pneumococcal, Zoster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When considering hx collection during a wellness exam, which statement below is NOT correct?

a. Wellness exams do not require a cc
b. Wellness exams are age and gender appropriate
c. Wellness exams include counseling and anticipatory guidance
d. Wellness exams are based on a presenting problem.

A

d. Wellness exams are based on a presenting problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which is TRUE about the use of screening tools to assess depression?

a. screening tools like PHQ-2 and PHQ-9 are recommended and evidence based.
b. screening tools should be used only when the clinician is short on time for the visit
c. screening tools like PHQ-2 and PHQ-9 are not to be used during wellness exams
d. screening tools like PHQ-2 are too short to be effective assessment

A

a. screening tools like PHQ-2 and PHQ-9 are recommended and evidence based.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Wt obtained during a patient’s chronic management f/u visit for HTN finds the pt has increased 10;b over the past year and the her BMI is considered morbidly obese. During the visit, the clinician should place greater emphasis on?

a. physical exam findings
b. lifestyle modifications
c. updating social hx
d. management of HTN

A

b. lifestyle modifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which is true about the impact of family on an individual’s health?

a. Family has little impact on an individuals health
b. Family has a negative impact on an individual’s health.
c. Family systems can impact on individuals health and wellness needs
d. Family systems are unlikely to impact healthy individuals

A

c. Family systems can impact on individuals health and wellness needs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does a clinician BEST assess the impact of an individual’s community on his or her health?

a. Assess the environment and location where the patient was born and raised.
b. assess whether the patient has any medical conditions affecting his or her health.
c. ask the patient if he or she has any community or cultural concerns.
d. ask about where the person resides, works, learns. plays. worships, and connects width others.

A

d. ask about where the person resides, works, learns. plays. worships, and connects width others.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are health disparities?

a. differences attributed to an individual’s health behaviors
b. differences in illness, injury, disability, or mortality experienced.
c. greater burden of implicit bias experienced
d. greater burden of overt bias experienced

A

b. differences in illness, injury, disability, or mortality experienced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which is true about the assessment of population health?

a. Assessments of the health of a population can lead to positive impact within communities.
b. Assessments of the health of a population often lead to clinician burnout.
c. Initiatives to improve health are unlikely to be effective at a community or population level.
d. Initiative to assess population health are better if completed by organizations like the CDC, rather than clinicians

A

a. Assessments of the health of a population can lead to positive impact within communities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Culture can be defined by

a. beliefs and behaviors only
b. physical characteristics
c. race or ethnicity only
d. race ethnicity, geography, language, values beliefs and behaviors.

A

d. race ethnicity, geography, language, values beliefs and behaviors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The role of the clinician in assessing health an health disparities includes

a. completing physical assessment w/o regard to rce or ethnicity
b. documenting advanced assessment w/o regard to race or ethnicity
c. recognizing barriers to care and being sensitive to cultural influences
d. telling each individual patient what is best for them and their health

A

c. recognizing barriers to care and being sensitive to cultural influences

17
Q

Which would be the best way to document an abnormal skin exam?
a Hard, fixed nodule found on left arm
b. 2x3 in firm, nontender, fixed nodule on left arm
c. 2x3 in firm, nontender, fixed nodule on left anterior arm 1 in below wrist
d. 2x3 in firm, nontender, fixed nodule on left anterior arm 1 in below wrist on ulnar side

A

d. 2x3 in firm, nontender, fixed nodule on left anterior arm 1 in below wrist on ulnar side

18
Q

Documentation provides:

a. a legal document of the visit
b. a way to document clinical progress
c. on ongoing record of the patient’s clinical picture
d. All the above

A

d. All the above

19
Q

Which of the following would be an appropriate documentation?

a. Patient takes 68 units of insulin
b. patient takes one tablet QD
c. Patient takes 10.0mg of lisinopril
d. Patient on 0mg MS

A

a. Patient takes 68 units of insulin

20
Q

Which of the following is NOT considered a pertinent negative finding for abdominal pain?

a. No fever
b. No shoulder pain
c. No diarrhea
d. No vomiting

A

b. No shoulder pain

21
Q

Which best describes how pediatric health history and physical exam are different from adults?

a. The clinician can use the same approach to hx and physical with a child if the clinician is highly skilled and efficient.
b. Compared with adults, children experience rapid periods of growth and development, so the clinician should tailor the approach to the child’s developmental level
c. children are unable to provide reliable info for the health history and exam; therefore, the clinician should solely on the info from the caregiver.

A

b. Compared with adults, children experience rapid periods of growth and development, so the clinician should tailor the approach to the child’s developmental level
* children must always be included especially greater than age 4-5

22
Q

Which approach by the clinician can increase a younger child’s cooperation with the physical exam?

a. Findings ways to transform the physical exam into a play activity
b. Move quickly through the exam, performing the most distressing assessment first to get it over with.
c. ask the child if it is okay to begin the physical exam to promote autonomy and trust
d. only examine the physical systems that the child permits so the child does not become distressed.

A

a. Findings ways to transform the physical exam into a play activity

never ask a child permission will always get a “no”

give them choices, but with in reason “do you want me to look in ears first or eyes?”

23
Q

What is the intended outcome of the ALARA principle?

a. Promote the use of CT in all kids
b. promote the use of high dose radiation to improve image quality
c. Limit radiation doses in children when possible to prevent harm
d. clinicians should always use US before CT.

A

c. Limit radiation doses in children when possible to prevent harm

24
Q

Which statements best applies to the care of the adolescent?

a. Adolescents are more likely to share personal info with the clinician if confidentiality is guaranteed.
b. More adolescents ar willing to seen healthcare if the clinician can provide a private, confidential encounter
c. the clinician should be aware of the state and federal law regarding adolescent consent and confidentiality
d. adolescents are minors and are not entitled to a confidential conversation with the clinician unless the caregiver consents.

A

a. Adolescents are more likely to share personal info with the clinician if confidentiality is guaranteed.
b. More adolescents are willing to seen healthcare if the clinician can provide a private, confidential encounter
c. the clinician should be aware of the state and federal law regarding adolescent consent and confidentiality

25
Q

Which statements describes the approach to the physical exam of infants and young children? Choose all that apply.

a. It is best to perform the otoscope exam while the caregiver is cradling the newborn.
b. Safe positioning of the infant or young child may require caregiver assistance.
c. The clinician can generate cooperation from young children by allowing them to become familiar with exam equipment like the otoscope or stethoscope
d. If the young child requires restraint to perform the exam sagely, the clinician should forego that part of the exam

A

b. Safe positioning of the infant or young child may require caregiver assistance.
c. The clinician can generate cooperation from young children by allowing them to become familiar with exam equipment like the otoscope or stethoscope

26
Q

Which statement is TRUE about musculoskeletal considerations in young children?

a. Closure of the growth plate occurs during Tanner stage 3.
b. All infants should be routinely assessed for DDH until they are walking normally.
c. The bones of young children are more brittle than those of adults.
d. clinicians rarely need to worry about growth plate fractures.

A

b. All infants should be routinely assessed for DDH until they are walking normally.

*Skeletal maturity occurs at the end of puberty
* children’s bones are more pliable not brittle more likely to have deformities (bowing)than breaks
DDH should be assessed/checked at birth and at every wellness exam until the child can walk normally

assessed by Ortolani’s and Barlow’s

27
Q
Normal range of onset for puberty development in girls is?
a. 8-10
b. 10-12
c. 8-13
d 13-14
A

c. 8-13

males 13-14

** much watch for early puberty

28
Q

Which of the following statements about preventative considerations for the care of children is FALSE?

a. BP in children needs to be checked only if children are showing signs or symptoms of cardiovascular or renal disease
b. According to AAP, BMI should be measured for all children annually beginning at age 2.
c. Children should be screened for dyslipidemia once b/w ages 9-11 and 17-21 yrs
d. Adolescents b/w 12-18yrs should be screened for major depressive disorder

A

a. BP in children needs to be checked only if children are showing signs or symptoms of cardiovascular or renal disease
* BP in children should be checked annually starting at 3

29
Q

Which of the following describes the BEST approaches to detecting DD in young children?

a. The clinician should conduct developmental surveillance only when a caregiver is concerned about slow development
b. The clinician should perform developmental surveillance at every routine health encounter
c. The clinician should be complete a standardize developmental screening at ages 9, 18, and 24 to 30
d. if a caregiver is offended by the suggestions that his or her child may have a DD delay, the clinician should drop the issue until the next visit.

A

b. The clinician should perform developmental surveillance at every routine health encounter
c. The clinician should be complete a standardize developmental screening at ages 9, 18, and 24 to 30

  • reasoning is for early detection in order to improve the child’s trajectory.
30
Q

Which statement about evaluating growth in children is FALSE?

a. Deviation in growth patterns may indicate a serious underlying conditions.
b. The CDC growth charts should be used for children aged 0-18yrs.
c. BMI is evaluated by comparing the BMI calculations with a reference population of children of the same age and natal sex.
d. Accurate growth measures are essential for a reliable evaluation.

A

b. The CDC growth charts should be used for children aged 0-18yrs.
* Growth charts are used for children aged 0-23 months
* Wt, HT, head circumference and BMI are all compared with a reference population of children of the same age

31
Q

Proper way to exam ear canal of children less than 3 years old?

A

Upward and back

  • greater than 3 years down and forward
32
Q

Developmental surveillance is performed at every routine admission in order to recognize children’s who may be at risk for DD. What are the months of routine visits?

A

9, 18, 24,30 months

33
Q

A. Patient is considered obese and at risk for certain medical conditions if his or her BMI is

a. Below 15
b. 18.5-24.9
c. 25.0 to 29.9
d. 30.0 and above

A

d. 30.0 and above

34
Q

The expected RR for a individual greater than 12 is

a. 12-20
b. 16-22
c. 20-24
d. 22-30

A

a. 12-20

  • 16-22= 6rs-12
  • 20-24 =3yrs -6 yrs
  • 22-30= 1-3 yrs
35
Q

Which BP is considered expected for an individual 36 yrs of age?

a. 140/88
b. 136/92
c. 118/78
d. 160/100

A

c. 118/78

<120 SBP and < 90 = normal adult
120-129/80 = elevated in adult
130-139/80-90 = Pre HTN

36
Q

Which factor may contribute to an inaccurate BP reading? Select all that apply
a. being cold
b Having caffeine
c. using a bp that is too small
d. taking an antihypertensive medication on the day of the exam
e. using a BP cuff that is too large

A

a. being cold
b Having caffeine
c. using a bp that is too smal
e. using a BP cuff that is too largel

37
Q

In assessing Tympanic membrane in an adult, which technique would result in the most accurate reading?

a. A plastic probe placed under the tongue
b. The pinna is pulled back and up
c. Scan across the forehead. and behind ear.
d. Removing hearing aides and wait one minute

A

b. The pinna is pulled back and up

* children pinna is pulled Back and down