Med Skills Test

Question 1

What sort of preparation do you need to do for patient interviewing? What is the interviewing process?

Answer 1

Review medical record
Set goals for the interview- clarify your goals for the interview
Review your clinical behavior and appearance
Adjust the environment as needed-to make the patient more comfortable

The interview process is a time for open ended questions listening and trying to connect with the patient and elicit the chief complaint.

Question 2

What are some examples of guided questions and when would you use this technique?

Answer 2

Moving from open ended to focused questions
Asking a series of questions one at a time
Clarifying what the patient means

Use these questions when trying to get subjective data from the patient during history taking

Question 3

How do you share power with your patient?

Answer 3

Ask for their perspective
Convey interest in the person as well as the problem
Follow their lead
Validate emotional content
Share information
Make your clinical reasoning transparent
Reveal the limits of your knowledge.

Question 4

What are the four methods of exploring the patents perspective?

Answer 4

FEELINGS
IDEAS about problem
IMPACT of the problem on daily living
EXPECTATIONS of disease, clinician, and healthcare in general

Question 5

What are the four classic techniques of the physical exam?

Answer 5

Inspection
Palpating
Percussion
Auscultation

Question 6

How might a patients dress and grooming reveal clues to medical conditions?

Answer 6

Excessive clothing could reveal cold intolerance, maybe meant to hide: appearance (obese or anorexic), drug use, or rash.

Shoes- cut out can indicated pain/gout, space limitation/bunions, edema.

Hair, fingernails, and use of cosmetics- These are clues to personality, mood, lifestyle, and self regard.

Are their grooming standards typical of their age, lifestyle, or stage of life?

Question 7

What are some steps to taking an accurate blood pressure?

Answer 7

No smoking or drinking caffeinated beverages 30mins prior
Room should be comfortably warm
Sit quietly for 5 mins
Arm selected should be CLOT FREE.
Confirm brachial artery pulse
Make sure the brachial artery is at heart level

Question 8

What are the three goals in choosing the sequence of the physical exam?

Answer 8

Maximize the patients comfort
Avoid unnecessary changes in position
Enhance clinical efficiency

Question 9

Define white coat HTN

Answer 9

Bp is high but ambulatory pressures are normal, so CV risk is low. This constitutes 15-20% of state 1 hypertensives.
This maybe a conditioned response to being in the office
Relax the patient and remeasure bp later

Question 10

What are korotkoff sounds and how can you intensify them when taking a patients bp?

Answer 10

Just regular bp sounds.
Raise the patients arm before and after you inflate the cuff, the lower the arm and take bp.
You can also ask the patient to make a fist several times prior

Question 11

Emotional stress is frequently associated with illness don’t miss opportunities to acknowledge these clues. With this concept in mind answer the following question.

Your patient has been having difficulty being intimate with their partner but is having difficulty expressing this. When asked about their sexual activity they shrug and jokingly say, “it’s alright I guess, not like when I was 18 or anything”

How might you dig deeper to find the truth?

Answer 11

Address the patients feeling about the issue
Ask them what they feel the nature and cause of the problem is
Find out what the effect their problem is having in their life
Find out what their expectations are

Question 12

What might you suspect about a patient leaning forward with their arms braced?

Answer 12

They may have COPD

Question 13

Why might noticing an impaired gait be important when working with the elderly?

Answer 13

It can increase fall risk, and hip fracture risk rises as well, which can be severely life changing.

Question 14

How might you take the bp of a very obese patient?

Answer 14

Use a thigh cuff, or very long cuff, or wrap a cuff around the patients forearm and hold the arm at heart level.

Question 15

What is masked HTN and why is it problematic?

Answer 15

It’s the opposite of white coat HTN. The patient has normal bp in the clinic but high outside the clinic. This translates to a masked risk of CV disease.

Question 16

You send a well instructed patient home to monitor their bp 2x daily for a week. What should you be concerned about that would give you an inaccurate bp?

A) wrist and finger monitors introduce inaccuracies
B) The cuff width at 40% of the upper arm circumference
C)The patient uses a device with an automatic read out
D) The arm is level with the heart

Answer 16

A) Some devices used for convenience introduce inaccuracies

Distal sights have higher systole and lower diastole

Question 17

List causes of generalized itching without apparent rash.

Answer 17

Causes of generalized itching without apparent rash include dry skin, pregnancy, uremia, jaundice, lymphomas and leukemia, drug reactions, lice….

Question 18

Describe why artificial light is not optimal when examining the skin.

Answer 18

Artificial light can distort color and mask jaundice, so use natural light when possible.

Question 19

Where would you look to observe jaundice?

Answer 19

Look for the yellow color of jaundice in the sclera. Jaundice may also appear in the palpebral conjunctiva, lips, hard palate, undersurface of the tongue, tympanic membrane, and skin.

Jaundice suggests liver disease or excessive hemolysis of RBCs

Question 20

Describe a common etiology of tonsillar exudates.

Answer 20

tonsillar exudates are common in streptococcal pharyngitis

Question 21

What does a positive Finklesteins test indicate?

Answer 21

Identifies de Quervain’s tenosynovitis from inflammation of the abductor pollicis longus and extensor pollicis brevis tendons and tendon sheaths.

Question 22

What might urethrius, conjunctivitis, and arthritis indicate?

Answer 22

Reiters syndrome/reactive arthritis (recent infection then appearance of these symptoms). Can’t see, pee, or climb a tree.

Question 23

Sciatica can be increased how, in a clinical setting?

Answer 23

cough or valsalva (forced exhalation with closed airway)

Question 24

Define dysdiadochokinesis

Answer 24

This is when one movement cannot be followed quickley by its opposite and movements are slow, irregular, and clumsy. This can occur is cerebellar disease.

This is tested with the rapid actions test in the neuro exam. Hand flopping back and forth, or finger to thumb touching.

Question 25

What does a positive Romberg test indicate?

Answer 25

Ataxia from dorsal column disease and loss of position sense. Vision will compensate so closing the eyes tells you quickly if this has been happening. They usually fall quickly to one side.

Question 26

A new patient of yours tells their friends that they are very satisfied with you as their new physician. Statistically their satisfaction will be highest if which of the following is true

A) You have strong technical ability
B) You listen, interpret, and empower the patient
C) You begin and end your visits on time
D) You seem competent and confident

Answer 26

B is correct. These are signs of a strong communicator. Communication failures are often the source of patient complaints.

Question 27

What’s the best way to build rapport in the first minute of the visit?

Answer 27

Be as curious about the person as the reason that brought them in. Take a minute to connect with them.

Question 28

What are the 5 steps to being a good listener and why is this a critical skill for a great physician?

Answer 28

Receiving
Understanding
Remembering
Evaluating
Responding 

This skill is critical in the art of persuasion, rapport building, and expressing empathy

Question 29

Which of the following is the best way to communicate understanding to a patient?

A) I hear you are worried about ….
B) I understand what you are feeling
C) I too have a similar illness…
D) I know exactly how you feel right now

Answer 29

A is correct

You don’t know what a patient is feeling
Don’t disclose personal examples

Question 30

Which of the following is not a barrier to building effective rapport?

A) Our professional demands such as intense focus
B) Gender differences, and the fear of patients misinterpreting concern as an advance
C) Counter-transferance
D) Acknowledging personal patient experiences with appropriate empathy

Answer 30

D is correct

The other answers demonstrate the challenge before you in building rapport

Question 31

One barrier to gathering the full agenda is the patients frequently begin a detailed description of the first presenting problem. What are two approaches to deal with this?

Answer 31

Allow them to continue for a minute and then ask “are there some other things we need to address before you leave today?”

When its clear they are focused on one problem for a few minutes say “pardon my interruption, I want to hear about your ______ but first is there anything else we need to deal with before you leave today?”

Question 32

What is a systematic way to close an interview?

Answer 32

Summarize problem
Give diagnosis, explanation, meds, counseling
Asses patients desire to share in decision making
Make sure they understand the plan
They accept the plan
Asses barrier in follow through
Clarify both of your responsibilities

Question 33

How can you check for a patients acceptance of the plan ?

Answer 33

Do it directly

Ask them about the plan by saying, “how does that sound to you?”