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Emma > MIDPR > Flashcards

MIDPR Flashcards

1
Q

Organizing the story

A 
Chief Concern
HPI: History of Present Illness
PMH: Past Medical History
SH: Social History
FH: Family History
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2
Q

PMH

A
  1. Chronic Illnesses/Hospitalizations
  2. Previous Surgeries
  3. Daily Medications (name/dose/freq)
  4. ALLERGIES to Medications
  5. Obstetric/Gynecologic History
  6. Health Maintenance

*mental health/MAT?

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3
Q

Obstetric/Gyn History

A

Number of pregnancies
Number of live births

LMP
Previous Pap smear
Abnormal Pap smears
Periods
Frequency
Duration
How heavy
Contraception
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4
Q

Health Maintenance

A 
Pap smear
Mammogram
Colonoscopy
Cholesterol
Vaccines/Chicken Pox
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5
Q

Social History

A
  1. Home/Family
  2. Work/School (stress, money, unemployment)
  3. Sex
  4. Tobacco
  5. Alcohol
  6. Drugs
  7. Seatbelts/Helmets/Distracted Driving
  8. Guns
  9. Intimate Partner Violence
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6
Q

Social History: Rule of 3’s

A

General: home, work, sex
Substances: tobacco, alc, drugs
Safety: seatbelts/hemlets/DD, guns, intimate partner violence

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7
Q

Home

A

Whom do you live with?
How are things with your wife/husband/partner?
How are your kids/parents?

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8
Q

Work/Education

A

School: Grades, Stress

Work: Money, Unemployment, Stress
*Do you work outside your home?

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9
Q

Sex

A

Avoid judgmental questions/Ask instead about behaviors

Do you use condoms? Every time?

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10
Q

Cigarettes

A

Do you smoke cigarettes?
How much?
For how long?
When are you quitting?

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11
Q

Alcohol

A 
Do you drink alcohol?
How much?
Social, occasional, etc. is unacceptable
Arrests? Blackouts?
Family History

*CAGE, AUDIT screen

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12
Q

CAGE

A

for alcohol abuse

C - cut down?
A - annoyed with you?
G - guilty?
E - eye opener?

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13
Q

Drugs

A 
Do you use illegal drugs
Do you use drugs not prescribed to you?
How often? 
How much?
For how long?
Smoked/Inhaled/Injected?
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14
Q

Seatbelts/Helmets/Distracted Driving

A

Do you always wear a seatbelt when you are in the car?

Do you always wear a helmet when you ride your bicycle, rollerblade, etc?

Do you put your phone away when you drive?

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15
Q

Guns

A

Do not assume
Locked up?
Ammunition stored separately?

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16
Q

Intimate Partner Violence

A

Screen men too

Does your partner ever hit you, hurt you, shove you, make you feel scared?

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17
Q

Other Important Considerations

A 
Spirituality
Nutrition/Exercise
Caffeine
Ability to afford medications
Access to transportation/care
Food Security
Health Literacy
Military History
Incarceration
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18
Q

Military History

A

Did you see combat, enemy fire, casualties?
Were you or a buddy wounded, injured, or hospitalized?
Did you ever become ill while in the Service?
Do you have any concerns about returning to civilian life since you’ve been back?
How has your family adjusted to your being home?

Thank you for serving.

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19
Q

Incarceration

A

Some of my patients have been incarcerated and this can affect their health.
Have you ever been incarcerated?
If Yes…
How long was your most recent period of incarceration?
When were you released from prison?
Do you know if you have been screened for HIV/Hep C?
Better not to ask for the reason for incarceration.

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20
Q

Family History

A
  1. Heart attack/Stroke
  2. Diabetes mellitus
  3. Breast CA/Prostate CA
  4. Colon CA
  5. Mental Illness
  6. Substance abuse
  • Start Open-ended
    Pertinent Negatives
    HTN and CHL not as important
    Age of family member at onset of disease
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21
Q

Pain Hx

A

Onset
Site (diagram)
Character (NPP)
Intensity (resting, movement, now, worst)
Effects (sleep, work, function, family, mood)
Meaning (expectations, beliefs, knowledge, culture)
CAM use (acupuncture, hypnosis, etc)

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22
Q

Pain goals

A

Decrease pain intensity (resting and with activity)

  • Rehabilitate/ restore (PT, OT, psychology)
  • Vocational counseling/ retraining, re-entry
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23
Q

“SIG-E-CAPS”

A

Sleep disorder* (increased or decreased)

Interest deficit (anhedonia)

Guilt (worthlessness, hopelessness, regret)

Energy deficit*

Concentration deficit*

Appetite disorder* (increased or decreased)

Psychomotor retardation or agitation

Suicidality

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24
Q

Screener and Opioid Assessment for Patients with Pain (SOAPP)

A

SOAPP-5: each item scored 0 (never) - 4 (usually)

  • Mood swings?
  • Smoke cigarette within an hour of awakening?
  • Medication use other than as prescribed?
  • Legal problems including arrest in your lifetime?
  • Document therapies, PGE, targeted physical exam
25
Q

Sexual hx

A
  • Partners
  • Practices
  • Protection against STDs
  • Past History of STDs
  • Pregnancy Prevention
26
Q

Sexual hx (details of the 5 P’s)

A 
Gender identity of patient and partners
• Number of partners
• Sexual orientation
• Sexual activity
• Sexual coercion and abuse • Frequency of intercourse
• Type of sex practices
• Contraceptive behaviors • STI history and risk
assessment
• Pregnancy history and risk assessment
• Substance use
27
Q

Sexual hx Qs

A

Start with open ended questions
“Men, women or both”
“Are you sexually active?”
“Tell me about your sexual partners / relationships?” “Who are you sexually active with?”
“What kinds of sexual activity do you enjoy?”
“In your sexual relationships, which of your body parts go inside of your partner? Do any of your partner’s body parts go inside of your body?”

28
Q

Things to avoid in sexual hx

A

Failing to take a sexual history alone

Making assumptions (gender, orientation, practices)

Using gendered language (husband, wife) or specific language (partner instead of partners)

Assuming only visible relationships (i.e. patient presents with wife therefore no other relationships)

Failure to identify risk behaviors (oral or anal intercourse)

Failure to ask appropriate clarifying questions

(“what do you mean by ‘hook up?’”)

29
Q

Normalize

A

“I ask all my patients these questions”

30
Q

HEADDSS (for approaching adolescents)

A 
H = home
E = education
A = activities
D = diet
D = drugs/alcohol/tobacco
S = sex
S = psyche/suicidality

*CHEADDSS –> confidentiality statement at the beginning:

“Our conversation will be private and confidential. I will spend a few minutes talking to you privately about your health issues and do the same with your parents. In cases where we identify a very serious problem, we will talk about how to let others know about it.”

31
Q

Reasons to Break Confidentiality: the 3 harms

A
  1. Harming self
  2. Harming others
  3. Someone harming them
32
Q

ESP (Eating Disorder Screen for Primary Care)

A
  • Are you satisfied with your eating patterns?
  • Do you ever eat in secret?
  • Does your weight affect the way you feel about yourself?
  • Have any members of your family suffered with an eating disorder?
  • Do you currently suffer with or have you ever suffered in the past with an eating disorder?
33
Q

SCOFF (for eating disorders)

A
  • Do you make yourself Sick because you feel uncomfortably full?
  • Do you worry you have lost Control over how much you eat?
  • Have you recently lost more than One stone (14 lb or 7.7 kg) in a three month period?
  • Do you believe yourself to be Fat when others say you are thin?
  • Would you say that Food dominates your life?
34
Q

CRAFFT (for drug use)

A 
C – driven in a CAR
R – use drugs/alcohol to RELAX
A – use drugs/alcohol ALONE
F – FORGET things while using 
F – FRIENDS tell you to cut down
T – ever been in TROUBLE
35
Q

Sex vs. gender vs. orientation

A

sex: assignment at birth
gender: how you identify (woman/male/transgender/genderqueer/
questioning/cisgender)
orientation: Who are you attracted to?

36
Q

Transgender

A

Umbrella term for anyone whose identity, appearance, behavior, etc. challenges societal expectations

Transsexual
Crossdressers
Intersex condition
Gender queer

37
Q

How do you ask sexual gender/orientation questions?

A

Confidentiality
I ask all my patients….
Why you are asking
Risk/screening/prevention

“are you in a relationship”
“who are you attracted to”

38
Q

How to ask drugs/alc…

A

I would like to ask about your use of alcohol. Is that OK?
Tell me about your alcohol use
And your drug use?
For example, cigarettes and marijuana.

Are you prescribed medications? Which?
Any others for anxiety or pain?
Other drug use?
     cocaine, opioids, methamphetamines
Have you been treated for substance problems?
39
Q

Other questions when asking about alcohol use:

A 
Quantity (concrete amount)?
Frequency?
What is type of alcohol do you typically drink?
When did you start drinking?
Who do you drink with?
Where do you normally drink?
What time of day do you drink?
Have you ever tried to stop drinking?
How do you pay for the alcohol?
Why do you drink?
How does drinking make you feel ?
40
Q

Questions about drug Use

A 
What type of drugs?
When did this start?
Frequency?
Method of administration
Have you ever been in trouble because of your drug use?
Who do you do the drugs with?
Have you ever tried to stop using?
How do you pay for the drugs?
How do they make you feel?
41
Q

CAGE

A

C- Have you ever thought you should CUT down?
A‐Are you ever ANNOYED by others’ complaints?
G‐ Have you ever felt GUILTY over drinking?
E‐ Have you ever had an EYE‐OPENER?

42
Q

AUDIT questionnaire: screen foralcohol use/misuse

A
  1. How often do you have a drink containing alcohol?
  2. How many standard drinks containing alcohol do you have on a typical day when drinking?
  3. How often do you have six or more drinks on one occasion?
  4. During the past year, how often have you found that you were not able to stop
  5. During the past year, how often have you failed to do what was normally expected of you because of drinking?
  6. During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session?
  7. During the past year, how often have you had a feeling of guilt or remorse after drinking?
  8. During the past year, have you been unable to remember what happened the night before because you had been drinking?
  9. Have you or someone else been injured as a result of your drinking?
  10. Has a relative or friend, doctor or other health worker been concerned about your
    drinking or suggested you cut down?
43
Q

AUDIT–C (CONSUMPTION)

A
  1. How often to you have a drink containing alcohol?
  2. How many standard drinks containing alcohol do you have on a typical day?
  3. How often do you have six or more drinks on one occasion?
44
Q

UNCOPE (assessing alc/drug use)

A

U- Have you spent more time drinking or USING than you intended to?
N- Have you ever neglected some of your usual responsibilities because of using alcohol or drugs?
C- Have you felt you wanted or needed to CUT down on your drinking or drug use in the last year?
O- Has your family, a friend, or anyone else ever told you they OBJECTED to your alcohol or drug use?
P- Have you found yourself thinking (PREOCCUPIED) a lot about drinking or using?
E- Have you ever used alcohol or drugs to relieve EMOTIONAL discomfort, such as sadness, anger, or boredom?

45
Q

Assessing mental health

A

Begin with general Qs –> How are things in life overall?

Where do you live and with whom
Are you working, what is your job
How are these things going for you

f/u Qs: mood, worries, relationships, sleep, appetite, work performance and overall satisfaction and well being

  • substance use, trauma and safety in home and relationships
46
Q

Hx of mental health/substance abuse tx

A 
Outpatient visits/therapy
Hospitalization
Medication
Current vs. Past Problems and Treatment
Helpful vs. Not Helpful
47
Q

Things to discuss with mental health pt

A

Stressors in your life
Specific concerns with mood or behavior
Coping skills and approaches

48
Q

SIG E CAPS

A

Sleep (Any changes in your sleep?)
Interests (Have you been less interested in your hobbies?)
Guilt (Do you feel hopeless, helpless, worthless, or a like a burden?)
Energy (Have you lost energy?)
Concentration (Has it been harder to focus?
Appetite (Has your appetite been more or less than usual?)
Psychomotor retardation/agitation*
Suicide (Do you want to die? Do you have a plan? Do you have means or access to this plan?)

49
Q

Q about suicidal idealizations

A 
Ever
Current or recent
Plan
Actions
Previous attempts
How are you now
50
Q

Altman Rule

A
  1. Locate the grams of sugar, protein
    and fiber on the food label. Be sure to check the serving size.
  2. Make sure there are at least 3 grams of fiber.
  3. Add the grams of protein and fiber:
    4 g protein + 3 g fiber = 7 g
  4. Compare the grams of protein and fiber to the total grams of sugar.
    7 g protein & fiber < 20 g sugar
  5. If the grams of protein + fiber total is greater than (>) total grams of sugar, the product is a good choice, if it is less than (
51
Q

Healthy eating on a budget

A

Avoid “out food.” Home cooked food is less $ and much healthier.
Organize frig/freezer/pantry to avoid wasting food.
Label leftovers with date, eat before they go bad.
Get flyers/coupons from grocery store.
Plan meals around what’s on sale (out of season F/V –> frozen)
Buy foods on sale in bulk, freeze what you don’t use.

52
Q

Nutrition hx

A 
Usual Day’s Intake
Yesterday’s Intake
-Be thorough, sort of
-Stay quiet (don’t give advice during history)
Servings of Fruits/Vegetables per Day
53
Q

Motivational interviewing –> use the ___ scale

A

On a scale of 1-10, how important is it for you to make this change?

If they say “3,” Why are you at 3 and not 1?

54
Q

Top 20 behaviors to change

A
  1. Nutrition
  2. Cigarettes
  3. Exercise/Screen time
  4. Seatbelts/Helmets
  5. Alcohol/Drugs
  6. Condoms/Contraception
  7. Stress Management
  8. Medication Adherence: HTN, Depression
  9. Screening: Pap smear, Colonoscopy, Mammogram
  10. Vaccines
55
Q

Using tech in the clinic

A

When working with patients
“I have an app for that…”
“Let me show you what I’ve found…”

When working with attendings/residents
“Let me look that up for you…”
“I’ll check that dose right now…”
“I’m going to make note of that…”

56
Q

RSVP (for compassion)

A

Reflect (I hear what you’re saying)
Sympathize (I am sorry)
Support (I am here if you need help or support)
Validate (it’s understandable that you would feel uncomfortable making this decision.”
Partnership (We will work on this together)

57
Q

Pt centered care

A

“What’s your understanding of this condition?”

“let’s watch how you do and f/u in X days/weeks”

58
Q

Talking with terminally ill

A

ASSESS PROGNOSTIC AWARENESS
What is your understanding of your illness?

When you think about the future, what are your hopes for your health?

What are your worries?

SHARE YOUR HOPES/WORRIES
Function:
“I hear you’re hoping for _______and I worry the decline we have seen is going to continue.”

Time:
“I hear you’re hoping for _______and I worry something serious may happen in the next few (wks/months/yrs)

EXPLORE WHAT’S MOST IMPORTANT TO THE PT
“If your health were to worsen, what is most important to you?”

“And what else?”

“How much do your family and friends know about your priorities and wishes?”

Emma (18 decks)

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