PA exam 1 Flashcards
Define DDX
A list of possible diagnoses from which we must eliminate all other possibilities.
What is the single most important part of patient visit?
The history. 80% of the diagnosis
Subjective portion
Information we obtain from the patient (the history)
Objective Portion
Information we obtain through our own observations (that are reproducible)
Assessment portion
DDx or final diagnosis
Plan portion
What we will order to help us make the diagnosis or what we will do to tx the pt.
Comprehensive history
includes everything
Focused history
specific problem based history
Outline of the SOAP note
Identifying data
S: (CC) (HPI)(PMH-current med illnesses, allergies, meds, surgical hx, acc/injuries, childhood illnesses, immunizations, habits, psych, OBGYN)(Fam Hx)(Soc HX)(ROS)
O: Physical Exam
A: DDX, and assessment
P: Plan, Tx, orders for additional labs etc.
What do we include in the identifying data?
Name, Age, DOB, Hospital/chart no
Chief complaint
Part of S: primary reason a pt is seeking medical attention Stated in the patient’s own words
First sentence of the HPI
Age of pt, gender of pt, restatement of CC and duration of CC (chronologically)
S: (HPI)
elaboration of the chief complaint, the Sacred 7,
S: (PMH)
focuses on the general current (and past) health of the pt. should include: Current med problems allergies meds pysch illnesses childhood illnesses Prior surgeries/hospitalizations/accidents/injuries Immunizations OBGYN Habits (PMH not social hx)
S: (FH)
Age and health of immediate blood relatives, (M, F, Sib, Ch)
S: (Soc hx)
Occupation, marital status, Habits (some include here but I do not), psych (can be here or PMH), Sexual Hx (can be here or PMH)
S: (ROS)
laudry list of common symptoms organized by organ system.
O: (PE)
Physical exam
O: Labs/Xray
if available at the time the pt presents they go in O, if ordering they go in P
A:
DDX/ the results of tests being ordered
What is the difference between a sign and a symptom
A symptom is what the patient tells you, a sign is what you observe that is reproducible
Sign or Symptom? Headache
symptom
Sign or symptom? Chest pain
symptom
Sign or symptom? Itching
symptom
Sign or symptom? Heart murmur
Sign
Sign or symptom? Nausea
symptom
Sign or symptom? Diarrhea
symptom (at least we hope so)
Sign or symptom? double vision
Symptom and sign (on exam we can support this)
Sign or symptom? Dizziness
Symptom
Sign or symptom? erythematous TM
Sign
Sign or symptom? Temperature of 102
Sign and symptom (the pt can tell you they took it at home and you can see by taking their temp.)
Sign or symptom? Weight loss
Sign and symptom
Sign or symptom? Wheezing
sign and symptom
The sacred seven
S: (HPI)-
Location-Where is the pain?
Quality-sharp, dull, aching, continuous
Quantity (or intensity)-scale of 0-10
Chronology (or duration)-when did it first start, how long has it been going on, better worse or the same?
Setting-what were you doing when it started?
Aggravating (or alleviating factors)-anything make it worse or better?
Associated manifestations-Weight loss, swelling, loss of appetite?
Levine sign
closed fist on chest description might include MI
Medical illnesses should include any hx of….
DM, Hypertension, CA, MI, CV DZ, Respiratory, Osteoporosis,
Allergies
Either NKA (if none at all), NKDA (if no drug allergies but something else) MAKE SURE TO INCLUDE WHAT HAPPENS IF THEY ARE EXPOSED TO THE ALLERGEN
CAGE
C: have you ever felt you should Cut down on your drinking?
A: Have people Annoyed you about your drinking?
G: Have you ever felt Guilty about your drinking?
E: Have you ever had an Eye opener (first drink in AM)
total score of 2 or higher is considered clinically significant
T/F You should include all lab results, X-ray results, CT or MRI results in your Assessment?
F-results of labs, CT MRI etc should go in OBJECTIVE data!
What is the basis of information for the assessment part of the SOAP note
subjective data in the HPI and objective data in physical exam (lab and X-ray results) are used to make the DDX or Dx which goes in the Assessment part of the note
What are the important pt issues in the PE
Equipment-make sure it’s available and working
Environment-comfortable and private
Identify-yourself and role (last name is PA-S)
Respect-pt’s privacy and modesty at all times
Wash your hands!!!-in fromt of the pt.
Which statement about ophthalmic exam is correct?
A. you should always use your right eye to examine the pt’s left eye and your left eye to examine the pt’s right eye.
B. You should always examine the pt’s eye with your dominant eye.
C. You should always use our Right eye to examine the patient’s right eye, and your left eye to examine the pt’s left eye.
C. you should always examine the pt’s left eye with your left and right with your right
This way you are not bumping noses and “kissing” the pt when you examine them
General survey of the pt should include….
Body language of the pt Apparent age vs. pt's stated age overall appearance (robust, emaciated) Overt signs of distress or dz Obvious deformities (amputations blindness kyphosis) Person hygeine Posture/gait Level of consciousness Ht., Wt., VS (temp, BP, HR, Resp, Pain),
T/F rectal temps are about 0.5 degrees lower than oral
F-Rectal temps are about 0.5 degrees higher than oral
What will a cuff that is too small give you for a BP
A falsely high BP
What will a cuff that is too large give you for a BP
A falsely low BP
What are the first sounds you hear when you release the pressure on the cuff and what do they represent?
Korotkoff sounds - represent the systolic pressure
What does the last sound you hear when taking a BP indicate?
Diastolic pressur
What does NB on a BP stand for
noto bene-NB when the beats don’t quit! instead it is where the sound became muffled or changed in tone
Parameters for BP normal reading
Ideal BP is 120/80, systolic should be <80
How do you classify a orthostatic hypotension?
difference of 20mmHg lower systolic from lying flat to standing, or a 10mm lower diastolic
T/F pain is subjective?
T. Pain is subjective. Tenderness is objective
What is the ROS
review of systems, a systemic approach to the symptoms that may uncover dz. Should be called the review of symptoms :)
If you uncover information relevant to the pt’s CC where does that info get recorded?
HPI-not the ROS
Systemic components of ROS
General, skin, HEENT, Neck, breasts, respiratory, CV, GI, GU, Peripheral Vascular, Musculoskeletal, Neuro, Heme, endocrine, psych
O: (ROS) (General)
Usual state of health, Fever, chills, night sweats, weight changes, fatigue
When our temperature is rising we feel ______
Cold
When our temperature is falling we feel ______
Hot
What is temp regulated by?
The hypothalamus
T/F for ROS you should always write negative responses first?
F You should always list positive responses first
What percentage of malpractice law suits are based on poor communication skills?
85%
According to the text what are the two central components of doctor-patient interaction
Art of speaking, and Active listening
mnemonic for working with interpreters
I-introduction N-Note goals T-transparency E-ethics R-respect beliefs P-patient focus R-retain control E-explain T-thanks
What is Schwartz’s “rule of 5 vowels?”
Audition-listening carefully
Evaluation-sorting relevant/irrelevant
Inquiry-probing into significant areas to obtain clarification
Observation-Nonverbal communication regardless of what is said
Understanding-concerns and apprehension of pt in order to be more empathetic
What is proxemics?
The technical term for personal space
When was HIPAA enacted?
1996
What is an open ended question?
A question that cannot simply be answered with a yes/no.
What are the four basic principles of PE
Inspection, Palpation, Percussion, Auscultation
According to the text, in examining the skin of a pt. the examiner must…
- Identify the primary lesion
- Identify it’s distribution
- Identify any associated findings
- Consider the age of the pt.
CC: ear pain, Pt tells you that they are also having some throat pain Where does this belong?
(S) (HPI)-under the sacred 7-associated manifestations
CC: Ear pain, on exam you notice the pt has a red TM, where does this belong?
(O)(HEENT)
CC: Nausea. When asked the pt states he does have a history of Upper back pain as well
(S)(PMH)(Med illnesses)
CC: Bilateral ankle swelling. Pt tells you he takes a daily multivitamin and nothing else.
(PMH)(Med list)
CC: Bilateral ankle swelling. Pt states that he is allergic to peanuts, when he eats them his throat swells up and he can’t breathe.
(PMH)(Allergies)
