Phys exam and Hx taking (Ch. 1) - Bates

Question 1

What are the 7 components to a comprehensive adult hx?

Answer 1

1) identifying data/source of the hx
2) CC
3) Present illness (HPI)
4) Past hx (PMH)
5) Family hx
6) Personal/Social hx
7) ROS

Question 2

Meds should include ___, ___, ___, and ___ of use.

Answer 2

name, dose, route, frequency

Question 3

Allergies must include ___ to the med/food.

Answer 3

reaction

Question 4

Pack-year is calculated by multiplying the # of ___ times the # of ___ the pt has smoked.

Answer 4

packs, yrs

Question 5

The ___ hx captures the pt’s personality and interests, sources of support, coping style, strengths, and fears.

Answer 5

social

Question 6

The ___ comes at the end of the interview and should go from ___-to-___.

Answer 6

ROS, head-to-toe

Question 7

In the ROS, ___ includes, weakness, fatigue, low energy, wt changes, fever.

Answer 7

general

Question 8

Thyroid trouble, heat/cold intolerance, excessive sweating, excessive thirst/hunger, and polyuria all fall under what category?

Answer 8

Endocrine

Question 9

What equipment will you need for a physical exam?

Answer 9

opthalmoscope/otoscope, flashlight/pen light, tongue depressors, thermometer, watch w/second hand, sphygomanomater (b/p), stethoscope, gloves, lubricant for pelvic/rectal exams, vaginal specula (female), reflex hammer, tuning forks, Q-tips/cottonball

Question 10

Visualize ___ area of the body at a time.

Answer 10

one

Question 11

The physical exam relies on 4 techniques including:

Answer 11

inspection, palpation, percussion, auscultation

Question 12

___ precautions include hand hygiene and gloves and deal w/bld, body fluids, secretions, excretions, nonintact skin, mucous membranes.

Answer 12

Standard

Question 13

___ precautions are used to prevent HIV, hepatitis, and other bld-borne pathogens. Protective barriers include gloves, gowns, aprons, masks, and protective eyewear.

Answer 13

Universal

Question 14

It’s important to minimize how often you ask the pt to ___ ___.

Answer 14

change positions

Question 15

Inspect and palpate the ___ ___ ___ on the neck and note any masses or enlgment.

Answer 15

cervical lymph nodes

Question 16

Pt should be in the ___ position while assessing the abdomen.

Answer 16

supine

Question 17

When assessing the ___ ___ system includes palpating the femoral pulses, inguinal lymph nodes, inspecting for lower ext edema, and palpate for pitting edema. Also inspect for varicose veins.

Answer 17

peripheral vascular

Question 18

When assessing the ___ system, note for any deformities or enlged joints and check for ROM. Also inspect the alignment and the spine and ext.

Answer 18

musculoskeletal

Question 19

When assessing the ___ system, assess lower ext bulk, tone, and strength, assess sensation and reflexes and observe any abnorm mvmts. Also observe the pt’s gait and ability to walk heel-to-toe, walk on the toes, walk on the heels, hop in place, and do shallow knee bends.

Answer 19

nervous/neurological

Question 20

If you can touch it and reproduce the pain, it’s most likely ___ in origin.

Answer 20

musculoskeletal