Session 1: History

Question 1

SHEEADSS I’M Very Good

Answer 1

Strengths: strengths or interests

Home: household relationship/family dynamics

Education/employment: school, grade, etc.

Activities

Disabilities/drugs

Sleep/safety/self image/sleep sexuality/suicide/self mutilation

Internet

Media

Violence

Gang

Question 2

CAGE Questionnaire

Answer 2

Four-question screening tool that evaluates substance use

*Can also be used to identify patterns, consequences, and tolerance of alcohol and other drugs

Question 3

Inventory History

Answer 3

Listed problems that the patient is asked and checks off if they have; used more in adult medicine

Question 4

Problem-focused history

Answer 4

Taken for acute illness

Question 5

Interim History

Answer 5

History of what has happened between last visits

Question 6

Recapitulation

Answer 6

Useful when a long complicated history or unusual history is presented
*Summarize frequently, especially with unusual histories

Question 7

Sentence Completion Game

Answer 7

Psychodiagnosis/type of communication tool

*Give the first part of the sentence, child completes the second half of the sentence

Ex: I feel bad when I…

Question 8

Developmental Considerations when taking history of baby 0-8 Months (3) Overview…

Answer 8

1. Examine the child in the mother’s lap
2. Once child is able to grasp, give the tongue blade to the child and see what the infant does with it
3. Show parents how to react to the child

Question 9

Communication with Child 0-2 months old (3)

Answer 9

1. Note child’s ability to self-quiet and observe tracking behaviors
2. Engage the infant by being face-to-face
3. Watch them coo

Question 10

Communication with Child 3-7 months old (5)

Answer 10

1. Note social responsiveness
   - -Should be very social: smiling, peek-a-boo, etc.
2. Reaching out play
3. Mother-child interactions
   - While you watch interactions, note if they are using legs and hands equally
4. How does child use hands and mouth in exploration?
5. How does the parent see the child?

Question 11

Communication with Child 8-12 months old (5)

Answer 11

1. At 8 months –> object permanence and infant hatching occurs (coming in to his or her own)
2. Greater sense of self
3. If you take off something, put it back on to make sure infant feels safe
4. Put stethoscope on mom’s arm first, then infant’s chest
5. Develops separation anxiety

Question 12

Communication with Child 12-18 months old (3)

Answer 12

1. Age of separation anxiety
2. Observe the child’s social distance - the limit of proximity that the child allows you before showing signs of distress
3. Does child appear depressed? baby’s reflect maternal depression

Question 13

Communication with Child 18 months-2 years old

Answer 13

18 months-2 years old = Toddlerhood

1. Communication by observation
   - Look for interactions with toys and caretakers
   - Look for aggressive behavior or hyperactivity
2. Look for maternal-child mismatch

Question 14

Preschool age

Answer 14

2-5 years old

Question 15

Interviewing the child 2-3 years old (2)

Answer 15

1. Ask the child’s name and age, guess wrong and play game with child
2. Play with puppets nurse-doctor games; have a medical kit in the office and have the child play with it and a doll

Question 16

Interviewing the child 3-5 years old (3)

Answer 16

1. Obtain initial history from child; by 2 years old you want to talk to the kid a lot
2. Draw-a-person test
   - gives idea of how they can handle a pencil and how developed they are
3. Has no concept of illness

Question 17

Pre-Schoolers Development (4)

Answer 17

1. Concept of illness is not clear, feel guilty when someone is sick around them
2. Cannot judge size well
3. Does not understand concept of time or people permanence
4. Ask child what they think made them sick
   - introduce germs, give band-aids, allow child to cry if upset

Question 18

School-Aged Children

Answer 18

6-10 years old

Question 19

Communication with School-Aged Child (6)

Answer 19

1. Sense of mastery and privacy is very important
2. Oriented toward peer-group
3. Ask about school life
   - Ask if child wants to stay home or go to school. If wanting to stay home, suspect learning disability, emotional difficulties, or separation difficulty
4. Very concrete thought processes; tend not to talk and keeps feelings inwards
   - Can be very quiet or introverted
5. Ask about social life and obtain peer history
6. Ask about home life (3 wishes)

Question 20

Communication with Adolescents 11-? (3)

Answer 20

1. It is now time to talk to the child on their own, without a parent present
2. Confidentiality issues and explanation
   - Set the scene, explain confidentiality and when confidentiality can be breached
3. Ask about sexuality in private after establishing boundaries

Question 21

Non-consensual sex definition

Answer 21

4 years apart is considered not consensual (ex: 9 year old and 13 year old)

16 years old is age of consent with adults

Question 22

The Five P’s in Sexual History

Answer 22

1. Partners
   - amount, type
2. Prevention of Pregnancy
   - preventative measures?
3. Protections from STDs
   - preventative measures?
4. Practices
   - Vaginal, anal, oral?
   - do you use condoms?
5. Past history of STDs

Question 23

Edinburg Postnatal Depression Scale (EPDS)

Answer 23

Screening for post-natal depression should be done 2 weeks, 6-8 weeks
*Designed for use at 6-8 weeks

Question 24

HITS Screening tOOL

Answer 24

HITS = hurt, insulted, threatened with harm, partner violence

How often does your partner:

1. Physically hurt you?
2. Insult or talk down to you?
3. Threaten you with harm?
4. Scream or curse at you?

Answers: 1=never, 5=frequently

Range is 4-20, and greater than 10 is positive

Question 25

CRAFFT Questionnaire

Answer 25

For Alcohol use CRAFFT --> 1. CAR -- have you ever been in car with someone under the influence? 2. RELAX -- do you use drugs or alc to relax? 3. ALONE -- do you use drugs or alc when you're alone? 4. FORGET -- do you forget things while using drugs or alc? 5. FRIENDS --do they ever tell you to cut down or quit? 6. TROUBLE -- do you ever get into trouble?

Question 26

Patient Health Questionnaire-2 (PHQ-2)

Answer 26

Over past 2 weeks, how often have you been bothered by any of the following: 1. Little interest or pleasure in doing things 2. Feeling down, depressed or hopeless (range is 1-3 points per question) A score of 3 or more means you need to do PHQ-9

Question 27

History of Present Illness OPQRST

Answer 27

``` O = onset P = Promoting, preventing, precipitating, palliating factors Q= Quality or quantity R = Region or radiation S= severity, setting, simultaneous symptoms T= temporal factors ```

Question 28

Pre-natal history cfDNA screening

Answer 28

10 week cell-free DNA screening; identifies trisomy, Down syndrome, fetal sex

Question 29

15-20 weeks gestation prenatal Quad screen

Answer 29

Risk of down syndrome (trisomy 21), trisomy 18, and open neural tube defects such as spina bifida

Question 30

High Grade Ultra Sound Pre-natal screen

Answer 30

Done at 16-18 weeks

Question 31

Genogram (4)

Answer 31

1. Male = square 2. Female = circle 3. Male is placed to the left of the female in the father/mother dyad 4. Children are noted oldest to youngest, left to right

Question 32

Genogram: Liason

Answer 32

Denotes a couple living together, unmarried | *Denoted by a dotted line between the male and the female, rather than a solid line

Question 33

Genogram: Separtism

Answer 33

Marked with one slashed line

Question 34

Genogram: Divorce

Answer 34

Marked by two slashed lines

Question 35

Genogram: death

Answer 35

Indicated by an "x" through the shape. the birth date and death date are recorded

Question 36

Genogram: remarriage

Answer 36

Remarriage is shown to the side with a smaller shape

Question 37

Heritability

Answer 37

Measures the contribution of genetics (compared to environment) in development of a particular disorder

Question 38

Recurrence risk

Answer 38

Likelihood that a trait or disorder present in one family member will occur again in other family members in the same or subsequent generations

Question 39

NEEDSS in history taking

Answer 39

``` Nutrition Elimination Education, environment Development, daycare Sleep, sexuality (if adolescent) Safety ```

Question 40

Environmental Health Anticipatory Guidance Topic at prenatal or first visit (5)

Answer 40

1. Home, 2. ETS, 3. mold, 4. occupational exposures, 5. breast/bottle issues

Question 41

Environmental Health Anticipatory Guidance Topic at 2 months (3)

Answer 41

1. ETS, 2. Sun exposure, 3. mold

Question 42

Environmental Health Anticipatory Guidance Topic at 6 months (3)

Answer 42

1. poisons, 2. household pesticides, 3. lead

Question 43

Environmental Health Anticipatory Guidance Topic at preschool

Answer 43

arts and crafts

Question 44

Environmental Health Anticipatory Guidance Topic for seasons (4 summer/spring, 2 fall/winter)

Answer 44

Spring/Summer: lawn, garden products, services Fall/winter: wood stoves/heating

Question 45

Interval history must include... (6)

Answer 45

1. Chief complaint 2. HPI 3. Brief significant past medical history 4. All meds/confirm allergies 5. Activities of daily living 6. NEEDS

Question 46

Interpretation

Answer 46

Move beyond clarification to an inference that can be made from the circumstances presented

Question 47

Confrontation

Answer 47

Pointing out contradictions between actions and feelings

Question 48

Perinatal history includes (7)

Answer 48

1. Birth history (type of delivery, problems?, Apgar) 2. Ease or difficulty of labor 3. Duration of labor 4. Type of anesthesia 5. Attendance by other family members 6. Birth order if multiple births 7. If C-section, why?