Symptom Development; ROS; Clinical Reasoning

Question 1

Components of Patent History

Answer 1

chief complaint (CC)
history of present illness (HPI)
past medical history (PMH)
     -medication list 
     -allergy 
family history 
social history 
review of systems

Question 2

Cardinal Techniques

Answer 2

inspection
auscultation
palpation
percussion

Question 3

Physical Evaluation

Answer 3

general survey
extraoral
intraoral

Question 4

7 Attributes of a Symptom

Answer 4

location 
quality 
quantity or severity 
timing (onset, duration, frequency) 
setting in which they occur 
relieving or aggravating factors 
associated manifestations

Question 5

OLD CARTS

Answer 5

Onset 
Location 
Duration 
Character 
Aggravating/Associated factors 
Relieving factors 
Temporal factors (time)
Severity

Question 6

PQRST

Answer 6

Precipitating/Palliating factors 
Quality 
Radiation 
Severity 
Temporal factors (time)

Question 7

Bleeding

Answer 7

loss of blood from circulatory system

 - blood vessel damage 
 - bleeding disorder 
 - internal 
 - external

Question 8

Bleeding - Content Items to Ask

Answer 8

source 
duration 
nature 
frequency 
severity

Question 9

Bleeding - Possible Causes

Answer 9

hemophilia; laceration/trauma; gingivitis; aspirin; nonstop bleeding is a primary sign of leukemia; vitamin deficiency or using a particular vitamin….
***oral bleeding can also come from the esophagus or nose

Question 10

Pain

Answer 10

a localized sensation that can range from a mild discomfort to an unbearable and excruciating experience
result of stimulation of sensory nerves following injury or caused by disease

Question 11

Psychological Aspects of Pain

Answer 11

associated with distress, anxiety, and sometimes fear
variations in pain thresholds
cause and circumstance effect perception
-kids cry when parents make a big deal when they fall
unexplained pain is often worse because of lack of diagnosis and patient anxiety
pain may be reduced by…
-arousal (ex. adrenaline)
-mental preparation (ex. childbirth)
response modified by past experiences
cultural difference in pain expression

Question 12

Types of Pain

Answer 12

descriptive
-throbbing
-shooting
-aching
-gnawing (constant pain)
-stabbing (sharper, short bursts)
each descriptor indicates a different source of pain
intensity: mild - severe
referred pain: pain felt at a point some distance from the disorder
-ex) heart attack: pain in left arm and left jaw
-ex) phantom limb pain

Question 13

Pain - Content Items to Ask

Answer 13

location 
     -localized, diffuse, superficial, deep, radiating?
quality and severity
     -"pain language" (pain type) 
timing 
     -continuous, episodic (pain, no pain, pain... over a short time fame), or recurrent (pain went away for a while, maybe a few months, and came back)?
context 
     -spontaneous, inciting factors?
modifying factors
     -activity, rest, distraction

Question 14

Pain - Experiences

Answer 14

everyone experiences pain differently

- variable timing 
- variable intensity 
- variable quality

Question 15

Pain - Possible Causes

Answer 15

trauma; abscess; toothache; exposed nerve; sinus pressure; salivary gland pressure (salivary stone); lymph node pressure; ear infection; neurologic pain; brain tumor (nerve compression); shingles (burning searing pain)

Question 16

Swelling

Answer 16

edema: an abnormal accumulation of fluid in body tissues
swelling = visible edema
-important to note that sweeping isn not ALWAYS from fluid
local
general
-if part of hear isn’t functioning right, legs can swell
-probably not just a toothache if whole face is swollen

Question 17

Swelling - Content Items to Ask

Answer 17

interference during swallowing or opening
-concerned about compromised airway
location
context
associated symptoms (pain)
duration

Question 18

Swelling - Possible Causes

Answer 18

infection; trauma; ALM; endocrine disorder; kidney failure; liver failure; mumps; cardiovascular disease; cancer; malnutrition

Question 19

Clinical Reasoning

Answer 19

three types of reasoning clinicians use for clinical problem solving

 - pattern recognition 
 - development of schemas 
 - application of relevant basic and clinical knowledge

Question 20

Steps to Clinical Reasoning

Answer 20

1. identify abnormal findings
2. localize findings anatomically
3. cluster the clinical findings
4. search for the probable cause of the findings
5. cluster the clinical data
6. generate hypotheses about the causes of the patent’s problems
7. test the hypotheses and establish a working diagnosis