The History & Physical as related to Health Promotion/ Disease Prevention

Question 1

Conventional Hx

Answer 1

• When evaluating symptomatic patients, questions relate to current situation
• Risk assessment performed to explain current signs and symptoms
• Oriented to the present, not future

Question 2

Prevention Hx

Answer 2

• Risk factors ARE the primary problem
• Goal: to prevent future disease processes from occurring
• Risk Factor-based thought process

Question 3

Identify opportunities that may arise for a clinician to insert probing questions about the patient’s history or to give advice, counseling, and/or patient education.

Answer 3

• Primary Screening Question: “Do you smoke?”
• Exploratory Question: “How old were you when you began to smoke?”
• Integration: look at CC for clues to preventive medicine needs, take advantage of “New patient time” (longer allotted) hx time, especially for counseling and Pt ed.
• Prioritization: focus on greater risk behaviors
• Timing: appropriate with CC and setting
• Almost any visit or setting can be an opportunity

Question 4

List the parts of a comprehensive physical examination which may help to screen for asymptomatic disease or risk factors

Answer 4

Heart, Lungs, abdomen, peripheral vascular, spine, upper and lower extremities
Head and face
Eyes
Ears
Nose
Throat/Mouth
Neck
Mental status, cranial nerves and cerebellar function
Muscle strength
Deep tendon reflexes

Question 5

According to the American Heart Association (AHA) and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VII) as well as (JNC VIII), indicate the optimal blood pressure suggested for maintenance for an otherwise healthy adult. Further classify the four categories of blood pressure/ hypertension

Answer 5

Systolic                Diastolic 
- Normal <120 mm Hg and <80 mm Hg
- Elevated 120-129               <80
Hypertension 
- Stage 1   130-139.      or.    80-89
- Stage 2.  >140.          or.    >90

Question 6

When doing a skin surveillance for a high-risk patient, list the meaning of the “ABCDs” for preventive screening for melanoma.

Answer 6

• Asymmetry
• Borders
• Color variations
• Diameter (greater than 6 mm)
• Evolution