Week 1 Objectives

Question 1

7 components of * Comprehensive Adult Health History *

Answer 1

Identifying Data and Source of History; Reliability
Chief Complaints
Present Illness
Past History
Family History
Personal and Social History
Review of Systems

Question 2

The Review of Systems includes:

Answer 2

General: Weight-related, weak, fatigued, fever.
Skin
HEENT (Head, Eyes, Ears, Nose, Throat)
Neck
Breasts
Respiratory
Cardiovascular
Gastrointestinal
Peripheral Vascular
Urinary
Genital
Musculoskeletal
Psychiatric
Neurologic
Hematologic
Endocrine

Question 3

Benefits of Tangential Lighting:

Answer 3

It amplifies contours, elevations, and depressions.

Question 4

Physical exam: Sitting

Answer 4

General
Vitals
Skin
Head and neck
Thorax and lungs
Breasts
Musculoskeletal: upper extremities

Question 5

Physical exam: Supine with 30degree incline

Answer 5

Cardiovascular

- JVP, Carotid upstrokes and bruits, PMI, S1, S2

Question 6

Physical exam: Supine, 30degree incline, left side

Answer 6

Cardiovascular

- S3 and murmur of mitral stenosis

Question 7

Physical exam: Sitting, leaning forward

Answer 7

Cardiovascular

- murmur of aortic insufficiency

Question 8

Physical exam: Supine

Answer 8

Breasts and axillae
Abdomen
Peripheral vascular
Nervous system

Question 9

Physical exam: Sitting or Standing

Answer 9

Musculoskeletal

Question 10

Physical exam: Lithotomy position

Answer 10

Women: pelvic and rectal examination

Question 11

Physical exam: Supine, left side

Answer 11

Men: Prostate and rectal exam

Question 12

Cardinal Techniques of Examination

Answer 12

Inspection
Palpation
Percussion
Auscultation

Question 13

6 Steps of Clinical Reasoning

Answer 13

ID abnormal findings.
Localize findings anatomically.
Interpret findings in terms of probable process.
Make hypotheses about the nature of the patient’s problem.
Test hypotheses and establish working diagnosis.
Develop plan agreeable to patient.

Question 14

The 10 Techniques of Skilled Interviewing:

Answer 14

Active listening.
Empathetic responses.
Guided questioning.
Nonverbal communication.
Validation.
Reassurance.
Partnering.
Summarization.
Transitions.
Empowering the patient.

Question 15

The Sequence of an Interview:

Answer 15

Greet and establish rapport.
Establish agenda.
Invite the patient's story.
Explore the patient's perspective.
ID and respond to emotional cues.
Expand and clarify patient's story.
Generate and test diagnostic hypotheses.
Share the treatment plan.
Close the interview and visit.
Self reflection.

Question 16

The 7 attributes of a symptom:

Answer 16

Location
Quality
Quantity or severity
Timing
Setting in which it occurs
Remitting or exacerbating factors
Associated manifestations

Question 17

CAGE Questioning

Answer 17

For Alcohol abuse:
C - Cutting down
A - Annoyance when criticized
G - Guilty feelings
E - Eye-openers

Question 18

4 Building Blocks of Ethics:

Answer 18

Nonmaleficence or "primum non nocere"
- First, do no harm.
Beneficence
- Do good.
Autonomy
- Patient has right to determine their own best interest.
Confidentiality
- Do not repeat what you learned about a patient.

Question 19

8 Components of Vitals

Answer 19

Heart rate.
Respiratory rate.
Temperature.
Weight.
Height.
Blood pressure.
Oxygen saturation.
Pain.

Question 20

FIFE

Answer 20

Mnemonic for exploring the patient's perspective of their "illness" (not disease):
F- Feelings
I - Ideas
F - effect on Function
E - Expectations