1
Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care healthcare provider. Which of the following describes a physical, not a cultural, differentiator?
Race
Component of health history includes all except:
Review of systems
Present illness
Personal and social items
Thorax and lungs
Thorax and lungs
You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is best for palpating vibration?
ulnar
When using an interpreter to facilitate an interview, where should the interpreter be positioned?
Next to the patient, so the examiner can maintain eye contact and observe the nonverbal cues of the patient
Interpreters are invaluable in encounters where the examiner and patient do not speak the same language, including encounters with the deaf. It should be noted that deaf people from different regions of the world use different sign languages. The priority is for you to have a good view of the patient. Remember to use short, simple phrases while speaking directly to the patient and ask the patient to repeat back what he or she understands.
Differential diagnoses belong in the
assessment. Correct
An example of a cold condition is
tuberculosis.
Mr. T has SOB for the past 8 days, what type of data is this?
subjective
You are growing fatigued of performing a maneuver on examination because you have never found a positive and are usually pressed for time. How should you next approach this maneuver?
Use this test when you have a higher suspicion for a certain correlating condition.
Omit this test from future examinations.
Continue doing the test, but rely more heavily on laboratory work and diagnostics.
Continue performing it on all future examinations.
Use this test when you have a higher suspicion for a certain correlating condition.
This is an example of a specific test that lacks sensitivity. With this scenario, when you finally find a positive, you might be very certain that a given condition is present. We generally develop our examinations to fit our clinical experiences. Sensitive tests are performed routinely on the screening examination, while specific tests are usually saved for the detailed or “branched” examinations. Branched examinations are further maneuvers we can perform to investigate positive findings on our screening examinations. Save this type of maneuver to confirm your hypothesis. All of this information also applies to history questions.
Mr. W. is a 51-year-old auto mechanic who comes to the emergency room wanting to be checked out for the symptom of chest pain. As you listen to him describe his symptom in more detail, you say “Go on,” and later, “Mm-hmmm.” This is an example of which of the following skilled interviewing techniques?
A) Echoing
B) Nonverbal communication
C) Facilitation
D) Empathic response
C) Facilitation
This is an example of facilitation. Facilitation can be posture, actions, or words that encourage the patient to say more.
A detailed description of the symptoms related to the chief complaint is presented in the
history of present illness. Correct
Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is likely to be most problematic for the hypertensive patient of which group?
Chinese
“The patient has a stent placed in the left anterior descending artery (LAD) in 1998.” Which category would the data be best documented?
medical history
A patient comes to the emergency room for evaluation of shortness of breath. To which anatomic region would you assign the symptom?
A) Reproductive
B) Urinary
C) Cardiac
D) Hematologic
cardiac
Cardiac disorders such as congestive heart failure are the most likely on this list to result in shortness of breath. There are cases within the other categories which may also result in shortness of breath, such as anemia in the hematologic category, pregnancy in the reproductive category, or sepsis with UTI in the urinary category. This demonstrates the “tension” in clinical reasoning between making sure all possibilities are covered, while still being able to pick the most likely cause
PC is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted?
ASSOCIATED MANIFESTATIONS
The interviewer has not recorded whether or not the pain has been accompanied by nausea, vomiting, fever, chills, weight loss, and so on. Associated manifestations are additional symptoms that may accompany the initial chief complaint and that help the examiner to start refining his or her differential diagnosis.
A 27-year-old woman is brought to your office by her mother. The mother tells you that her daughter has been schizophrenic for the last 8 years and is starting to decompensate despite medication. The patient states that she has been taking her antipsychotic and she is doing just fine. Her mother retorts that her daughter has become quite paranoid. When asked why, the mother gives an example about the mailman. She says that her daughter goes and gets the mail every day and then microwaves the letters. The patient agrees that she does this but only because she sees the mailman flipping through the envelopes and she knows he's putting anthrax on the letters. Her mother turns to her and says, “He's only sorting the mail!”
Which best describes the patient's abnormality of perception?
illusion
An illusion is merely a misinterpretation of real external stimuli. In this case, the mailman is looking through the letters before he puts them in the box. The mother correctly assumes he is sorting the mail but her schizophrenic daughter attributes his actions to being part of a nefarious bioterrorism plot.
Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to
inform the patient of the reason for the examination and ask if it is acceptable to him.
“Patient denies chest pain, orthopnea, and dyspnea” where would this be best documented?
ROS
True positives; the degree to which those who have a disease screen/test positive
vs
True negatives; the degree to which those who do not have a disease screen/test negative
Sensitivity
vs.
Specificity
Ideally, tests would be both sensitive and specific; in practice, there is often a choice between a more sensitive test and a more specific test. A useful mnemonic for determining when you'd like a sensitive test vs. a specific test is "SPIN and SNOUT." SPIN stands for "SPecific tests rule IN the condition when they're positive." SNOUT stands for "SeNsitive tests rule OUT the condition when they're negative." A specific test is rarely results in false alarms, so a positive result on a specific test is good evidence for a condition. A sensitive test rarely misses a condition, so a negative result on a sensitive test is good evidence against the condition.
A 30-year-old sales clerk comes to your office wanting to lose weight; her BMI is 30.0 kg/m2. What is the most appropriate amount for a weekly weight reduction goal?
A) 0.5 to 1 pound per week
B) 1 to 2.5 pounds per week
C) 2.5 to 3.5 pounds per week
D) 3.5 to 4.5 pounds per week
A) 0.5 to 1 pound per week
A set of evidence-based recommendations for preventive services were developed by which agency?
A. U.S. Agency of Health and Human Services
B. U.S. Institute of Medicine Task Force
C. U.S. Preventive Services Task Force
D. U.S. Center for Health and Wellness
C. U.S. Preventive Services Task Force
A 22-year-old female nurse is interviewing an 86-year-old male patient. The patient avoids eye contact and answers questions only by saying, “Yeah,” “No,” or “I guess so.” Which of the following is appropriate for the interviewer to say or ask?
“Are you uncomfortable talking with me?” Correct
M has been seen in your clinic for 5 years. She presents today with signs and symptoms of acute sinusitis. The type of history that is warranted is a(n) _________ history.
Complete
Inventory
problem or focused
interim
What about a pt establishing care?
problem or focused
When are open-ended questions generally most useful?
During sensitive area part of the interview Correct
True or False:
Blood pressure is part of the General Survey.
false
A 39-year-old nurse who is a well-established patient complains of irregular menstrual periods and pelvic pain. She says that she is having trouble sleeping and asks whether she could be given a "sleeping pill." The patient also says she is thinking of leaving her job. What is the best "next step" in caring for this patient?
Obtain a more complete description of problems.