Clinical Skills and Physical Exam Lecture Notes Review

Clinical Skills and Physical Exam Review Flashcards

What is at the core of effective communication in the medical interview?

Embracing respect for all patients regardless of age, gender, race, religion, culture, ethnicity, etc.

What is the overall concept of the Biopsychosocial model?

Disease is not just a medical problem - there are many other factors that can impact the patient’s overall health including psychologic and social issues

What is Mindfulness?

Focusing attention on your thoughts and feelings in the moment. Paying attention on purpose, to one's own mental and physical processes during everyday tasks, so as to act with clarity and insight

What is Delusion in mindful practice?

The tendency of the mind to seek premature closure, imposing definition on things and then mistakes the definition for the actual experience

What are the fundamental qualities of mindful practitioners?

Attentive observation, critical curiosity, beginner's mind and presence

What does tacit knowledge depend on?

Depends on experience, but this does build competence

What is explicit knowledge?

Easily explained

What does relationship building reflect?

Combination of non-verbal behavior (attentiveness, responsiveness, and warmth) and attention to patient not just disease

Which overpowers the other, non-verbal or verbal statements?

Nonverbal statements will overpower verbal if the two are in discrepancy

What are some examples of non-verbal communication of attentiveness and warmth?

Eye contact, body language, nodding, uh-huh, facial expression, silence

What are two ways of Communicating empathy to a patient?

Reflection and Legitimation

What does Legitimation communicate?

Communicates acceptance of the emotional experience and respect for it

Besides legitimation, Reflection, what else can a doctor do to show respect?

Patient praise, Support, Promote partnership

What should you allow the patient to do to begin a successful interview?

Let patient make opening remarks without interrupting

Besides letting them speak, what should you do to make sure you get all the info?

Direct and redirect the patient to make sure all info is elicited

What is the purpose of focused open questions?

To explore a particular symptom and form a hypothesis about disease process

What is the common acronym doctors use for responding and getting information?

Elicit, explore, acknowledge, and respond

What do anchoring questions explore?

Explore ideas that were just elicited

What are first impressions almost always made off of?

Nonverbal communication

What is rapport?

The nonverbal structure of empathy

What channels carry the meaning of a message vs concrete content?

Nonverbal channel carries the meaning of a message while the verbal channel carries the concrete content of the message

In mixed messages, which response will be more accurate?

The nonverbal response will be the more accurate message

What are examples of Kinesics?

Facial expressions, eye contact, body tension, gestures, fidgeting, body posture

What is Proxemics?

Shared space between individuals

What is Paralanguage?

Tone, rate, rhythm, volume, emphasis

What are examples of autonomic responses?

Sweat, tears, facial coloring, breathing, pupils

What is a 'Safe' pattern of nonverbal response?

Body is engaged, relaxed, in open posture

What is a 'Fight' pattern of nonverbal response?

Engagement, but in a stance of attack or retaliation in self-defense

What is a 'Flight' pattern of nonverbal response?

Body tension, with disengagement

What is Conservation-withdrawal pattern?

Overwhelmed with excessive input and is withdrawn, can't make a response yet

What is 'Matching' when building rapport?

Matching the other persons’ behaviors to reflect the state they are in

What is 'Leading' when building rapport?

Using the rapport that has been set up by matching

How can you address mixed messages?

Using verbal reflection of non-congruence and normalization/ legitimization

What is the focus of a Patient-centered interview?

Elicits the patient’s perspective

What is the focus of a Doctor-centered interview?

Elicits symptoms of disease

What is an Integrated Interview?

Patient-centered + Doctor-centered

What are some benefits of the integreted interview?

Improves adherence, patient satisfaction, and health outcomes and decreases malpractice lawsuits

What snap judgments do doctors often make?

Most doctors, within the first 18 seconds of seeing a patient, will interrupt him or her while they are telling their story and also generate an idea of what's wrong

What are some Non-focusing open-ended data gathering skills?

Silence, Nonverbal encouragement, Neutral utterances, continuers

What are some Focusing open-ended data gathering skills?

Reflecting, echoing, Requesting “Tell me more”, Summarizing, paraphrasing

What are Close-ended data gathering skills?

Direct, usually one word answer, questions

What are Emotion-seeking skills?

Direct inquiry, Indirect inquiry

What is NURS in cognitive empathy?

Naming, Understanding, Respecting, Supporting

What is sympathy?

Having the same emotional response as the patient

What are the 5 steps of the Patient-centered interview?

Setting the stage, Eliciting the chief complaint and setting the agenda, Non-focused Interviewing, Focused Interviewing, Transition to the Doctor-Centered phase

What are the 5 steps of the Doctor-centered interview?

HPI - History of Present Illness, PMH - Past Medical History, SH - Social History, FH - Family History, ROS - Review of Systems

What is the overall goal of the HPI?

To clarify the symptoms and all of the secondary data that pertains to the patient’s story

What is a symptom?

Phenomenon that is experienced by the individual affected by the disease

What is a sign?

Phenomenon that can be detected by someone other than the individual affected by the disease

What is primary data?

Patient’s statement or physical test findings

What is secondary data?

Information found in a patient handoff, old chart, or from third party individuals

What does OPQQRST stand for?

Onset and chronology, Position and radiation, Quality, Quantity, Related symptoms, Setting, Transforming factors

When asking about medications, what should you ask?

Name, dose, frequency, reason for use, and adherence

What kind of allergies should you confirm?

Drugs, Environmental, food

What are the 5 P's of Sexual Health History?

Partners, Practices, Prevention of Pregnancy, Prevention of STD’s, Past History of STD’s

When taking Family History, how many generations should you ask about?

At least 2 generations

What does a Full H&P (Admission Note) do?

Contains all health information on a patient to date

What are the kinds of Focused H&Ps?

Problem-focused: Daily medical progress note, Task-focused: Operative note, Labor and delivery note

What is subjective information?

What the patient tells you

What is objective information?

What the doctor finds

What are the components of a health document?

Comprehensive History – including CC, HPI, PMH, SH, FH, ROS, Physical Exam, Problem List, Assessment & Plan

What should the Chief Complaint be?

Clear and concise and in the patient’s own words

What does the HPI do?

Illustrates the patient’s story and describes the problem chronologically in an organized manner

Where does Objective Data start in a health document?

Objective data starts here

What is the Problem List?

A list of the problems identified or addressed in the visit

What questions does the Assessment and Plan answer?

What do you think is happening? What are the next steps?

What happens if the blood pressure Cuff is too small (narrow)?

The blood pressure will read high

What happens if the blood pressure Cuff is too large (wide)?

The blood pressure will read low on a small arm and high on a large arm

How large should the blood pressure inflatable bladder be?

Width of the inflatable bladder of the cuff ≈ 40% of upper arm circumference. Length of the inflatable bladder ≈ 80% of the upper arm circumference (almost long enough to encircle the arm).

Prior to taking a patient's blood pressure, what should you instruct them to avoid?

Instruct patient to avoid smoking or drinking caffeine for 30 min prior to bp reading

When taking Bp where does the Brachial artery need to be?

Brachial artery, at the antecubital crease, is at the level- roughly level with the 4th interspace at its junction with the sternum

If the brachial artery is too low, the __.

Blood pressure will read high

If the brachial artery is too high, the __.

Blood pressure will read low

When taking blood pressue, inflate to approx __.

30 mm Hg above estimated systolic pressure

What does the First Korotkoff sound equal?

Systolic BP

When the sound disappears while taking blood pressure, it indicates what?

Diastolic BP

What are the normal ranges for blood pressure, prehypertension, and both hypertension stages?

Normal: <120/<80. Prehypertension: 120-139/80-89. Hypertension Stage I: 140-159/90-99. Hypertension Stage II: 160+/100+

What is Atrial Fibrillation?

Palpation of an irregular rhythm (irregularly irregular on ECG)

What is Isolated Systolic Hypertension?

Systolic >140, diastolic <90

What is Essential Hypertension?

High blood pressure that doesn't have a known secondary cause

What is Orthostatic/Postural hypotension?

Fall of 20 mmHg in systolic or 10 mmHg in diastolic or more after reading standing up

What is Nocturnal Hypertension?

Elevated BP when sleeping

How to assess Respiratory Rate?

Visually inspect or subtly listening over patient’s trachea with stethoscope for 1 minute

What is a normal respiratory rate?

12-20 breaths/minute

What is the average oral temperature?

Average oral temperature = 98.6˚ F (37˚ C)

Ranging from Hottest to Coldest, what is the correct order for measuring temperature

Tympanic, Rectal, Oral, Axillary

Fever of Pyrexia

100.4˚F (38˚C)

Hyperpyrexia

106˚F (41.1˚C)

Hypothermia

<95˚F (35˚C)

General Appearance is defined by what?

Apparent state of health, Level of consciousness, Signs of distress, Sexual Development

What are Common or concerning symptoms, also known as constitutional symptoms?

Changes in weight, fatigue and weakness, fever, chills, night sweats, and pain

What is Underweight BMI?

Underweight BMI <18.5

What is normal BMI?

Normal = 18.5-24.9

What is Overweight BMI?

Overweight = 25.0-29.9

What is Obese Class 1 BMI?

Obesity I = 30-34.9

What is Obese Class 2 BMI?

Obesity II = 35.0-39.9

What is Obese Class 3 BMI?

Extreme obesity III >40

What waist measurements indicate increased risk for diabetes, hypertension, and cardiovascular disease?

35+ inches for women, 40+ inches for men

Where is the worst kind of weight to gain?

Weight gain in the area of and above the waist (apple type)

What are the Four A’s of monitoring patient outcomes of Pain?

Analgesia, Activities of daily living, Adverse effects, Aberrant drug-related behaviors