Week 3

Fundamentals of Skilled Interviewing:

  • Practice Active Listening- Verbal communication, non-verbal communication

  • Empathetic Responses - Recognizes patient’s feelings

  • Ask Open-Ended Questions - Allows patient to explain their chief complaint in their own words first. “Tell me about your leg.”

  • Ask Questions that Elicit a Graded Response - Specific questions that give you more incite into the issue. “Does your leg hurt when you walk?”

  • Validation/affirmation - Reassurance, Acknowledge their Chief Complaint

  • Partnering with patient - support them & make them feel heard, so they are more comfortable going through with at home instructions

  • Summarization - capsule overview: “Let me make sure I have the full story”…”Did I miss anything?”

  • Transitions - Puts Patient at ease as you change directions, ie. Chief Complaint to Medical History, Interview to Exam, etc.

Empower the patient- so they follow instructions at home as well; so they follow through with the treatment plan.

Patient-centered questions: try to get the patient to talk, open-ended

Doctor-centered questions: Specific questions, typically yes/no answers

Doctor- centered questions fill in the holes that patient-centered didn’t answer

Ask yourself- Did I develop a rapport? Am I helping the patient provide an accurate and unbiased report of their illness? Did I collect enough information to make an accurate Diagnosis?


General Survey:

  1. Apparent State of Health: general judgment, acutely ill, fit, robust

  2. Level of Consciousness: alert, responsiveness

  3. Signs of Distress: Shortness of breath, pain, cough, depression, wincing, antalgia, grimacing

  4. Skin Color/ Lesions: Jaundice, cyanosis, rashes, bruises, scars, neck

  5. Dress, Grooming, Hygiene: attire, shoes, copper bracelets, unkempt

  6. Facial Expressions: affect, eye contact, stare

  7. Body Odor, Breath: alcohol, diabetes, liver, kidney

  8. Posture, Gait, and Motion Activity: tremors, agitation, lean, shorter leg, toe out, Multiple Sclerosis, etc.

  9. Height/Weight: unusually tall/short, symmetry, generally proportional


Chest Pain could signify Heart Attack, Anxiety, Indigestion, etc.

Pallor: pale skin

Clubbed finger tips/fingernails typically signify a Cardiac issue due to decreased blood flow to the fingers

Paralysis/limited function on one side of the face could signify Stroke or Bell’s Palsy

Dowager’s Hump: Lump at the base of the neck/top of the back. Advanced Osteoporosis, a person sometimes develops Vertebral fractures and Kyphosis, or a spinal hump often occurs.

Normal Osteoarthritis (Wear & Tear/ old age) causes joint swelling in the fingers.

Ulnar deviation: Fingers move towards the pinky side (ie. Rheumatoid Arthritis)

“Butterfly Rash” is typically a sign of Lupus.

Goiter in neck is caused by an enlarged/inflamed Hypothyroid (low functioning) (Hashimoto’s Disease)

One limb noticeably smaller than the other could signify a nerve compression in the spine, lading to muscle atrophy. Could take a year to notice

Bulging eyes is caused by Hyperthyroid (overactive) (Graves Disease)

Vital Abbreviations:

HR=Heart Rate (pulse)

BP= Blood Pressure

RR= Respiration Rate

BT= Body Temperature

BMI= Body Mass Index- American system= calculated by Weight in lbs divided by Height in in² then Multiplied by 703. (Weight lbs/height in²)X703=BMI

Why do Vitals? identify acute problems, quantifies the magnitude of an illness and how the body is coping, marker of chronic disease states.


Blood Pressure:

Systolic Pressure: Top number, amount of pressure your heart generates when pumping blood through your arteries.

Diastolic Pressure: Bottom number, amount of pressure in your arteries when your heart is at rest between beats.

Pulse Pressure: the difference between Systole and Diastole

  • Normal BP: less than 120/80

  • Elevated BP: 120-129 and less than 80

  • Stage 1 HTN: 130-139 and 80-89

  • Stage 2 HTN: >140 and >90

  • HTN Crisis: >180 and >120

BP varies throughout the day due to- Stress, activity, pain, noise, caffeine, smoking, etc.

  • Arrhythmias: irregular, extra beats. Effects BP

  • HTN: Hypertension, High BP

  • Hypotension: low BP

  • White Coat Hypertension: BP high in the office but otherwise normal

  • Masked Hypertension: BP normal in office but is usually high

Cuff size matters! Too small of cuff increases Systolic. Too large cuff decreases Systolic

Complications of HTN- Brian Stroke, Vision loss, blood vessel damage, heat attack, kidney failure, bone loss. Prolonged HTN causes organ failure over time

  • Primary prevention: treatment of HTN prior to end organ damage

  • Secondary prevention: Treatment of HTN to prevent of slow progression of end organ damage

What causes HTN? Cardiac output increase, blood volume increase, resistance (flexibility and diameter of artery walls, blood viscosity).

  • Plaque blocks are caused by cholesterol particles building up in arteries, typically entering through a small tear.

Orthostatic Hypotension: When Systole drops 20mmHG of Diastole drops 10mmHG within 3 minutes of standing up. Causes dizziness upon standing. Usually self resolves


Normal RR: 12-20/minute

  • Inhale=inspiration, Exhale=expiration

  • Bradypnea=slow breathing, Tachypnea=Rapid Shallow breathing, Hyperpnea/Hyperventilation=Rapid Deep breathing

  • Cheyenne-Stokes Breathing: Dysrhythmia alternates between hyperpnea and apnea (when someone is dying)

  • Obstructive breathing: prolonged expiration, COPD