History and Physical Exam

Question 1

BOLDCARTS

Answer 1

Before
Onset
Location
Duration
Characteristic
Alleviating or Aggravating
Radiation
Timing
Severity

Question 2

OPQRST

Answer 2

Onset: “Did your pain start suddenly or gradually get worse and worse?” This is also a chance to ask, “What were you doing when the pain started?”

Provokes or Palliates: Instead of asking, “What provokes your pain?” use real, casual words. Try, “What makes your pain better or worse?”

Quality: Asking, “Is your pain sharp or dull?” limits your patient to two choices, when their pain might not be either. Instead ask, “What words would you use to describe your pain?” or “What does your pain feel like?”

Radiates: This is another chance to use real, conversational words during the assessment. Asking, “Does your pain radiate?” sounds silly and pompous to the patient. Instead use this question, “Point to where it hurts the most. Where does your pain go from there?”

Severity: Remember, pain is subjective and relative to each individual patient you treat. Have an open mind for any response from 0 to 10.

Time: This is a reference to when the pain started or how long ago it started.

Question 3

Key differentiator between aortic and pulmonic stenosis:

Answer 3

Murmur with aortic stenosis characteristically radiates to the carotid arteries and may also radiate to the apex; in contrast, the murmur of pulmonic stenosis does not radiate as widely as that of aortic stenosis

Question 4

HEEADSSSS

Answer 4

H - Home
E - Education/Employment
E - Eating
A - Activities
D - Drugs
S - Sexuality
S - Suicide/Mental Health
S - Safety

Question 5

SSHADESS

Answer 5

S - Strengths
S - School
H - Home
A - Activities
D - Drugs
E - Emotions
S - Sexuality
S - Safety

Question 6

PQRST AAA

Answer 6

P - Position
Q - Quality
R - Radiation
S - Severity
T - Timing

A - Alleviating
A - Aggravating
A - Associated syptoms

Question 7

Hypoactive bowel sounds are

Answer 7

less than 3-4 sounds a minute

Question 8

Hypoactive bowel sounds meaning

Answer 8

Sometimes can be normal, but combined with complaints can indicate paralytic ileus (a halt in peristaltic activity due to extreme irritation from obstructive peritonitis or unknown reasons)

Question 9

Hyperactive bowel sounds indicate

Answer 9

Sometimes normal if combined with abdominal complaints, can indicate early obstruction or GI bleed

Question 10

Bowel sounds cannot be said to be absent unless

Answer 10

they are not heard after listening for 3 minutes

Question 11

High pitched tinkling bowel sounds usually due to

Answer 11

tension of air/fluid in a loop of dilated bowel. This suggest obstruction.

Question 12

Rushes

Answer 12

If located at one area, usually are due to air fluid being forced through small partially occluded lumen. This suggest partial obstruction, especially if associated with concurrent abdominal activity