Clinical Skills

Question 1

mneumonic for pathophysiologic differential diagnosis

Answer 1

I VINDICATE AID

• Infectious
• Vascular
• Inflammatory
• Neoplastic
• Drug
• Idiopathic
• Congenital
• Autoimmune
• Traumatic
• Endocrine
• Allergic
• Iatrogenic
• Degenerative

Question 2

First sentence of SOAP note

Answer 2

• Starts with identifying information
• Follow with statement of CC

Question 3

first paragraph of SOAP notes

Answer 3

• Complete HPI
• Relevant review of systems (ROS)
  
  • “relevant” means that it contributes to the differential diagnosis

Question 4

Relevant Positive ROS

Answer 4

Associated symptoms that are present and change the likelihood of a diagnosis

Question 5

Relevant Negative ROS

Answer 5

Associated symptoms that are absent and change the likelihood of a diagnosis

Question 6

Second paragraph of SOAP note

Answer 6

Includes relevant PMH, FH, and SH

Question 7

Objective portion of SOAP

Answer 7

• What you observe and examine
• Results of testing (lab, xray)

Question 8

Assessment of an Acute Problem (SOAP)

Answer 8

• Statement of the Problem (the “one liner”)
• Differential Diagnosis
• Clinical Reasoning
  
  • present the rationale for each hypotheses using data from the history, PE, labs

Question 9

When assessing acute problem, in what order differential diagnosis be prioritized?

Answer 9

Prioritized from most to least likely and finish with an unlikely but possibly life-threatening (explaining why it isn’t the life-threatening case if there is one worth considering)

Question 10

Assessment of Chronic Problems (SOAP)

Answer 10

• Statement of Problem
• Status of the Problem
  
  • well-controlled vs. not well-controlled
• resolved, improving, worsening, persistent
• Clinical Reasoning
  
  • present rationale for the status of the problem using data from history, PE, test results

Question 11

Multiple Issue Assessments (SOAP)

Answer 11

• can be mix of chronic and acute conditions
• use numbers to list the issues

Question 12

The complete cardiovascular exam is usually recorded in this manner:

Answer 12

Cardiac:

PMI non-displaced, regular rate and rhythm, normal S1 and S2, no murmurs, rubs, clicks or gallops

Vascular:

2+ carotid pulse bilaterally–no bruits

JVP at x cm above right atrium

Aortic pulsation normal, no bruits over aorta, femoral or renal arteries

Pulses: 2+ brachial, radial, femoral, popliteal, dorsalis pedis and posterior tibialis bilaterally

No lower extremity edema, no varicosities

Question 13

Cardiovascular Exam Checklist

Answer 13

• Palpate carotid arteries – one at a time
• Auscultate carotid arteries – using bell
• Estimate jugular venous pressure (JVP)
• Test for hepatojugular reflux (HJR)
• Inspect precordium
• Palpate PMI in supine position
• Identify and name major auscultatory regions
• Auscultate over each valve area with diaphragm
• Auscultate apex with bell
• Palpate PMI and auscultate apex with patient on left side
• Auscultate aortic valve area while patient sits up, leans forward and exhales completely
• Auscultate aorta and renal arteries
• Palpate abdominal aorta
• Palpate brachial and radial arteries
• Palpate and auscultate femoral arteries
• Palpate popliteal, dorsalis pedis and posterior tibial arteries
• Check for pretibial edema