Exam 1 Flashcards

Question

1st educational requirements to attend a pod school

Answer 1

-1918 CPME requires HS graduation and two years in chiropody school -1954 DOE requires HS diploma, and two years of undergrad before pod school -1960 seldon commission upgraded to bachelors and 4 years pod

Answer 2

-affiliate pod schools with other academic health centers/programs -1981 DMU was first school to integrate pod with other med programs

Answer 3

3 year residency standard to mirror allopathic

Answer 4

-1942- ACFAS -1958 - profession changed to podiatry -1985 - profession changed to podiatric medicine

Answer 5

Poor decision-making Irritability Exhaustion Increased errors Lower adherence to best practices

Answer 6

 High-risk drinking Men: 14 drinks/week OR 4 drinks/day Women: 7 drinks/week OR 3 drinks/day 1 drink = 12 oz. beer, 5 oz. wine, or 1.5 oz. liquor  Driving While Intoxicated (0.08 BAC) Most adult men: 5 drinks in 2 hours Most adult women: 4 drinks in 2 hours Varies by body weight, consumption of food, mixer used with alcohol, etc.  Impaired Driving 1 drink consumed by a 140 lb. woman on an empty stomach increases the odds of death in a single-vehicle accident

Answer 7

It degrades your health over the long- (and potentially short-) term It increases your risk of injury, and both perpetration of and victimization by criminal acts It can progress to impairing your professional judgment But it’s my private life!! Role modeling Reputation of profession Personal reputation Trust

Answer 8

Women tend to weigh less Even with identical body weight, women have less water in their bodies, so because alcohol disperses in water, women have a higher BAC with the same alcohol intake Women are more likely to suffer health problems as a result of heavy drinking than men are, including damage to the liver, brain, and heart

Answer 9

Gratitude Compassion Acceptance (not all you plant bears fruit) Higher Meaning (whats important to you) Forgiveness Tribe (nurture relationships, share struggles) Relaxation and Reflection

Answer 10

Recognize suffering Validate suffering Set an intention Take action

Answer 11

 Work/leisure experiences that lead to flow  Finding meaning/purpose in religion/spirituality  Having positive relationships that provide social support**  Being physically healthy  Community service/helping others

Answer 12

Patient:  Not thinking about change  May be resistant to change  May be resigned – a feeling of no control  Obese patients may have tried unsuccessfully many times to lose weight and have given up  Denial - do not believe it applies to them  Patients with high cholesterol levels may feel immune to health problems that strike others  Believe consequences not serious – or pt is unaware of consequences  Cons of change outweigh pros Doctor: Goal: Patient will begin thinking about change  Build a relationship  Express caring concern - don’t use scare tactics  Personalize risk factors  Educate in small bits

Answer 13

Patient: “Some day – getting ready – thinking about it”  Acknowledging a problem, but ....  Not yet committed to change  Ambivalent about change, but giving it serious consideration Doctor: Goal: Elicit from pt reasons to change & consequences of not changing  Explore ambivalence  Praise pt for considering difficulties of change  Restate both sides of the ambivalence  Question possible solutions for one barrier at a time  Pose advice gently to reduce natural resistance

Answer 14

Patient:  Has decided change is needed  Preparing to make a specific change  Experimenting with small changes as determination to change increases Doctor: Goal: Pt will discover elements necessary for decisive action  Has decided a change is needed  Encourage the pt’s efforts  Encourage taking small steps

Answer 15

Patient: “Taking steps to change”  A stage clinicians are eager to see patients reach  Sometimes too eager  Patients take definitive action to change  Any action taken by patient should be praised  Demonstrates a desire for life style change Doctor: Goal: Patient will take decisive action  Reinforce the decision  Build and facilitate increased self-efficacy  Delight in even small successes  View problems as helpful information  Ask what else is needed for success

Answer 16

Patient: “Forever” – a process of keeping changes made in place  Patient incorporates the new behavior “over the long haul”  Broad implications for one’s life Doctor: Goal: Patient will incorporate change into daily lifestyle  Continue reinforcement & support  Explore & lift up internal rewards & benefits from change  Identify risks for relapse and helpful strategies to manage them

Answer 17

Patient:  Most patients find themselves “recycling” through the stages several times before change becomes established  Part of the change process, but not one of the stages  Points of caution and proactive planning Doctor: Goal: Patient will communicate honestly with clinician  Learn from the temporary successes  Use this to re-engage patient in the change process  Remind patient that change is a process, & most people “recycle”  Reframe the relapse  “failure” to “successful for a while,” and  “new lessons for continued success”  Identify & evaluate triggers

Answer 18

 A patient’s level of motivation for change is not fixed  Motivation for change is affected by the quality of the relationship  How you communicate impacts not just how patients feel, but what they do

Answer 19

 Resist the righting reflex  Understand and explore the patient’s own motivations  Listen with empathy (OARS)  Empower the patient by encouraging hope and optimism

Answer 20

 Open Questions  Affirmations- If you affirm a strength, the person will expand on how they accomplished something, rather than focus on barriers  Reflections- use purposefully. Stay on topic, reflect ambivalence about change. A primary strategy.  Summaries- focus on person’s strengths and capacity to change, in a way that avoids overshooting where the patient really is

Answer 21

-Engage-You engage with a patient by listening to them first  Two functions  Enables accurate understanding of the patient  Communicates to patient that what they are saying is important to you  Encourages the patient to reveal more and keep thinking about the topic at hand  Makes patients feel like you have spent a lot of time with them -Focus-  Lay a menu of options on the table, including both their stated concerns and your concerns  Allow patient to choose  If the patient does not choose your concern, you have at least planted a seed Evoke- -diecting, guiding,  All three styles are useful  Goal is to match the best style for a given context  Ability to flexibly shift between the 3 styles is important to effective practice  Current culture in medicine favors too much directing regardless of context of interaction  MI is a refined form of the guiding style Plan-  Assess the patient’s level of commitment to change  “So what do you make of all this now?”  “What do you intend to do?”  Do not try to push a patient into more commitment than they are ready to make. Instead, continue conversations about their desires, abilities, reasons, and needs

Answer 22

 RULE (guiding principles)  OARS (listening techniques)  DARN (pre-commitment types of change talk)

Answer 23

 Empathy and good listening evoke change talk.  Confrontation and the righting reflex evoke sustain talk  Themes in change talk:  Desire  Ability Pre commitment  Reasons  Need  Commitment  Taking steps  Recognize and affirm change talk  Helping patients to express change talk gradually moves them towards changing behavior

Answer 24

1. Chief Complaint 2. History of Present Illness 3. Review of Systems

Answer 25

-Short description of presenting complaint * In patient’s terms – main complaint * Subjective * Doesn’t have to correlate with the final diagnosis

Answer 26

* Vascular - pulses, swelling, temp * Neurologic - sensation, reflexes * Dermatologic - lesions, discoloration, texture * Musculoskeletal - strength, ROM, palpitation, deformity * Gait - cadence, stride length, speed, pattern

Answer 27

* What’s your differential? * Can be very general or specific based on your findings * Two formats: * Narrative * List

Answer 28

-proximal- closest to the head from point of reference Distal- closest to the toes from point of reference

Answer 29

superior and interior of heel bone

Answer 30

- dorsal - top of foot - plantar - bottom of foot

Answer 31

thigh-femur, where your hips stick out

Answer 32

bone at the lateral border of the patella

Answer 33

inferior bone to patella (bottom bone of knee cap)

Answer 34

nerve running lateral/the outside of the leg

Answer 35

ball on inside of your ankle

Answer 36

bone before your foot gets more narrow

Answer 37

artery that runs through inside ball of ankle

Answer 38

artery that runs diagonally across top of foot

Answer 39

runs parallel with posterior tibial artery

Answer 40

*Burning, tingling *Elicit symptoms with palpation -medial side of ankle tibial nerve issue and gets too much pressure put on it/ gets irritated -will palpate nerve to see if there is tingling to diagnosis

Answer 41

outside ankle ball

Answer 42

arch of foot

Answer 43

-the gastrocnemius and a deeper muscle, the soleus, join distally to form the Achilles tendon. -largest tendon in body

Answer 44

Trusted with access to information and power that is not available to everyone Specialized skill set that is societally necessary The motive is service to others rather than profit There is a code of ethics developed by the profession that must be followed

Answer 45

In exchange for its service according to the values above, medicine receives: Autonomy/Self-regulation Trust Respect Non-financial and financial rewards

Answer 46

Promotion of health and disease prevention Maintenance/improvement of quality of life by relief of symptoms, pain and suffering Cure of disease Prevention of untimely death -Improvement of functional status/maintenance of compromised status Education/counseling re: condition/prognosis Avoidance of harm to patient in course of care Providing relief and support near time of dea

Answer 47

Branch of philosophy related to morals, moral principles and moral judgment Way of examining and interpreting moral life (and guide/evaluate conduct) Uses reason and logic to analyze problems and find solutions

Answer 48

-Identification, analysis, and resolution of moral problems that arise in care of a particular patient Based on moral principles or practice customs of medical profession Involves consideration of others in deciding how to act -Can we? , Should we? Do we have to?

Answer 49

-Primacy of patient welfare Patient autonomy Social justice

Answer 50

Regulation and oversight of professional conduct Moral dilemmas Ethical conflicts

Answer 51

Different reasoning: -Consequences and Liability Different loyalties: -Patient, institution, society Different perceptions: -Personal or professional experiences Different values -Culture, religion, etc.

Answer 52

Prudence—wisdom Justice Fortitude Temperance Fidelity to trust Compassion Integrity Effacement of self-interest

Answer 53

Medical indications -Good ethical decisions always begin with good (correct) information Patient preferences Quality of life Contextual features

Answer 54

Requirement that physician obtains consent from patient before proceeding with treatment has been a part of Anglo-American jurisprudence since eighteenth century England

Answer 55

 Admitted to the hospital in January 1908 suffering from stomach disorder.  Physician discovered a tumor which was ultimately diagnosed as a fibroid tumor.  She was advised that the nature of the lump could not be determined without an ether examination.  She consented to the examination AND informed the surgeon, the anesthesiologist and others that there must be no surgery.  The ether examination was undertaken and while she was unconscious, the tumor was removed.  Post-op she developed gangrene in her left arm necessitating the amputation of some of her fingers.  Arguments followed regarding “where the fault rested” given that this was a charity hospital that hired physicians and others to provide charity care.

Answer 56

 Collaborative decision-making process  To create an ongoing partnership between health care professional and patient  Designed to prevent coercion or deception  Opportunity to assess patient’s understanding and to review risks and benefits  Process can be difficult (and time-consuming), but always important  Optimal result is shared decision-making

Answer 57

-Encourage the patient to play an active role in decisions -Encourage that patients are informed -Protect the patient’s best interests

Answer 58

 Autonomous authorization  Decision-making capacity: -Competence (of legal age), Judgment, Understanding, ability to choose between options  Adequate disclosure  Patient comprehension*

Answer 59

1. Use of technical language, lack of effective communication skills 2. Difficulty interpreting to patient the uncertainty intrinsic to medical information 3. Concern re: information overload, alarming patient 4. Time pressure 5. Diminishing the process as bureaucratic and unnecessary (Have you “consented” the patient?)

Answer 60

1. Limited in understanding 2. Inattentive and distracted Evidence shows very few patients remember most of what they consented to as little as a day after the consent process 3. Overcome by fear and anxiety

Answer 61

 Life threatening emergencies or threat of severe disability creating inability to express preferences or give consent  Immediate action is necessary to preserve life and/or function  No surrogate available (Document what was done to identify and/or contact surrogate decision makers.)  Customary for physicians to presume patient would give consent if he was able to do so. (Recommend: Do what is medically necessary for preservation of life/function; implied consent is not carte blanche permission for HCP to do everything they believe is medically important.)  The law has embraced this practice, entitling it “Implied Consent”  Provides physician with defense against battery – but may not defend against charges of negligence if emergency treatment falls below acceptable standards of care

Answer 62

-Requires many health care providers receiving Medicare/Medicaid payments to provide adults, at the time of admission or enrollment, certain information re: their rights under state laws governing advance directives, including:  the right to participate in and direct their own healthcare decisions  the right to accept or refuse medical or surgical treatment  the right to prepare an advance directive  The receipt of information on the provider’s policies that govern the utilization of these rights

Answer 63

1. Patient lacks medical decision-making capacity 2. Patient wants more than medical standard: medical futility debates 3. Patient requests not in keeping with standards of treatment** 4. Conscientious refusal by physician

Answer 64

 only a judge can declare a person incompetent  Medical Decision-making Capacity is determined by a qualified health care professional

Answer 65

1. Engage patient in conversation 2. Observe patient’s behavior 3. Talk with third parties – family, friends, or staff

Answer 66

 Tests for cognitive functioning, psychiatric disorders, or organic conditions that affect medical decision-making capacity can be used – mental status exam most common  No single test sufficient to capture concept of medical decision-making capacity – interaction with patient best tool (MacArthur Competence Assessment Tool)  The patient’s primary HCP who has known the patient over time is often in the best position to determine presence or absence of medical decision-making capacity (and is rarely consulted!!)

Answer 67

 Important element of advance planning  Identifies who will make decisions when patient lacks medical decision- making capacity  May be a relative or friend (not mandated)  Speaks with the patient’s own voice

Answer 68

 Conflict of interest  Monetary or other gain  Beliefs/values differing from patient’s (when they motivate the decision)  Lack medical decision-making capacity

Answer 69

 Substituted judgment: “What would the patient want?” surrogate relies on known preferences of patient  Best interest: “What do I believe is best for patient?” used when patient’s preferences unknown

Answer 70

 Shared decision-making respects patient self-determination/autonomy.  For patients to make informed choices, physicians must discuss the alternatives for care and the benefits, risks, and consequences of each alternative.  Physicians need to encourage patients to play an active role in decision making and to ensure that patients are informed.  Be aware of the role of the community in shaping values and in contributing to decision-making

Answer 71

 Limiting access of others to one’s body or mind, such as through physical contact or disclosure of thoughts or feelings.  Individuals usually desire to preserve, protect, and control privacy.  Privacy and right to privacy are not always clearly distinguished.

Answer 72

Physical privacy: Touching, imaging, direct observation, single v. shared hospital room-personal spaces  Informational privacy: Human Genome Project, HIPAA (Health Information Portability and Accountability Act) 1996, 2009, GINA (Genetic Information Nondiscrimination Act) 2008  Proprietary privacy: Ownership of human identity—photos, genome  Decisional privacy: Control over intimate aspects of personal identity—”choices”

Answer 73

Concerns the communication of private and personal information from one person to another with the expectation that the recipient of the information (healthcare professional) will not ordinarily disclose the confidential information to third persons*

Answer 74

 To other health care personnel for purposes of providing care or for health care operations  To appropriate authorities when disclosure is required by law  To other third parties to mitigate the threat when, in the physician’s judgment there is a reasonable probability that

Answer 75

 When disclosing PHI, only the “minimum necessary” to fulfill the request should be disclosed to anyone  And disclose only to those who “need to know”

Answer 76

 Physical “paperwork” is owned by the clinician  Information contained in the medical record is owned by the patient  Patient has the right to access the chart and copy the records at their expense (or for a standard fee)

Answer 77

-A subpoena is a lawyer's assertion that she/he is entitled to the requested information, while a court order determines that the lawyer is in fact entitled to it.  A health care provider or health plan may share PHI if it has a court order, and only what is specifically described in the order  A provider or plan may disclose information in response to a subpoena but must satisfy notification requirements (signed release or objection)

Answer 78

 STDs, contraception, substance abuse  Testing for HIV may be done confidentially, but if positive, parent or legal guardian MUST be notified

Answer 79

 Each parent has a right to a minor’s medical record unless:  Child is seeking care for addiction, contraception or sexually transmitted infections  Divorce decree prohibits one parent from access  Parental rights have been legally terminated  Step-parents have no right to medical records of a minor unless natural parent(s) have signed consent form allowing it

Answer 80

Most states have statutes requiring physicians to report cases of certain disorders/circumstances:  STDs: Syphilis, Gonorrhea, Chlamydia  Gunshot and stab wounds  Suspected child and dependent adult abuse**  Infections that are considered reportable: TB, ebola, etc

Answer 81

-Horizontal axis “X” (“side to side”) -Lies in the frontal and transverse plan

Answer 82

-Horizonal axis “Z” (“front to back”) -Lies in the sagittal and transverse plane

Answer 83

-vertical axis “Y” (“up/down”) -Lies in the frontal and sagittal plane

Answer 84

inversion and eversion

Answer 85

tibia, fibula, talus

Answer 86

-Imaginary line bisecting the inferior-lateral fibula and inferior medial tibia -primary motion of the ankle joint is sagittal

Answer 87

-complex triplanar joint (motion occurs simultaneously in all planes) consisting of the three “facets” of the talocalcaneal joint. -STJ axis shows an inclination from dorsal medial and anterior to plantar, lateral and posterior -Motion is pronation/supinatio

Answer 88

-functional articulation between the rearfoot and forefoot. - midtarsal joints will lock and unlock with supination and pronation

Answer 89

-Big toe --> metacarsals --> navicular -almost no motion transverse plane motion at this joint

Answer 90

-valgus - lock knee inwards and foot eversion -varus - foot is inversion position

Answer 91

-Equinus- walk on toes -Calcaneus - walk on heel

Answer 92

-foot on ground = closed -foot dangling = open

Answer 93

* The organization that sets the policy, guides the development, and sponsors the administration of the licensing examination used throughout the United States * Administers the APLME via Prometric – Part I - Basic sciences exam taken in year 2. – Part II - Advanced sciences exam taken 2nd semester in year 4. * Written exam - medicine, radiology, orthopedics, biomechanics, surgery, community health, jurisprudence, and research * Clinical Skills Patient Encounter – assesses skills needed to enter residency

Answer 94

* General category breakdown – Allows toe amputation – Allows partial foot amputation – Allows foot amputation – Includes ankle – Includes leg – Includes hand – Can administer anesthesia

Answer 95

* Licensure is granted by each state in which you intend to practice – Granted based on education and examination – Licensure allows you to treat patients within that states scope of practice – Licensure is governed by a state podiatry board – Practicing in multiple states requires multiple licenses * The purpose of licensure is to protect the public by verifying licensees are qualified to practice

Answer 96

* The state board is the link between the consumer and the licensed practitioner and, as such, promotes public health, welfare, and safety. * The state board evaluates new applicants and monitors current licensees via renewal requirements. * Licenses are typically renewed every 2 years * A condition of license renewal is accruing Continuing Medical Education (CME) hours. – The number of hours varies by state * IA requires 40 CME hours per 2 year cycle (20 hours per year) * WA requires 50 CME hours per 2 year cycle (25 hours per year) – Verified by a random audit

Answer 97

* The composition of the state podiatry board will vary by state. – IA – Board executive, secretary, attorney, 5 licensed podiatrists, 2 licensed orthotists, and 2 members of the general public * Board members are typically appointed by the governor and confirmed by the senate

Answer 98

* Application for privileges is dependent on training/skill level – Most require submission of your logged cases from residency as proof of your competence. – Most institutions require board qualification to get privileges and can require board certification to keep them (ABFAS). * A committee designated by the hospital (privileging board) must approve or deny your privilege requests.

Exam 1 Flashcards

(123 cards)