Med Skills Test Flashcards
(33 cards)
What sort of preparation do you need to do for patient interviewing? What is the interviewing process?
Review medical record
Set goals for the interview- clarify your goals for the interview
Review your clinical behavior and appearance
Adjust the environment as needed-to make the patient more comfortable
The interview process is a time for open ended questions listening and trying to connect with the patient and elicit the chief complaint.
What are some examples of guided questions and when would you use this technique?
Moving from open ended to focused questions
Asking a series of questions one at a time
Clarifying what the patient means
Use these questions when trying to get subjective data from the patient during history taking
How do you share power with your patient?
Ask for their perspective
Convey interest in the person as well as the problem
Follow their lead
Validate emotional content
Share information
Make your clinical reasoning transparent
Reveal the limits of your knowledge.
What are the four methods of exploring the patents perspective?
FEELINGS
IDEAS about problem
IMPACT of the problem on daily living
EXPECTATIONS of disease, clinician, and healthcare in general
What are the four classic techniques of the physical exam?
Inspection
Palpating
Percussion
Auscultation
How might a patients dress and grooming reveal clues to medical conditions?
Excessive clothing could reveal cold intolerance, maybe meant to hide: appearance (obese or anorexic), drug use, or rash.
Shoes- cut out can indicated pain/gout, space limitation/bunions, edema.
Hair, fingernails, and use of cosmetics- These are clues to personality, mood, lifestyle, and self regard.
Are their grooming standards typical of their age, lifestyle, or stage of life?
What are some steps to taking an accurate blood pressure?
No smoking or drinking caffeinated beverages 30mins prior
Room should be comfortably warm
Sit quietly for 5 mins
Arm selected should be CLOT FREE.
Confirm brachial artery pulse
Make sure the brachial artery is at heart level
What are the three goals in choosing the sequence of the physical exam?
Maximize the patients comfort
Avoid unnecessary changes in position
Enhance clinical efficiency
Define white coat HTN
Bp is high but ambulatory pressures are normal, so CV risk is low. This constitutes 15-20% of state 1 hypertensives.
This maybe a conditioned response to being in the office
Relax the patient and remeasure bp later
What are korotkoff sounds and how can you intensify them when taking a patients bp?
Just regular bp sounds.
Raise the patients arm before and after you inflate the cuff, the lower the arm and take bp.
You can also ask the patient to make a fist several times prior
Emotional stress is frequently associated with illness don’t miss opportunities to acknowledge these clues. With this concept in mind answer the following question.
Your patient has been having difficulty being intimate with their partner but is having difficulty expressing this. When asked about their sexual activity they shrug and jokingly say, “it’s alright I guess, not like when I was 18 or anything”
How might you dig deeper to find the truth?
Address the patients feeling about the issue
Ask them what they feel the nature and cause of the problem is
Find out what the effect their problem is having in their life
Find out what their expectations are
What might you suspect about a patient leaning forward with their arms braced?
They may have COPD
Why might noticing an impaired gait be important when working with the elderly?
It can increase fall risk, and hip fracture risk rises as well, which can be severely life changing.
How might you take the bp of a very obese patient?
Use a thigh cuff, or very long cuff, or wrap a cuff around the patients forearm and hold the arm at heart level.
What is masked HTN and why is it problematic?
It’s the opposite of white coat HTN. The patient has normal bp in the clinic but high outside the clinic. This translates to a masked risk of CV disease.
You send a well instructed patient home to monitor their bp 2x daily for a week. What should you be concerned about that would give you an inaccurate bp?
A) wrist and finger monitors introduce inaccuracies
B) The cuff width at 40% of the upper arm circumference
C)The patient uses a device with an automatic read out
D) The arm is level with the heart
A) Some devices used for convenience introduce inaccuracies
Distal sights have higher systole and lower diastole
List causes of generalized itching without apparent rash.
Causes of generalized itching without apparent rash include dry skin, pregnancy, uremia, jaundice, lymphomas and leukemia, drug reactions, lice….
Describe why artificial light is not optimal when examining the skin.
Artificial light can distort color and mask jaundice, so use natural light when possible.
Where would you look to observe jaundice?
Look for the yellow color of jaundice in the sclera. Jaundice may also appear in the palpebral conjunctiva, lips, hard palate, undersurface of the tongue, tympanic membrane, and skin.
Jaundice suggests liver disease or excessive hemolysis of RBCs
Describe a common etiology of tonsillar exudates.
tonsillar exudates are common in streptococcal pharyngitis
What does a positive Finklesteins test indicate?
Identifies de Quervain’s tenosynovitis from inflammation of the abductor pollicis longus and extensor pollicis brevis tendons and tendon sheaths.
What might urethrius, conjunctivitis, and arthritis indicate?
Reiters syndrome/reactive arthritis (recent infection then appearance of these symptoms). Can’t see, pee, or climb a tree.
Sciatica can be increased how, in a clinical setting?
cough or valsalva (forced exhalation with closed airway)
Define dysdiadochokinesis
This is when one movement cannot be followed quickley by its opposite and movements are slow, irregular, and clumsy. This can occur is cerebellar disease.
This is tested with the rapid actions test in the neuro exam. Hand flopping back and forth, or finger to thumb touching.
