Flashcards in Midterm Deck (90):
Four marks of a profession?
1.) Acquisition and application of a body of knowledge
2.) Regulate themselves
3.) Fiduciary duty
4.) A shared commitment
What are the six guiding principles of the student and the doctor?
5.) Honor and integrity
6.) Respect for others
What are the four ethics in medicine?
How can stress impact you physically?
A 15 second episode of stress can cause hormonal changes that last 6 hours
Physical signs of stress?
Weight gain or loss
What percent of patients leave the office without understanding what their doctor is telling them?
How long before a doctor interrupts a patient?
What percent of medical students have symptoms of depression?
20% (12% major depression)
What percent of medical students report suicidal ideations?
What percent of medical students positive for at risk drinking? Illicit drugs?
Which doctors have the highest rate of substance use?
Psychiatrists and anesthesiologists
What are three symptoms of burn out?
Diminished sense of personal accomplishment
What percent of physicians and medical students experience burn out?
What are the three stages of burnout?
What percent of patients fully understand what their doctors tell them?
What is the average time for a patient to tell you why they are there?
What are the three components of communication?
What we say
How we say it (pitch, tone, volume)
Non-verbal body language
What does the doctor patient relationship depend on?
Empathy (putting yourself in their shoes)
What is important to listen to when speaking with a patient?
How many questions does a female ask versus a male in an average 15 minute appointment?
What is verbal communication primarily based on?
What is non-verbal communication primarily based on?
Biological behavior (ubiquitous across cultures)
What percent of our meaning is derived from non-verbal communication?
What is the single most effective diagnostic tool?
A good medical interview
What are the three functions of the medical interview?
1.) Gathering data
2.) Establishing a therapeutic rapport
3.) Educating the patient
What are the two types of interviewing techniques?
What is a clinician-centered interview?
The physician takes charge of the entire interaction to acquire details of the patient's symptoms and data to help with disease ID
What is a patient centered interview?
Encourages patients to express what most important to them (recognizes the importance the patient's expression of personal concerns, feelings, and emotions)
What two categories of information does the medical interview provide?
What the patient says about the illness
How the information is told
What are the objectives of the medical interview?
1.) Establish a supportive environment and initial rapport
2.) Develop an awareness for the patient's emotional state
3.) ID all of the problems or issues that the patient has come to discuss
4.) Develop a partnership with the patient. Enable the patient to become a part of the collaborative process
What are the two basic categories of medical interviews?
Problem oriented (specific problem)
Health promotion (baseline or past)
What is an important type of question to ask patients?
Open ending questions
What is wrong with using leading questions?
They direct the patient to answer as they feel the doctor wants to hear; leads to misinformation and or misunderstanding
What is the difference between a "why" and a "what " question?
"Why" may make the patient feel as if they need to defend themselves
What are four interviewing techniques?
What is a facilitation technique?
Encouragement and guidance for the patient to tell their story without specifying the kind of information you are seeking
What is a reflection technique?
Mirror what the patient just said in a way that encourages more detail
What is a clarification technique?
Ask for clarification of anything you do not understand, but wait for the proper moment
What is a confrontation technique?
Bringing attention to something the patient says or how they act that they may not be aware of. Draw attention to the patients verbal or non-verbal responses
What are the two types of support?
How is empathy used to show support?
Telling the patient that you understand what they are going through. Validates the patient's feelings without criticism
How is reassurance used to show support?
A statement given to the patient or family to help them feel better. It must be based on fact.
What are the four steps to closing an interview?
1.) Summarize the important issues discussed
2.) Opportunity for questions
3.) Offer reassurance if appropriate
4.) Guide as to what is next
What does S.O.A.P. stand for?
What is the difference between signs and symptoms?
Symptoms are what the patient experiences (Subjective)
Sign is what is observable and palpable (Objective)
Where is the chief complaint written?
Under the subjective portion (stated in the patients own words)
What is the proper way to start the HPI section?
Age, Sex, Racial profile of the patient
When is it appropriate to take a comprehensive history and physical?
New patient evaluation
Annual health examination
Admission for a hospitalization
What does the subjective portion include?
PMH, PSH, Meds, Allergies, Social History, Family History, ROS
Why is it important to ask a patient what happens when they encounter a substance they are "allergic" to?
They may give symptoms that are intolerance not true allergies
What is important to note about medications?
Name, dosage, route, frequency and reason for use
What is asked about in allergies?
Drug reactions, foods, and environmental agents
What does the Objective portion contain?
Facts about the patient's physical exam
What are the vital signs?
Temp., BP, Pulse, Respiratory rate, Height, Weight
What is in the assessment portion?
The physician's medical diagnoses and impressions for the medical visit on the given date of the visit
What is the plan portion?
What the physician will do to treat or further workup the patient's problem or concern
What are the four cardinal vital signs?
Pulse, Respiratory rate, body temp, blood pressure
What is the difference between spot and continuous vital signs?
Spot: taken periodically (not as accurate)
Continuous: taken continuously (big picture; more accurate)
Difference between heart rate and pulse?
Heart rate is the number of times a heart beats per minute whereas pulse is the palpable amount of times it beats per minute
Where is the first place you attempt to measure a pulse on an adult?
Where do you take a pulse in an older child?
Where do you take a pulse in an infant?
What is the average respiratory rate in adults?
12 to 16 per minute
Normal adult heart rate?
What is a Korotkoff sound?
Sounds created by pulsatile blood flow through the compressed artery (non-laminar flow)
What is a pre-hypertensive blood pressure?
What is hypotensive blood pressure?
Less than 90/60
What is mean arterial pressure (MAP)?
The average blood pressure in a person
What is a normal value for MAP?
What MAP value is needed for basic organ perfusion?
What is the red thermometer used for??
What is the average body temperature when taken orally?
98.6 F/ 37C
What is the average body temperature when taken rectally?
What is the most accurate way to obtain a temperature in an infant?
What are three other "5th" vital signs?
End tidal CO2
Where are the vital signs and general appearance documented?
In the first two lines of the physical exam
What happens to a blood pressure reading if you use a cuff too small?
What happens to a blood pressure reading if you use a cuff too large?
What is the most effective method of radiation protection?
What angle of X ray is superior?
What are the factors that affect X ray image quality?
Fog (improper development; exposure)
Focal spot size
What is a safe distance in modern x ray units?
What does the ALARA concept mean?
Keeping radiation As Low As Reasonably Achievable
What are the properties of T1 MRI?
Anatomic, short TR and TE
Bright signal if there is fat, acute blood, or high proteinaceous material
What are the properties of T2 MRI?
Water sensitive, long TR and TE
Bright tissue has high fluid content such as cyst, bladder, spinal fluid
What are X-rays best used for?
What are CT scans best used for?
Internal damage of soft tissues and bone; 3D reconstruction
What are MRIs best used for?
Soft tissue damage 3D
Where does golfer's elbow occur?