CS2_Exam One
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Wayne State University *
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MISC
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Health Science
Date
Jan 9, 2024
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14
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Clinical Skills 2 – Exam One 1.
Define HPI and discuss its purpose è
Amplifies the chief complaint & describes how each symptom developed è
Includes patient’s thoughts, feelings, effects on life, etc. 2.
Discuss the components of the HPI è
Onset, frequency, location, quality, quantity, setting, timing of the symptom, alleviating and aggravating factors, associated symptoms, patient perspectives è
WWQQAA+B 3.
Decide which data should/should not be included in the HPI è
May/should include: medications, treatments, allergies, tobacco/alcohol use o
Medications = Rx, OTC, alternative, since when, dosage, frequency, etc. è
Should include pertinent positive & negative findings (i.e. cough w/ phlegm OR cough does not have phlegm) 4.
ID the proper format in writing the HPI è
Clear, chronological order written in paragraph format è
Must be accurate, concise, and complete 5.
Define PMH and discuss the purpose of it 6.
Discuss the components of the PMH & decide which data should/should not be included è
Childhood history = diseases, hospitalizations, vaccinations è
Adult history = diseases, hospitalizations, operations, vaccinations, screening tests è
Injuries/accidents è
Blood transfusion è
Mental health è
Allergies è
Other medications è
Obstetrical & menstrual history = age of onset, duration, cycle, flow, OB score, contraceptives, deliveries, etc. 7.
ID the proper format in writing the PMH è
Not in paragraph form – it is just listed in bullet form 8.
Define FH & discuss its purpose è
Enquiry into diseases that present in the family & might affect the patient’s health è
Although you may already have an idea of diagnoses, the FH can provide other info or indicate risk factors for certain diseases 9.
Discuss the components of the FH & which data should/should not be included è
Hereditary diseases, familial illnesses, current/recent sickness in family, social habits 10.
ID the proper format in writing the FH è
Written in bullet form 11.
Describe all process skills used in the interview and determine which skill best facilitates the interview after patient responses OB
sore
G-
p
-
CFPAL
)
è
Gives appropriate non-verbal cues, picks up on non-verbals, appropriate communication, summarizing/checking for accuracy, logical structure and timing, support and concern, etc. 12.
List the specific areas of questioning and cite examples of questions when asking about “family status and relationships” and about “home situation” è
who lives with you in your home? Are you in a relationship/married – and how long? are there any children living in your home? What is the support system like in your household? è
Tell me about your home situation (type of housing, location of housing) è
Are there any problems or stressors with your housing? 13.
ID key concerns when asking about employment, education, and health literacy & use appropriate questions è
Are you working now? Tell me about your job/daily work è
Have you ever served in the military? è
Are there any stressors in your work at this time? è
Tell me about your schooling/education. How happy are you with how well you read? 14.
ID key concerns about sleep, diet, and financial concerns & use appropriate questions è
Do you have any concerns about affording your health care? è
Tell me about your normal diet. Do you have any restrictions? Do you consume enough water? Allergies? è
What’s your average number of hours of sleep per night? Do you wake up refreshed? Any problems falling asleep or staying asleep? 15.
Describe an “explanatory model” and how it was assessed è
Refers to how the patient explains their illness to themselves è
Partially derived from asking the patient their perspective: “what do you think might have caused the problem?” è
This is important because it will influence how they’re going to respond and try to get well 16.
Assess sleep and make a statement about the patient’s sleep and risks in a note è
There’s a wide range of sleep time that’s considered “normal” but ~7.5hrs is the standard è
If patient feels refreshed & awake throughout the day after 6 hours, then they don’t need more sleep è
If patient needs 9 hrs/night to feel refreshed then the 7.5 is not enough 17.
ID potential hazards in the patient’s life è
Are you being exposed to any kind of environmental hazards? è
Do you use any safety measures such as seat belts, smoke detectors, sun screen? 18.
Describe what is meant by complementary, alternative, and integrative medicine and ID some common alternative & complementary practices used in the US è
CAM = complimentary and alternative medicine è
“
complementary medicine
” = use of CAM together w/ conventional medicine e
If
acvpuntvre
to
help
wl
side
effects
of
cancer
treatment
è
“
alternative medicine
” = use of CAM in place of conventional medicine è
“
integrative medicine
” = combines treatments from conventional medicine and CAM for which there’s some high-quality evidence of safety and effectiveness è
CAM Therapies: acupuncture, hypnosis, meditation, naturopathy, tai chi, qi gong, chelation therapy, deep breathing exercises, homeopathic treatment, massage, yoga 19.
Describe a basic screening protocol for assessing domestic violence when taking the social and personal history è
SIGNPOST: “because abuse is common in many patient’s lives, I’ve begun to ask about it routinely. In the last year, have there ever been times that you do not feel safe at home?” o
If patient says they don’t feel safe or is considered high risk due to their history, signs, symptoms, or any red flags then follow up w/ the PEACE or HITS questions 20.
ID indicators and red flags for the possibility of domestic violence and determine when to use screening questions è
Unexplained injuries or inconsistent w/ patient’s story è
Injuries cause significant embarrassment or reluctance to speak è
When the patient or someone close to them has a history of alcoholism/drug abuse è
When spouse or other accompanying person tries to dominate the interview, is anxious, or controlling 21.
Describe what happens in the interview if the patient says they do not feel safe at home è
Follow up w/ the PEACE or HITS questions è
HITS = hurt, insult, threaten, scream 22.
Determine when to use PEACE questions and how they’re asked è
P: have you ever been in a relationship in which you’ve been
physically
hurt by a partner or someone you love? è
E: have you ever felt you’re walking on eggshells
to avoid conflicts w/ a partner or loved one? –
start w/ this question, then go in order**
è
A: have you ever been sexually abused
, threatened, or forced to have sex, or participate in sexual practices when you did not want to? è
C: has your partner/loved one tried to control where you go, what you do, and who you talk to or who your friends are? è
E: have you ever been emotionally abused or threatened by a partner or loved one? 23.
ID which of the 5 stages of change a patient is showing è
Pre-contemplation: not currently considering change o
Validate lack of readiness, encourage re-
evaluation/self-exploration, explain and personalize the risk è
Contemplation: ambivalent or not considering change within the month treating
heart
disease
"
WI
chelation
o
Validate lack of readiness, encourage evaluation of pros/cons, ID/promote new and positive outcome expectations è
Preparation: some experience w/ change, trying to change or planning to act within the month o
Identify and assist in problem solving, help ID social support, verify patient has underlying skills for change, encourage small initial steps 24.
Use the OARS techniques è
O: open ended questions è
A: appreciate è
R: reflect è
S: summarize 25.
Explain the A’s of ask, advise, assess, and assist for a patient who’s trying to quit smoking è
Ask:
“Do you smoke?” at every visit, even after they quit è
Advise
them to quit smoking at every visit. Be clear, strong, and personal. è
Assess their readiness to quit by asking them if they want to quit. Find out what stage they’re in by asking for them to rate the importance, and pros/cons, etc. è
Assist
them w/ a plan if they’re ready to quit. Keep the conversation active and keep the patient thinking about the behaviour. Make a quit date and use self-monitoring and goal setting. è
Arrange follow up if possible 26.
Determine the risks of caffeine consumption and apply to the concept of dose dependence. è
A dose of 300mg does NOT act as a positive reinforcer and can produce increased anxiety and mild dysphoria (average intake is 200-250mg/day = 2 cups) è
Even higher doses produce confused thinking, rambling speech, marked agitation, and mild visual hallucinations è
Risks of caffeine consumption are dose-dependent: o
Gastric ulcers, trigger coronary/arrhythmic events, side effects on fetus, headache, anxiety, tremors, insomnia o
Cancer may be associated but data is lacking o
Long term = generalized anxiety disorder, depression, and substance abuse disorders è
Caffeine shots have tons of Vitamin B, which could possibly be overdosed on if not enough H2O is consumed 27.
Calculate pack years & explain to a patient è
One pack = 20 cigs è
Pack years = (# of packs/day) x (years of smoking) è
Measurement forms an international standard used to determine tobacco exposure & is used in two ways: o
Smoking risk appraisal o
Determine association or causality w/ specific smoking related diseases
è
Incidence of lung cancer is strongly correlated w/ smoking, and this risk increases w/ the # of cigarettes smoked over time è
> 30 pack-year histories have the greatest risk for developing lung cancer o
Among those who smoke 2 or more packs/day, 1 in 7 will die of lung cancer è
Helps put the patient’s risk in the proper perspective 28.
Provide appropriate medical advice concerning nicotine & alcohol use è
“Quitting tobacco is the most important thing you can do to protect your health. I strongly recommend that you consider quitting, and I am willing to assist you in this” è
Assess the patient’s readiness to quit through MI è
Clinical trials have demonstrated that brief interventions promote significant, lasting reductions in drinking levels of “at-risk drinkers” who are not yet showing signs of alcohol use disorder; even if they don’t accept a referral, repeated alcohol-focused visits w/ a health care provider can lead to significant improvement
29.
Determine the risk for male & female patients in terms of the amount of alcohol consumed & pattern of consumption è
All heavy drinkers have a greater risk of: hypertension, GI bleeding, sleep disorders, major depression, hemorrhagic stroke, cirrhosis of liver, several cancers è
Heavy alcohol use commonly INDUCES: cardiac arrhythmias, depression, irritability, trauma, sexual dysfunction, dyspepsia, anxiety, insomnia, headaches è
Drinking becomes too much when it causes/elevates the risk for alcohol-related problems or complicates the management of other health problems o
Men who drink more than 4 standard drinks/day (or >14/week) o
Women who drink more than 3 drinks/day (or >7/week) 30.
ID early symptom patterns shown by patients w/ alcohol use disorder è
Headaches, early morning awakenings, GI problems, irritability, inability to focus è
9/10 primary care physicians in US fail to correctly diagnose alcohol use disorders, even when their adult patients present w/ these symptoms 31.
Use CAGE screening questions è
Used for drug & alcohol use – used on each substance to determine how the substance is affecting the patient’s life è
C:
have you ever felt you need to CUT down on drug use? è
A
: have people ANNOYED you by criticizing your drug use? è
G
: have you ever felt GUILTY about your drug use? è
E
: have you ever had a drink/substance first thing in the morning to steady your nerves or get rid of a hangover (EYE opener)? è
If yes to any of these 4 questions… o
Do you use any other drugs than those prescribed by your physician? o
Has a physician ever suggested that you might cut down or stop use of any substances? o
Has your drug use ever caused you any family/work/legal problems? o
When using drugs have you ever had a memory loss or blackout?
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