Fcm Session 1

Front 1

Describe attributes of professional behavior?

Back 1

-Commitment to highest standards of excellence in practice of medicine and in generation and dissemination of knowledge

-Commitment to sustain interests and welfare of patients

-A comittment to be responsive to the health needs of society

Front 2

Can you describe behaviors that would be unprofessional? Describe how these
behaviors could negatively impact a physician’s ability to successfully carry out
his/her role?

Back 2

Abuse of power; Arrogance; Sexual harassment; Greed; Misrepresentation; Impairment; Lack of conscientiousness; Conflicts of interests

Front 3

What is confidentiality? What does it have to do with professionalism?

Back 3

Not divulging patients' medical and personal info with anyone not involved in the care of the patient or in a place where it can be overheard. If patients can't trust physicians, they won't share potentially useful info.

Front 4

Describe special circumstances in which confidentiality guidelines must be
adhered to. What about confidentiality when caring for adolescents?

Back 4

Health care provider should discuss confidentiality and when it will be breached with both parent and adolescent in exam room. Place emphasis on common goal of optimal health for adolescent patient.

Confidentiality is breached when pt poses immediate risk of severe harm to self or others, or physical or sexual abuse is suspected. The adolescent must be informed of the breach of confidentiality.

Front 5

What is HIPAA and why is it important to me as an M1 student?

Back 5

health insurance portability and accountability act. Law that lays out guidelines for a variety of impt things including how health info should be shared.

Front 6

What is patient-centered interviewing?

Back 6

Letting patient take the lead in interview and allowing pt to reveal full set of concerns. Results in more info, and increased pt satisfaction. Increases physician efficiency.

Front 7

Describe how this skill assists in information gathering:
nonverbal communication

Back 7

signifies attentiveness, including positions of physician and patient in room, eye contact, posture, gestures

Front 8

Describe how this skill assists in information gathering:
open-ended questions

Back 8

Allow the pt latitude in choosing a response. More likely to say a complete and accurate description of problem AND be more efficient, especially early in the interview. enhances pt satisfaction.

Front 9

Describe how this skill assists in information gathering:
directed questions

Back 9

Elicit specific info later in the interview. Review of Systems is an example. Don't use prematurely or they can prevent patient from disclosing other impt data.

Front 10

Describe how this skill assists in information gathering:
Reflection/echoing

Back 10

Lets patient know dr. is listening. Encourages pt to give more info about facts and feelings.

Front 11

Describe how this skill assists in information gathering:
Facilitation

Back 11

Any comment/behavior that encourages patient to keep talking. Examples: Tell me more...

Front 12

Describe how this skill assists in information gathering:
Clarification

Back 12

Questions that clarify ambiguity or direct process and flow of interview. Eg. "Tell me what you mean by a dizzy feeling"

Front 13

Describe how this skill assists in information gathering:
Checking and summarization

Back 13

Providing a summary and asking patient to review accuracy and completeness of the info. Confirms interviewers understanding of the problem. Can help beginning interviewers refocus the interview if they get stuck or confused about how to proceed.

Front 14

How do you, as a student, introduce yourself to a patient?

Back 14

Greet patient by name and introduce yourself, giving own name. Explain role.

Front 15

What is a “chief complaint”?

Back 15

Primary reason for seeking medical care, expressed when possible in patient's own words

Front 16

What is the best way to obtain a chief complaint?

Back 16

open-ended questions and basic data-gathering skills

Front 17

Can you name two situations in which the “chief complaint” that the patient tells
you at the start of the interview may not be his/her true concern?

Back 17

When chief reason is psychosocial, or otherwise embarrassing to patient

Front 18

What if there is more that one “chief complaint?”

Back 18

Keep asking "anything else" or "tell me more" makes use of time more meaningful, and reduces short shrift given to late-emerging concerns

Front 19

What are the 4 components used for most medical records?

Back 19

Medical history; Physical exam; assessment; plan

Front 20

What is the difference between a complete medical database (complete H&P) and
a problem-based note (progress note)?

Back 20

Complete H&P is a source of fundamental and personalized knowledge about the patient that strengthens the clinician-patient relationship. Provides more complete basis.

Problem-based note is more appropriate for established patients, esp during routine or urgent care; restricted to specific body system

Front 21

What are the three medically relevant definitions of “normal”?

Back 21

Commonly encountered;
Statistical norm;
Associated with health;
Cultural or social norm

Front 22

What are different ways to check temperature? What are their limitations and
accuracy?

Back 22

Rectal: about .5 degree C above body temp; usually used for infants. Most accurate for infants

Axillary: One degree below oral temp; least acc.

Tympanic temp: requires special instrument. Accuracy depends on operator

Oral temp: affected by mouth breathing, hot/cold beverages

Special low range thermometer for assessing hypothermia

Front 23

How do you check a heart rate (pulse)?

Back 23

Radial and/or brachial by palpation; apical by auscultation

Observe rate and rhythm, note sinus arrhythmia as normal variant

Normal range in adult is 60-100 bpm.

Heart rate decreases as children age.

Front 24

How do you check a respiratory rate?

Back 24

Have to do it surreptitiously.
Normal range is 14-20 bpm, decreases as children age.

Front 25

Walk through the steps required to check an accurate blood pressure.

Back 25

Make sure pt is seated, feet on ground. Check to make sure cuff is in range. Palpate radial pulse. Inflate cuff until you can't feel radial pulse. Deflate cuff. Wait 30 seconds. Pump to 30 units above, then deflate slowly, 2 mm Hg/second.

Front 26

What can deflating the cuff too fast do?

Back 26

Result in underestimating the systolic blood pressure and overestimating the diastolic pressure. Recommended to deflate at 2 mmHg/sec

Front 27

What is pseudo-hypertension?

Back 27

Atherosclerosis of the brachial artery results in stiffening of the artery wall. Artificially high blood pressure measurements results.

Front 28

What can happen if excessive pressure if held on stethoscope head?

Back 28

Falsely low diastolic

Front 29

What is the auscultatory gap?

Back 29

A silent interval that may be present between the systolic and diastolic pressure. Associated with arterial stiffness and atherosclerotic disease.

Front 30

What can an unrecognized auscultatory gap do?

Back 30

May lead to serious underestimation of systolic pressure.

Front 31

What can slow or repetitive inflations of the cuff cause?

Back 31

Venous congestion, which may produce artificially low systolic and high diastolic pressures. Makes sounds less audible.

Front 32

What can deflating the cuff too fast cause?

Back 32

May miss sounds, less accurate

Front 33

What is the definition of stage 1 hypertension in adults?

Back 33

Systolic: 140-159
Diastolic: 90-99

Front 34

What is the definition of stage 2 hypertension in adults?

Back 34

Systolic: >160
Diastolic: >100

Front 35

What is the definition of pre-hypertension in adults?

Back 35

Systolic: 120-139
Diastolic: 80-89

Front 36

What are Korotkoff sounds?

Back 36

Sounds during the taking of a blood pressure. There's several of them. They result from the flow of blood returning to the artery.

Front 37

How can you intensify Korotkoff sounds?

Back 37

Have patient raise arm before and during cuff inflation, then lower arm and determine blood pressure.

Ask patient to make a fist several times after you inflate cuff and before determining blood pressure.

Front 38

Which Korotkoff sounds signify diastolic blood pressure in children?

Back 38

The 4th (muffling of the sounds)

Front 39

Which Korotkoff sounds signify diastolic blood pressure in adults and adolescents?

Back 39

The 5th (disappearance of sounds)