Pds Exam I

Front 1

describe the sequence of the medial encounter

Back 1

o Ask the patient about their problem
o Examine the patient
o Perform test
o Determine the diagnoses
o Develop a plan with the patient

Front 2

describe the typical order of medical documentation

Back 2

o Subjective: what the patient tells you
o Objective: what you observe and test results
o Assessment: what are your diagnoses
o Plan: what are you going to do

Front 3

give three reasons why history is important part of interview

Back 3

o Beginning of every encounter
o Undervalued
o To establish trust
o To acquire information

Front 4

give three reasons for the medical interveiw

Back 4

o Gathering data
o Developing rapport
o Responding to emotions
o Educating and motivating the patient
o Developing a differential diagnosis

Front 5

state the steps to beginning the interview

Back 5

o Introduce yourself and greet the patient
o Ask patient what he/she wishes to be called
o Explain your role as a medical student
o Explain the purpose of your session with the patient
o Explain that the physician will see the patient following the student interview
o Obtain the patient’s permission for the interview

Front 6

describe how non-verbal communication plays a role in the interview

Back 6

o Look like you are there to stay for awhile
 Posture
 Eye contact
o Let the patient tell you what is wrong
 Open-ended questions
 Don’t interrupt
 Use the patient’s language
o Don’t scare the patient
 Distance
 Gestures
 Professional dress (no shoulders, breasts, stomachs or toes showing)

Front 7

state the seven components of the patient history

Back 7

o Introduce yourself (Intro)
o Chief Concern (CC)
o History of Present Illness (HPI)
o Past Medical History (PMH)
o Family History (FH)
o Social History (SH)
o Review of Systems (ROS)

Front 8

develop a framework to analyze complex medical ethics issues

Back 8

o Can be harder than the medical decision
o Can conflict with the “best” medical therapy
o “Not taught to do this”
o Often seems based on intuition or personal value systems
o Needs to be practiced – this is not just something to write about or talk about in lectures…
o Ethical problems, like medical problems cannot be left hanging – resolution must be sought

Front 9

what are the four main categories of the four box model

Back 9

medical indication
patient preferences
quality of life
contextual features

Front 10

what are some examples of medical indications.

Back 10

 Determine diagnostic and therapeutic interventions
 Verify medical facts of the patient’s case
 Understand the possible benefits
 What are the goals of the treatment?
 How can harm be avoided?

Front 11

what are some examples of patient preferences

Back 11

 What are the patient’s goals and values?
• “Go big or go home”
• Live as long as possible
 Does the patient understand the options?
 Does the patient have the capacity to make a decision?
 How do/should surrogates decide for patients?

Front 12

what are some examples of contextual features

Back 12

 People
 Institutions
 Financial arrangements
 Social arrangements
 Psychological ramifications
 Legal repercussions
 Religious impact
 Scientific inquiry

Front 13

what are some examples of quality of life

Back 13

 Freedom from pain
 Possess cognitive abilities
 Care for self
 Full supportive care on a ventilator
 Able to play 18 holes…

Front 14

name the four guiding principles of ethics

Back 14

benevolance
non-malificence
patient autonomy
fairness

Front 15

define confidentiality

Back 15

with faith or trust that information will not be disclosed

Front 16

give two reasons why confidentiality is essential

Back 16

patient care
societal welfare

Front 17

name 5 criteria exceptions to confidentiality

Back 17

Consent
Harm to others
legal determination
Miranda
Definite breach criteria

Front 18

what are five reasons you should deifnitely breach confidentiality

Back 18

Last resort
Illegal contact
serious harm
high probablity of harm
intervention likely to prevent harm

Front 19

give three main reasons you should take a social history

Back 19

screening exam
hidden agenda
diagnosis clearly related

Front 20

how can you make taking a social history easier

Back 20

o Consciously acknowledge your discomfort
o Be non-judgmental with the goal of improving your patient’s health (body language/expression)
o Get to know your patients first (visits over time)
o Explain your reasons for asking

Front 21

name some barriers to talking about sexual behavior or social history in general

Back 21

o Patient
 MD uncomfortable, disclosure of habits/behaviors, denial, presence of someone else, embarrassed, reluctant to change behaviors
o Physician
 Inexperienced/uncomfortable, Pandora’s box, offending patient, lack of time, presence of another individual, community overlap, relevance to current problem

Front 22

name everything in the social history

Back 22

o Current lifestyle
 Living situation
 Relationships
 Support system
 Daily activities
 Leisure
 Cultural/spiritual beliefs
 Advanced directives
o Risk factors
 Health habits
• Nutrition
• Caffeine
• Exercise
• Sleep
• Safety
• Environmental exposures
• Tattoos/piercings
 Substances
• Tobacco
• Alcohol
• Illicit drugs
 Sexual habits
 Economic risks
 Stress
 Violence
o Social impact

Front 23

what are the two main goals of nutritional assessment

Back 23

If there is deficiency or excess, the cause, and plan.

Front 24

name three major consequences of undernutrition

Back 24

reduced immune
slower wound healing
decreased survival
(in children, growth retardation)

Front 25

list five components of nutrition history

Back 25

Medical, family and social history
Physical activity history
Weight history
Diet history
Medication history

Front 26

describe four methods to obtain a diet history

Back 26

diet history of usual intake
24 recall
food frequency questionaire
food records