Clinical Skills Exam 1 Examples Questions And Answers Fully Solved.

Subjective Information - correct answers Chief complaint history of present illness PMH Family history social history review of systems History of Present Illness (HPI) - correct answers Onset Location Duration Character Associated Factors Aggravating Factors Relieving Factors Temporal Factors Severity of Symptoms Past Medical History (PMH) - correct answers Medical Illnesses Medications Allergies Immunizations Surgeries Hospitalizations Injuries Family History Travel Social History - correct answersHabits (tobacco, alcohol, drugs, diet, exercise, sleep) Occupation Relationships Safety of relationships Sexual history Environment Spirituality Objective - correct answersVital Signs Head to Toe Physical Exam Cardinal Principles of Physical Exam - correct answersInspection -- as they walk in room physical signs Auscultation -- with and without stethoscope, voice Percussion -- what you hear when strike body Palpation -- use fingers Plan - correct answersFollow up Additional Tests/Referrals Medications OMT Understanding of disease impact Self care A problem - correct answersanything that will need further evaluation and/or attention - uncertain diagnosis - new findings related to previous diagnosis - new findings of unknown etiology - personal/social difficulties - unusual findings revealed in clinical evaluation or by lab tests Ways to make a diagnosis - correct answers1. Regonise patterns -- used most, past experiences 2. Hypothesis generation and testing -- come with as many diagnosis and test 3. Sampling the Universe -- order every test, exhaustive measures 4. Use algorithms -- step-by-step, yes/no pattern Bayes Theorem - correct answersprobability of an event based on conditions that might be related to that event - how much symptoms relate to diagnosis - if that disease is present in the community ex. malaria not here so not really probable Professional DO Definition - correct answersOsteopathic medicine is a complete system of medical care practiced by physicians with an unlimited license that represented by a philosophy that combines the needs of the patient with the current practice of medicine, surgery and obstetrics. It emphasises the interrerlationship between structure and function, and that has an appreciation of the body's ability to heal itself Lay DO Definition - correct answersA doctor of osteopathic medicine is a fully licensed physician who can perform surgery and prescribe medication. DOs receive extra medical training so they can use their hands to help in the diagnosis and treatment of their patients. There is also a focus on understanding home and work life in order to treat the whole person. ECOP - correct answersEducational Council of Osteopathic Principles - organization in AACOM - obtain consensus on usage - each DO school has rep - expert panel in DO 4 principles of osteopathic philosophy - correct answers1. The body is a unit, the person is a unit of body, mind and spirit 2. The body is capable of self-regulation, self-healing, and health maintenance 3. Structure (anatomy) and function (physiology) are reciprocally interdependent 4. Rational treatment is based upon an understanding of the basic principles of body unit, self-regulation, and the interrelationship of structure and function Somatic Dysfunciton - correct answersimpaired/altered function of related components of the somatic (body frame) system - treatable using OMT - Diagnose with TART (knots not broken bone) TART - correct answersDiagnose Somatic Dysfunction Tissue Texture abnormalities Asymmetry Restriction of motion Tenderness Direct Treatment - correct answersForce applied towards pain, Towards somatic dysfunction - move body part towards restrictions for all planes of motion and applying steady force until tissue give is completed Indirect Treatment - correct answersForce applied away pain, away from somatic dysfunction Joint Play - correct answers- determine if somatic dysfunction is present - Loss of joint play can be restored by OMT - Movement within a synovial joint that is independent of/cannot be reproduced by voluntary muscle contraction - essential for max pain free movement - very small movement Contraindication - correct answerssituation when treatment should not be used because it may be harmful to the person Absolute Contraindication - correct answers1. patient refuses to have OMT performed 2. Absence of somatic dysfunction Relative Contraindication - correct answers- caution should be used - potential benefit < harm to patient - OMT is quite safe besides treatment rxn and somatoemotional rxn Treatment Reaction - correct answersAfter OMT - soreness - acute muscle spasm - can last 24-48 hours Somatoemotional Reaction - correct answersAfter OMT - stirs up memory Modalities of OMT - correct answersCounterstrain Myofascial release Muscle energy technique High Velocity Low Amplitude (HVLA) Counterstrain - correct answers- indirect modality - passive positioning of patients Myofascial Relese - correct answers- Indirect modality -- move part in lax position - direct modality -- move part to restriction until tissue give is complete - continuous palpatory feedback High Velocity Low Amplitude (HVLA) - correct answers- direct modality - thrust -- rapid therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint Muscle energy technique - correct answers- direct modality - patient's muscles actively used on request by DO - Contraction occurs from precisely controlled position, in a specific direction against DO counterforce Soft tissue technique - correct answers- direct - not unique to DO - lateral stretching, linear stretching, deep pressure, traction and/or separation of muscle organ and insertion while monitoring tissue response and muscle changes by palpation - treat patient and simultaneously palpate soft tissue response Soft tissue dysfunction - correct answers- found by layer by layer palpation of soft tissues - type of soft tissue determines the type and duration of soft tissue technique Therapeutic effects of soft tissue techniques - correct answers- relaxers hypertonic muscles, reduce spasms - stretches and increases elasticity of shortened fascial structures - enhances structures to local myofascial structures -- improves local tissue nutrition, oxygenation, removal of metabolic wastes - improves abnormal neurological reflexes -- somato-visceral, visceral somato - improves local and systematic immune responses - provides general state of relaxation - optimise overall autonomic tone Types of soft tissue techniques - correct answers- traction -- stretching parallel to muscle fibers, longitudinal muscle stretch - kneading -- stretching perpendicular muscle fibers, lateral muscle pressure - inhibition -- sustained muscle pressure others - pertissage -- squeezing pressure to move fluid - effleurage -- stroking pressure to move fluid - tapotement -- striking with side of hand - skin rolling -- lifting skin away from the deeper structures and rolling the skin along the body Medical Record - correct answers- legal doc - precise record of patient history and physical findings - on going source of patient assessments - up to date record of management plans and outcomes - confidential - readily available for review by the patient Progress and encounter note - correct answers- focused summary of visit - hospital/ambulatory care - with established patient - may or may not include full ROS - may or may not include past med info - SOAP Format History and Physical (H and P) - correct answers- all aspects of history and physical (OLDCAARTS, MAISHIFT, HORSSES) - maybe SOAP - Complete and comprehensive (when care is established, up to date, preventative health care visits) - actual diagnosis and pertinent problems/risks Become a good communicator - correct answers1. Open Discussion 2. Relationship Building 3. Gathering Info 4. Understanding the Patient's Perspective 5. Sharing Information 6. Reaching Agreement 7. Providing Closure Open ended questions - correct answersallows patients to tell their story in their own words encourages them to say words they want to say Tell me about these headaches Closed ended questions - correct answersasks for specific information where does it hurt? does anything make it feel better? National Standardization of Health Care Communication - correct answers1. Kalamazoo Consensus Statement 2. COMPLEX Level 2 PE Kalamazoo Consensus - correct answersNational Standardization of Health Care Communication essential elements of doctor-patient communication (consensus of leaders in the field) - provide framework for communication in the curricula and standards COMLEX Level 2 PE - correct answers- must pass both biomedical and humanistic domain to pass PE - taken at beginning of year 4 - humanistic domain -- interpersonal s