NU 650 / NU650 Midterm Exam Advanced Health Assessment | 2026 Update | Questions & Answers with Detailed Rationales | Grade A | NP, APRN & Advanced Health Assessment Exam Prep PDF

INSTANT PDF DOWNLOAD — This is the comprehensive midterm exam preparation guide for NU 650 / NU650 - Advanced Health Assessment , featuring questions and answers with detailed rationales. Designed for Nurse Practitioner (NP), Advanced Practice Registered Nurse (APRN), Physician Assistant (PA), and graduate nursing students, this resource consolidates the critical advanced health assessment concepts required to master the NU650 midterm exam and excel in advanced practice clinical education. The guide is meticulously aligned with advanced practice nursing curricula, national certification exam blueprints (AANP, ANCC, NCCPA), and current evidence-based practice standards. This verified resource provides comprehensive coverage of key NU650 Advanced Health Assessment exam topics, including: Advanced Interviewing and Health History (comprehensive health history for adults, children, adolescents, older adults, pregnant patients; chief complaint (CC) analysis using OLDCARTS (Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity); history of present illness (HPI) - chronological narrative, associated symptoms, treatments tried, impact on function; past medical history (PMH) - childhood illnesses, adult illnesses, surgeries, hospitalizations, injuries, transfusions, immunizations, allergies (medication, food, latex, environmental), current medications (prescription, over-the-counter, supplements, herbal, dose, frequency, adherence, last dose); family history (FH) - three generations, age and health status of immediate family, cause of death, hereditary conditions (cardiovascular disease, hypertension, diabetes, cancer, stroke, kidney disease, arthritis, asthma, allergies, mental illness, substance abuse, genetic disorders), pedigree diagram, genogram; social history (SH) - lifestyle (tobacco (type, amount, duration, pack-years), alcohol (type, amount, frequency, CAGE questionnaire), illicit drugs (type, frequency, route), caffeine, exercise, diet, sleep), occupation (exposures, hazards, job satisfaction, shift work), education, military service, sexual history (activity, orientation, partners, STI history, contraception, safe sex practices, HPV vaccination), living situation (home environment, support system, pets, safety, intimate partner violence screening), activities of daily living (ADLs), instrumental activities of daily living (IADLs), spiritual/religious beliefs, cultural considerations, health literacy, patient preferences/goals; review of systems (ROS) - systematic head-to-toe review of body systems (general (weight change, fatigue, fever, chills, night sweats), HEENT (headaches, dizziness, vision changes, hearing loss, tinnitus, nasal congestion, sore throat, hoarseness), respiratory (cough, sputum, hemoptysis, dyspnea, wheezing, chest pain with breathing), cardiovascular (chest pain/pressure, palpitations, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, edema, claudication), gastrointestinal (appetite changes, dysphagia, nausea, vomiting, hematemesis, abdominal pain, change in bowel habits, diarrhea, constipation, hematochezia, melena, jaundice), genitourinary (dysuria, frequency, urgency, hematuria, incontinence, retention, flank pain, vaginal discharge, penile discharge, testicular pain/mass, erectile dysfunction), musculoskeletal (joint pain, swelling, stiffness, redness, warmth, decreased range of motion, muscle weakness, back pain, trauma), neurological (headache, seizure, syncope, weakness, numbness, tingling, tremor, gait disturbance, memory loss, confusion), integumentary (rash, lesions, itching, bruising, changes in moles, nail changes), endocrine (heat/cold intolerance, weight changes, polyuria, polydipsia, polyphagia, goiter, hirsutism), hematologic (easy bruising, bleeding, fatigue, pallor, lymphadenopathy), immune (frequent infections, autoimmune history, allergy history, immunizations), psychiatric (mood, anxiety, depression, suicidal ideation, homicidal ideation, hallucinations, sleep disturbance, appetite change, anhedonia, hopelessness, helplessness)); Advanced Physical Examination Techniques (inspection - visual examination, lighting, exposure, comparison of bilateral structures; palpation - light (1 cm depth, assess tenderness, temperature, moisture, texture), deep (4-5 cm depth, assess organs, masses), bimanual (two hands, assess deep structures); percussion - direct (strike body surface), indirect (strike finger on body surface), blunt (strike hand on hand over organ), assess density (dullness (solid organ), resonance (air-filled lung), hyperresonance (hyperinflated lung), tympany (air-filled stomach/intestine), flatness (muscle/bone)); auscultation - bell (low-frequency sounds: heart murmurs, bruits), diaphragm (high-frequency sounds: breath sounds, bowel sounds, normal heart sounds), sequence varies by body system; Comprehensive Head-to-Toe Assessment (general survey - appearance, behavior, mood, speech, hygiene, odor, distress, mobility, assistive devices, vital signs (temperature, pulse, respiration, blood pressure, oxygen saturation, pain), height, weight, BMI; HEENT - head (normocephalic, atraumatic, scalp, hair distribution), eyes (visual acuity (Snellen, Rosenbaum), confrontation visual fields, extraocular movements (EOMs), pupillary response (PERRLA), funduscopic examination (optic disc, vessels, macula)), ears (external ear, otoscopic examination (canal, tympanic membrane), hearing (Weber, Rinne)), nose (external, nasal speculum, septum, turbinates, mucosa), mouth and throat (lips, teeth, gums, mucosa, tongue, palate, pharynx, tonsils), neck (lymph nodes, thyroid, trachea, carotid pulses, bruits, jugular venous pressure (JVP), range of motion); respiratory system - inspection (shape, symmetry, retractions, accessory muscle use, respiratory rate/rhythm/effort), palpation (tracheal position, tactile fremitus (99, say 99), chest expansion), percussion (dullness (effusion, consolidation), resonance, hyperresonance (COPD, pneumothorax)), auscultation (breath sounds - vesicular (soft, low-pitched, peripheral), bronchial (loud, high-pitched, over trachea), bronchovesicular (intermediate, between scapulae), adventitious sounds - crackles (rales, fine, coarse), wheezes (sonorous, sibilant), rhonchi (low-pitched, snoring), pleural friction rub (leathery, grating), stridor (high-pitched, upper airway obstruction)), egophony (E-to-A change, consolidation), whispered pectoriloquy (increased clarity, consolidation), bronchophony (99 sounds louder/bronchial, consolidation); cardiovascular system - inspection (JVP, precordial movement, heaves, lifts), palpation (apical impulse (PMI) - 5th intercostal space, left midclavicular line, diameter 2.5 cm, pulsations, thrills (palpable murmur)), auscultation (heart sounds - S1 (mitral/tricuspid closure, beginning of systole), S2 (aortic/pulmonic closure, end of systole), physiologic splitting of S2 on inspiration, S3 (ventricular gallop, early diastole, heart failure, volume overload), S4 (atrial gallop, late diastole, compliance decrease, hypertrophy, ischemia), murmurs (timing (systolic, diastolic, continuous), location (aortic, pulmonic, tricuspid, mitral, Erb's point), radiation, intensity (Grade I-VI), pitch, quality, configuration (crescendo, decrescendo, crescendo-decrescendo, plateau)), pericardial friction rub (high-pitched, scratching, grating, three components), carotid upstroke, bruits; peripheral vascular system - peripheral pulses (radial, ulnar, brachial, femoral, popliteal, posterior tibial, dorsalis pedis) - amplitude (0 absent, +1 thready/weak, +2 normal, +3 full/bounding), symmetry, Allen test (ulnar collateral circulation), capillary refill (2 seconds), edema (pitting 1+ (2mm, disappears rapidly), 2+ (4mm, 10-15 seconds), 3+ (6mm, 1 minute), 4+ (8mm, 2 minutes), non-pitting), skin temperature, color, hair distribution, venous insufficiency (stasis changes, hemosiderin deposition, venous ulcers), arterial insufficiency (hair loss, shiny skin, thin skin, dependent rubor, elevation pallor, arterial ulcers); abdomen - inspection (contour (flat, rounded, scaphoid, distended), symmetry, scars, striae, veins, peristalsis, pulsations), auscultation (bowel sounds (normal, hyperactive, hypoactive, absent), listen 5-30 seconds per quadrant, bruits (renal, aortic, iliac, femoral), venous hum, friction rub), percussion (tympany (gas), dullness (solid organ, mass, fluid)), palpation - light (tenderness, guarding, rigidity, superficial masses), deep (organs, deep masses, aortic pulsation), liver span (6-12 cm midclavicular line, percussion), spleen (enlarged if palpable below costal margin, dullness to percussion), kidneys (costovertebral angle tenderness (CVAT) - pyelonephritis, nephrolithiasis), Murphy sign (cholecystitis, pain on inspiration with palpation of right upper quadrant), McBurney point tenderness (appendicitis), rebound tenderness (peritonitis), Rovsing sign (right lower quadrant pain with left lower quadrant palpation), psoas sign (pain with right hip extension, retrocecal appendicitis), obturator sign (pain with internal rotation of right hip, pelvic appendicitis); male genitourinary system - inspection (penis (lesions, discharge, circumcision status), scrotum (size, symmetry, swelling, masses), inguinal area (bulge, hernia)), palpation (testes (size, shape, consistency, masses), epididymis, vas deferens, spermatic cord, inguinal canal (hernia, cough impulse), prostate (digital rectal exam (DRE) - size, shape, consistency, nodules, tenderness)); female genitourinary system - external genitalia (vulva, clitoris, labia majora/minora, urethral meatus, vaginal introitus, lesions, discharge, inflammation, masses), speculum examination (vaginal walls, cervix (nulliparous (round), parous (slit-like), lesions, discharge, cervical os), cervical ectropion, nabothian cysts, polyps), bimanual examination (uterine size, shape, position (anteverted, retroverted), mobility, tenderness, adnexal masses (ovarian, tubal), cul-de-sac); breast examination - inspection (size, symmetry, contour, skin changes (dimpling, peau d'orange, erythema, ulceration, retraction), nipple (deviation, retraction, discharge), axilla (masses, lymphadenopathy)), palpation (breast tissue (four quadrants, tail of Spence), nipple (discharge), axillary lymph nodes (central, pectoral, subscapular, lateral, infraclavicular, supraclavicular)); musculoskeletal system - inspection (posture, gait, symmetry, swelling, erythema, deformity, muscle atrophy, joint contour), palpation (tenderness, warmth, crepitus, swelling, effusion), range of motion (active, passive, against resistance), strength grading (0/5 no contraction, 1/5 flicker, 2/5 movement without gravity, 3/5 movement against gravity, 4/5 movement against some resistance, 5/5 normal), joint-specific maneuvers (Lachman (ACL integrity), anterior/posterior drawer (ACL/PCL), McMurray (meniscal tear), apprehension test (shoulder instability), Neer impingement sign, Hawkins-Kennedy impingement sign, empty can test (supraspinatus), drop arm test (rotator cuff tear), Phalen test (carpal tunnel syndrome), Tinel sign (carpal tunnel syndrome, ulnar neuropathy), Finkelstein test (De Quervain tenosynovitis), straight leg raise (lumbar radiculopathy), crossed straight leg raise, femoral stretch test, Patrick/FABER test (sacroiliac joint, hip pathology), Trendelenburg sign (hip abductor weakness, developmental dysplasia of hip), Thomas test (hip flexion contracture), Ober test (iliotibial band tightness), anterior drawer test (ankle instability), Thompson test (Achilles rupture)); neurological system - mental status (level of consciousness (AVPU: Alert, Verbal, Pain, Unresponsive), Glasgow Coma Scale (Eyes 1-4, Verbal 1-5, Motor 1-6), orientation (person, place, time, situation), memory (immediate (repeat 3 words), short-term (recall 3 words after 5 minutes), long-term (historical events)), attention (spell WORLD backward, serial 7s), language (fluency, naming, repetition, comprehension, reading, writing), construction (draw a clock, copy intersecting pentagons), executive function (similarities, proverbs, judgment), mood, affect, thought content (suicidal ideation, homicidal ideation, delusions, hallucinations, obsessions, compulsions), insight, judgment; cranial nerves - CN I (olfactory) - smell (coffee, peppermint), CN II (optic) - visual acuity (Snellen, Rosenbaum), visual fields (confrontation), funduscopic examination, CN III, IV, VI (oculomotor, trochlear, abducens) - extraocular movements (EOMs), pupillary light reflex (direct, consensual), accommodation, ptosis, CN V (trigeminal) - facial sensation (light touch, pain, temperature on forehead, cheek, jaw), motor (masseter, temporalis (clench teeth, palpate)), corneal reflex, CN VII (facial) - facial movements (raise eyebrows, close eyes tightly, smile, show teeth, puff cheeks), taste (anterior 2/3 tongue), CN VIII (vestibulocochlear) - hearing (Rinne (air conduction bone conduction, AC/BC ratio 2:1), Weber (lateralization to affected ear in conductive loss, unaffected ear in sensorineural loss)), vestibular function (Romberg (sensory ataxia, cerebellar ataxia, vestibular dysfunction), nystagmus, Dix-Hallpike (benign paroxysmal positional vertigo)), CN IX, X (glossopharyngeal, vagus) - gag reflex, voice quality (hoarseness), swallowing, palate elevation (uvula midline), CN XI (spinal accessory) - trapezius (shrug shoulders), sternocleidomastoid (turn head against resistance), CN XII (hypoglossal) - tongue movement (protrude, deviate to side of lesion, fasciculations); motor system - muscle bulk, tone (normal, spasticity (velocity-dependent), rigidity (lead-pipe, cogwheel), paratonia (gegenhalten), flaccidity), strength (0-5 scale, proximal vs distal, upper vs lower extremity, bilateral comparison), coordination - finger-to-nose (cerebellar dysfunction), heel-to-shin (cerebellar dysfunction), rapid alternating movements (dysdiadochokinesia, cerebellar), gait (tandem gait (cerebellar), Romberg (sensory ataxia), gait velocity, base, arm swing, turning); reflexes - deep tendon reflexes (DTRs) - biceps (C5-C6), brachioradialis (C5-C6), triceps (C6-C8), patellar (L2-L4), Achilles (S1-S2), grading (0 absent, +1 hypoactive, +2 normal, +3 hyperactive, +4 clonus), Babinski (plantar response) - normal flexor (toes down), abnormal extensor (toes up, Babinski sign, upper motor neuron lesion), Hoffman (finger flexor reflex, upper motor neuron), clonus (sustained, upper motor neuron); sensory system - light touch (cotton wisp), pain (sharp/dull, safety pin), temperature (warm/cool, tuning fork), vibration (tuning fork on bony prominence), proprioception (position sense, movement of great toe, finger), discriminative sensation (stereognosis (object identification), graphesthesia (number identification), two-point discrimination, extinction, point localization); Advanced Assessment Across the Lifespan (pediatric assessment - developmental milestones (gross motor, fine motor, language, social-emotional), immunization schedule (ACIP), growth charts (WHO 0-2 years, CDC 2-20 years), pediatric vital signs (age-dependent, percentiles), pediatric physical examination (sequence (distraction, least invasive to most invasive), parent/caregiver present, age-appropriate communication, play, child life specialist), pediatric assessment tools (APGAR (1,5 minutes), Ballard (gestational age), Denver II (developmental screening), M-CHAT (autism screening), CRAFFT (adolescent substance use), HEADSS (adolescent psychosocial assessment: Home, Education/Employment, Activities, Drugs, Sexuality, Suicide/Safety); adolescent assessment - confidentiality, consent, emancipated minor, mature minor, HEADSS assessment, risk behaviors (substance use, sexual activity, violence, suicide, self-harm, eating disorders), Tanner staging (sexual maturity rating - breast, genital, pubic hair development), scoliosis screening (Adams forward bend test, scoliometer), sports physical (preparticipation physical evaluation (PPE)); geriatric assessment - comprehensive geriatric assessment (CGA), functional status (ADLs (Katz Index), IADLs (Lawton Scale)), gait and balance (Timed Up and Go (TUG), Berg Balance Scale, 4-stage balance test), falls risk (Hendrich II Fall Risk Model, Morse Scale), cognitive screening (Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Saint Louis University Mental Status Examination (SLUMS), Mini-Cog (clock drawing, 3-word recall)), depression screening (Geriatric Depression Scale (GDS-15), PHQ-9), frailty (Fried Frailty Index - weight loss, exhaustion, weakness (grip strength), slowness (gait speed), low physical activity), polypharmacy (Beers Criteria, STOPP/START criteria), urinary incontinence, hearing impairment (whisper test, audiometry), vision impairment (Snellen, Amsler grid), elder abuse screening (suspicion of abuse, neglect, exploitation), advance care planning (advance directives, POLST/MOLST, healthcare proxy, living will); pregnant patient assessment - obstetric history (GTPAL - Gravida (number of pregnancies), Term (≥37 weeks), Preterm (20-36 6/7 weeks), Abortions (20 weeks), Living (living children), LMP (last menstrual period), EDC/EDD (estimated date of confinement/delivery)), prenatal visits (q4 weeks to 28 weeks, q2 weeks 28-36 weeks, q1 week 36 weeks to delivery), fundal height (cm = weeks gestation, 20-36 weeks), fetal heart tones (Doppler 10-12 weeks, fetoscope 18-20 weeks, Leopold maneuvers (fetal lie, presentation, position, engagement)), quickening (first fetal movements, 16-20 weeks), common discomforts of pregnancy (nausea/vomiting, heartburn, constipation, back pain, edema, varicose veins, hemorrhoids, round ligament pain, Braxton-Hicks contractions), high-risk pregnancy indicators (maternal age 18 or 35, multiple gestation, gestational diabetes, preeclampsia, chronic hypertension, heart disease, renal disease, autoimmune disease, thyroid disease, thrombophilia, prior preterm delivery, prior C-section, prior pregnancy loss, substance use, infections (HIV, hepatitis B, syphilis, rubella, toxoplasmosis, CMV, HSV, parvovirus B19, Zika, COVID-19), Rh incompatibility, isoimmunization); transgender and gender-diverse patient assessment - gender identity vs sex assigned at birth, preferred name and pronouns, gender-affirming hormone therapy (estrogen/testosterone), gender-affirming surgeries (top surgery, bottom surgery, gender confirmation surgery, orchiectomy, hysterectomy, vaginoplasty, phalloplasty, metoidioplasty), screening guidelines (cervical cancer, breast cancer, prostate cancer, colon cancer, bone density), hormone-related health risks (venous thromboembolism, cardiovascular disease, osteoporosis, liver disease, polycythemia, infertility, bone mineral density), mental health considerations (gender dysphoria, minority stress, depression, anxiety, suicide risk), inclusive language, trauma-informed care, confidentiality; Diagnostic Reasoning and Differential Diagnosis (clinical decision-making - hypothesis generation, pattern recognition, illness scripts, probability (pretest, posttest), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios (LR+, LR-), diagnostic test interpretation, clinical prediction rules (Well's criteria for DVT/PE, Ottawa ankle rules, Canadian C-Spine Rule, NEXUS criteria, Centor criteria (pharyngitis, Group A Strep), CURB-65 (pneumonia severity), PORT Score (pneumonia severity), HEART score (cardiac chest pain, MACE risk), TIMI score (unstable angina/NSTEMI risk), GRACE score (ACS risk, mortality), ABCD2 (stroke risk after TIA), CHADS2-VASc (atrial fibrillation stroke risk), HAS-BLED (bleeding risk on anticoagulation), MEWS (early warning score), qSOFA (sepsis screening), PESI (pulmonary embolism severity), Geneva score (pulmonary embolism probability), Wells criteria (pulmonary embolism, DVT), Alvarado score (appendicitis probability), Ranson criteria (pancreatitis severity), Glasgow-Blatchford score (upper GI bleeding risk), Rockall score (upper GI bleeding mortality, rebleeding), Child-Pugh score (cirrhosis severity, MELD score (end-stage liver disease, transplant priority), PIRO (pneumonia severity, mortality), SMART-COP (pneumonia severity, ICU need), PSI/PORT score (pneumonia mortality), CURB-65 (pneumonia 30-day mortality), ATS/IDSA minor criteria (severe pneumonia, ICU admission), H&P integration - data synthesis, problem representation (one-liner), problem list, differential diagnosis (exhaustive, prioritized, working, ruled out), most likely diagnosis, most dangerous diagnosis (cannot miss), diagnostic testing strategy (test ordering, pretest probability, test characteristics, posttest probability, test threshold, treatment threshold), Bayesian reasoning, clinical reasoning errors (premature closure, anchoring, confirmation bias, availability bias, representativeness bias, overconfidence bias, hindsight bias, outcome bias, framing effect, search satisfaction bias, diagnosis momentum, commission bias, omission bias, gender bias, age bias, racial bias, socioeconomic bias, cognitive load, dual process theory (System 1 (intuitive), System 2 (analytical)), metacognition); Documentation and Communication (SOAP note - Subjective (patient's words, HPI, ROS, PMH, FH, SH, allergies, medications), Objective (vital signs, physical examination findings, diagnostic results, laboratory results, imaging results), Assessment (problem list, differential diagnoses, most likely diagnosis, supporting evidence, plan rationale, clinical reasoning, ICD-10 codes), Plan (diagnostic tests, consultations, medications (name, dose, route, frequency, duration), treatments, procedures, patient education, follow-up (timing, location), preventive care (screening, immunizations), goals of care, advance care planning); oral presentation (one-liner (age, gender, chief complaint, key medical history), HPI (story, relevant positives/negatives), PMH, FH, SH, ROS (pertinent positives/negatives), physical examination (vital signs, key findings), assessment (problem list, differential diagnoses, leading diagnosis), plan (diagnostic, therapeutic, educational, disposition)), interprofessional communication (SBAR (Situation, Background, Assessment, Recommendation), handoff (I-PASS (Illness severity, Patient summary, Action list, Situation awareness and contingency plans, Synthesis by receiver), sign-out, transfer of care), closed-loop communication, read-back); Preventive Health and Health Promotion (USPSTF screening recommendations (A and B grades) - blood pressure (annually, adults), lipid panel (≥40 years, q5 years, earlier if risk factors), colorectal cancer screening (45-75 years (A), 76-85 years (C), colonoscopy (q10 years), FIT (annually), FIT-DNA (q3 years), CT colonography (q5 years), flexible sigmoidoscopy (q5 years)), breast cancer screening (50-74 years (B), biennial mammography, 40-49 years shared decision-making (C)), cervical cancer screening (21-65 years (A), Pap (21-29 years q3 years), Pap + HPV (30-65 years q5 years)), lung cancer screening (50-80 years, ≥20 pack-year history, current smoker or quit within 15 years (B), annual low-dose CT), prostate cancer screening (55-69 years shared decision-making (C), PSA, DRE), osteoporosis screening (≥65 years women (B), DEXA scan), diabetes screening (35-70 years overweight/obese (B), fasting glucose, HbA1c), HIV screening (15-65 years (A), adolescents at risk, pregnant women (A)), hepatitis C screening (18-79 years (A), one-time), hepatitis B screening (high-risk populations (B)), syphilis screening (high-risk populations (A), pregnant women (A)), chlamydia/gonorrhea screening (sexually active women ≤24 years (B), older women at risk, pregnant women (B), men who have sex with men (B)), depression screening (adults (B), adolescents 12-18 years (B), PHQ-2, PHQ-9), anxiety screening (adults (B), GAD-2, GAD-7), suicide risk screening (adults (B), adolescents (B)), unhealthy alcohol use screening (adults (B), AUDIT, CAGE, CAGE-AID), unhealthy drug use screening (adults (B), DAST, CRAFFT (adolescents)), tobacco use screening and cessation (adults (B), adolescents (B), 5 A's: Ask, Advise, Assess, Assist, Arrange), obesity screening (adults (B), BMI, counseling, behavioral interventions, pharmacotherapy, bariatric surgery), healthy diet counseling (adults with cardiovascular risk factors (B)), physical activity counseling (adults (B)), fall prevention (≥65 years (B), exercise, vitamin D, multifactorial assessment), intimate partner violence screening (women of childbearing age (B)), immunizations (ACIP schedule) - influenza (annual), Tdap (once, then Td q10 years), MMR (1-2 doses), varicella (2 doses), HPV (2-3 doses, 9-26 years), meningococcal (11-12 years, booster 16 years), pneumococcal (PCV13, PPSV23 for adults ≥65 years or high-risk), hepatitis B (3 doses), hepatitis A (2 doses, at-risk populations), zoster (RZV, ≥50 years, 2 doses), COVID-19 (primary series, boosters), RSV (≥60 years, shared decision-making)); Cultural Competence and Health Equity (cultural awareness, cultural knowledge, cultural skill (cultural assessment, LEARN model (Listen, Explain, Acknowledge, Recommend, Negotiate)), cultural encounter, cultural desire, explanatory model ( Kleinman's questions), interpreter services (qualified medical interpreter, avoid family/friends for complex information, telephone/video interpretation), health literacy (universal precautions, teach-back, show-me, plain language, visual aids, patient education materials (5th-8th grade reading level), Ask Me 3 (1. What is my main problem? 2. What do I need to do? 3. Why is it important for me to do this?)), social determinants of health (SDOH) - economic stability (employment, income, expenses, debt, medical bills, food insecurity, housing instability, utility insecurity), education (literacy, language, early childhood education, vocational training), healthcare access (health insurance, primary care, dental care, mental health care, prescription medications, transportation, child care, elder care), neighborhood and built environment (housing quality, violence, environmental toxins, parks, walkability, grocery stores, food deserts), social and community context (social support, social cohesion, discrimination, incarceration, civic participation, workplace conditions), screening for SDOH (AHC HRSN Screening Tool, PRAPARE, WE CARE, IHELP), resource referral (211, community health workers, patient navigators, social workers, case managers, food assistance (SNAP, WIC), housing assistance (Section 8, public housing, emergency shelter), utility assistance (LIHEAP), transportation assistance (medical transport, public transit vouchers), legal aid, childcare, elder care, job training, financial counseling, legal services, domestic violence shelter, substance use treatment, mental health services); Telehealth and Virtual Assessment (telehealth modalities (synchronous (live video), asynchronous (store-and-forward), remote patient monitoring (RPM), mobile health (mHealth)), telehealth platforms (Zoom for Healthcare, D, Teladoc, Amwell, Epic MyChart, Cerner HealtheLife), technology requirements (HIPAA-compliant platform, encrypted, secure, patient consent, broadband internet, camera, microphone, speakers), patient selection (appropriate for telehealth, stable, not requiring physical examination (or physical exam can be modified), follow-up, chronic disease management, medication management, behavioral health, patient preference, access to technology, digital literacy), virtual physical examination (patient self-reported vital signs (home blood pressure monitor, pulse oximeter, thermometer), visual inspection (rashes, swelling, symmetry, gait, range of motion), remote guidance (patient as examiner, palpation, percussion (self-percussion or with smartphone), auscultation (digital stethoscope, smartphone microphone, Bluetooth), pupillary examination (smartphone light, video), ear examination (smartphone otoscope attachment), throat examination (tongue depressor, smartphone light, video), respiratory assessment (observe breathing, count respiratory rate, listen to cough, wheezing (through microphone)), cardiovascular assessment (palpate pulse, capillary refill, edema, JVP (video, smartphone level)), abdominal assessment (patient self-palpation, video observation of contour, distension), neurological assessment (facial symmetry (smile, raise eyebrows), extraocular movements, visual fields (confrontation via video), strength (resist patient pushing/pulling against resistance), sensation (patient self-test with cotton ball, paperclip), coordination (finger-to-nose, heel-to-shin), gait (patient walk across room), speech (fluency, clarity), mental status (orientation, memory, mood, affect, thought content)), limitations (cannot auscultate heart/lungs without digital stethoscope, cannot palpate abdomen deeply, cannot perform pelvic/rectal exams, cannot assess blood pressure without patient equipment, cannot assess pupillary light reflex without assistance, cannot assess fundoscopic exam, cannot assess otoscopic exam without attachment, cannot assess DTRs, cannot assess Babinski, cannot assess clonus), documentation (same as in-person SOAP note, note telehealth modality, location of patient, patient consent, technology issues, limitations of exam, plan for in-person follow-up if needed), reimbursement (Medicare telehealth coverage (originating site (rural), patient home (waived during PHE)