FCP Test 1 Questions and Answers

3 functions of medical interview - Answer- Build relationship, Assess and understand, Collaborate for management Purpose of history - Answer- Relationship (learn about pt and why they're there), Collect relevant info related to chief concern/state of health, Lead to diagnosis 10 steps of pt history - Answer- Pt ID, CC, HPI, PMH, Social history, family history, Review of systems, physical exam, DD, Diagnostic testing, Problem list/therapeutic plan Pt ID - Answer- In FIRST line, define AGE, GENDER(both biological and how pt identifies), ETHNICITY, RELIABILITY (ex: dementia, reliable, etc) *AGER since info ages a pt* CC - Answer- WHY pt here. IN PT OWN WORDS. Include duration. Use open-ended questions HPI - Answer- Story of CC. Chronological, complete. WWQQA(A)ALCI. Then get pertinent positives/negatives (PPPN) PMH - Answer- Choronological. SOCCHAMP (surgical, obgyn, childhood illness, current meds, health maintenance, allergies, medical history, psychiatric history) Social history - Answer- Family history - Answer- Doc all first degree relatives DD - Answer- 1 for CC. List 3 possible conditions that could explain and base initial management plan on this. Remaining problem list can be worked up if applicable Vital signs - Answer- BP, HR, respiratory rate, temp, pain General survey - Answer- Apparent state of health, consciousness, signs of distress, skin, dress, facial expression, odors, posture/gait, height/weight Healthy BMI - Answer- 18.5-24.9 Overweight BMI - Answer- 25-29 Obese BMI - Answer- 30 Nonverbal communication skills - Answer- Body posture, attentive listening, eye contact, look for nonverbal signs, minimize vertical distance Empathetic communication - Answer- Reflection + Legitimation (+ Exploration for deepening understanding) Reflection - Answer- State observed feeling/thoughts of pt. Acknowledge their feelings (give pt permission to talk more about their feelings) "I see how upset you are" Legitimation - Answer- Acceptance of and respect for the patient's emotional experience "Pt often feel this way when they hear this diagnosis" Exploration - Answer- "What makes YOU feel this way?" Support - Answer- Make explicit efforts to reassure the patient that he or she is there and wants to help ("How can I help") Partnership - Answer- Increase participation of pt in their own treatment Respect - Answer- Affirm and encourage Pt perspective consist of - Answer- ICE: Ideas, concerns, expectations Kalamazoo model 7 essential sets of communication tasks - Answer- Build P/P relationship, Open discussion, Gather info, Understand pt perspective, Share info, Reach agreement on problems/plans, Provide closure *Boring Old Guys Usually Say Aw Crap* Macy Model PEARLS - Answer- Partnership, empathy, apology, respect, legitimation, support Macy Model steps to interview - Answer- Begin/Prepare, Open, Gather info, Elicit/understand pt perspective, Communicate during physical, Pt education, Negotiate/agree on plan, Close *added pt education* Ask-tell-ask - Answer- Method in pt education. Ask about knowledge, feeling, etc. Tell info concisely. Ask repeatedly about understanding Why improve communication - Answer- Better ID pt problem, improve adherence, improve health outcomes, decrease malpractice suits, improve well-being of health professionals Factors that decrease malpractice suits - Answer- Longer length of interview time spent with pt, laughter/jokes, acknowledgement of errors, apology for mistakes, availability and approachability of provider through hard times Barriers to effective communication - Answer- Brief encounters, More pt in less time with lower reimbursements, challenging documentation, EMR leads to typing Mindfulness Moment - Answer- Take a moment before going into room to review charts/leave behind anything not having to do with the pt Adaptive unconsciousness - Answer- Set of mental processes influencing judgement and decision making, in a way that is inaccessible to introspective awareness (part of unconscious mind) Open ended questions start with - Answer- how, what, when, why Close ended questions start with - Answer- did, can, will Restatement - Answer- Repeat back phrase/statement to ensure it was heard correctly Paraphrasing - Answer- Summarize and interpret info POISED - Answer- Use of computers in exam room. Prepare (rvw pt chart before entering), orient (1-2 min w/o computer), info gathering, share (turn computer screen), educate (educate about weight/BP/glucose/etc), debrief (have pt teach back) EMR - Answer- Software application used for "organizing and using health data, from charting to prescribing to transmitting MRI results digitally" Medical errors is #__ cause of deaths each year - Answer- 3 LEVEL - Answer- When use computer, L(et pt look on), E(ye contact with pt), V(alue computer), E(xplain), L(og out) Registered nurse - Answer- provide and coordinate patient care, educate patients and the public about various health conditions and provide advice and emotional support to patients and their family members. Generalist Audiologist - Answer- Help with pt's issues on balance, hearing, ear-related Licensed practical nurse - Answer- basic nursing duties including monitoring vital signs, changing wound dressings, assisting patients with dressing and bathing, updating medical records, and answering patient questions Case manager - Answer- works collaboratively with the medical health team to provide assessment, planning and facilitation of care coordination Occupational therapist - Answer- help patients develop, recover and improve the skills needed for daily living and working When asking about chronic illness, make sure you get - Answer- Dates of diagnosis, complications, current status, treatments, residual side effects, follow-up Health maintenance includes - Answer- Immunizations, eye/dental exams, mammogram/pap smear 3 function model when interviewing elderly - Answer- Build relationship, understand/assess pt, collaborate for management Immunizations given - Answer- 12, 15, 18 mo, and 2 yrs Professional ethics includes - Answer- Autonomy, fidelity/responsibility, veracity, integrity, justice, respect, cultural diversity, reporting sexual harassment 3 domains of social history - Answer- Interpersonal relationships, Daily activities, Other factors With sensitive subjects, what can affect reliability/validity of pt report? - Answer- Your own anxiety, pt anxiety, method of asking questions "How" to ask questions - Answer- Wording, order, form Normalizing - Answer- "many people find it difficult..." Transparency - Answer- explain why you need to know about certain things Permission - Answer- "is it OK with you if I ask you about your sexual history" Wording to decrease anxiety - Answer- Close ended questions, offer response choices, use formal non-judging words (ex: recreational, not illicit, drugs), assume behavior is occuring Should you use open-ended questions for sensitive subjects? - Answer- No. The more specific, the harder to deny. Avoid j