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126 notecards = 32 pages (4 cards per page)

Viewing:

Clin skills

front 1

Vindicate

back 1

acronym for differential diagnosis

front 2

Vindicate - V

back 2

Vasculature

front 3

Vindicate - I

back 3

Infection/inflammation

front 4

Vindicate - N

back 4

Neoplasms

front 5

Vindicate - D

back 5

Drugs/Degenerative

front 6

Vindicate - I

back 6

Iatrogenic/idiopathic

front 7

Vindicate - C

back 7

Congenital/inherited/developmental

front 8

Vindicate - A

back 8

Autoimmune/Allergy/Anatomic

front 9

Vindicate - T

back 9

Trauma

front 10

Vindicate - E

back 10

Environmental/Endocrine

front 11

Clinical decision making includes

back 11

Ddx
Diag studies
Interpret
Decision

front 12

Step 1 to decision making

back 12

Identify

front 13

Step 2 to decision making

back 13

Frame the ddx (recall)

front 14

Step 3 to decision making

back 14

organize

front 15

step 4

back 15

limit

front 16

Step 5

back 16

explore

front 17

step 6

back 17

rank

front 18

When ranking, rank by

back 18

Leading hypothesis
Must not miss hypothesis
Alternative hypothesis

front 19

The leading hypothesis is

back 19

The most likely diagnosis

front 20

The must not miss hypothesis is

back 20

The life threatening one that must not be missed

front 21

The alternative hypothesis is

back 21

Reasonably likely or very long

front 22

ICEP

back 22

Ideas
Concerns
Expectations
Pertinent resolution

front 23

Evidence based medicine is

back 23

A systematic approach to identifying the most appropriate strategy for an individual patient based on current literature

front 24

EBM Steps

back 24

Formulate a clinical question
Gather evidence to answer
Evaluate the quality and validity of the evidence
Decide how to apply the evidence

front 25

Frequency of phased array

back 25

1-5 (2-7)

front 26

Phased array most useful during

back 26

cardiac assessment

front 27

Curved probe frequency

back 27

2-5 mhz

front 28

Linear probe frequency

back 28

5-15

front 29

Linear probe best used for

back 29

superficial structures

front 30

Musculoskeletal exam or thyroid are commonly examined by the

back 30

linear probe

front 31

Limitations of EBM

back 31

Patient desires
Time
Lack of data

front 32

Cognitive errors

back 32

Heuristics
Faulty assessment of pre-test probability
Failure to seriously consider all relevant possiblities
Representation error
Anchoring error
Base rate neglect
Confirmation bias
Attribution errors
affective error

front 33

Heuristics

back 33

Rule of thumb

front 34

Faulty assessment of pre-test probability

back 34

Over or underestimating the disease likelihood

front 35

Failure to seriously consider all relevant possbilities

back 35

too limited differential diagnosis

front 36

availability error

back 36

presumes higher or lower probability based on recent exposure

front 37

representation error

back 37

presumes illness that has similar symptoms but does not take into account prevalence in the population

front 38

Premature closure

back 38

Quick diagnosis based on pattern, stop collecting data

front 39

anchoring error

back 39

clinging to initial impression when faced with conflicting and contradictory data

front 40

base rate neglect

back 40

pursuing a rare diagnosis despite minimal prevelence (horses and zebras)

front 41

confirmation bias

back 41

selective acceptance of data that supports, rejects data that does not (cherry picking)

front 42

attribution errors

back 42

failure to consider or ignore the possibility of serious disease in patients with negative stereotypes (crazy guy always thinks hes poisoned, he was actually poisoned this time)

front 43

affective error

back 43

avoiding necessary tests or exams due to rude patient

front 44

65% of positive findings in hx or PE have specificity

back 44

>80%

front 45

21% of negative findings have sensitivity

back 45

>80%

front 46

seNsitivity

back 46

false negative rate

front 47

sPecificity

back 47

false positive rate

front 48

High sensitivty

back 48

low false negative rate

front 49

high specificity

back 49

low false positive rate

front 50

Screening guideline USPSTF

back 50

A - gold standard
B - mid benefit
C - small benefit
D - dont recommend

front 51

comprehensive visits

back 51

take longer and are for new patients

front 52

In a comprehensive visit

back 52

thorough review of history and full exam
establish baseline for new pt
usually scheduled for longer appointments
Documented as H&P

front 53

Problem focused visits

back 53

Usually for established patients who have a problem or are there for routine care

front 54

In a problem focused visit

back 54

Shorter appointments
Documented as a soap note

front 55

Components of health history

back 55

CC
HPI - OPRST/ICE, Pertinent +/-
MED
ALLERG
Pmhx,SHx,
FMHx - 1st degree relatives
SocHx - occupation, sex hx, habits
ROS

front 56

Subjective

back 56

What the patient tells you
CC, HPI, PMHx, ROS

front 57

Objective

back 57

What you find on your own
Physical exam, diagnostic studies

front 58

Family hx

back 58

Primary relatives
Any genetic diseases

front 59

Social hx

back 59

Marital status
Occupation
Habits: ETOH/Drugs/Tobacco

front 60

ROS

back 60

Yes or no questions, head to toe review of symptoms for each system

front 61

General ROS

back 61

Recent weight changes, fatigue, etc

front 62

Integument ROS

back 62

Rashes, lumps, sores, itching, dryness, change in moles or hair or skin/nails

front 63

HEENT ROS

back 63

Head - Injury, dizziness, vertigo, change in hat size
Eyes - Glasses, changes in sight
Ears - Changes in hearing, tinnitus
Nose - Congestion, dischage
Throat - Dental problems,

front 64

Neck ROS

back 64

Swollen glands, goiter, lumps, pain,

front 65

Breast ROS

back 65

Lumps, pain or discomfort, nipple discharge

front 66

Respiratory ROS

back 66

Cough, sputum, SOB, wheezing, pain

front 67

Cardiovascular ROS

back 67

Palpitations, edema, CP or discomfort

front 68

GI ROS

back 68

Heartburn, trouble swallowing, changes in appetite or BM

front 69

Urinary ROS

back 69

Frequency, urgency, dysuria, incontinence, hesitancy or dribbling

front 70

Genital ROS

back 70

Male: swelling or masses, lesions
Female: Heavy perios, pain, pain with intercourse

front 71

MSK ROS

back 71

Joint pain, stiffness, weakness, limit of motion

front 72

Psych ROS

back 72

Anxiety, panic, sadness HI/SI, trouble sleeping or social function

front 73

Neuro ROS

back 73

Confusion, memory problems, HA, dizziness, balance, syncope, SZ

front 74

Endocrine ROS

back 74

Changes in hair distro, heat/cold intolerance

front 75

Paralanguage

back 75

Qualities of speech. pacing, tone, volume

front 76

Motivational interviewing RULEs
4 principles

back 76

Resist the righting reflex
Understand your patients motivations
Listen to your patient
Empower your patient

front 77

_____
S

back 77

without

front 78

_____
A

back 78

before

front 79

_____
P

back 79

After

front 80

_____
X

back 80

Except

front 81

CTAB

back 81

Clear to auscultation bilaterally

front 82

NABS

back 82

Normal active bowel sounds

front 83

NCAT

back 83

Normocephalic, atraumatic

front 84

If you have results of diagnostics, where do they get charted?

back 84

Objective

front 85

If you have blood drawn during the visit but dont get results, or the patient will be sent for labs where does this get charted?

back 85

Plan

front 86

Probable XYZ does not equal diagnosis

back 86

Probable nerve impingement vs acute thoracic back pain - probably due to nerve impingement

front 87

AADC VAAN DISSL

back 87

Admission note format

front 88

AADC VAAN DISSL

back 88

Admit to, (location)

front 89

AADC VAAN DISSL

back 89

Attending physician

front 90

AADC VAAN DISSL

back 90

Dx and planned procedure

front 91

AADC VAAN DISSL

back 91

Condition (stable, critical, guarded, etc)

front 92

AADC VAAN DISSL

back 92

Vitals (how often)

front 93

AADC VAAN DISSL

back 93

Allergies (meds, foods, tape, etc)

front 94

AADC VAAN DISSL

back 94

Activity (bedrest, bathroom privledges, ambulate w/assistance)

front 95

AADC VAAN DISSL

back 95

Nursing (neuro checks, wound check, line monitoring, education, procedure)

front 96

AADC VAAN DISSL

back 96

Diet (regular, renal, cardiac)

front 97

AADC VAAN DISSL

back 97

Intake and output

front 98

AADC VAAN DISSL

back 98

Specific medications

front 99

AADC VAAN DISSL

back 99

Symptomatic medications

front 100

AADC VAAN DISSL

back 100

Labs/imaging

front 101

Classes of obesity

back 101

Underweight BMI <18.5
Normal BMI 18.5-24.9
Overweight 25-29.9
Obese I 30-34.9
Obese II 35-39.9
Extremely obese III 40.0 +

front 102

If class II obesity or higher -

back 102

Measure waist circumference above hips.

front 103

Risk for DM, HTN and CVD markedly increased for waist circumference

back 103

35" in women
40" in men

front 104

Weight KG/ (Height M)^2

back 104

BMI calc

front 105

IBW calculation

back 105

Female 100lbs +5lbs for each inch above 5ft

Male 106lbs for first 5ft + 6lbs for each inch extra

front 106

Normal BP

back 106

Systolic <120
Diastolic <80

front 107

Atherosclerotic arteries may present with

back 107

Auscultatory gap

front 108

Auscultatory gap

back 108

silent interval between systolic and diastolic phases due to stiff arteries

front 109

Orthostatic BP

back 109

Measure BP and HR with pt supine after 3 minutes, pt stands and remeasure within 3 minutes

front 110

Positive orthostatic findings

back 110

Systolic BP drop >20, diastolic BP drop >10

front 111

Differential BP

back 111

up to 10mm difference is normal, >10 is pathologic

front 112

PP

back 112

>65 abnormal (wide, large stroke volume)
50 normal
<30 narrow (low stroke volume)

front 113

MAP

back 113

Normal 70-110

front 114

Pulse and BP

back 114

Pedal pulse =>90
Radial >80
Femoral >70
Carotid >60

front 115

Pulse quality

back 115

3+ bounding
2+ strong
1+ weak
0 absent

front 116

SPO2

back 116

>90 adults
>95 children

front 117

40-80% of medical info provided by hcp is

back 117

forgotten immediately

front 118

half of recalled info

back 118

is incorrect

front 119

The silent patient

back 119

Be patient and encouraging
Silence is okay
"When you are quiet, what are you thinking about?"
"You seem very quiet, have i said something to upset you?"

front 120

The talkative patient

back 120

Directed vs. rambling
Avoid showing annoyance
Letting them talk at first may help you
Set limits when needed
Brief summary to validate
What is your main concern?
Make a longer visit if necessary

front 121

Altered state

back 121

Memory, delirium, loc, MH
obtain history from another reliable source
Introduce yourself
Never make assumptions
POA/Proxy
Remember HIPAA

front 122

Emotionally Labile

back 122

Let them cry
Offer silent support
try and wait for them to compose themselves
learn to accept emotions

front 123

Angry/aggressive

back 123

Dont return the anger
Sympathize
Stay safe
Never let patient get between you and the door
Restraints/sedatives

front 124

Patient who is discriminatory

back 124

identify it
report it

front 125

Patient who is nonadherent

back 125

What happened?
How do we fix it?

front 126

Kubler Ross

back 126

DABDA