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For which of the following patients would a comprehensive health history be appropriate? A new patient with the chief complaint of "I sprained my ankle" An established patient with the chief complaint of "I have an upper respiratory infection" A new patient with the chief complaint of "I am here to establish care" A new patient with the chief complaint of "I cut my hand" - Correct Answer ✅ A new patient with the chief complaint of "I am here to establish care" This patient is here to establish care, and because she is new to you, a comprehensive health history is appropriate. The components of the health history include all of the following except which one?
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Review of systems Thorax and lungs Present illness Personal and social items - Correct Answer ✅ Thorax and lungs The thorax and lungs are part of the physical examination, not part of the health history. The others answers are all part of a complete health history. Is the following information subjective or objective? Mr. M. has shortness of breath that has persisted for the past 10 days; it is worse with activity and relieved by rest. - Correct Answer ✅ Subjective
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Present illness Personal and social history Review of systems - Correct Answer ✅ Present illness This information describes the problem of abdominal pain, which is the present illness. The interviewer has obtained the location, timing, severity, and associated manifestations of the pain. The interviewer will still need to obtain information concerning the quality of the pain, the setting in which it occurred, and the factors that aggravate and alleviate the pain. You will notice that it does include portions of the pertinent review of systems, but because it relates directly to the complaint, it is included in the history of present illness. The following information is recorded in the health history: "The patient completed 8th grade. He currently lives with his wife and two children. He works on old cars on the weekend. He works in a glass factory during the week." Which category does it belong to?
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Chief complaint Present illness Personal and social history Review of systems - Correct Answer ✅ Personal and social history Personal and social history information includes educational level, family of origin, current household status, personal interests, employment, religious beliefs, military history, and lifestyle (including diet and exercise habits; use of alcohol, tobacco, and/or drugs; and sexual preferences and history). All of this information is documented in this example. The following information is recorded in the health history: "I feel really tired." Which category does it belong to?
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Present illness Personal and social history Review of systems - Correct Answer ✅ Review of systems Review of systems documents the presence or absence of common symptoms related to each major body system. The absence of cardiac symptoms is listed in the above example. The following information is best placed in which category? "The patient has had three cesarean sections." Adult illnesses Surgeries Obstetrics/gynecology
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Psychiatric - Correct Answer ✅ Surgeries A cesarean section is a surgical procedure. Approximate dates or the age of the patient at the time of the surgery should also be recorded. The following information is best placed in which category? "The patient had a stent placed in the left anterior descending artery (LAD) in 1999." Adult illnesses Surgeries Obstetrics/gynecology Psychiatric - Correct Answer ✅ Adult illnesses
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placing this information in the present illness section, because it relates to the chief complaint at that visit. A patient presents for evaluation of a sharp, aching chest pain which increases with breathing. Which anatomic area would you localize the symptom to? Musculoskeletal Reproductive Urinary Endocrine - Correct Answer ✅ Musculoskeletal Chest pain may be due to a musculoskeletal condition, such as costochondritis or intercostal muscle cramp. This would be worsened by motion of the chest wall. Pleuritic chest pain is also a sharp chest pain which increases with a deep breath. This type of pain can occur with inflammation of the pleura from pneumonia or other conditions and pulmonary embolus.
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A patient comes to the emergency room for evaluation of shortness of breath. To which anatomic region would you assign the symptom? Reproductive Urinary Cardiac Hematologic - Correct Answer ✅ Cardiac Cardiac disorders such as congestive heart failure are the most likely on this list to result in shortness of breath. There are cases within the other categories which may also result in shortness of breath, such as anemia in the hematologic category, pregnancy in the reproductive category, or sepsis with UTI in the urinary category. This demonstrates the tension in clinical reasoning between making sure all
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A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct? Infectious Inflammatory Hematologic Traumatic - Correct Answer ✅ Inflammatory The description is most consistent with an inflammatory process, although all the other etiologies should be considered. Lyme disease is an infection which commonly causes arthritis, hemophilia is a hematologic condition which
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can cause bleeding in the joints, and trauma can obviously cause joint pain. Your clinical reasoning skills are important for sorting through all of the data to arrive at the most likely conclusion. A 47-year-old contractor presents for evaluation of neck pain, which has been intermittent for several years. He normally takes over-the-counter medications to ease the pain, but this time they haven't worked as well and he still has discomfort. He recently wallpapered the entire second floor in his house, which caused him great discomfort. The pain resolved with rest. He denies fever, chills, rash, upper respiratory symptoms, trauma, or injury to the neck. Based on this description, what is the most likely pathologic process? Infectious Neoplastic Degenerative
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This description is most consistent with allergic rhinitis. A 19-year old-college student presents to the emergency room with fever, headache, and neck pain/stiffness. She is concerned about the possibility of meningococcal meningitis. Several of her dorm mates have been vaccinated, but she hasn't been. Which of the following physical examination descriptions is most consistent with meningitis? Head is normocephalic and atraumatic, fundi with sharp discs, neck supple with full range of motion Head is normocephalic and atraumatic, fundi with sharp discs, neck with paraspinous muscle spasm and limited range of motion to the right Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion
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Head is normocephalic and atraumatic, fundi with blurred disc margins, neck supple with full range of motion - Correct Answer ✅ Head is normocephalic and atraumatic, fundi with blurred disc margins, neck tender to palpation, unable to perform range of motion Blurred disc margins are consistent with papilledema, and neck tenderness and lack of range of motion are consistent with neck stiffness, which in this scenario is likely to be caused by meningeal inflammation. Later, you will learn about Kernig's and Brudzinski's signs, which are helpful in testing for meningeal irritation on examination. A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis? Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.
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A 55-year-old data entry operator comes to the clinic to establish care. She has the following symptoms: headache, neck pain, sinus congestion, sore throat, ringing in ears, sharp brief chest pains at rest, burning abdominal pain with spicy foods, constipation, urinary frequency that is worse with coughing and sneezing, and swelling in legs. This cluster of symptoms is explained by: One disease process More than one disease process - Correct Answer ✅ More than one disease process The patient appears to have several possible conditions: allergic rhinitis, arthritis, conductive hearing loss, pleuritic chest pains, heartburn, stress urinary incontinence, and venous stasis, among other conditions. Although we always try, it is very difficult to assign all of these symptoms to one cohesive diagnosis. A 62-year-old teacher presents to the clinic for evaluation of the following symptoms: fever, headache, sinus congestion,
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sore throat, green nasal discharge, and cough. This cluster of symptoms is best explained by: One disease process More than one disease process - Correct Answer ✅ One disease process This cluster of symptoms is most consistent with sinusitis. The chance that all of these symptoms are caused by multiple synchronous conditions in the same patient is much less than the possibility of having one problem which accounts for all of them. Steve has just seen a 5-year-old girl who wheezes when exposed to cats. The patient's family history is positive for asthma. You think the child most likely has asthma. What have you just accomplished? You have tested your hypothesis.
