AST V3 Lecture 2 Assessment

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The audio recording is based on a real patient visit. Take notes on the information that you think is relevant from the visit. Your notes will not be graded.This audio recording applies to questions 25-30.

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The patient is a 45-year-old male who presents for follow up of several symptoms. He complains of mental exhaustion since January 2014 which has been gradually worsening. His symptoms are exacerbated by reading and conversation. He reports episodes 8 hours after any mental activity. He reports that he has been sleeping 10-12 hours per night. He also reports mild cough recently but denies fever and muscle aches. He recently had a spinal tap which the patient reports was normal. Which elements are included in HPI above? (Check all that apply.)

• Location

• Severity

• Onset/Duration

• Context

• Modifying Factors

• Associated Symptoms

Which of the following are correct matches between HPI element and example? (Check all that apply.)

• Quality: sharp pain

• Associated symptom: relief with Tylenol

• Location: right knee

• Onset/Duration: onset 3 weeks ago

• Context: began after a large greasy meal

He has additional complaint of intermittent chest pain for the last month. He describes the pain as dull and radiating to his left side. The patient's symptoms are not aggravated by laying down, exertion, or eating. He denies associated ear pain, abdominal pain, diarrhea, constipation, or hematochezia but admits to a cough for the last few months.Which elements are NOT included in the HPI above? (Check all that apply.)

• Location

• Quality

• Severity

• Timing

• Context

• Onset/Duration

• Associated Symptoms

"The patient also reports that she sustained a finger laceration 1 week ago while cutting apples. She has been applying Neosporin to the wound which seems to be helping. She denies swelling or drainage.  She states that the apple 'wasn't even worth it.'"All of the information in the HPI above is medically relevant.

• True

• False

Patient is an 18-year-old female who presents today with complaint of sore throat for the last several months.  She initially had a fever which has now resolved. She reports associated cough, nasal congestion, and headache but denies nausea or diarrhea. Patient tested negative for strep throat.  Which elements are NOT included in the HPI above? (Check all that apply.)

• Onset/Duration

• Modifying factors

• Timing

• Associated symptoms

The patient is a 21-year-old female who presents today with complaint of cold symptoms for the last seven days. Her symptoms include cough, congestion, and body aches. Symptoms began the morning after the patient’s birthday party which included “heavy drinking and very little sleep”. She had a severe headache which gradually improved with fluid intake over the course of the day. She noted onset of dry cough the next day. She has had fatigue and body aches since yesterday. She has taken Advil with moderate relief of body aches. She also complains of subjective fever, worse at night. Patient denies nausea, vomiting, dizziness, shortness of breath, chest pain, leg swelling, confusion, mood swings, hot flashes, dysuria, hematuria, and back pain.  “Heavy drinking and very little sleep” represents which HPI element? 

• Modifying factor

• Context

• Associated symptom

• This does not represent an HPI element

___________ is the HPI element that describes the symptom (ie, sharp).

• Sensation

• Severity

• Quality

• Modifying factor

Which of the following are among the Top 10 Most Common Chief Complaints? (Check all that apply.)

• Allergic Reaction

• Urinary Tract Infection (UTI)

• Headache

• Syncope

• Mood Disorders

• Rheumatoid Arthritis

Which of the following Top 10 Common Chief Complaints are chronic conditions? (Check all that apply.)

• Urinary Tract Infection

• Osteoarthritis

• Diabetes Mellitus

• Skin Disorders

• Headache

Which of the following is BOTH a Top 10 Chief Complaint AND an acute complaint?

• Skin Disorder

• Scoliosis

• Upper Respiratory Infection (URI)

• Back Pain

Which one of the following is NOT a chief complaint?

• Annual physical

• Right lower extremity

• Abdominal pain

• Chest pain

• Medication refill

• Hair loss

• Post-op

• All of the above are examples of chief complaints

To determine the chief complaint of a visit, you can ask yourself, "What is the reason for the patient's visit today?"

• True

• False

What information was discussed during this information? (Check all that apply.)

• Lab results

• Diet

• Exercise habits

• Leg symptoms

• Headache

• Skin Symptoms

Of the following information mentioned in the recording, which do you think is LEAST medically relevant.

• Patient is prediabetic and has a family history of diabetes.

• Patient lost 3lbs since their last visit.

• Patient is doing her best to eat healthy.

• Patient's weakness is tortillas.

Which of the following mentioned in the recording is medically relevant. Check all that apply. 

• Patient complains of tingling in her legs.

• Patient describes the tingling as "ants in her pants".

• Patient states that her symptoms her worse with standing.

• Patient denies associated numbness.

Which of the quotes from the recording contain information that belongs in the HPI? (Check all that apply.)

• Provider: Yes as we get older we see more people with diabetes.

• Provider: Numbness in feet at all? Patient: No.

• Provider speaking to scribe: She has good motion in her ankles and her knees, and good dorsal pedal pulses, and trace edema.

• Provider: Try to avoid standing. If something gets worse let me know.

• Provider: How long have you had that funny feeling in your legs? Patient: For 1 year now.

Which of the quotes from the recording contain information that is SUBJECTIVE? (Check all that apply.)

• Patient: No, I feel like I have ants inside my pants. When I am ironing clothes I feel something in my legs when I am standing.

• Provider: Numbness in feet at all? Patient: No.

• Provider speaking to scribe: She has good motion in her ankles and her knees, and good dorsal pedal pulses, and trace edema.

• Provider: Try to avoid standing. If something gets worse let me know.

• Provider: How long have you had that funny feeling in your legs? Patient: For 1 year now.

Of the following information mentioned during the recording, which do you think is the LEAST appropriate to include in the HPI?

• Patient: "Yeah... its been raining so much so I’ve been coughing more"

• Patient: "Yeah, only when I’m kneeling down it hurts not even when I apply pressure."

• Patient: "Last time i was here, the pharmacy gave me a Zyrtec."

• Provider: "You know, allergies can predispose you to a cold" Patient: "Oh I know. Been there, done that. "

Which of the following were discussed in the visit above? (Check all that apply.)

• The patient denies fever and chills.

• The patient takes Motrin with no side effects.

• The patient complains of a sharp knee pain with kneeling.

• The patient complains of sneezing and cough but denies significant congestion.

When considering the recording, which of the following statements IS medically relevant? (Check all that apply.)

• Patient: "I’ve noticed every time I kneel down there is a sharp pain."

• Patient: "Oh I also gargle salt in the morning and night."

• Patient: "Yeah... its been raining so much so I’ve been coughing more."

• Patient: "I’m not that congested but I am sneezing."

When the patient says, "The other day, I went to kneel down in the garden and I’ve noticed every time I kneel down there is a sharp pain," what HPI elements are discussed? (Check all that apply.)

• Context

• Severity

• Quality

• Onset/Duration

• Location

What information does NOT belong in the HPI?

• Patient: "Yeah.. its been raining so much so I’ve been coughing more"

• Provider: "You don't have ulcers?" Patient: "Nope, but I don't think I’ve taken any type of pain pill since"

• Patient: "I’m not that congested but I am sneezing."

• Provider: "So the bone itself has a very thin layer called the periosteum. It is very sensitive. Sometimes by just laying down you can injure the top layer"

What HPI element is contained in the following piece of dialogue from the visit" Provider: "Are you able to take Motrin?"Patient: "As far as I know"Provider: "You don't have ulcers?"Patient: "Nope, but I don't think I’ve taken any type of pain pill since"

• Context

• Modifying Factors

• Associated Symptoms

• No HPI element is contained in this piece of dialogue.

If information is NOT an HPI element, it should NOT be included in the HPI.

• True

• False

If information from the visit IS an HPI element, it SHOULD be included in the HPI.

• True

• False

Which of the following questions are you LEAST likely to hear during a follow-up visit?

• Have your symptoms worsened or improved since the last visit?

• When was the patient last seen?

• What are your chronic conditions?

• How effective was the treatment?

Which of the following information is important during a pre-operative visit? (Check all that apply.)

• Date of surgery

• Underlying illnesses

• Type of Surgery

• Name of Surgeon

In what order should the following topics be presented in the HPI?

• 1. Most recent colonoscopy which was unremarkable. 2. Frequent episodes of chest pain. 3. Recent fall with minor injuries.

• 1. Recent fall with minor injuries. 2. Most recent colonoscopy which was unremarkable. 3. Frequent episodes of chest pain.

• 1. Frequent episodes of chest pain. 2. Recent fall with minor injuries. 3. Most recent colonoscopy which was unremarkable.

• 1. Frequent episodes of chest pain with associated shortness of breath. 2. Recent fall with minor injuries. 3. Most recent colonoscopy which was unremarkable.