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1- In which part of the patient encounter would it be most appropriate to include the following statement; " My head feels like it is going to explode"? -chief complaint/concern -history of present illness -past medical history -assessment -plan - - - correct answer ✅chief complaint/concern 1- In which part of the patient encounter would it be most appropriate to include the following phrase: Mr. Smith, a 55 year old male smoker with hypertension, was feeling well until last Sunday when he experienced chest pain while mowing the lawn. It radiated to his left arm. It was relieved when he sat down for 5 minutes. It occurred again this morning when he needed to climb the stairs since the elevator at work was broken. -chief complaint/concern -history of present illness
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-past medical history -assessment -plan - - - correct answer ✅history of present illness 1- A patient presents to the doctor's office complaining of "back pain". You enter the room and introduce yourself to the patient. What would be the best opening statement on your part once the patient says "I'm here because my back hurts"? -"Does your pain radiate into your leg?" -"Do you have any chronic medical conditions?" -"Are you having any urinary problems with this back pain?" -"Please tell me more about your back pain?" - - - correct answer ✅"Please tell me more about your back pain?" 1- Which statement is true regarding effective patient-doctor communication? -Although it is a nice thing to strive for, it does not have any measurable impact on patient-care
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1- In a problem focused visit, for which chief complaint/concern would it be most important to elicit a pertinent family history as part of the HPI? -"I sprained my ankle while playing soccer" -"I have had sinus pressure and congestions for 6 days" -"For the past 3 months I have experienced chest pain while walking up stairs" -"I was working in my garden yesterday and have developed an itchy rash." - - - correct answer ✅"For the past 3 months I have experienced chest pain while walking up stairs" 1- Which question would be most likely to encourage a patient to provide complete information about their sexual history? -"Are you married?" -"Do you have a boyfriend ?" -"Would you please tell me about your sexual relationships?"
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-"Do you have a girlfriend?" - - - correct answer ✅"Would you please tell me about your sexual relationships?" 1- The complete medical encounter includes the Subjective, Objective, Assessment, and Plan (SOAP). Which of the following belongs in the objective section of a note? -Heart rate: 68 beats per minute -The patient is employed as a high school teacher -The patient has been experiencing heartburn after eating pizza. -The patient's father died of colon cancer at age 57 - - - correct answer ✅Heart rate: 68 beats per minute 1- If a patient presents to you in the ER with crushing chest pain and is visibly short of breath, which type of history are you likely to obtain most immediately? -Complete history -Inventory history -Problem (or focused) history
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-Using a nicotine patch plus a short-acting form of nicotine replacement like lozenges and gum for urges not relieved by the patch. -nicotine patches plus scheduling an appointment with a psychiatrist or social worker. - - - correct answer ✅Using a nicotine patch plus a short-acting form of nictine replacement like lozenges and gum for urges not relieved by the patch. 2- Which best describes the goals of motivational interviewing? -to convince the patient to agree to adapt behaviors that will improve their health -to help the patient resolve their ambivalence, develop some momentum and believe that behavior change is possible -to provide the patient with a list of referrals to resources such as dieticians and counselors in case they should decide to pursue helath behavior change -to make sure that you document the health behvior's that are impeding your ability to treat the patient's chronic conditions. - - - correct answer ✅to help the patient resolve their ambivalence, develop some momentum and believe that behavior change is possible
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2- Which is not one of the principles of the "5-A's" for engaging patients to quit smoking? -Ask about tobacco use -Advise all tobacco users to quit -Assess interest in quitting -Assist in developing a quit plan and Arrange for follow-up -Arrange for follow-up -Allow the patient to contact you when they feel like quitting - - - correct answer ✅Allow the patient to contact you when they feel like quitting 2- Your patient agrees that smoking is a problem, and would like to consider quitting, but they have no plan to quit within the next month. In which stage of readiness to change is your patient? -precontemplation -contemplation -preparation
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-If you can't block out at least 20 minutes in the visit, don't attempt to cousel the patient, as shorter times are not effective. -Motivational interviewing by a healthcare professional for as little as 3-5 minutes has been shown to increase cessation success. -All patients wanting to discuss smoking scessaion should be referred to a certified counsellor. - - - correct answer ✅Motivational interviewing by a healthcare professional for as little as 3-5 minutes has been shown to increase cessation success. 2- Your patient is overweight, with a BMI of 32, and you just informed them that they are "pre-diabetic". They want to talk with you about options for modifying their diet. You learn that your patient loves to cook. According to the "OARS" principle of motivational interviewing, which statement would be most appropriate? -You love cooking, and you want to pursue a healthy diet. Would you like to explore options for healthy menu choices? -You love to cook, but now you are "pre-diabetic". You need to stop cooking pasta dishes. -You are prediabetic, so you need to decide what is more important to you, your health, or baking cakes.
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-You should follow a diabetic diet. - - - correct answer ✅You love cooking, and you want to pursue a healthy diet. Would you like to explore options for healthy menu choices? 3- Match the description of the murmur with the likely valve disease Mitral stenosis (narrowed valve) - - - correct answer ✅A diastolic rumble-like murmur heard best at the apex 3- Match the description of the murmur with the likely valve disease Aortic stenosis (narrowed valve) - - - correct answer ✅A coarse systolic ejection murmur heard best at the second right intercostal space at the right sternal border (though it may radiate to the apex and into the carotids) 3- Match the description of the murmur with the likely valve disease
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3- Which is the most significant potential problem with using templates in documenting the physical exam in the electronic medical record? -Elements of the template might not be spelled correctly -The template might use terminology which is not familiar to other physicians in the practice. -Using a template usually increases the amount of time it takes to complete a note. -If not properly edited, the template may contain elements of the physical exam which were not actually performed during the encounter - - - correct answer ✅If not properly edited, the template may contain elements of the physical exam which were not actually performed during the encounter 3- A 62 year old patient with a history of hypertension reports to you that they feel their heart "jumping around" in their chest and "skipping beats". Which condition would present with an irregular heart RHYTHM? -Sinus bradycardia
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-Ventricular tachycardia -Normal sinus rhythm -Atrial fibrillation - - - correct answer ✅Atrial fibrillation 3- Which corresponds to the first heart sound ("S1" or "lubb")? -The closing of the aortic and pulmonic valves during diastole -The opening of the mitral and tricuspid valves during systole -The opening of the aortic and pulmonic valves during diastole -The closing of the mitral and tricuspid valves during systole - - - correct answer ✅The closing of the mitral and tricuspid valves during systole 3- From a medical-legal perspective, which statement is most correct? -If you didn't document in the medical record that you did or said something regarding a patient encounter, then it will later be assumed that you didn't do or say it ("If you didn't document it, you didn't do it")
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-The initial muffling of the Korotkoff sounds upon deflation of the cuff -The appearance of 2 consecutive beats upon deflation of the cuff -
correct answer ✅The appearance of 2 consecutive beats upon deflation of the cuff 3- A patient with a history of congestive heart failure presents to you for evaluation of leg swelling. According to Seidel, In which grade of pitting edema does the "pit" usually disappear in 10- seconds? -1+ -2+ -3+ -4+ - - - correct answer ✅2+ 3- Match the heart valve with the proper area for auscultating that valve:
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Aortic Valve - - - correct answer ✅Second right intercostal space at the right sternal border 3- Match the heart valve with the proper area for auscultating that valve: Pulmonic Valve - - - correct answer ✅Second and third intercostal space at the left sternal border 3- Match the heart valve with the proper area for auscultating that valve: Tricuspid valve - - - correct answer ✅Fourth left intercostal space along the lower left sternal border 3- Match the heart valve with the proper area for auscultating that valve:
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-Dyspnea - - - correct answer ✅Tactile fremitus 4- Dyspnea refers to -Rapid breathing -Difficult, labored breathing -Slow breathing -Shallow breathing - - - correct answer ✅Difficult, labored breathing 4- Egophony is best described as: -A dullness is heard to percussion -A vibration is palpated when the patient breath -A crackly sound is heard outside the respiratory tree -When the patient says "ee", it sounds like "aa" due to a lung consolidation - - - correct answer ✅When the patient says "ee", it sounds like "aa" due to a lung consolidation
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4- Match the lung finding the best fits the condition; Pneumonia - - - correct answer ✅Dullness to percussion with crackles and rhonchi 4- Match the lung finding the best fits the condition; Pneumothorax - - - correct answer ✅Hyperresonance to percussion, diminished to absent breath sounds 4- Match the lung finding the best fits the condition; Asthma - - - correct answer ✅Prolonged expiratory wheeze with diminished lung sounds 4- Match the lung finding the best fits the condition;
