questions with expert solutions.
subjective vs objective - answer feeling vs fact
pain vs tenderness - answer patients feeling vs physicians assessment
benign - answer normal, nothing of concern
acute vs chronic - answer new onset vs long standing
baseline - answer an individuals normal state of being
ausculation - answer listening to sound with a stethoscope
palpation - answer act of pressing on an area (by the physician)
inpatient - answer admitted to the hospital overnight
outpatient - answer seen and sent home the same day
chief complaint - answer main reason for the patients visit
,meaningful use - answer set of government mandated criteria that
must be obtained for every patient
medical decision making - answer physicians though process
Scribes can... - answer document history, physician exam, results,
procedures. access and document laboratory and radiology findings.
locate and obtain PMHx, previous charts, past results.
Scribes cannot... - answer partake in any activity that may affect patient
health, touch patients, handle bodily fluids, sign any charts, give verbal
orders or submit electronic orders.
are physician assistants and nurse practitioners considered medical
providers? - answer YES
T/F: The scribe can listen to a patient's heart and lungs as long as it is for
learning purposes and under the supervision of the physician. - answer
False
Lucy has been seen by Dr. Heart for the past 2 years. She is here today
for a routine appointment with Dr. Heart. Is Lucy a new or established
patient? - answer Established
,a patient made an appointment because she developed a rash a few
days ago. what type of visit would this be? - answer diagnostic
diagnostic visits consist of - answer new problems, new symptoms
health management visits consist of - answer check-ups, management
visits
a patient has an appointment for management of her diabetes. what
type of visit would this be? - answer health management
who is the first person to speak with the patient after he/she is place in
a room? - answer Nurse/MA
What are the meaningful use requirements the nurse/MA will obtain? -
answer Chief complaint; Vital signs (HR, BP, T, RR), Height, weight, BMI;
Smoking status
What does H&P abbreviate and who performs this evaluation? - answer
history and physical, performed by the provider
, Is a differential diagnosis necessary for a health maintenance visit? -
answer nope.
what information will be included in the patient's plan? give 3
examples. - answer F/U for specialist, instructions for lifestyle, F/U for
next routine appointment
name the 8 elements of the HPI - answer Location, Quality, Severity,
Context, Timing, Duration, Associated signs and symptoms, Modifying
factors
polydipsia - answer excessive thirst
paresthesia - answer sensation of tingling or numbness
anticoagulant - answer a drug that prevents blood clotting
chronic illness - answer longer than 3 months
if a patient has had respiratory symptoms for the past 5 weeks, are the
symptoms considered chronic? - answer No