Podcast
Questions and Answers
What is a common nonverbal behavior displayed by an angry patient?
What is a common nonverbal behavior displayed by an angry patient?
Which verbal strategy is recommended for managing an angry patient?
Which verbal strategy is recommended for managing an angry patient?
What might indicate that a silent patient is feeling anxious?
What might indicate that a silent patient is feeling anxious?
What is one potential cause of a patient's silence?
What is one potential cause of a patient's silence?
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How should a clinician approach a silent patient?
How should a clinician approach a silent patient?
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Which behavior could suggest an angry patient during a consultation?
Which behavior could suggest an angry patient during a consultation?
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What can be a first step in managing an angry patient?
What can be a first step in managing an angry patient?
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When dealing with a silent patient, which of the following should be avoided?
When dealing with a silent patient, which of the following should be avoided?
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What percentage of individuals over 50 years old are estimated to have premalignant polyps?
What percentage of individuals over 50 years old are estimated to have premalignant polyps?
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At what age should routine CRC screening begin for individuals with no other risk factors?
At what age should routine CRC screening begin for individuals with no other risk factors?
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Which of the following factors is NOT considered a risk factor for colorectal cancer?
Which of the following factors is NOT considered a risk factor for colorectal cancer?
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For individuals with a family history of CRC, when should screening begin?
For individuals with a family history of CRC, when should screening begin?
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What type of colorectal polyps carry an increased risk for cancer?
What type of colorectal polyps carry an increased risk for cancer?
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How often should a colonoscopy be performed for average risk individuals starting at age 45?
How often should a colonoscopy be performed for average risk individuals starting at age 45?
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Which dietary choice is associated with a decreased risk of colorectal cancer?
Which dietary choice is associated with a decreased risk of colorectal cancer?
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What is the incidence of new colorectal cancer cases reported annually?
What is the incidence of new colorectal cancer cases reported annually?
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What is the average sleep requirement for a healthy adult?
What is the average sleep requirement for a healthy adult?
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Which of the following sleep disorders is most likely to increase in prevalence with age?
Which of the following sleep disorders is most likely to increase in prevalence with age?
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Which process is primarily responsible for regulating circadian rhythms?
Which process is primarily responsible for regulating circadian rhythms?
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What tool can help document sleep time and breathing rhythms?
What tool can help document sleep time and breathing rhythms?
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During which phase of sleep is EEG monitoring particularly important for diagnosis?
During which phase of sleep is EEG monitoring particularly important for diagnosis?
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How are clinical assessments for sleep disorders conducted in an office setting?
How are clinical assessments for sleep disorders conducted in an office setting?
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Which group of people are often the first to notice sleep problems in pediatric or geriatric patients?
Which group of people are often the first to notice sleep problems in pediatric or geriatric patients?
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What percentage of adults experience sleep-related symptoms annually?
What percentage of adults experience sleep-related symptoms annually?
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What is the primary purpose of active surveillance in localized prostate cancer?
What is the primary purpose of active surveillance in localized prostate cancer?
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Which test measures the level of deviation in the spine while performing the Adams Test?
Which test measures the level of deviation in the spine while performing the Adams Test?
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What describes neurogenic pain due to spinal issues?
What describes neurogenic pain due to spinal issues?
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What indicates a positive Adams Test for scoliosis?
What indicates a positive Adams Test for scoliosis?
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What is the maximum score on the Epworth Sleepiness Scale, and what score indicates a need to refer to a sleep specialist?
What is the maximum score on the Epworth Sleepiness Scale, and what score indicates a need to refer to a sleep specialist?
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Which of the following treatments is most appropriate for mechanical low back pain?
Which of the following treatments is most appropriate for mechanical low back pain?
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What is a likely cause of back pain classified as factitious?
What is a likely cause of back pain classified as factitious?
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Which of the following activities is NOT included in the Epworth Sleepiness Scale assessment?
Which of the following activities is NOT included in the Epworth Sleepiness Scale assessment?
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Which component is NOT part of the STOP-BANG questionnaire?
Which component is NOT part of the STOP-BANG questionnaire?
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In the context of low back pain, what does Wadell's sign assess?
In the context of low back pain, what does Wadell's sign assess?
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What condition can result in comorbid insomnia as described in sleep disorder categories?
What condition can result in comorbid insomnia as described in sleep disorder categories?
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What does the Ottawa Criteria help determine?
What does the Ottawa Criteria help determine?
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What is classified under hypersomnia disorders?
What is classified under hypersomnia disorders?
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What does the 'A' in STOP-BANG signify?
What does the 'A' in STOP-BANG signify?
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What category best describes sleepwalking?
What category best describes sleepwalking?
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What was the primary focus of the Diabetes Control and Complications trial?
What was the primary focus of the Diabetes Control and Complications trial?
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Which of the following is a characteristic of chronic insomnia?
Which of the following is a characteristic of chronic insomnia?
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What significant outcome was demonstrated in the Kumamoto Study regarding Type 2 Diabetes management?
What significant outcome was demonstrated in the Kumamoto Study regarding Type 2 Diabetes management?
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What was a key finding of the Steno-2 Study after a mean follow-up time of 7.8 years?
What was a key finding of the Steno-2 Study after a mean follow-up time of 7.8 years?
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Which complications were shown to have lower rates in the intensive multifactorial intervention arm of the Steno-2 Study?
Which complications were shown to have lower rates in the intensive multifactorial intervention arm of the Steno-2 Study?
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What type of cancer predominantly arises in the context of colorectal cancer (CRC) pathophysiology?
What type of cancer predominantly arises in the context of colorectal cancer (CRC) pathophysiology?
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Which of the following types of lesions are commonly associated with adenocarcinomas in colorectal cancer?
Which of the following types of lesions are commonly associated with adenocarcinomas in colorectal cancer?
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What consequence is associated with inadequate blood glucose control in diabetes management?
What consequence is associated with inadequate blood glucose control in diabetes management?
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What aspect of diabetes management was emphasized by all three studies mentioned?
What aspect of diabetes management was emphasized by all three studies mentioned?
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Study Notes
HPDP2 - Midterm 1 Study Guide
- Difficult Patient Types: The Feldman article outlines four types of challenging patients: Angry, Silent, Demanding, and Yes, But... patients. Strategies for dealing with each are also detailed.
The Angry Patient
- Nonverbal Communication: Rigid postures, piercing stares, refusal to shake hands, gritting teeth, and confrontational/abusive language are common. Subtle behaviors include refusing to answer questions, avoiding eye contact, and creating non-verbal barriers.
- Management: Evaluation should begin with calmly confronting the patient. Phrases like "You seem angry" can help the patient express their feelings, acknowledging the emotion as opposed to judging it. Encourage expression to find unresolved conflicts impacting care.
The Silent Patient
- Characteristics: Silent patients usually offer little verbal communication, appear withdrawn, avoid eye contact or acknowledgement, and may show signs of anxiety or sadness.
- Management Strategies: Acknowledge the patient's silence and offer quiet support, encourage expression of feelings, and address any underlying issues.
The Demanding Patient
- Characteristics: Patient requests are demanding (tests, specialist referrals, very specific treatments). These demands may stem from dissatisfaction with evaluation, wanting secondary gain, concerns about the diagnosis, or overlooking vital historical aspects.
- Management: Clinicians should consider why these demands are important to the patient, asking the patient about their desired outcome. Then, explain any realistic limits on treatment expectations.
The Yes, But... Patient
- Characteristics: These patients appear engaged initially but become withdrawn when recommendations are made. They often react with "I'd like to do that, but..."
- Management: Emphasize that taking responsibility for their own health is key to recovery.
Practitioner Well-being
- Important Considerations: Physical, emotional, and spiritual aspects of health in a practitioner. The relationship with patients is important.
- Personal Philosophy: The deeply held beliefs and values that impact how one perceives life, its purpose, suffering, and relationships.
Control vs. Relational Model
- Control Model: Focuses on control over diseases, patients, and teams. This is often stressful..
- Relational Model: Understanding the multidimensionality of patients and their context is key to successful interactions. This involves recognizing that patients are not just biological entities; acknowledging their lived experiences can also improve outcomes.
Diabetes Types
- Type 1 Diabetes: An autoimmune disease resulting in a lack of insulin production, and exogenous insulin administration is typically required. More common in children and younger adults.
- Type 2 Diabetes: A disease where the body either doesn't properly utilize insulin, or the body struggles producing enough insulin. More commonly found in adults, associated with increased risk for obesity.
Diabetes Diagnosis Testing
- Fasting Glucose: Plasma glucose levels of less than 100 mg/dL (Normal Fasting), 100-125 mg/dL (impaired fasting glucose tolerance), ≥126 mg/dL (Diabetes Mellitus).
- Oral Glucose Tolerance Test: A fasting blood sample is taken, followed by consumption of a glucose solution, and then samples are taken afterward at set intervals (0 and 120 minutes usually). Normal oral glucose tolerance ranges from values of less than 100 mg/dL (at 0 minutes) and less than 140 mg/dL (at 2-hour mark)."
Diabetes Ethnicity & Risk
- Groups at higher risk: Native Americans and Alaskan Natives (Pima) have higher risk than other groups.
- General Risk: Several groups have a higher incidence of Type 2 than others (Hispanic, Blacks) and a risk for development of diabetes.
Metabolic Syndrome
- Criteria: Includes waist circumference, elevated glucose, high blood pressure, elevated triglycerides, and low HDL cholesterol. Most individuals will have 3 out of these 5 criteria.
- Complications: Higher risk of developing diabetes and cardiovascular disease.
Diabetes Prevention Programs
- Diabetes Prevention Program: Demonstrates that lifestyle changes such as diet changes and exercise can prevent diabetes in high-risk individuals.
- UK Prospective Diabetes Study: Found that consistent monitoring of glucose (glycemic control) reduced cases of chronic complications in type 2 diabetes.
- Diabetes Control and Complications Trial (DCCT): Showed tight glucose control can lower risk of chronic complications in type 1 diabetes.
Testing for Diabetes
- HbA1c: Reflects the average blood glucose levels over the last three months. Reflects the overall compliance.
- Urine Glucose Test: Quick, accessible way to screen for glucosuria and high blood sugar levels ( >100mg/dL)
- Nitroprusside test: another indicator to detect glucose in urine.
CRC (Colorectal Cancer)
- Pathophysiology: Majority are adenocarcinomas, often appearing as bulky exophytic masses or constricting lesions. The tumor arises from malignant transformation of pre-cancerous polyps.
- Epidemiology: Usually develops in individuals older than 50 years old.
- Risk Factors: Family history (first-degree relative) is a risk factor; a risk increases with age. Increased risk with IBD; diets high in fat, red meat..
- Testing/Screening: Annual fecal occult blood testing, fecal immunochemical tests, or fecal DNA testing every 1-3 years (screening begins from age 45), colonoscopies recommended every 10 years for average risk individuals.
Prostate Cancer Screening
- Risk Factors: Family history, age, and ethnicity (African American men have a greater likelihood).
- Screening Tests: DRE (digital rectal exam), PSA (prostate-specific antigen), sometimes ultrasound-guided biopsy.
- Strengths and Limitations: The tests have some drawbacks, for instance a PSA level between 4.0-10.0 may be problematic, additional testing is suggested, to further investigate a suspicious case. A level > 10.0 is indicative of a more suspicious case of prostate cancer.
Other Conditions
- Osteoporosis: Characterized by a decrease in bone mineral density and matrix. Age, sex hormone deficiency, and alcohol abuse are risk factors. Bone dencity tests (DXA tests) are used to diagnose the disease (T-scores below -2.5).
- Musculoskeletal Conditions: RICE (rest, ice, compression, elevation) is a common treatment for many conditions.
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Description
Prepare for your HPDP2 Midterm with this comprehensive study guide focusing on difficult patient types as discussed in the Feldman article. Learn about the characteristics and management strategies for Angry and Silent patients, along with techniques to address their specific needs. Equip yourself with essential communication skills to navigate challenging situations effectively.
