1. History Taking (30 Q&A)

1. Q: What is the WHO definition of health? A: A state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.
2. Q: What is illness? A: The subjective experience of feeling unwell (e.g. pain, fatigue, nausea), even without objective findings.
3. Q: What is disease? A: A pathological condition diagnosed based on clinical, laboratory or imaging findings.
4. Q: What is anamnesis? A: The process of gathering a patient's past/current health, family history and lifestyle information relevant to diagnosis and treatment.
5. Q: Difference between comprehensive and focused assessment? A: Comprehensive covers the full history/exam; focused targets a specific complaint.
6. Q: What is subjective data? A: What the patient tells you - symptoms, chief complaint, history, review of systems.
7. Q: What is objective data? A: What you observe/measure - signs, exam findings, labs, vitals, imaging.
8. Q: What initial information is documented before the history proper? A: Date/time, identifying data (age, gender, marital status, occupation, source), and reliability.
9. Q: When should reliability of the history be judged? A: At the end of the interview, noting if info was clear or vague.
10. Q: What is the correct sequence of collecting anamnesis? A: Introduction, chief complaint, HPI, past medical history, family history, social history, review of systems.
11. Q: Key steps in introducing yourself to a patient? A: Greet, introduce yourself/role, ensure confidentiality, ask consent, set the tone.
12. Q: What is the chief complaint? A: The primary reason the patient is seeking care, ideally in their own words.
13. Q: Why avoid leading questions for the chief complaint? A: They bias the patient's answer instead of letting them describe symptoms freely.
14. Q: What does SOCRATES stand for in HPI? A: Site, Onset, Character, Radiation, Association, Time course, Exacerbating/relieving factors, Severity.
15. Q: In HPI, what does "Site" mean? A: Where the patient feels the symptom.
16. Q: In HPI, what does "Onset" mean? A: When the symptom started.
17. Q: In HPI, what does "Character" mean? A: How the patient describes the symptom.
18. Q: In HPI, what does "Radiation" mean? A: Whether and where the symptom spreads.
19. Q: In HPI, what does "Exacerbating/relieving factors" mean? A: What makes it better or worse.
20. Q: In HPI, what does "Severity" mean? A: How much it affects the patient's daily life.
21. Q: What are the components of past medical history? A: Chronic illnesses, past acute illnesses/hospitalizations, surgical history, medications, allergies/ADRs, immunizations.
22. Q: Why is family history important? A: It helps detect early hereditary diseases.
23. Q: How should family history questioning start? A: With an open-ended question like "Do any medical conditions run in your family?"
24. Q: What relatives are asked about in family history? A: First- and second-degree relatives, age of onset and cause of death if relevant.
25. Q: What topics are covered in social history? A: Smoking/alcohol/drugs, occupation, living conditions, diet/exercise, sexual history, travel, social support.
26. Q: What does review of systems (ROS) assess? A: Symptoms organized by body system, separate from the HPI.
27. Q: What is asked under HEENT in ROS? A: Headache, tinnitus, runny nose, nosebleed, swallowing difficulty, bleeding gums, mouth ulcers.
28. Q: What is asked under cardiovascular in ROS? A: Chest pain, palpitations, racing heart.
29. Q: What is asked under endocrine in ROS? A: Frequent urination, increased thirst, weight changes.
30. Q: What is asked under general symptoms in ROS? A: Weight loss/gain, fatigue, fever, night sweats.

2. Ethics and Professionalism (30 Q&A)

1. Q: What are examples of skilled interviewing techniques? A: Active listening, empathic responses, guided questioning, nonverbal communication, reassurance, partnering, summarization, transition, empowering the patient.
2. Q: What is guided questioning? A: Moving open-ended to focused questions, graded responses, one question at a time, offering choices, clarifying, using continuers and echoing.
3. Q: What is "echoing" in interviewing? A: Repeating the patient's own words back to encourage elaboration.
4. Q: What techniques help share power with the patient? A: Evoking their perspective, showing interest in the person, following their lead, validating emotions, sharing information, transparent reasoning, revealing knowledge limits.
5. Q: How should a clinician prepare for an interview? A: Review the clinical record, set goals, review own behavior/appearance, adjust the environment.
6. Q: What is the typical sequence of a clinical interview? A: Greeting/rapport, notes, agenda, exploring perspective, emotional cues, clarifying the story, diagnostic hypotheses, sharing the plan.
7. Q: What does FIFE stand for? A: Feelings, Ideas, Function, Expectations.
8. Q: In FIFE, what does "Ideas" explore? A: What the patient thinks is causing the problem.
9. Q: In FIFE, what does "Function" explore? A: How the illness affects daily life and activities.
10. Q: In FIFE, what does "Expectations" explore? A: What the patient hopes to get from the visit/treatment.
11. Q: What does NURSE stand for? A: Name, Understand, Respect, Support, Explore.
12. Q: In NURSE, what does "Name" mean? A: Identify and label the patient's emotion.
13. Q: In NURSE, what does "Respect" mean? A: Validate the patient's feelings.
14. Q: What are the three steps of sharing a treatment plan? A: Present options/explore preferences, move toward a decision, confirm readiness and support.
15. Q: What is cultural humility? A: Willingness to learn from the patient about their cultural background, values and beliefs.
16. Q: Why is cultural humility important? A: Respects autonomy, builds trust/communication, reduces bias and stereotyping.
17. Q: What are the three dimensions of cultural humility? A: Self-awareness, respectful communication, collaborative partnerships.
18. Q: What does "self-awareness" mean here? A: Learning about your own biases.
19. Q: What does "collaborative partnerships" mean here? A: Building relationships on respect and mutually acceptable plans.
20. Q: What types of challenging patients are described? A: Silent, confusing, altered cognition, talkative, crying, angry/disruptive, and those with language, hearing or vision barriers.
21. Q: Difference between capacity and competence? A: Capacity is a clinician's assessment of ability to make a specific decision now; competence is a court's legal determination overall.
22. Q: Who determines capacity vs competence? A: Clinician determines capacity; a court of law determines competence.
23. Q: Key signs a patient may lack capacity? A: Can't understand information, weigh options, reason through choices, communicate a choice, or has fluctuating/impaired cognition.
24. Q: Two main types of advance directives? A: Living will and health care power of attorney.
25. Q: What is a living will? A: Instructions about medical treatments, especially end-of-life care.
26. Q: What is a health care power of attorney? A: Appoints an agent/proxy to make decisions if the patient can't.
27. Q: What topics are considered "sensitive" in history taking? A: Sexual history, mental health, alcohol/drug use, domestic violence.
28. Q: What does CAGE screen for? A: Alcohol use problems (Cut down, Annoyed, Guilty, Eye-opener).
29. Q: What are the four principles of medical ethics? A: Autonomy, beneficence, non-maleficence, justice.
30. Q: What should a clinician do if a capacitated patient refuses life-saving treatment against family wishes? A: Respect the patient's autonomous, voluntary decision.

3. Informed Consent (30 Q&A)

1. Q: What is informed consent? A: An ethical/legal process where a patient voluntarily agrees to an intervention after understanding its risks, benefits, alternatives and costs.
2. Q: What are the three types of informed consent? A: Implied, verbal, and written.
3. Q: What is implied consent? A: Agreement shown through actions.
4. Q: What is verbal consent? A: Agreement expressed orally.
5. Q: What is written consent? A: Agreement documented with a signature.
6. Q: What are the components of informed consent? A: Description of the procedure, risks vs benefits, alternatives, risks/benefits of alternatives, assessment of understanding.
7. Q: What are the five requirements for valid informed consent? A: Capacity/competence, voluntariness, adequate disclosure, understanding, authorization/consent.
8. Q: What does "voluntariness" mean? A: The agreement must be given freely, without coercion.
9. Q: What does "adequate disclosure" mean? A: Enough information about the procedure, risks, benefits and alternatives must be given.
10. Q: Why isn't a signed form alone sufficient for valid consent? A: Valid consent also needs disclosure, understanding, capacity and voluntariness.
11. Q: Can a patient withdraw consent after signing? A: Yes, at any time before the procedure.
12. Q: If a stable, oriented patient withdraws consent minutes before a procedure, what should the team do? A: Stop and respect the withdrawal of consent.
13. Q: What are examples of special circumstances in informed consent? A: Emergency/unconscious patients, lack of capacity, minors, language barriers, refusal, surrogate decision-makers, withdrawal, research/teaching.
14. Q: How is consent handled for an unconscious emergency patient? A: Treatment proceeds under emergency/implied consent when delay would cause harm.
15. Q: Who consents for children and adolescents? A: A parent or legal guardian, with the child's assent sought when appropriate.
16. Q: What is informed assent? A: A minor's or cognitively impaired person's affirmative agreement to participate, alongside guardian consent.
17. Q: Why use assent instead of consent for minors? A: They lack legal capacity to consent, but their willingness still matters ethically.
18. Q: In a laboring patient refusing an urgent cesarean, what should be respected if she has capacity? A: Her voluntary refusal.
19. Q: Can a partner's agreement override the patient's own refusal? A: No, the competent patient's refusal takes precedence.
20. Q: What must be done when a surrogate decision-maker is needed? A: Identify the legally authorized surrogate for a patient lacking capacity.
21. Q: What must be reassessed before proceeding with a previously signed procedure? A: Whether the patient still has capacity and wants to proceed voluntarily.
22. Q: What role do "alternatives" play in consent disclosure? A: Patients must be told about alternative options and their risks/benefits, not just the proposed procedure.
23. Q: How is a patient's understanding assessed? A: By having them explain the procedure and its risks/benefits back in their own words.
24. Q: Difference between disclosure and understanding? A: Disclosure is what the clinician tells the patient; understanding is whether the patient actually comprehends it.
25. Q: Why is consent needed even for "routine" procedures? A: Every procedure carries risks and alternatives that must be disclosed and understood.
26. Q: What is the risk of minimizing risks just to get a signature? A: It invalidates informed consent due to inadequate disclosure/understanding.
27. Q: What is required for consent to be "authorized"? A: Clear patient agreement after understanding all relevant information.
28. Q: How should language/communication barriers be addressed for consent? A: Using professional interpreters to ensure understanding.
29. Q: Must a capacitated patient's refusal of treatment be honored even if risky? A: Yes.
30. Q: What is the "dual procedure" in informed assent? A: Obtaining both the minor's/impaired person's assent and the guardian's informed consent.