Term
| What was George Engel's original biopsychosocial interpretation of disease? |
|
Definition
Disorders are biologically based, but psychosocially influenced.
1) Genetics and biology play the larger role in determining pathogenesis and treatment responsiveness, as well as resilience and vulnerability to stress
2) Developmental experiences confer vulnerability to certain types of illnesses
3) Life stresses may precipitate illness onset or relapse |
|
|
Term
| Provide 2 examples of biological, psychological and social therapies for chronic pain? |
|
Definition
Biological- Opiates, Nerve blocks
Psychological- Biofeedback, Acupuncture
Social- Vocational rehab, group therapy |
|
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Term
Many physicians have advocated for an increased ephasis on psychosocial perspectives in medicine. All of the following would likely be advantages to this shift, EXCEPT.
a. Increased funding from NIH
b. Improved patient-doctor communication
c. Decreased physician burnout
d. Decreased malpractice/regulatory actions against physicians |
|
Definition
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Term
Which statement best describes how George Engel's theory conceives of biological factors in medicine?
a. The proportion of etiology attributed to biological factors remains fairly constant across most general medical conditions
b. Biological factors have a relatively larger role in determining pathogenesis, compared to psychosocial factors.
c. Mental health professionals are best suited to address psychosocial factors of illness, while physicians are best suited to address biological factors. |
|
Definition
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|
Term
| Distinguish between Classical (Pavlovian) and Operant Conditioning |
|
Definition
1) Classical
- Involuntary
- Created externally with triggering stimulus and conditioned reflex
Ex) dog salivating
2) Operant
- Voluntary
- Developed internally with reinforcers to strengthen or weaken response.
Ex) infant banging to get attention, but not to make mom angry |
|
|
Term
| What Best reinforces behavior? |
|
Definition
1) Positive reinforcement> negative
2) Intermittent reinforcement is more powerful
3) Lack of reinforcers will extinguish behavior. |
|
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Term
| What is the basic structure of the Health Belief Model (HBM)? |
|
Definition
Assumes patients will take a health-related action or change a behavior IF
1) Feel it will help them avoid problems
2) Expect that a recommended actin will help achieve a goal
3) Believe they can be successful |
|
|
Term
| What are 4 factors that post-HBM theorists believe are central to behavioral change? |
|
Definition
1) Individual choice (Brehm and "reactance theory")
2) Empathy (non-directive approach championed by Rogers)
3) Elicit Motivation
-self-perception theory
- cognitive dissonance
4) Readiness for change |
|
|
Term
| What are the 5 major stages of change exemplified in the Health Behavior Model? |
|
Definition
Pain Can Corrupt PAM
1) Pre-contemplation (not seeing problem or need)
2) Contemplation (seeing some benefits and considering)
3) Preparation (making concrete plans)
4) Action (doing something)
5) Maintenance (working to maintain |
|
|
Term
| How can the Health Behavior Model of change be applied to helping patients achieve their goals? |
|
Definition
FRAMES
1) FEEDBACK regarding personal risk or impairment
2) Emphasis on personal RESPONSIBILITY for change
3) Clear ADVICE to change
4) A MENU of alternative change options
5) therapeutic EMPATHY
6) Enhancement of SELF-EFFICACY |
|
|
Term
A patient with asthma keeps forgetting to take his inhaled medication. To help improve adherence, the physician recommends that the mom set up a calendar, give stickers each day the child takes his inhaler, and go out to Chuck E Cheese if the child uses the inhaler at least six days per week. This would be an example of
a. classical conditioning
b. client-centered counseling
c. health belief modeling
d. motivational interviewing
e. operant conditioning |
|
Definition
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|
Term
When asked about smoking, a patient replies: "I know I should quit- these cigarettes are killing me. But everybody at work smokes, and it would really look funny if I quit." What stage of change does this represent?
a. Pre-contemplation
b. Contemplation
c. Preparation
d. Action
e. Maintenance |
|
Definition
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|
Term
Self-efficacy, or confidence in ability to change, is a construct that may predict change readiness. Which statement about self-efficacy is TRUE?
a. It is not included in either the health belief model (HBM or the transtheoretical model (stages of change).
b. It is included in HBM but not TTM
c. It is included in TTM but not HBM
d. it is included in both HBM and TTM. |
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Definition
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Term
Which of these statements about the spirit of MI is FALSE:
a. Elicits motivation, doesn't impose it
b. Sets up a collaborative model that values patient autonomy
c. Relies on a directive communication approach
d. Uses empathy to decrease resistance. |
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Definition
|
|
Term
| What are the 3 steps to generating Stress? |
|
Definition
1) Negative Events
2) Self-Perception
3) Negative Responses |
|
|
Term
| What is the model of "allostatic load" of stress? |
|
Definition
| Stress can promote memory storage and mobilization of energy, but if the load it "too high", the system suffers. |
|
|
Term
| Explain the neuroanatomical basis for stress generated by Emotional and Physical Stressors. |
|
Definition
1) Emotional acts to Cerebral cortex to hypothalamus
2) Physical acts through Brainstem and thalamic nuclei to hypothalamus.
3) From hypothalamus
- Pituitary..Adrenal cortex...Central adiposity (decrease inflammation and increase intravascular volume)
- Sympathetic output to Adrenal medulla leading to Catecholamine release
- Sympathetic output to Peripheral sympathetic nerves (Norepinephrine)
- Cerebral cortex to Hypothalamus
- HPA |
|
|
Term
| What is the evidence linking Stress to CVD? |
|
Definition
Stress, Negative Attributions and Depression all increase CV risk
1) INTER-HEART links psychosocial factors to MI (2.5 RR)
2) Women's Health INitiative (WHI) linked "attributions" to CV mortality
3) Optimism lowers risk of CVD |
|
|
Term
| What does the SMART-HEART study tell us about stress management and CVD? |
|
Definition
| Stress management, particularly CBT and relaxation techniques lower risk of CVD (as well as a number of other conditions). |
|
|
Term
| Mild stress causes increased appetite and energy mobilization, while extreme stress can cause muscle wasting, atherosclerosis and diabetes. What model has been hypothesized to account for this progression? |
|
Definition
|
|
Term
What chemical messenger is produced by the adrenal cortex in response to stress?
a. Catecholamine
b. Corticotropin
c. Cortisol
d. NE
e. 5-HT |
|
Definition
C
a (Adrenal Medulla)
b (Adenohypophysis)
c (Adrenal Cortex)
d (Catecholamine)
e (Raphe nucleus) |
|
|
Term
You're a researcher interested in finding out if hopelessness predicts negative CVD outcomes in healthy subjects with no cardiac history. What might be the best outcome measure to examine?
a. Acute MI rate
b. Circulating IL-6
c. CRH production
d. Intima Media Thickness (IMT)
e. None of the above |
|
Definition
D (subacute CVD)
a. actual event, not precursor
b. Produced by pituitary to stimulate adrenal cortex and lead to cortisol production
c. Produced by hypothalamus to activate Pituitary
d. True
e. False |
|
|
Term
All of the following are stress management interventions that have been shown to reduce CV risk in susceptible patients, EXCEPT.
a. Acupuncture
b. Cognitive therapy
c. Problem-solving skills
d. Relaxation techniques |
|
Definition
|
|
Term
| What are the 4 main tasks of MI? |
|
Definition
1) Developing rapport
2) Increasing motivation
3) Dealing with resistance
4) Strengthening commitment |
|
|
Term
| What are the 5 major MI strategies? |
|
Definition
EDARS
1) Express Empathy
2) Develop Discrepancy
3) Avoid Argument
4) Roll with Resistance
5) Support self-efficacy |
|
|
Term
| What does OARS mean in the context of MI? |
|
Definition
1) Open-ended questions
2) Affirmations
3) Reflective listening (focus on content, meaning or feeling)
4) Summarizing |
|
|
Term
All of the following are MI strategies that can increase motivation for behavior change, EXCEPT:
a. Challenging with consequences
b. Developing discrepancy
c. Expressing empathy
d. Supporting self-efficacy |
|
Definition
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|
Term
You ask a patient about their eating, and they say that they'd like to stop snaking so much but just can't seem to stop themselves. What might be the BEST reflective statement to make at that point?
a. "I can only imagine what its like."
b. "So its hard to change, but you really need to."
c. "This is a tough problem your're dealing with."
d. "You must feel helpless at times." |
|
Definition
D (affirmation)
Remember, focus on open-ended questions, affirmation, reflective listening and summarizing |
|
|
Term
A patient gets angry with their physician following a recommendation to cut back on drinking. If the physician is using an MI approach, what might be the best strategy at this point?
a. Defend the recommendation by revieiwing the medical evidence.
b. Empathize with the patient and roll with the resistance.
c. Shift the focus to pharmacotherapy options and away from behavioral change
d. Stop talking about it and return to the subject in a future appointment. |
|
Definition
|
|
Term
| How long will it take after quitting smoking to reduce your risk of CHD? |
|
Definition
| Immediate- it is an acute issue |
|
|
Term
| How does smoking dependence arise (molecular)? |
|
Definition
Worse the earlier you start
1) Nicotine binds to a4b2 nACh receptors in VTA, which projects to NA (increasing DA)
2) As you continue to smoke over the course of the day, these receptors become desensitized, and with chronic use, this leads to increase in receptor #.
3) Withdrawal leads to re-sensitiization of the receptors (dependence) |
|
|
Term
| What are the 5 As of treatment for smoking cessation? |
|
Definition
1) Ask about smoking at every visit
- use 4 R's (Relevance, Risks, Rewards, Repetition)
2) Advise all smokers to quit (not cut down)
3) Assess dependence, comorbidity
4) Assist with quitting
5) Arrange followup (VERIFY BIOCHEMICALLY) |
|
|
Term
| What are the 4 Rs involved in Asking about smoking dependence? |
|
Definition
1) Relevance
2) Risks
3) Rewards
4) Repetition |
|
|
Term
| What types of Assistance can a physician offer a smoker who wants to quit? |
|
Definition
1) Medication
- Varenicline (Chantix)- partial agnost of a4b2
- Bupropion (Zyban)- originally anti-depressent
- Nicotine replacement
2) Counseling- SET A DATE
3) Combinations of NRT patch and gum
NOT ACUPUNCTURE, HYPNOSIS |
|
|
Term
| What are some common reasons for smokers relapsing after quitting? |
|
Definition
1) Lack of social support
2) Ambivalence
3) Concerns about weight gain
4) Stress |
|
|
Term
| When arranging a followup visit, how o you verify abstinence from smoking? |
|
Definition
1) Carbon Monoxide in exhalation (half-life of 4 hrs)-
Pros- inexpensive after machine purchase and immediate quantitative feedback
Cons- only 12-24 hours
2) Cotinine (saliva or urine) (half-life of 18 hours)-
Pros- Can assay smoking 3-4 days in advance
Cons- Must be sent off for analysis (only "yes" or "no") |
|
|
Term
What efforts have effectively shown to prevent smoking?
Which efforts have had more limited effect? |
|
Definition
Food Smoking Prevention and Tobacco Control Act (2009) allows FDA to regulate tobacco products
EFFECTIVE
1) Tax (decrease 3-4% adults and 6-7% kids)
2) Smoke-free workplace (does not decrease business revenue)
3) Counter-advertising
LESS EFFECTIVE
1) School-based health education
2) Warning labels (need to be more large and graphic)
3) Prohibition on sales to minors |
|
|
Term
Cigarette smoking is much more dependence-producing than nicotine replacement medication (patch, gum, ect) because:
a. smoking delivers nicotine to brain more quickly
b. smoking involves non-nicotine stimuli, like smoke inhalation,t hat become conditioned reinforcers
c. cigarettes long have been marketed more intensely to consumers
d. cigarrettes cost less per unit dose |
|
Definition
|
|
Term
All but which of the following are common causes of smoking relapse after attempting to quit on an FDA-approved medication:
a. Not using medication long enough
b. Not understanding what the medication is designed to do to help quitting
c. Comorbidities that are contraindications for these medications.
d. Failing to cope effectively with cues for smoking |
|
Definition
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|
Term
All but which of the folllowing approache s have een shown to successfully prevent smoking in children:
a. Increasing tobacco taxes
b. School-based programs
c. Counter-advertising
d. Indoor smoking bans |
|
Definition
|
|
Term
| How can you best assess dependence on smoking in your patient? |
|
Definition
1) Assess Dependence
2) Assess Difficult smoking situations
3) Assess Co-morbid conditions (could affect pharmacokinetics of med after cessation) |
|
|
Term
| What is the BMI ranges for underweight, normal weight and overweight? |
|
Definition
1) Underweight is <18.5kg/m2 (low risk of co-morbidities, but other issues)
2) Normal is 18.5-24.9
3) Overweight is >25.0
4) Obese is >30 (with class II >35 and II >40) |
|
|
Term
| What 4 factors influence the relationship between BMI and overall health risk? |
|
Definition
1) Weight gain since young adulthood
2) Waist circumference
3) Fitness level
4) Ethnic or racial background |
|
|
Term
| What constitutes a "metabolic syndrome," which would increase the risk for CAD, stroke and type 2 diabetes? |
|
Definition
Three of the following together:
1) High waist circumference (>40 in m and >35 in w)
2) High triglycerides (>150mg/dL)
3) Reduced HDL (<40mg/dL in men and <50mg/dL in women)
4) Elevated BP (>130/85 mm Hg)
5) Elevated fasting glucose (>100mg/dL) |
|
|
Term
| What are the consequences to society of an obese USA? |
|
Definition
2/3 are overweight or obese in US
Co-morbidity risk increases cost (147 billion annually) |
|
|
Term
| What treatments are available for obesity? |
|
Definition
>5% of body weight for at least 1 year is successful
1) Behavioral weight control(5-10% can be lost in 6 m, but often gained back)
2) Diet (cutting 500/1000 cal/day)
3) Exercise (30 min moderate intensity, but more may be needed for loss)
4) Pharmacotherapy- Orlistat reduces absorption by 1/3 by blocking lipase
5) Surgery most effect if BMI>40 (Laparoscopic adjustable banding vs. Roux-en-Y bypass) |
|
|
Term
| What pharmacotherapties are available to treat obesity? |
|
Definition
1) Orlistate- lipase inhibitor that prevents 1/3 of fat absorption
NOT FDA approved
2) Anti-depressents
3) AEDs (topiramate)
4) Diabetes drugs |
|
|
Term
| Under what circumstances should pharmacotherapy be applied to obesity treatment? |
|
Definition
1) BMI 27-29.9 with co-morbidities
2) Any BMI >30 |
|
|
Term
| Under what circumstances should bariatric surgery be applied to obesity treatment? |
|
Definition
1) 35-39.9 with co-morbidity
2) >40 |
|
|
Term
The course director for Behavioral Medicine is 5'11 and 205lbs (BMI 28.6 kg/m2). His weight status might be classified as
a. Underweight
b. Normal
c. Overweight
d. Obese
e. Severely obese |
|
Definition
|
|
Term
All of the following biological mechanisms have been associated with obesity, EXCEPT
a. Acetylcholine
b. Genetics
c. Hypothalamus
d. Leptin
e. Serotonin |
|
Definition
|
|
Term
What type of cancer has been most closely linked with Obesity?
a. Endometrial
b. GBM
c. Leukemia
d. Testicular |
|
Definition
|
|
Term
What is the mechanisms of action of orlistat in treatment of obesity?
a. Appetite suppression through DA mechanism
b. Oral hypoglycemic agent
c. Selectively inhibits lipase, blocking fat absorption in gut
d. Serotonin/NE re uptake inhibitor |
|
Definition
|
|
Term
| What medical conditions are exacerbated by Obesity? |
|
Definition
1) CVD (HTN)
2) Diabetes type 2
3) Cancer (Endometrial)
4) Gallbladder disease
5) OSAS
6) Nonalcoholic fatty liver disease |
|
|
Term
| What is the time/setting associated with acute vs. subacute vs. chronic pain? |
|
Definition
1) Acute- occurs in ER and post-surg because of trauma or infection and lasts <3 months
2) Subacute- can be anything but lasts 3-6 months
3) Chronic- experienced in outpatient clinics/PCP because of Neuropathy or Osteoarthritis and lasts >6 months |
|
|
Term
What kind of pain is experienced as a constant, dull ache and is localized to the site of a lesion?
What about sharp, burning pain that is also localized? |
|
Definition
1) Somatic (Arthritis, bony metastases)
2) Neuropathic (Sciatica, Neuropathy) |
|
|
Term
| What is the basic neurobiological circuitry of pain? |
|
Definition
Gate Control Theory
**Chronic pain passes through hypothalamus leading to stress hormone release**
1) Pain comes into substantia gelatenosa and dorsal horn
2) It then ascends in spinothalamic and/or spinoreticulardiencephalic tracts up through the thalamas and to the limbic cortices.
3) Descending cortical Serotoninergic (as well as other NT) fibers modulate experience of pain. |
|
|
Term
| What is Loesser's 'Onion' theory of pain perception? |
|
Definition
1) Pain mechanisms i s a series of nested layers
2) Nerve stimulus or damage is at centre, the next layer is pecrpetion of pain, then come suffering, pain behavior and finally interaction with environment
**Pain behavior and interaction with environment are only factors able to be observed** |
|
|
Term
| What is the basic structure of the "Current Pain Theory"? |
|
Definition
Amalgamation of Onion theory and Gate-Control theory
Consists of 3 stereo amplifiers with groups of fibers in between.
1) Body part that hurts
2) SC
3) Brain |
|
|
Term
| What are the notable epidemiological facets of Pain conditions? |
|
Definition
1) Account for 80% of physician visits
2) 50% of severely ill patients are spend >half their time in pain
3) Chronic pain prevalence is 10-40% (older females, with limited education are at greatest risk) |
|
|
Term
| What is the relationship between persistent pain and psychological disturbances? |
|
Definition
Positively related, most likely by impairment of daily activities.
Pain is poorly handled in women, minorities, elderly and patients with intellectual disability |
|
|
Term
| Why is pain so hard to treat? |
|
Definition
1) Physicians are uncomfortable treating symptoms rather than a disease process (one size treatment rarely fits)
2) Patients get frustrated, which stresses D-P relationship and may worsen pain
3) Poor training and bias towards procedures in terms of physician compensation |
|
|
Term
| What aspects of a patient's pain must be addressed to adequately provide treatment? |
|
Definition
1) Chief complaint (quant and qual)
2) Functional consequences of pain
- impairiment
- limitations
- disability
3) Past treatment
4) Medical/psychiatric review
5) Social history
6) PE |
|
|
Term
| What types of cognitive distortions frequently characterize patients with significant pain? |
|
Definition
This is why Psychiatric analysis is key
1) Catastrophizing
2) Anxiety
3) Helplessness |
|
|
Term
| What 'problem-oriented' approaches to pain management are currently encouraged? |
|
Definition
1) CBT- Locus of control
2) Procedural (surgical and stimulation)
3) Functional/Rehabilitate
4) Pharmacologic (start low potency) |
|
|
Term
You accidentally place your hand on a hot stove, detect the uncomfortably intense heat and rapidly withdraw your hand. What process best describes this situation?
a. Nociception
b. Pain
c. Reinforcement
d. Suffering
e. All of the above |
|
Definition
A
Pain is conscious while Nociception is not. |
|
|
Term
The most common body site for pain is
a. Abdomen
b. Back
c. Head/neck
d. Limbs |
|
Definition
|
|
Term
When interviewing a new female patient, you find out that on Friday and Saturday nights she likes to go out, and she usually drinks about four mixed drinks each night. She firmly denies any problems with this use in any domain of her life. Should you be worried about her use?
a. No: This amount does not exceed usual limits and does not put her at risk for abuse.
b. No: This amount does not reflect either abuse or dependence
c. Yes: Any amount of alcohol puts a person at risk for medical, social and psychiatric problems
d. Yes: This pattern exceeds usual limits and puts her at risk for harmful consequences |
|
Definition
|
|
Term
All of the following statements about the consequences of alcohol cause are true, EXCEPT:
a. About 80% of intimate partner violence can be linked to alcohol.
b. Alcohol directly damages not just eh liver, but also the pancreas and stomach.
c. Heavy alcohol use often causes respiratory and immune system dysfunction
d. More preventable deaths can be attributed to alcohol than to infectious causes. |
|
Definition
|
|
Term
Physicians can screen for alcohol problems by asking the CAGE questions. What does the "C" stand for in that mnemonic?
a. Does your family Condone use?
b. Have you Continued your use despite problems?
c. Have you ever been diagnosed with Cirrhosis?
d. Have you every tried Cutting down on your use? |
|
Definition
|
|
Term
Once hazardous or harmful alcohol use has been identified, a physician may attempt to use a brief intervention to reduce future risk. All of the following are key techniques in the brief intervention, EXCEPT
a. Giving feedback to the patient about your concerns
b. Insisting on abstinence from use
c. Providing encouragement about use reduction
d. Soliciting comment and reaction from the patient. |
|
Definition
|
|
Term
| What are the 4 types of Alcohol Use? |
|
Definition
1) Dependent (5%)- need 3 of:
- tolerance
- withdrawal
- continued despite knowledge of harm
- social, occupational activities given up
- great deal of time spent consuming
2) Harmful (20%)- abuse (occurs within 12-month period) with consistent issues in 1 or more realms of life
3) Hazardous (35%)- without physical, mental or social harm.
4) Safe use/Abstain (40%) |
|
|
Term
| How many drinks per day/week are within "limits" for women vs. men? |
|
Definition
1) Women is 3/7
2) Men is 4/14 |
|
|
Term
| Which types of drinkers cause the most damage to society as a whole? |
|
Definition
| Hazardous (35%) and Harmful (20%) drinkers |
|
|
Term
| What are direct toxic effects of alcohol abuse? |
|
Definition
3rd highest cause of preventable death in US!
1) End organ damage (cirrhosis, gastritis, cardiomyopathy, pancreatitis, risk of viral hepatitis, ventriculomegaly)
2) Social- 80% intimate partner violence (25% heavy drinkers abuse child or commit suicide) |
|
|
Term
| What is the CAGE principle of early identification of substance use disorders (SUD)? |
|
Definition
2 or more (+) is considered suspicious
C- have you ever considered CUTTING down
A- Do you every get ANNOYED when people ask you about it?
G- Do you ever feel GUILTY about your use?
E- Have you ever need to use an EYE-OPENER? |
|
|
Term
| What is the structure of an Intervention for someone suspected of alcohol abuse (FLO principle)? |
|
Definition
FLO method reacting to CAGE screen
2x as likely to change behavior! Low-cost, high-yield
Feedback (pt's screen results)
Listen (pt's reaction)
Options (educate, establish goal) |
|
|
Term
| What are major strategies that can help physicians deal with death and dying? |
|
Definition
1) Affiliation
2) Altruism
3) Anticipation
4) humor
5) Mastery/Control
6) Religiosity
7) Self-assertion
8) Self-observation
9) Suppresion |
|
|
Term
| What specifically can a physician do to help care for grieving family members of a deceased patient? |
|
Definition
1) Meet with family (right after and 3-6m later)
2) Support and empathy
3) Give permission to grieve (normalize)
4) Sleep medicine
5) Write condolence |
|
|
Term
Which of these strategies would be LEAST effective as a coping strategy for providers dealing with the dying patient?
a. Mastery/Control
b. Religiosity
c. Repression
d. Suppression |
|
Definition
|
|
Term
With respect to doctor-patient relationships, what do dying patients fear most?
a. Abandonment
b. Empathy
c. False hope
d. Opiate use |
|
Definition
|
|
Term
What would be the best approach to providing humane care at the end-of-life?
a. Discourage patients from spending too much time reflecting on their lives
b. Refer to palliative care specialist and let them take over care
c. Relieve pain without risking abuse or addiction on pain medications
d. Respect the patient's choices, even if those are not the ones you would make yourself
e. All of the above |
|
Definition
|
|
Term
| What disparities face minorities facing health care in the US? |
|
Definition
1) Shorter lifespans
2) Lack of access to quality care (ER>PCP)
3) Higher incidence of medical conditions
4) Worse treatment
5) Worse outcomes |
|
|
Term
| To which 3 types of causes can disparities in healthcare for minorities be attributed? |
|
Definition
1) Patient factors
- Beliefs, language, education, lifestyle
2) Physician factors
- Cultural competence, stereotyping, beliefs, time
3) Systems factors
- Interpreter availability
- Diversity
- Cultural competence
- Fiscal |
|
|
Term
| What are 5 basic steps towards improving outcomes for culturally diverse patients? |
|
Definition
1) Assess cultural background (values/customs/norms)
2) Respect diversity
3) Understand the patient's "theory of illness"
4) Negotiate treatment plans
5) Communicate clearly |
|
|
Term
Why might mexican-americans suffer more complications from diabetes than Caucasian americans?
a. Language barriers interfere with adherence
b. Clinics that serve this population may lack resources
c. Physicians may negatively stereotype such patients
d. A & B
e. All of the above |
|
Definition
|
|
Term
Which statement best describes how a physician might approach a patient from a non-western cultural group who fails to make eye contract during a visit?
a. Accept and respect the difference, carry on
b. Ask patient to try and look you in the eye during the visit
c. Assume lack of eye contact reflects an underlying depressive disorder
d. A + B |
|
Definition
|
|
Term
Ethnic and cultural differences contribute to all of the following health disparities EXCEPT:
a. Lack of care access
b. Lower intelligence
c. Shorter lifespan
d. Worse treatment |
|
Definition
|
|
Term
| What is the classic "choice triad" needed to successfully encourage medication adherence? |
|
Definition
1) They must think something is wrong
2) They must be motivated to try and get relief
3) They must believe that the pros outweigh the cons. |
|
|
Term
| What is the "LEAP" principle of medication adherence management? |
|
Definition
| Listen, Empathize, Agree, Partner |
|
|
Term
True or False:
Social demographics are predictive of a patient's likelihood to adhere to their medication protocol. |
|
Definition
FALSE
It is not predictive |
|
|
Term
| What are the 5 critical elements of motivational interviewing? |
|
Definition
1) Express Empathy
2) Develop Discrepancy
3) Avoid Argument
4) Roll with Resistance
5) Support Self-efficacy |
|
|
Term
| What is the OARS principle of motivational interviewing? |
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Definition
1) Open-ended questions
2) Affirmation
3) Reflective listening
4) Summarizing |
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Term
| What neurotransmitter is utilized by the limbic/cortical system to activate the HPA axis in response to emotional stress? |
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Definition
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Term
| What neurotransmitter is utilized by the Hypothalamus to regulate release of ACTH from the pituitary gland to activate the adrenal cortex? |
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Definition
Hypothalamus releases Corticotropin-releasing hormone, which acts on the pituitary gland, causing it to release ACTH and Corticotropin.
ACTH acts on the adrenal cortex, and causes it to produce and release cortisol, which in turn modulates the stress response |
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Term
| How does the hypothalamus influence the stress response via the ANS and the Adrenal Gland? |
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Definition
1) Excites the SNS leading to
-NA production by ANS
- Epinephrine production by the Adrenal Medulla
2) Releases CRH to act on Pituitary, which releases ACTH to activate Adrenal Cortex (produces cortisol) |
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Term
| How are Emotional and Physical Stressors integrated into the stress response? |
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Definition
Meet at Hypothalamus!
1) Emotional stressors via Cerebral cortex
2) Physical stressors via Brainstem and thalamic nuclei |
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