samad
Forum Newbie
Topics: 1
Posts: 2
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PLEASE POST YOUR ANSWERS WITH EXPLANATIONS...THANK YOU
1 . A 49-year-old patient is evaluated for suicidal ideation after he is found laying on train tracks by police. The man is disheveled and malodorous and states that he has "reached the end" and would rather die. He admits to depressed mood, anhedonia, poor energy and appetite; he feels miserable and regrets what he has done with his life and wants to put an end to it. He states he has felt this way since age 26, after he was discharged from the military. The man indicates that his life was "great" until he increased his drinking, which caused a divorce at age 30. He has had two arrests for driving under the influence. He was in jail for 6 months after he had an accident while drunk that resulted in public property damage. He remembers that he initially felt sick in jail, with sweating, vomiting, shaking, and he experienced a seizure. He then improved after a few days and felt better during the rest of his imprisonment without any depression.
Which of the following criteria most strongly suggests alcohol abuse?
A. Desire to cut down
B. Recurrent drunk driving
C. Seizure after withdrawal
D. Suicidal ideation
E. Tolerance
2 . A 10y/old boy was noted for his extreme fear of water during his first day of swimming lessons. The teacher helps the child sit on the edge of the pool and splash the water with his feet. She then goes one step further and shows him how to wet his knees. It takes her an hour to have him float on the water while holding his hand. What technique has the teacher used to help the child conquer his fear of water?
A. Classical conditioning
B. Desensitization
C. Extinction
D. Flooding
E. Operant conditioning
3. The mother of a 6-year-old boy brings him to see the local pediatrician complaining that the boy is enuretic from 4 to 5 times a week. She reports that the problem began in the past few months after she gave birth to a baby girl. Breast-feeding for the new baby has been difficult and has consumed a great deal of her time each day. She says that the boy is very embarrassed about his enuresis and is afraid that the other children where he goes to school will find out and make fun of him. She asks the physician help and advice. The physician’s best course of action would be to do which of the following?
A. Arrange to interview the boy about his condition
B. Direct her to have a serious discussion with her son about whether anything is
bothering him
C. Prescribe a course of imipramine for the boy
D. Refer the mother to a seminar on breast feeding
E. Send the boy to a child psychologist for counseling
F. Suggest that the mother block out some special time each day and give exclusive attention to her son
G. Tell the mother that the boy’s problem is normal and temporary, and will soon pass if left alone
4. A nurse on an inpatient internal medicine ward comes to see the attending physician.While drawing blood for routine laboratory tests ordered by the medical staff, the nurse inadvertently stuck herself with a hypodermic needle, in which were several drops of the patient's blood. The nurse is anxious, and wants the physician to order that the patient's existing blood sample be tested for HIV. The physician is aware that the patient has a history of homosexual encounters, although neither the physician nor the nurse are aware of the patient's HIV status. At this point, the physician should do which of the following?
A. Assure the nurse that the probability of contracting HIV by this method is relatively low, but that she should be more careful in the future
B. Convene a meeting of the nursing staff and ask if anyone on the ward is aware of the patient's HIV status
C. Order the test, as the nurse requests
D. Review the patient's chart and medical history for clinical signs consistent with HIV infection
E. Talk to the patient and order the test only if the patient gives his permission
F. Tell the nurse that you will order the test if she can obtain the patient's permission.
5. A 36-year-old married woman complains to her physician that she is having trouble sleeping. A detailed history shows that her insomnia is sporadic and seems to be connected to cyclical stressors related to her working environment. The physician prescribes alprazolam to be taken “as needed.” The next day, the physician receives a distressed call from the patient. With anger in her voice, she tells the physician that the “pharmacist said that taking this medication might cancel out the effects of my birth control pills.” At this point the physician’s next response should be which of the following?
A. “I’m sorry. This is my fault. The problem is not very likely given the dose level I
prescribed and your only occasional use, but I should have discussed this issue with you
before.”
B. “It’s not the pharmacist’s job to be tinkering with your medications. I suggest you
have the prescription filled somewhere else.”
C. “Its really such a small chance that it is not worth worrying about.”
D. “Really, its nothing to worry about. I’ll call the pharmacist and work it out.”
E. “Really, there is no problem here. Pharmacists just like to show what they know.”
F. “The pharmacist is being overly cautious. As long as you take both medications as I prescribed them for you, you will have no problem.”
G. “Well, if you don’t like the drug I prescribed, what would you rather have?”
H. “You seem angry about this. Tell me more about what you are feeling right now
6. A 41-year-old married woman of Asian decent becomes pregnant with her first child. During the course of routine prenatal care, the women undergoes a series of tests checking on her health and the health of the fetus. The results of the tests suggest the woman is in good health, but strongly indicate that her child will be born with Down syndrome. When informed of this result the woman becomes visibly upset and begins to cry. “How could this happen to me?” she says, “God must be punishing me!” At this point the physician’s best reply would be which of the following?
A. “I don’t think God has anything to do with this. This sort of thing just happens some of the time.”
B. “I know it is hard to heard this kind of news, but let me assure you that you are still young enough to have other children.”
C. “Let’s take a moment to reflect and pray together for guidance.”
D. “Sometimes God works in mysterious ways that we can not understand. We just have to try to keep our faith.”
E. “Take some deep breaths and try to relax. When you collect yourself, we can talk about how you want to proceed.”
F. “Tell me a bit more about why you think God is punishing you.”
G. “The chances for Down syndrome are simply higher when a woman your age becomes pregnant. That’s why we run these tests.”
H. “The real issue before us is, how do you want to proceed? Do you want to carry the child to term or explore other options?”
7. A 24 year old woman comes to see her male physician complaining of pain and stiffness in the left lower quadrant of her back. During the physical examination to locate the extent and severity of the pain she says, “Wow, you’ve got great hands, Doc. Just having you touch me helps me feel better.” As the patient is getting dressed, she asks the physician if he is married, and then asks if he ever dates his patients. The physician is unmarried, is attracted to the woman, and would like to see her socially. At this point his best action would be to do which of the following?
A. Begin to see the patient socially as long as she understands that it must be kept separate from the medical relationship
B. Explain that as long as she is his patient, no social relationship is possible
C. Have the patient sign a liability waiver and begin to see her socially
D. Refer the patient to a colleague and begin to see her socially
E. Refer the patient to a colleague and refuse to see her socially
F. Refer the patient to a colleague, wait six months, and then begin to see her socially
G. Tell the patient that he will not pursue any social relationship with her, but that he would like to continue to be her physician
8. A 64-year-old married man is admitted to the hospital complaining of abdominal pain. Symptoms are consistent with cancer of the colon, and an MRI reveals a large abdominal mass. The patient consents to surgery, and the mass is removed along with 1/3 of the patient's colon. The report from the pathologist confirms that the mass was cancerous and, further, that the tumor had extended though the colon wall, and metastasis is likely. Under the circumstances, the physician estimates life expectancy at less than one year. The patient has not yet been informed of either the extent of the cancer's spread or his projected life expectancy. As the physician enters the patient's room to inform the patient
of the negative prognosis, the patient is sitting with his wife and teenage daughter. After introducing himself, the best thing for the physician to say would be which of the following?
A. "I have some bad news. Would you like to discuss it in private or would you like to have your family present?"
B. "I have some things to discuss with you in private. Would you mind having your
family wait outside?"
C. "I'm glad that your family is here. Can any of you recall whether any of your close relatives have ever had cancer?"
D. "I'm glad that your family is here with you. I have some things to discuss with you."
E. "This is the part of my job that I hate the most. I came here today to tell you that the cancer has very likely spread."
F. "Well, lets get right to it. I'm afraid that I have some bad news."
G. "We need to talk about your condition. Would you like your family to be present?
9. A 34-year-old man comes to see his physician complaining of sore throat, stuffy nose, and difficulty sleeping at night. The physician diagnoses him with a sinus infection and writes him a prescription for a course of a common antibiotic. On the last day of the prescribed course of antibiotics, the man calls his physician and leaves a message saying that he is feeling better, but does not feel fully recovered. He asks, in his message, that the physician calls the local pharmacy with a refill of his prescription for an additional 7 days so that “I can really kick this thing.” After he receives the message, the physician’s best course of action would be to do which of the following?
A. Call the local pharmacy and ask to have the prescription refilled
B. Call the patient and tell him that he will be fine and does not need any further
medication
C. Call the patient back and explain that antibiotics cannot be extended beyond the
normal course without the risk of side effects
D. Call the patient back and talk with him about his condition, and, if all seems well, call the pharmacy to order that the prescription be refilled
E. Call the patient, schedule a follow-up appointment and reevaluate the patient’s condition
F. Have the office nurse call the patient to schedule a follow-up appointment
10. Which of the following diseases should be reported to the Department of Public Health?
A.Candida albicans infection
B. Condyloma acuminatum
C. Gonorrhea
D. HIV infection
E. Streptococcal pharyngitis
11. A 22-year-old, married woman presents with pain in her lower right abdomen. Her abdomen is tender to palpation and there is rebound tenderness. The patient reports nausea, and has a temperature of 38.3 C (101 F). A diagnosis of acute appendicitis is made, and the patient consents to, and is scheduled for immediate surgery. Prior to the surgery, the woman tells the surgeon that she is a practicing Catholic, and says that she will pray for the successful completion of the surgery. Surgical examination of the appendix reveals that it is normal and without inflammation. Examination of the abdominal cavity reveals that the true underlying cause of the patient’s pain is an ectopic pregnancy on the right side. At this point, what action should the surgeon take next?
A. Close the incision, wait until the patient recovers from anesthesia, and seek full
informed consent before proceeding
B. Consult the chief of surgery
C. Consult with the local Catholic chaplain about how to proceed based on the woman’s expressed religious beliefs.
D. Seek permission to operate on the ectopic pregnancy from the woman’s spouse
E. Surgical intervention to deal with the cause of the pain
12. A primary care physician (Dr. Green) in a community of 100,000 people enters an examination room to find a new patient sitting on a chair just inside the door. Although the patient had been instructed by the nurse to remove her clothes and have a seat on the examination table, the patient remains fully clothed, including her shoes. The patient glances up briefly when the physician enters the room and closes the door, and then returns her gaze to stare at the floor. She says nothing. At this point, the best thing for the physician to say next would be which of the following?
A. "Didn't the nurse ask you to remove your clothes?"
B. "Hello, I'm Dr. Green. How are you feeling today?"
C. "I see that you are still dressed. Is there something you want to talk with me about?"
D. "OK. Hop up on the table and let's have a look at you."
E. "So, what brings you to see me today?"
F. "You seem a little depressed. Why don't you tell me about it?"
G. "You seem very quiet. I'll just sit here for a moment while you collect your thoughts."
13. A 16-year-old girl comes to see her physician for a standard physical examination prior to attending summer camp. The examination is unremarkable. The girl falls within the normal range for height and weight. The physician notes that she has had menses for the past 4 years. As the girl is getting dressed, the physician sits and completes the required forms for the camp. When handed the completed forms, the girl thanks the physician and says, “Just one more thing. Could you also give me a prescription for birth control pills?
I’m going to camp with my boyfriend and want to be prepared. And please, please, don’t tell my parents!” The physician’s most appropriate reply would be which of the following?
A. “Before I write you that type of prescription, I’d like to examine your boyfriend first.”
B. “How long have you been having sexual relations with your boyfriend?”
C. “I can only give you a prescription like that if I have your parents’ permission. Let’s set up a time to talk with them.”
D. “I wish you would reconsider. Sex before marriage can be very complicated.”
E. “I’ll be glad to give you the prescription, but I want you to discuss things with your parents first.”
F. “I’ll be happy to give you a prescription, but let’s talk about some important issues first.”
G. “I’ll make a decision about the prescription after I have a discussion with you and your boyfriend. When should we schedule that?”
H. “I’m pleased that you are responsible enough to be prepared. I’ll be happy to give you the prescription and see no reason to tell your parents.”
14. A 76-year-old man of Korean descent goes to see his primary care physician complaining of chest pains, difficulty breathing, and general fatigue. When interviewed, he answers the physician’s questions respectfully in a soft voice with little eye contact. When questioned about any pain, he indicates that it is always with him. Subsequent examination and testing leads the physician to suspect that the patient might have lung cancer. When the possibility is mentioned to the patient, he becomes very quiet, stares at the floor and says softly, but distinctly, “I do not think I want to know this if it is true.”
At this point the physician’s best reply would be which of the following?
A. “I know cancer can seem a bit frightening, but modern advances in treatment give us some options you may not be aware of.”
B. “I understand the custom of your culture is not to discuss these things, but I’ll need you to work with me so we can beat this.”
C. “I understand your hesitation, respected Grandfather. I will work with your family if that is what you direct.”
D. “I’m sorry, but I will need your cooperation as we arrange treatment. I will need to tell you and you will have some decisions to make.”
E. “If it is your wish, I will not tell you. Whom in your family should I talk to in your place?”
F. “In this country, patients have to be told everything. I’ll let you know when we have more definitive information.”
G. “Let’s wait until we know something definitive and then we can talk about things further.”
H. “OK, I’ll respect your wishes and not tell you.”
I. “Tell me a bit more about why you do not want to know.”
15. A 25-year-old HIV-positive woman gives birth to a 6-pound baby boy at a local health clinic. The woman has received no prenatal care. She is ecstatic about the birth, holds the child closely, and talks softly to the child every chance she gets. Tests performed to assess the child’s HIV status return positive results. When told of these results, the new mother appears unfazed, and says that she will just have to be an even better mother to “help the child through this.” She requests a consultation with a breast-feeding counselor because she says, “I want to make sure I do this right.” The physician tells her that breastfeeding is not advisable, to which she replies, “I know that breast-feeding is best, and I want the best for my baby.” The physician’s best reply would be which of the following?
A. “I’m pleased that you are taking your responsibilities so seriously. I’ll arrange an appointment with the breast-feeding counselor for you myself.”
B. “If you insist on breast-feeding your child, the courts will remove the child from your custody.”
C. “If you really love your child, you will do what is best and not breast-feed.”
D. “It is important that you listen to me carefully. Breast-feeding increases the risk to your child. You must not do it.”
E. “It’s wonderful to see how happy you are. We can talk a bit more about these things after you’ve has some rest and have recovered from the birth.”
F. “Let me explain. A positive test when the child is this young is not definitive. But if you breast-feed your child, you greatly increase the chances of your child contracting HIV.”
G. “Yes, breast-feeding is best in most circumstances, but given your HIV status, I
strongly advise against it.”
16. A 55-year-old male begins group therapy. After the first session, he befriends one of the other clients, and begins telling her how extraordinarily intelligent and talented the facilitator is. At the next session, he and the facilitator disagree. After the session, he tells his fellow group member that the facilitator is utterly incompetent and that they should sue for malpractice. This is an example of
A. displacement
B. fixation
C. reaction formation
D. regression
E. splitting
Edited by samad on 09/25/07 - 05:28 PM. Reason: Font Edit.
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| Jackofknives
Ipwnpoker.com
Topics: 91
Posts: 704
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1. C
2. B
3. F
4. E
5. H
6. E
7. F
8. G
9. E
10. D, C
11. D
12. C
13. F
14. I
15. A
16. E
___________________
There are many things in this world that can’t be changed no matter how hard you try. That’s why you must not hesitate when the time comes where you have to give it all you’ve got.
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| samad
Forum Newbie
Topics: 1
Posts: 2
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Thanx for your answers,
For these questions i thought of the following options
5 A
6 B
12 B
14 D
15 B or F
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| Jackofknives
Ipwnpoker.com
Topics: 91
Posts: 704
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5. I cannot be sure that birth control is the underlying issue to her anger, and further investigation is warranted.
6. B is quite an insensitive thing to say and its said without knowing how she feels about this “crisis”. This obviously comes as a shock and you need to give her some space so she can recollect her thoughts.
12. B is the standard line and this case is not standard. We need to find out why she is still dressed, whether it’s cultural custom, she s a rape victim or whatnot.
14. you are not allowed to forcefully inform your patients against their consent, remember you are treating the patient not the disease. I think I is the best answer bc it enhances communication and understanding and could lead to the elucidation of the actually problem with this case, i.e. why doesn’t he want to know.
15. I think you are right, retrospectively I would pick F.
PS dont you have the answers?
___________________
There are many things in this world that can’t be changed no matter how hard you try. That’s why you must not hesitate when the time comes where you have to give it all you’ve got.
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| kiterunner
Forum Junior
Topics: 14
Posts: 65
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1. C
2. B
3. F
4. E
5. A
6. F
7. G
8. G
9. E
10. C (STDs and AIDS are notifiable, being HIV +ve is not)
11. A
12. B
13. F
14. I
15. F
16. E
___________________
When you reach the end of your rope, tie a knot in it and hang on!!
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| test123
Forum Newbie
Topics: 5
Posts: 16
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I totally agree with kiterunner except for 4th and 15 th ques. I still cannot decide whether it should be F OR G for 15 th ques. Can some one explain to me in detail please.All three of you decided it is F.
Coming to 4th Q, BRS HAVE THE FOLLWING INF IN PAGE 222 4TH ED.
If a health care provider is exposed to the body fluids of a patient who may potentially be infected with HIV(E.G, A nurse is struck with a needle whose hiv status is not known) It is acceptable to test the patient even if the pt refuses for the test.
In the Q above, the risk factor is "The physician is aware that the patient has a history of homosexual encounters"
Given the options above the answer should be "C".The proper answer though, will be first try to gain permission frm the pt and if he still refuses go ahead with the test. Please discuss if you contradict the answer. It will be helpful to all of us.
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| cleopatra
Forum Senior
Topics: 3
Posts: 119
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about qs 7 &15; i think Q 7 ans should be g coz a doc cannot me romantically involved with pt its inappropriate.
Q 15 i think ans is f i thought breastfeeding was contrainidcated in a hiv positive mother
guys let me know if i am wrong
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| i_m_legend
Forum Newbie
Topics: 3
Posts: 43
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C. Seizure after withdrawal
B. Desensitization
F. Suggest that the mother block out some special time each day and give exclusive attention to her son
E. Talk to the patient and order the test only if the patient gives his permission
H. “You seem angry about this. Tell me more about what you are feeling right now
G. “The chances for Down syndrome are simply higher when a woman your age becomes pregnant. That’s why we run these tests.”
B. Explain that as long as she is his patient, no social relationship is possible
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| medikus
Forum Senior
Topics: 49
Posts: 97
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1-B
2-B
3-F
4-C
5-A
6-F
7-G
8-G
9-E
10-C
11-E
12-B
13-F
14-I
15-F
16-E
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