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SILVER
DoWhatYouGotToDo!  Topics: 56 Posts: 1289 |
25 yr old HIV+ woman gives birth to 6 lb baby boy at local health clinic. She's received no prenatal care. She's ecstatic about the birth, holds the baby 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 breast-feeding counselor because she says 'I want to make sure I do this right'. Physician tells her that breast-feeding is not advisable, to which she replies, 'I know that breast-feeding is best, and I want the best for my baby'. What's the physician's best reply to this? A. I'm pleased that you're taking your responsibilities so seriously. I'll arrange an appointment with the b-f counselor for you myself. B. If you really love your child, you will do what is best and not breast-feed. C. If you insist on breast-feeding your child, the courts will remove the child from your custody. D. It's 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 had some rest and recovered from the birth. F. Yes, breast-feeding is best in most circumstances, but given your HIV status, I strongly advise against it. G. 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.
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usmlekiller
| Forum Newbie  Topics: 23 Posts: 785
f?
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Karime
| Sun and Shield  Topics: 27 Posts: 2493
g
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maoudoody
| Forum Junior  Topics: 157 Posts: 1823
g
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sackatdoc
| Forum Guru Topics: 8 Posts: 685
G,here the question is testing the knowledge of false positive at the time of birth and not how physician speaks to mother, coz the choice of words used are all okay(almost) but this fact surpasses everyother choice.
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sigh
| Forum Junior Topics: 73 Posts: 1743
This one form USMLE world, I think. Like above people said, G
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NNL
| Awaitin The Unexpected  Topics: 779 Posts: 6613
F. Yes, breast-feeding is best in most circumstances, but given your HIV status, I strongly advise against it
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brainstem
| Forum Junior  Topics: 30 Posts: 1531
F
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hmmm_hmmm
| Forum Senior Topics: 17 Posts: 111
i would pick G over F, because F sounds a bit condescending to a patient... 'given your HIV status, I advise against it' - you dont say that to a mother! thats something a patient would expect as a last resort, if she is not listening. the next step would be to explain WHY she shouldnt breast feed...i.e. G...maybe she doesnt know that HIV can be tranferred via breast milk... so I pick G
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SILVER
| DoWhatYouGotToDo! Topics: 56 Posts: 1289
yup G is the right answer. actually this ques. is sort of 2-fold. first you have to know about HIV and then you have to know what is the best way to phrase your reply to the mother....so it's not just about knowing the facts on HIV. G is right because as we all know that children of HIV+ mothers will test positive at birth due to mother's antibodies but the actual transmission rate is just under 20%. Women shouldn't breast-feed because that can increase the chances of congenital transmission to a considerable degree. Apparently there are cases where the child has been taken away from the mothers who have breast-fed, therefore it's important she knows this. Being authoritative is not right so you have to explain the recommendation in a way that makes the risk to the child clear to her. B & F just gives her advice but doesn't explain the reason. She doesn't need advice or commands, she needs information. C is a true statement but said in a harsh way. It's threatening her without explaining what the underlying issue is. D is said in a tone that you're talking down to her, like talking to a child not an adult. Plus it doesn't explain the difference between a positive test result and the child actually having HIV. E is just putting the discussion off to a later time, and you need to discuss this now.
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5fluorouracil
| Forum Elite  Topics: 4 Posts: 359
excellent question!
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