doctor-pt issues

you are caring for a pt originally from Mexico & are communicating with the help of a Spanish-speaking interpreter. which of the following statements is true regarding the effective use of an interpreter? a. ask the interpreter to explain your statements, when necessary b. arrange seats in a triad, and speak slowly, facing the interpreter c. act as if the interpreter is not present, speaking to the pt normally d. use as many nonverbal gestures as possible e. if you get an unexpected response, repeat the same question over aggain

A - greet pt in own language if possible - introduce self to everyone present - arrange the seats in a triad & address the pt - speak clearly in normal voice volume - use common terms & simple language structure - express one idea at a time & pause for the interpreter - expect the interpreter to use first person singular, verbatim translation - consider multiple meanings to nonverbal gestures - ask the same questions to different ways if you get inconsistent / unconnected responses - ask the interpreter to explain, but do not place the interpreter in the middle of conflicts

a pt with severe Alzheimer disease is admitted to the hospital for pneumonia. the pt is usually cared for at home & has no living will or health care power of attorney. code status is not obtained upon admission. during hospitalization, the pt suffers a suffers a cardiac arrest. which of the following is most appropriate? a. the pt should be resuscitated. b. the pt should have CPR but no intubation c. the pt should have CPR but no pressors should be given d. the pt should not be resuscitated bc care is futile. e. the pt should not be resuscitated b/c he has a poor quality of life.

A assume full code otherwise

your pt has terminal cancer w/ a life expectancy of <3mo. you are managing her chronic cancer pain w/ morphine sulfate. she has been stable & on the same dosage of meds for weeks, but is now requiring increasing amts of opiates to maintain pain control. which of the following statements is true regarding this situation? a. the pt's disease is progressing & you should increase her med dosage b. the pt's disease is progressing & you should change meds c. the pt is developing tolerance & you should increase her meds d. the pt is developing tolerance & you should maintain the dosage of medication to avoid dependence e. the pt is developing tolerance & you should slowly withdraw meds

A palliative care

you are taking care of a 62yo woman w/ a UTI. you prescribe Bactrim for her infection but forget to ask about her allergies. The next day, she returns with significant hives, asking if the Bactrim contains "sulfa," something she is allergic to. which of the following fundamental principes of medical professionalism has been violated? a. the principle of primacy of pt welfare b. the principle of pt autonomy c. the principle of social justice d. the principle of professional competence e. the principle of honesty with patients

A pt welfare = dedication to serving the itnerest of the pt; doing no harm professional competence = professional responsibility, NOT fundamental principle pt honesty = informed consent; acknowledging medical errors

you are caring for a 65yo man with lung cancer. he was diagnosed 4 mo ago, and he is not expected to live for >2 mo. He is experiencing dyspnea. his CXR shows progression of his cancer & his pulse oximetry shows a room air O2 sat of 94%. which of the following is most likely to relieve his sxs? a. opioids b. nebulized morphine c. steroids d. benzos e. albuterol

A so that he cares less about it Nebulized morphine no better than placebo only use benzos / anxiolytics if anxiety is a strong component

you are making a home visit to a 68yo man with terminal cancer. his family says that his breathing seems labored. upon eval, you know that this is the "death rattle" that often signals approaching death. which of the following drugs would be most useful in controlling this sx? a. atropine b. ketorolac c. lorazepam d. haloperidol e. thorazine

A - atropine decreases secretions; helps with gurgling of "death rattle". --> otherwise, scopolamine, glycopyrrolate, mycosamine, morphine

you are caring for a 40yo lesbian with no family history of breast cancer. she asks you about her risk of having breast cancer. which of the following is true regarding breast cancer among lesbian women. a. breast cancer rates do not differ between lesbians & heterosexual b. breast cancer rates are higher among lesbians b/c of nonparity c. breast cancer rates are higher among lesbians b/c of obesity d. breast cancer rates are higher among lesbians b/c of ETOH and tobacco use e. breast cancer rates are lower among lesbians b/c they generally use less of oral contraceptives

A - no difference in breast cancer rates

you are caring for a pt who has suffered w/ ALS for several years. during the past month, she has been hospitalized 2x w/ aspiration pneumonia & has required mechanical ventilation. she was admitted to the hospital again 4d ago with difficulty in breathing & was found to have another pneumonia. 1d ago, her BP fell to 60/36 and she began to appear septic. she is not responding to volume or pressors. her creatinine rose today to 5.2 and it is becoming harder to adequately ventilate her. which of the following statements is most accurate regarding her situation? a. the pt's condition is physiologically futile & the physician should recommend withdrawal of all support except those needed for patient comfort. b. the pt is terminally ill & the physician should recommend withdrawal of support c. the pt is terminally ill, but the physician cannot withdraw intervention as it would hasten death. d. the pt is is experiencing an acute decompensation of a chronic condition & aggressive treatment is indicated. e. the principle of beneficence requires aggressive treatment in this case.

A. physiologic futility is justification for the physician to recommend withdrawal fo interventions principle of beneficence is superseded by quality of life & appropriate use of resources

you are in an office that serves a large uninsured population. which of the following is true regarding thsi population as compared to the privately insured population? a. this population has fewer chronic health conditions. b. this population has a lower mortality rate c. this population has a better general health status d. this population has has a better mental health status e. this population has a higher rate of chronic dz among children

A. more acute. higher motality, poorer general health, poorer mental health. similar rates of chronic dz likely poorer

you are working with a smoker who has failed several attempts to quit smoking. he decides to try hypnosis in an effort to finally quit. which major domain of alternative medicine doe this best fit under? a. alternative health care systems b. mind-body interventions c. biologically based therapies d. energy therapies e. bioelectromagnetics

B a. alternative health care systems = Ayurvedic medicine; chiropractic; traditional chinese meds b. mind-body interventions = meditation; hypnosis; guided imagery; prayer; mental healing c. biologically based therapies = herbal therapies; special diets; specific biologic therapies d. energy therapies = Qigong, reiki e. bioelectromagnetics = magnet therapy

you are addressing smoking cessation with a pt and are determining the pt's readiness to change his behaviors. during the discussion, you find that the pt is aware of the health impact of his smoking on him & his family. he understands the economic impact and feels that if he were to quit, it would benefit him financially. he feels very addicted to cigarettes and says that he'd like to quit sometime in the future. according to the stages of change model, at what stage of change is this pt? a. precontemplation b. contemplation c. preparation d. action e. maintenance

B " in the future"

you are working with a pt who recently retired fro his job after 41y. he is currently 67 years old and has HTN and high cholesterol. his wife thinks he drinks too much and during your visit, he admits to 3 alcoholic beverages a day. you have screened him for alcoholism and he does not meet the criteria. you would like to negotiate a safe drinking amt for this pt. which of the following best represents a safe level of ETOH intake for this pt? a. 7 drinks per week, no more than 3 per occasion. b. 14 drinks / week, no more than 4 per occasion c. no more than 1 drink / day d. no more than 2 beers / glasses of wine / day or no more than 1 alcoholic beverage per day. e. there is no safe drinking amt for this pt

B 2 per day for a male < 65yo 1 per day for a male > 65yo

you were involved in a minor motor vehicle accident on the way to work. as a result you saw your first pt of the morning >1h after the scheduled appt time. when you walk in, he appears extremely angry. which of the following alternatives is the most pt-centered way to approach this situation? a. explain what happened so he will understand why you are late. b. acknowledge his anger with a statement like, "you seem very angry" c. apologize for the delay & effficiently take care of his problem d. expore the reasons for his anger if he brings it up e. help the pt understand that his anger should be directed at his illness, not at you.

B Anger --> validate no excuses, just do the work

you are working with a patient who has been on benzos for >2y. she was initially prescribed the med for help with sleep, but you are now concerned that she has become dependent. after a brief discussion, the pt admits that she'd like to be off the meds. you decide to withdraw her from the med using a trial of placebo sleeping aids. which of the following statements is most correct regarding the use of placebos in this situation? a. placebo use is never ethical b. placebo use is not ethical in this case c. placebo use is ethical in this case b/c the pt's diagnosis is likely depression & depression has a high response rate to placebos d. placebo use is ethical in thise case b/c the alternative to placebo use is unacceptable e. placebo use is ethical in this case b/c the pt is demanding treatmnet

B b/c she has insomnia & you should treat it. placebo tx is a clinical intervention to benefit the pt for psychologic / psychosocial effect (NOT physiologic) clinical use of placebos is unethical --> EXCEPT for those with a condition that is known to have a high response to placebo, where alternative to using placebo is harmful, or if pt insists on a prescription & wants to be treated / cured (but there is no option).

a 26yo homoseual man presents with stool on the toiler paper when wiping. exam of the anal mucosa reveals this condition (with papules surrounding the anus in a clustered fashion). which of the following statements is true regarding this condition? a. this condition is rarely seen in men who are not immunocompromized b. the pt's physician should consider anal cytologic screen with a pap test c. the pt should be trated with IM penicillin 1x a week for 3w d. the pt shoudl be treated with valciclovir e. the pt should be treated with one dose of azithromycin

B looks like HPV warts men infected with HPV have been shown to have anal dysplasia

you are working as a student int he ED. after a cardiac arrest & a prolonged attempt at resuscitation, a pt dies. the attending physician asks if you would like to gain eperience by practicing intubations on the pt who has died. you feel this relates to one of your professional responsibilities, to maintain clinical competence & consider the offer. which fundamental principle of professionalism & ethics would be violated if you do this? a. the principle of pt welfare b. the principle of pt autonomy c. the principle of social justice d. the principle of honesty with pts e. the principle of maintaining trust

B -- the pt can't say yes or no

a 23yo man is following up to discuss the results of laboratory tests you did at his complete physical examination 1w ago. his HIV screen was + and you need to tell him this news. which is the most appropriate approach? a begin the session by inquiring about his understanding of HIV b. help him prepare for the information by using a statement like: "i'm afraid I have some bad new for you." c. ensure you schedule enough time to discuss treatment goals & options d. make sure he brings a support person into the room before you disclose the results e. offer hope by saying, "i'm sure there will be a cure for this disease soon>"

B. as a warning before launching into full description --> have the room be private, free of interruptions, enough time for visit

you are working in an office that provides care to a large populatin of homeless pts.which is true about medical illness in homeless children as compared with other groups of children? a. homeless children are mre likely to develop T2DM b. homeless children experience a higher # of ear infections c. homeless children are more likely to have chronic illness d. homeless children are more likely to hav edepression e. homeless children are more likely to have attention deficit d/o

B. poor health status overall --> higher number of acute illnesses (fever, ear infections, diarrhea, asthma)

you are caring for a 42yo lesbian woman. she has recnetly left a 10y monogamous relationship and is concerned about her risk for vaginal & other infections once she resumes sexual activity with a new partner. which of the following is true regarding her concerns? a.the rate of STIs among lesbians is less than the rate in heterosexual women b. the rate of genital warts is higher in lesbians than in heterosexual women c. the rate of bacterial vaginosis is higher in lesbians than in heterosexual women d. the rate of genital herpes is higher in lesbians than in heterosexual women e. sexually active lesbians have a lower prevalence of HIV than women who have sex exclusively with men.

C Similar rates of STIs Type is selective: Heterosexuals = genital warts, herpes Lesbians = bacterial vaginosis; HIV

you are caring for a 38yo woman who is depressed. she would like to try an alternative therapy but is worried about the risks of different modalities. which of the following therapies is most risky? a. meditation b. guided imagery c. st. john's wort d. homeopathy e. acupuncture

C can speed up the liver

you are caring for a 39yo woman who is dying of breast cancer. her family wonders how to recognize the sxs of impending death. which of the following is a reliable sign that death is near in this pt? a. delirium b. episodic hyperalertness c. decreased communication d. desire for favorite food e. increased attention to dates & time

C indicators of approaching death - remaining bedbound - confusion --> NOT delirium (can be d/t meds) - cool & mottled extremities - "death rattle" - decreased hearing vision - difficulty swallowing - decreased conversation - decreased oral intake - disorientation to tie - drowsiness progressing to somnolence for extended periods - dry mouth - hallucinations - increased distance from all but a few intimate others - decreased attention span - profound weakness - agitation, hallucinations

you are working at a medical office whose population includes a large proportion of Native American pts. which of the following health issues has a higher prevalence in this population than in other American population groups? a. HTN B. CAD c. obesity d. asthma e. tuberculosis

C usually T2DM, obesity, ETOH, suicide

you are caring for a pt who has just assumed the home care for his father. the father has inoperable lung cancer, and it is expected that he has <6mo to live. the father executed a valid "DNR" order while in the hospital during his last visit. the father & your pt want to be sure that in the event of an emergency requiring activation of emergency medical service providers, the EMS team does not resuscitate the father. which of the following is true regarding DNR orders in the home? a. EMS providers must resuscitate pts if they are called to respond to an emergency. b. the hospital DNR orders automatically transfer to the home setting & nothing needs to be done to ensure they will be followed by EMS providers c. in order for a DNR order to be followed in the home, the attending physician must re-write a DNR order, and the family must produce it when EMS providers enter the home. d. the family may simply state that the pt is a DNR and the EMS providers will refrains from resuscitation. e. with direction from the family, the EMS providers will perform a "slow code."

C --> "portable DNR" - written physician order that pt can take with them to the home (worn on bracelets, necklaces, wallet cards). with this, emergency service providers are authorized to refrain from CPR (otherwise full code)

you are evaluating a hispanic pt with multiple somatic complaints and suspect a mental health disorder. which of the following is true regarding mental health disparities in the US today? a. mental health d/o are diagnosed less frequently in minority populations than in non-Hispanic whites. b. it is uncommon for minority groups to express mental health d/o via somatization c. minority pts are more likely to be misdiagnosed than nonminority counterparts. d. minorities who maintain cultural practices & resist involvment in the dominant culture have better mental health e. culture is less of a factor in mental health than in other organic syndromes / illnesses

C. mental health disparities --> psychiatry heavily influenced by culture

after a prolonged fight with colon cancer, your 68yo pt decides to forego further attempts at curative treatment & focus on palliative care. you has tried NSAIDs & acetamineophen for management of his pain, but this has been ineffective. which of the following would be the best initial pain-management regimen a. a steroid burst to get the pain under control then scheduled NSAID meds to maintain pain control b. a long-acting narcotic pain patch at the lowest dose that controls the pain c. a short-acting narcotic on a scheduled basis, with the possibility of additional short-acting narcotics as needed for breakthrough pain control d. a long-acting narcotic, with a short-acting narcotic as needed for breakthrough pain e. a pt-controlled analgesia device using opioids.

C. palliative care - give the good stuff.

regarding pt education & counseling, which of the following statements is true? a. pts usually understand & remember most info from their physicia. b. pts commonly believe that physicians give them too much information c. pts are more likely to make behavior changes if they are given several options for change from which to choose. d. physician eye contact does not improve pt recall e. pts feel patronized when physicians repeat info

C. pts commonly believe that physicians don't give them enough info

you are interacting w/ a pt who has emigrated from Russia. the pt is not complying w/ the treatment plan you outlined for his HLD. which of the following is the most effective way to improve this situation? a. speak with Russian colleagues to better understand the Russian culture b. refer the pt to a physician from the same cultural background as the pt c. study the Russian culture as it relates to illness & healing and offer alternatives for tx consistent with the cultural norms. d. listen to the pt's perspective, expression your tx plans & focus on similarities & differences. e. examine the beliefs of russian culture & use these beliefs to convince the pt to comply with tx.

D

you are working with a physician who is treating a pt for HTN. the pt has a documented allergy to ACE inhibitors, and you note that the physician is prescribing them. you assume that the physician knows best & do not let the physician know of the potential mistake. what professional responsibility have you violated? a. commitment to honesty w/ pts b. commitment to professional competence c. commitment to mantaining appropriate pt relationshiops d. commitment to improving quality of care E. commitment to maintaining trust

D

you are caring for an unmarried 28yo woman. she is overweight and you are conducting a brief intervention to help her develop an action plan for her weight loss. which of the following will be most effective? a. let the pt know what has worked for you in your efforts to maintain a healthy weight b. discuss the impact of successful weight loss on her overall appearance. c. work with her to agree to a weight loss goal, for example, losing 1 pound per week d. work with her to agree to an exercise goal, for example, walking 1 mile daily e. encourage her to set a start date for beginning her new dietary & exercise regimen

D and then to follow in up 3mo C - not controllable E - should start making changes immediately.

you are evaluating health disparities in your community & using mortality rates as a measure of overall health. which fo the following population subgroups in the US has the lowest mortality rate at each age of the lifespan? a. African Americans B. hispanic americans c. native americans d. asian americans e. non-hispanic white

D b/c everyone else has higher rates of obesity & DM

you are caring for a 24yo lesbian. she asks about Pap testing in lesbian women. which of the following is true about cervical cancer screening in this population? a. lesbians do not need pap testing b. lesbians do not need pap testing except if they are smokers c. lesbians need pap testing, but less frequently than heterosexual wome d. lesbians should be screened for cervical cancer at the same intervals that are recommended for heterosexual women e. lesbians should be screened fro cervical cancer more frequently than heterosexual women

D b/c if they were exposed AT ALL --> even in women reporting that they have never had sex with a men, up to 20% have HPV DNA. don't assume that a lesbian has never had sex with a man & vice versa

while working in the hospital, you get called to help during a code blue. the pt is a 66yo Caucasian female with a history of HTN. the arrest was witnessed by a floor nurse & the initial rhythm was ventricular fibrillation. which of the following characteristics of this situation make CPR less likely to be successful? a. the fact that it was a witnessed arrest b. the fact that the initial rhythm was ventricular fibrillation c. the pt's comorbid HTN d. the pt's age e. the pt's gender.

D factors that make resuscitation less likely to be successful - cardiac (v. pulmonary) - men - many comorbid conditions - older - black factors that make resuscitation more likely to be successful (10%-17% of pts survive arrest) - pulmonary - witnessed - initial rhythm is V. tachy / fib - iatrogenic cause for arrest - short duration of arrest

you are treating a 61yo chinese immigrant. you diagnose T2DM but the pt is reluctant to make the dietary changes necessary to help treat the condition, as much of her high glycemic index diet is culturally based. which of the following is the most culturally appropriate approach? a. ask her to involve her americanized children in future communication to help encourage the changes b. since her culture believes that health is a balance between yin & yang, tell her that the dietary changes you suggest will restore this balance. c. organize an appt with the pt & a diabetes educator who can better take the time & explain the etiology & dietary regimen necessary for DM. D. inquire as to the pt's concept of the etiology of DM & any tx she would like to try e. use a chinese interpreter to ensure your message is being heard appropriately

D what about this will speak to her culturally

you are taking the complete history of a pt new to your office. the pt is dressed as a woman, but is biologically male. further history reveals that the pt takes female hormones & is considering sexual reassignment surgery. what term most specifically describes the person? a. cross dresser b. bigender c. transvestite d. transsexual e. transgender

D even though has not gone through transition a. cross dresser = not necessarily feel like are the wrong sex b. bigender = both genders c. transvestite = like gross dresser d. transsexual = + considered / completed sexual reassignment surgery e. transgender = + hormones

a 19yo sexually active homosexual male asks you about his risk for hepatitis. he is currently Asx and unsure of his immune status. Which of the following would you recommend? a. Vaccination against Hep A only b. Vaccination against Hep B only c. Vaccination against Hep C only d. Vaccination against both HAV and HBV e. Vaccination against both HBV and HCV

D --> b/c HAV (oral / fecal); HBV (sex) no vaccine for HCV (just testing)

you are caring for a woman who has lung cancer & is discussing treatment options with you. she is choosing radiation therapy over surgery, despite the fact that the 5y survival rate for radiation is lower than the 5y survival rate for surgery for her type of cancer. in both cases, the survival rate is <25%. You think surgery is the better option. according to the ethical principle of autonomy, which of the following is correct? a. you should comply w/ the pt's treatment request b. the pt should have surgery b/c of physician autonomy c. the pt must respect your decision b/c the principle of physician paternalism overrides pt autonomy in this case d. you should explain your preferences for treatment, then honor the pt's preference e. you should refuse to treat the pt

D. always appropriate for physician to explain, but to be ok with pt's wishes. b/c she's choosing a clinically reasonably treatment

in the elevator, your senior resident says, "before I forget, make sure you send Mr. Davis home on his usual HIV meds." you know that there are new medications that you could take that might give him a better antiviral response. there are other health care providers in the elevator. what professional responsibility has your senior resident violated? a. commitment to maintaining trust b. commitment to improving quality of care c. commitment to professional competence d. commitment to scientific knowledge e. commitment to patient confidentiality

E

you are caring for a 38yo man with metastatic cancer. he thoroughly understands his condition and realizes that he has only a few months to live. he asks that you do not tell his wife about his prognosis, as "she wont' be able to take it." the patient's wife sees you in the hallway and says, "tell me the trust...how is his condition?" which of hte following responses best reflects an ethically sound course of action. a. tell her the truth about the situation because she has a right to know b. tell her the truth b/c you have the legal obligation to do so. c. consult the ethics committee to help you make the decision. d. do not tell the patient's wife, but inform her that you will not tell her husband about the conversation you've just had e. do not tell the pt's wife, but make an effort to encourage an open dialogue b/w her and her husband

E

you are performing a medical nterview w/ a patient & having some difficulty obtaining accurate info regarding the events that brought him into the office. which of the following physician communication tactics leads to the collection of the most accurate info? a. controlling the interview w/ more directive questions b. using medical terms that the physician feels the pt can understand c. redirecting the pt if he/she strays from teh relevant points d. involving the pt in his/her treatment plan e. using open-ended questions

E maybe c if too circuitous

traditional therapies have offered limited benefit to a 55yo woman who suffers form migraine HA and she asks you about alternative therapies. she currently takes 325mg of enteric-coated aspirin daily and paroxetine 20mg daily. which of the following has the lowest risk of toxicity or harm? a. st. john's wort b. megavitamins c. macrobiotic diet d. ginkgo biloba e. acupuncture

E paroxetine is converted by the liver. a. st. john's wort --> LIVER; cyp inducer = serotonin syndrome w/ paroxetine. b. megavitamins c. macrobiotic diet d. ginkgo biloba --> antiplatelet effects; cyp inducer e. acupuncture

you are working in a small town ED with an attending physician trained in family medicine when the paramedics bring in a 55yo woman after a car accident. she suffered massive head trauma from the accident, and brain tissue is actually extruding from her skull. she had been intubated by the paramedic and after careful evaluation, your attending physician has judged that no intervention can stop the pt's imminent death. when the attending physician meets her family, they demand that she be transferred to the OR for neurosurgery. which of the following is the most ethically sound response? a. the physician should continue physiologic support until a health care power of attorney is identified and can make treatment decisions. b. the physician should recommend a DNR status, but continue support and discussions with the family. c. the physician should continue support until a court-appointed surrogate is identified. d. the physician should continue support, consult neurosurgery, and ask for his/her opinion on the case. e. the physician should refuse to pursue further treatment.

E (physiologic futility) --> impossible for the pt to continue life regardless of anyy intervention. physician is ethically justified in refusing to pursue treatment. --> physician should try to work with family to resolve the care dispute.

you are caring for a 68yo man who has had colon cancer for 3y. therapies have been unsuccessful, and he has chosen palliative care only. he complains of excessive fatigue, feeling tired after minimal activity and lacking energy to perform the activities of daily living. he denies depression & feels he is handling his diagnosis well with the support of his family & friends. his lab eval is normal, except for mild anemia. which fo the following therapies would be most likely to help his sxs? a. transfusion b. nutritional supplementation c. SSRis d. sedative hypnotics e. a psychostimulant, like methylphenidate.

E --> increase energy & mood mild anemia --> so shouldn/t explain his fatigue can be due to direct tumor effects, paraneoplastic neuropathy, tumor involvement of CNS

one of your pts is 6mo pregnant and is found to have a medical condition that, if left untreated, will be life threatening to both her and the fetus. she believes that GOd will take care of her and the baby and she refuses medical interventions offered to her. which of the following best describes the principle of pt autonomy in this case? a. she has no right to refuse the intervention, based on the fact that her decision is lethal to both her & her unborn infant. b. she has no right to refuse the intervention, based on the fact that her decision is lethal to her infant c. she has the right to refuse the intervention regardless of the condition d. she has the right to refuse the intervention, only if the father of her baby agrees e. she has the right to refuse the intervention if she is found competent to make the decision

E, if she has expressed a desire to die before

you are evaluating a 62yo man who has a new complaint of back pain. he lost his wife to breast cancer 8y ago and has recently decided to marry his girlfriend. his w/up includes lumbar spine xrays that reveal metastatic lesions. the pt comes back to the office for the results & says, "i hope you don't give me any bad news. I'm leaving for my honeymoon in 2d and don't want anything to ruin my week in paradise!" which of the following statements is the most accurate? a. the principle of pt autonomy dictates that you wait to tell the pt until his return. b. the principle of physician autonomy dictates that you tel the pt at this visit. c. the principle of beneficence dictates that you wait to tell the pt until his return. d. the principle of physician paternalism dictates that you tell the pt at this visit. e. the principle of honesty dictates tha you tell the pt at this visit

E. B/c it would be risky for him not to know (can just off a cliff & lead to a pathological fracture). Studies show that most pts with serious diagnoses want to know the results regardless of their initial fears.

you are having trouble caring for a 58yo woman with uncontrolled DM. her measures of glucose control are always significantly higher than you'd like to see & you feel that she may not be taking her meds as directed. which fo the following is the most effective way to measure her adherence to the prescribed medical regimen? a. ask her if she is taking her medications b. look for a reduction in her blood glucose measurements in subsequent visits c. have her bring in her meds so that you may perform pill counts. d. measure serum blood levels of her meds e. ask her specific questions about her medication names, dosages, & administration times.

E. be more specific or "some of my pts find it difficult to remember to take their meds. does this ever happen to you?"

you are caring for a 68yo man with severe end-stage COPD but a life expectancy >6mo. Once month ago, he developed a rash. the rash consisted of grouped vesicles on erythematous bases in a dermatomal pattern. you effectively treated the rash, but the pt complains of a persistent burning & itching pain in the same area as the rash. the pain is significant & keeps him from sleeping. what is the best approach for long-term pain management in this pt? A. NSAIDs b. Opiate analgesics c. steroids d. anticonvulsants e. SSRIs

Shingles --> neuropathic pain D (gabapentin) opioids in the short term.

you are seeing a 65yo woman who has smoked for 50 years. you want her to quit & are considering different communication tactics to use in the discussion. which of the following is likely to be the most powerful motivator. a. point out the positive results that can be expected if she complies w your advice. "by quitting, you'll significantly reduce your chances of developing lung cancer." b. point out the consequences of not following your advice. "if you don't quit, you might develop lung cancer." c. empathize. "ill bet that quitting is extremely difficult" d. provide data. "evidence shows that 1 in 20 pts who try can quit smoking cold turkey e. ask about her experience with the illness that she is at risk for. "do you know anyone who has ever suffered w/ emphysema?"

a. be positive explore reasons for noncompliance

you are caring for a 72yo man with hyperlipidemia. he is complaining of difficulty starting his urinary stream & increasing nocturia. exam & lab eval reeals a diagnosis of benign prostatic hypertrophy. which of the following botanical medicines has been show to improve this situation a. gingko biloba b. saw palmetto c. garlic d. bee pollen e. st. john's wort

an anticholinergic B a. gingko biloba --> dementia b. saw palmetto --> BPH c. garlic --> prevent heart disease d. bee pollen --> energy e. st. john's wort --> depression

the practice where you are working cares for a wide variety of pts. which of the following subgroups is most likely to explore & use complementary & alternative medicine (CAM)? a. children b. college students c. men d. women e. the elderly

d women more likely to explore & use. women are frequently central to health care decisions made in a family.

a30 yo gay male asks you about hos his sexuality impacts his cancer risks. which of the following statemnts most accurately reflect his risk for cancer? a. homosexual men have an increased rate of oral cancer. b. homosexual men have an increased rate of colon cancer. c. homosexual men have an increased rate of liver cancer. d. homosexual men have an increased rate of testicular cancer. e. homosexual men have an increased rate of anal cancer.

e increase in anal cancer d/t anal HPV, even in men without HIV.

you are working with a pt w/ advanced MS. he has just been diagnosed w/ pneumonia & is being treated for respiratory failure. in the past, he has discussed with his family & his physician that he does not wish to be on permanent mechanical ventilation. neurology consultation has determined that his respiratory insufficiency is due to a combo of his MS & pneumonia. the physician writes a DNR order, but the family disagrees. Which of the following is most correct in this situation? a. the DNR order should stand & be enforced b. the court should determine if the DNR order should stand or not c. the hospital ethics committee should be consulted. d.. the physician should remove himself from the case e. the dNR order should be reversed but a "slow code" should be conducted if necessary.

maybe c --> based on pt's wishes, DNR to be recommended, not written. if family disagrees, go to ethics committee

you are caring for a 41yo male pt with high risk for heart disease. his dietary habits are increasing his risks and you would like to work with him to develop healthier eating habits. assuming he is in the "precontemplation" stage, what should your action be to move him toward changing his behavior? a. educate him about the impact of diet on heart disease risk b. outline the costs of his behaviors & contrast those to the benefits of healthy eating c. show him the gap between his health goals & his current behavior d. brainstorm options for healthier eating with the pt e. assist him in developing a concrete action plan for behavior change.

next his contemplation --> so A or B A - education. C/D/E --> planning stage

you are caring for an obese pt who would like you to prescribe amphetamines to help her lose weight. you feel this is an inappropriate treatment. according to the ethical principle of autonomy, which of the following is correct? a. you must respect pt autonomy & should comply with the pt's treatment request. b. the pt must respect your decision not to prescribe amphetamines b/c of physician autonomy c. the pt must respect your decision b/c the principle of physician paternalism overrides pt autonomy in this case. d. you should explain your preferences for treatment, then honor the pt's preference e. you should refuse to treat the pt

none of these sound very good. E. if physician feels pt's request is unreasonable, can refuse to treat. physician autonomy never overrides pt autonomy

you are treating a 60yo pt with end stage ovarian cancer. you are concerned that she may be developing depression. which of the following would be the most reliable sx of depression in this pt? a. loss of appetite b. fatigue c. insomna d. sadness e. anhedonia

older, so be careful of lack of activation E - hopelessness, guilt, wish to die