Exam 2: Behavioral Sciences

A 25-year-old woman comes to the physician because of generalized fatigue for the past 3 years. During this period, she has also had persistent sadness and difficulty concentrating on tasks, because of which she has been reprimanded at work for poor performance. She no longer plays the drums for his band and has stopped attending family events. Physical examination shows no abnormalities. On mental status examination, she describes her mood as "ok." She has a flat affect. There is no evidence of suicidal ideation. Her speech is slow in rate and monotone in rhythm, and her thought process is organized. sHe has no delusions or hallucinations. Detailed workup, including urine toxicology screen, is negative.  Which of the following is the most likely diagnosis?

A 79-year-old man is being evaluated for hospitalization after experiencing an exacerbation of chronic obstructive lung disease. His wife is concerned about his health because he has been hospitalized several times in the previous year for various issues connected to his comorbidities. For for over 50 years, the patient has smoked cigarettes every day. Coronary artery disease, type 2 diabetes mellitus, and obesity are all part of the medical history. Following a comprehensive history and physical examination, the physician chooses to admit the patient and continue his diabetes and heart disease meds. Supplemental oxygen, bronchodilators, antibiotics, and systemic corticosteroids are also included in admission orders. Which of the following new components should be included in the admissions process?

The mother of a 9-year-old girl brings her to the clinic for an examination of regular stomach problems. According to the mother, her daughter has always had a "sensitive stomach," but it has become worse since she started attending a new school a few months ago. The girl has been missing class owing to frequent visits to the nurse's office. When her mother arrives to pick her up, the patient's symptoms improve. "She has friends but never likes sleepovers," the mother says in answer to the doctor's questioning regarding the girl's peer interactions. When the patient visits a friend, she frequently complains of stomach pain and nausea. She has dreams of being alone and wakes up weeping on occasion. Although both parents are healthy, the patient says she worries about them "dying of a terrible illness, like cancer."  Abdominal examination shows no abnormalities.  Which of the following is the most likely diagnosis in this patient?

A 49-year-old lady is moved from a community hospital to a tertiary care institution for treatment of a chronic obstructive pulmonary disease exacerbation. A hospitalist cares for the patient overnight before transferring care to the teaching service in the morning. During morning rounds, the patient's new medical team meets with her for the first time. The attending physician introduces the team and informs the patient that the intern will interview him. The patient then calls the intern by his first name and says, "You are eerily similar to my kid. He's highly intelligent and looks a lot like you." Which of the following activities by the intern would be the best way to start the interview?

A 27-year-old man comes to the emergency department with his wife because of a 3-day history of severe abdominal pain. The symptoms began after the patient woke up one morning. He is otherwise healthy. He works as a waiter and says that he feels exhausted from working several night shifts per week. He adds that he "can barely keep his eyes open" when looking after their daughter the next day. Since the onset of the pain, he has been unable to work and is fully dependent on his wife, who took on an extra shift to make enough money to pay their monthly bills. The patient appears relaxed but only allows himself to be examined after his wife convinces him. His vital signs are within normal limits. On physical examination, heart and lung sounds are normal.  Abdomen is soft and nondistended with normoactive bowel sounds.  The patient grimaces and moans in pain throughout the evaluation.  .  Laboratory evaluation and abdominal CT scan show no abnormalities.  After hearing the results, the patient asks for a note to excuse him from work so that he can recover at home for a few days.  Which of the following additional features is most likely to be present in this patient?

A 34-year-old woman arrives at the workplace with her spouse for an employment physical. "I'd prefer not be here," the patient replies, "but my job demands labs every two years." She begins to feel uncomfortable, queasy, and short of breath while having her blood drawn, and she comments, "I feel like the room is spinning." According to the patient's husband, she has had such incidents since childhood, beginning with a bike accident in which she sliced her knee and bled heavily. Asthma and type 2 diabetes mellitus require a thorough medical history. The temperature is 36.7 C (98.1 F), the blood pressure is 140/90 mm Hg, the pulse rate is 104 bpm, and the respirations rate is 20  / min. The BMI is 36 kg/m2. P ²   Physical examination is significant for anxious demeanor but is otherwise unremarkable.  Which of the following is the most likely diagnosis?

A 3-year-old kid is sent to the emergency room with a fever and stiff neck. The youngster is admitted to the hospital with bacterial meningitis and begins therapy with intravenous antibiotics. On the second day of hospitalization, the mother asks to take the kid home and tells that she plans to cure him with homeopathic medicines. She also has four more children who have "never required immunizations or drugs" and are "strong and healthy." The doctor describes the dangers of meningitis, which include brain damage and death. After a lengthy conversation, the mother states that she recognizes the dangers but feels that homeopathic medications would enough for therapy and is not persuaded that hospitalization is necessary. Which of the following is the most appropriate course of action?

A 16-year-old boy arrives at the office for a well-child check-up. The patient has no medical history but reports a lack of appetite and a weight loss of 2.3 kg (5 lb). He just stopped playing soccer owing to a lack of desire. The patient is also concerned about his grades since he struggles to stay focused in class and concentrate on his assignments after school. Despite sleeping 10 hours a night and taking midday naps when he comes home, he is exhausted. "My parents try to be sympathetic, but everything they say these days grates on my nerves," the patient adds. He has had a few drinks and used marijuana at parties, but he does not use other substances. The vital indicators are within normal ranges. Physical examination is unremarkable.  Which of the following is the most appropriate next step in management of this patient?

A 12-year-old girl arrives at the office for her annual exam. The mother is concerned about her daughter's conduct and academics, and she adds, "She is obstinate, angry, highly emotional, and refuses to listen. She also appears to be angry of her twin brother and purposefully bothers or disturbs him. I can't seem to get her to perform her chores, schoolwork, or go to bed on time." The school guidance counselor has phoned the mother numerous times in the last year about her daughter talking back to instructors and skipping classes. The patient describes school as "boring" and blames her conduct on "pointless restrictions and demanding demands," claiming that all of her instructors are "dumb." Which of the following is the most likely diagnosis in this patient?

A 28-year-old medical student arrives to the office with nervousness and difficulty concentrating. He has worked part-time as a volunteer fireman and claims that he has struggled to concentrate in class after seeing a critically burned youngster removed from a house fire three weeks ago. The patient began to sweat, tremble, and have difficulty breathing on two occasions: "I felt like my head was spinning and had to rush out of the classroom to recover my breath." He also claims to have difficulty sleeping, to be irritated with friends and family, and to periodically feel as if he is in a dream. "Sometimes I'll be sitting in class and I'll feel like I'm back in the burning room," the patient adds. I can smell the fire and see the child."  He has missed almost half of his classes to avoid being in crowded classrooms and has recently quit his volunteer job.  Which of the following is the most likely diagnosis?

A 39-year-old man is brought into the office by his wife, who is concerned about his recent conduct. She states, "He used to be lively and optimistic, but now he appears melancholy and estranged from his family. He is dissatisfied with his job and is having problems making decisions." He has been increasingly paranoid in the last month, believing that his business partner is attempting to murder him. The patient has no history of psychiatric illness. Both his father and grandpa died in their 50s after being hospitalized in long-term care institutions. Physical examination reveals uncontrolled, erratic motions of the left leg. On mental status examination the patient is restless and irritable.  He is convinced that not only his business partner but also the government is out to harm him.  Which of the following is the most likely diagnosis?

His parents bring a 16-year-old youngster with suicide thoughts to the office. He has been at odds with his parents since since he refused to quit consuming alcohol, which he does on a regular basis. The patient is the oldest of six children; his mother has lower back problems and relies on him to care for the children, which he finds stressful. His father works two jobs and is frequently unavailable to assist with the children. When his mother is alone with the children at night, she keeps a handgun by her bedside for safety. After being dumped by his lover, the patient dropped out of high school last year. He recently developed Lyme disease, which caused lethargy and myalgia symptoms. Which of the following interventions is the best next step to decrease this patient's risk of completed suicide?

Due to significant shortness of breath, an 80-year-old man is rushed to the emergency room by his son. The patient has a persistent cough and has lost 13.6 kg (30 lb) in the last 6 months. A chest x-ray reveals a big tumor in the right lung and a pleural effusion. The patient is admitted to the hospital and undergoes bronchoscopy with biopsy; the pathology report reveals bronchogenic cancer. When the doctor suggests a private chat regarding the biopsy results, the patient responds, "I'd rather not be told anything. You are free to discuss anything with my kid. I have faith in his judgment." The patient is intellectually sound and shows no indications of mental disease. Which of the following is the most suitable medical response?

Due to acute stomach discomfort, a 38-year-old man is transported by ambulance to the emergency room and has an emergency appendectomy. After a successful procedure and recuperation, the patient wonders if the appendectomy was truly necessary. He questions the surgeon's explanation that the procedure was possibly lifesaving, accuses the hospital furiously of taking advantage of his outstanding medical insurance, and threatens to sue the hospital. He requests immediate discharge and adds, "I've earned everything I have on my own, and this hospital isn't getting any of it." When asked whether he had any family or friends with whom the team may communicate, he says, "I haven't talked to my family in 20 years, and I wouldn't call anyone my friend.  Even if I did, that's none of your business."  Which of the following is the most likely explanation of this patient's behavior?

Her son brings an 86-year-old woman with Alzheimer's disease to the emergency department with a worsening cough and exhaustion; she is diagnosed with pneumonia. The doctor describes the diagnosis and treatment plan, which includes hospitalization for intravenous antibiotics. The patient responds: "I'd rather go. I feel more at ease at home." She requests that she be released with oral antibiotics. The doctor says that intravenous antibiotics are preferable and that the dangers of infection increasing include sepsis and death. The patient understands the dangers and states, "I will return to the hospital if I feel worse; I simply don't enjoy staying in the hospital." The patient is widowed and lives with her son, who insists that she stay in the hospital for treatment.  He reports that his mother has been increasingly forgetful and has gotten lost several times while walking in the neighborhood.  On mental status examination, the patient is alert and oriented.  Mini-Mental State Examination score is 24, indicating mild cognitive impairment.  Which of the following is the most appropriate next step in the managment of this patient?

A 36-year-old lady with well-controlled asthma and hypothyroidism arrives at the clinic to consult with her primary care physician about recent thyroid function testing. For the past eight years, she has been his patient. She reveals during the appointment that she is just divorced and has had problems meeting "educated and fascinating" guys. When the patient notices that the doctor is not wearing a wedding band, he questions whether he is single. "Yes, why do you ask?" says the doctor. The patient responds that she was wondering whether he would go out to supper now that they are both single. The doctor has always thought the patient was lovely and want to accept the offer. Which of the following responses to the patient's request is most appropriate?

Due to trouble managing on her own, a frail 93-year-old woman with moderate dementia enters a nursing facility. She has lately experienced multiple falls, including one while getting out of bed to use the restroom in the middle of the night. The patient blames his fall on "clumsiness." The syncope workup reveals no abnormalities. She has a history of high blood pressure, osteoarthritis, depression, and anxiety. Amlodipine, sertraline, aripiprazole, and amitriptyline are among her prescriptions. Which of the following is the most effective method for lowering this patient's risk of falling?

A 9-year-old boy is brought to the office after he refused to go to the school.  He has not gone to school for a few days, saying that he has a stomachache.  However, when it comes time for soccer practice, he has no physical symptoms.  When the pediatrician asks how things are going at school, the patient says, "kids laughed at me when the teacher said she couldn't read my homework."  His mother brings a recent report from the boy's teacher, which says that he is able to read and do math, but that when writing he fidgets a lot and stares out the window.  His writing is unclear, disorganized, and below the level of his peers.  His mother received a call from his teacher last week after the boy threw his writing book on the floor and began to cry.  Vital signs and physical examination, including abdominal examination, are normal.  At this time, which of the following is the most likely diagnosis in this patient?

A 65-year-old man is taken to the hospital overnight for stomach discomfort. He has a simple minor bowel blockage, which will necessitate surgery in the morning. The temperature is 37 degrees Celsius (98.6 degrees Fahrenheit), the blood pressure is 130/82 mm Hg, and the pulse rate is 90 beats per minute. To consider surgical intervention, the resident meets with the patient and his adult son, who has accompanied him to the hospital. After introducing herself, the resident discovers that the patient predominantly speaks Vietnamese and has low English competence, despite the fact that his kid speaks both Vietnamese and English. The son introduces himself as a critical care nurse and offers to translate the talk for his father. Which of the following replies to the patient's son is correct?

A 49-year-old woman visits the clinic because her hot flashes and nocturnal sweats have been worse over the last year. The patient's menstrual cycles have been inconsistent for the previous two years, with her most recent cycle occurring a year ago. She has no chronic medical issues and has never had surgery. The BMI is 23 kg/m2². Vital indicators are typical. The neck is flexible and free of thyromegaly. The remainder of the exam is routine. The sufferer declares, "This is terrible. I become hot and sweaty at work meetings and have to leave to cool down. I'm curious whether hormones may assist." Which of the following is the best way to deal with this patient?