Exam 2: Behavioral Sciences

A previously healthy 66-year-old woman is taken to the hospital with recurring hemoptysis. A 10-cm perihilar lump in the right lung is seen by a chest x-ray performed at the emergency room. A bronchoscopic biopsy is performed on the patient, which reveals non-small cell lung cancer. When the doctor enters her room to reveal the biopsy findings, he sees the patient enjoying lunch with relatives and friends who have been at her bedside since her admittance. They all seem nervous, and the patient sobs as she tells the doctor, "This is the moment I've been dreading. I believe I already know what my test findings will be." Which of the following physician replies is most appropriate?

A 28-year-old man comes to the workplace at the request of his wife. He complains of terrible sleeplessness but otherwise feels physically OK. His wife is concerned that the patient is struggling since returning from military service. She states, "He used to be so cheery and laid-back. His feelings now range from anxious and on edge to disconnected and numb." The patient can't sleep at night because every time he shuts his eyes, he sees his friend getting blown up after walking on a landmine. He is hypersensitive to loud sounds throughout the day, such as firecrackers or a car backfiring. The patient says, "Sometimes I feel as if I'm back in combat and have to duck and take cover."  Vital signs are within normal limits, and physical examination shows no abnormalities.  On mental status examination, the patient has an anxious mood and blunted affect.  Which of the following is the most appropriate pharmacotherapy?

A 40-year-old jobless man with persistent back pain arrives at the office for a consultation with a new doctor. Years ago, the patient damaged his back in a job accident and has not worked since. He acknowledges that he takes marijuana everyday to "calm the agony" and that a percentage of his earnings go toward its purchase. The patient claims that nothing has changed and requests that the doctor sign a disability form so that he can continue to receive disability benefits. When the doctor inquires about his condition and previous treatment, he responds furiously, "I wouldn't be here re-applying for disability if anything had worked," slamming the disability form down on the table. The patient walks normally with no apparent discomfort or limitations.  Which of the following is the most appropriate response by the physician?

A 25-year-old man is brought to the emergency after he was found in the street shouting and laughing to himself.  He insists on wearing several layers of aluminum foil and explains that to prevent laser beams from reprogramming his mind.  For the past 4 years, the patient has been hearing the voices of his deceased mother, the devil, and a world-famous singer.  he responded well to haloperidol during the previous psychiatric hospitalization.  However, the patient stopped the medication shortly after discharge because he did not like the way it made him feel.  A decision is made to administer a second-generation antipsychotic medication.  Compared with first-generation antipsychotics, this class of medication is associated with which of the following?

Two hours after birth, a male infant delivered at 39 weeks gestation is assessed in the labor and delivery facility. Prenatal care was restricted owing to minimal follow-up, and the birth was uneventful. At 1 and 5 minutes, Apgar values were 7 and 9, respectively. The weight is 2.47 kg (5 pounds, 7 ounces), and the vital signs are normal. Upslanting palpebral fissures, transverse palmar creasing, and expansion of the gap between the first and second toes are all visible on physical examination. The parents express their relief that the delivery went smoothly. Which of the following statements by the physician is the most suitable at this time?

His wife brings a 39-year-old right-handed man to the office because she is concerned about his conduct. When the patient protested, he was robbed and struck in the head and legs with a baseball bat two months ago. He had trouble walking at first, but his injuries have now healed. His wife and other family members claim that his disposition has shifted dramatically following the attack. Prior to the assault, the patient was courteous, respectful, and nice. However, he has been extremely irritated and disrespectful since the incident, and he was recently dismissed from his job for insulting customers and making socially inappropriate comments to coworkers. Which anatomical area of the brain is the most likely cause of this patient's symptoms?

A 21-year-old woman comes to the office at her mother's request because she is irritable and depressed. The patient was sexually attacked in the parking lot of her job two months ago. Since then, she has felt that "the world is not a secure place," and she prefers to stay at home rather than return to work. She will "zone out" in the midst of the day and hear her assailant's voice, "as if I am standing there in the parking lot." At times, she feels as if she is outside her body and cannot recollect the specifics of what happened, and she adds, "I feel like I am going insane." The patient has become withdrawn and either avoids her friends or becomes "snappy" when they visit her.  She has lost interest in her hobbies of writing poetry and exercising.  There is a family history of major depression in the patient's mother and schizoaffective disorder in her maternal grandmother.  Which of the following is the most likely diagnosis?

Her mother brings a 13-month-old girl to the workplace. She is concerned that something is wrong and recalls, "My kid used to sit alone and enjoy chatting and clapping her hands. She still plays with her sisters and enjoys snuggles, but she hasn't babbled as much in the last three months and can't sit without my assistance. I can't persuade her to quit twisting her hands together. I'm concerned that her hands' skin is turning red, dry, and uncomfortable." Both my weight and height are in the 60th percentile. However, the patient's head growth has dropped from the 50th to the 40th percentile in three months. On examination, the child is globally hypotonic and unable to sit upright without being held.  She makes no sound apart from an occasional grunt.  She shows interest in toys the doctor provides her but does not reach out for them, wringing her hands repeatedly.  Which of the following best explains this patient's condition?

A 64-year-old man is brought to the office for assessment of atypical sleep patterns. According to his wife, the patient has been striking at the pillow and shouting loudly while sleeping for the previous three months. When he awakens from these dreams, he recalls a distressing scenario in which he is pursued by enemies and either defend himself or flee. The episodes are generally little more than 1-2 minutes long. The vital indicators are within normal ranges. Examinations of general physical and mental condition reveal no anomalies. A proper sleep study (polysomnogram) has been requested. Which of the following is most likely to be discovered as a result of this testing?

A 46-year-old lady is admitted to the hospital owing to acute sadness and exhaustion. She does not have any other medical issues. Routine laboratory testing are conducted, and depression medication is prescribed. Her depression improves marginally after a week, and she is released home to continue with outpatient therapy. However, the patient is still extremely tired and unable to return to work, requiring her to seek a leave of absence. At her follow-up appointment two weeks later, the outpatient physician reviews the hospital record and discovers a TSH level of 15.2 U/mL that was never addressed by the inpatient physician. Following an assessment and therapy with thyroid hormone, her sadness and exhaustion improve quickly. Which of the following is the appropriate categorization for this type of medical error?

A 3-year-old boy is brought to the office by his parents due to a concern of his behavioral difficulties.  His mother says, "He is physically healthy but has become more defiant and often resists our instructions during breakfast meal.  He plays roughly with his 5-year-old brother and throws tantrums when he has to share his toys or put them away."  His preschool teacher describes him as an "active child" who sometimes talks out loud to classmates while the teacher is speaking.  He is easily distracted and often gets up to walk around the classroom.  The patient is able to draw circles, speak 3-word sentences, go up stairs with alternating feet, and use the toilet but cannot wipe himself.  His parents express concern about his inability to dress himself and about his bed-wetting that occurs approximately twice a week.  Physical examination is unremarkable.  Which of the following is the most likely explanation for the child's behavior?

A 33-year-old man arrives at the office complaining of back discomfort. He has a 2-week history of mild lumbar discomfort that began after a hard day of yard labor. There is no temperature, muscle weakness, or urine symptoms. The patient has no history of severe trauma and a normal medical history. Lower extremity strength, sensibility, and reflexes are all normal, according to the examination. The straight-leg raising test results are negative. The patient declares, "My brother experienced comparable symptoms last year, and an MRI revealed a bulging disc. Could you please order the test for me?" The physician suggests symptomatic relief choices but advises against any imaging investigations. Which of the following is the most likely outcome of this suggestion?

An 82-year-old man with advanced Alzheimer's disease is taken to the hospital by his daughter, who serves as his power of attorney and carer. Her father, she claims, is becoming increasingly disoriented and verbally hostile. He gets brought to the hospital after being diagnosed with a urinary tract infection. Intravenous antibiotics are started, and he seems less disoriented and agitated, but he is unable to recall nursing instructions and is mostly silent during the day. The antibiotic order expires three days into his treatment and is overlooked by the doctor, nurses, and pharmacy personnel. The patient is not given medicine for two days before the problem is discovered and fixed. This error has no consequences other than extending his hospital stay by 2 days Which of the following is the most appropriate course of action?

A 37-year-old man is taken to the hospital with pneumonia of the right lower lobe. He is given antibiotics, and by the second hospital day, his shortness of breath and fever had improved. He is now experiencing new-onset stomach discomfort, diarrhea, and severe muscle pains. The patient has no history of gastrointestinal problems or previous surgery, although she does admit to using recreational drugs. The temperature is 36.8 degrees Celsius (98.2 degrees Fahrenheit), the blood pressure is 124/80 mm Hg, and the pulse rate is 88 beats per minute. The patient seems uneasy and nervous upon inspection. Pupils are dilated, and lacrimation is noticeable. An abdominal examination indicates hyperactive bowel noises in the absence of discomfort or distension. Which of the following diagnoses is more likely?

A 55-year-old man is set to undergo electrode implantation surgery to treat severe Parkinson's disease. Three days before the procedure, the surgeon goes through the specifics of the procedure, including the risks and advantages, as well as alternative treatment choices. The patient signs the permission form after expressing understanding of the talk. However, on the day of the surgery, in the preoperative room, he feels apprehensive and anxiously confesses, "I'm afraid I can't do it, doctor. I apologize. I no longer want to get the procedure." Which of the following is the best course of action?

A 72-year-old previously healthy man is brought to the office by his wife because of strange movements and behavior during sleep that have been more frequent in the last three months. She states, "He's been waking me up in the middle of the night lately, wailing and flailing around as if he's having a nightmare. He sometimes turns angry in his sleep, kicking and punching me. I can easily wake him up, although he is frequently perplexed for a few seconds. Then he frequently recounts a dream in which he was protecting himself against an assault." The physical exam is ordinary. The most likely cause of this patient's disease is neurodegeneration caused by the buildup of which of the following?

A 49-year-old man arrives to the office complaining of dysuria and hematuria. The vital signs are normal, and the physical examination is uneventful; the urinalysis reveals extensive hematuria but is otherwise normal. The doctor outlines the possible causes and the need for a cystoscopy. The patient is informed about the surgery and provided written information as well as a referral list with directions on how to make an appointment with a urologist. He looks at the documents anxiously, claiming he will arrange an appointment soon. The physician had been notified by office personnel that the patient was unable to follow the guidelines on the sign-in page and refused to complete out paperwork. Which of the following physician replies is the best at this time?

A 59-year-old man visits the office for a check-up. A month ago, the patient suffered an acute myocardial infarction, and a drug-eluting stent was effectively implanted. He has no indications of cardiovascular disease, but he does have hypertension and hyperlipidemia, as well as a 40-pack-year smoking history. The blood pressure is 132/86 mm Hg, and the pulse rate is 68 beats per minute. 30.8 kg/m² is the BMI. The physical exam is ordinary. The patient declares, "I can't wait to get back to work, but I'm worried about having another heart attack. I have a demanding work, yet I need to find time to exercise. In addition, I know I should quit smoking and drop at least 20 pounds." Which of the following is the physician's most suitable reaction at this time?

A 82-year-old lady is admitted to a tertiary care hospital with a fever and shortness of breath. The patient has had chronic obstructive pulmonary disease in the past. The admitting physician diagnoses her with pneumonia and begins her on empiric antibiotic treatment overnight. The patient's health worsens after several days of therapy, and she is moved to the critical care unit. On admission, sputum cultures were taken, but the findings were not examined by the daytime staff, causing a delay in commencing more precise antibiotic therapy. Which of the following interventions is most likely to avoid this sort of medical error?

A 32-year-old lady arrives to the office with severe worry and tension. The patient is an accountant who has been under growing job-related stress for the past 6 weeks as a result of an impending tax deadline. She states, "The worst thing is that I suddenly become really frightened, becoming trembling, dizzy, nauseous, and sweating. It happened a few weeks ago while I was speaking with my supervisor, and I had to excuse myself." The patient is particularly concerned about having an episode during a work meeting, despite the fact that her symptoms have also happened while she was relaxing at home. She says, "I've stopped going out with my friends because I never know when I'm going to feel this way."  The patient has no significant medical history and does not use alcohol or drugs.  Blood pressure is 120/70 mm Hg, pulse is 72/min, and respirations are 18/min.  Physical examination and laboratory evaluation show no abnormalities.  Which of the following is the most likely diagnosis?