Exam 2: Behavioral Sciences

A 40-year-old man arrives at the office for an examination of concentration problems. He believes he has ADHD after reading a book about adult attention deficit hyperactivity disorder (ADHD) and demands stimulant therapy. The patient had no history of ADHD as a youngster, but his parents were ignorant of the disease and never had him assessed. He does not now exhibit hyperactivity or impulsivity, but he does admit, "I simply get easily sidetracked certain days and know I might be more effective at work." The patient does not drink alcohol or use recreational drugs. Medical history is irrelevant. The vital signs and physical exam are normal. The doctor explains that the patient's symptoms are not compatible with an ADHD diagnosis. The patient insists that he will benefit from stimulants.  Which of the following is the most appropriate statement?

A 54-year-old man arrives at the clinic for a first evaluation of lower back discomfort. According to the patient's medical record, he has seen multiple doctors for back pain therapy. He was provided several pain medicines and physical rehabilitation treatments, but he frequently stopped taking them too soon or did not follow through on the instructions. The patient adds at the start of the visit, "I'm sick of living with back pain, and I haven't worked in years. Nothing has helped me-I might as well quit up and go on disability at this point." Which of the following statements best describes your initial response to this patient?

A 25-year-old lady visits the office for a check-up on her type 1 diabetes mellitus. She is on long- and short-acting insulin, has adequate glycemic control, and no diabetic problems. She also has a history of hypothyroidism and takes levothyroxine for it. The patient has been covered by her parents' medical insurance for several years, but she recently began working full-time for a firm that offers a wide range of employee insurance options. She seeks assistance in selecting a health insurance plan. The patient is not disabled and states that her major concern is low monthly payments. Which of the following insurance plans would be best for this patient?

A 73-year-old lady with congestive heart failure is being readied for hospital release. The patient has heart failure with a low ejection fraction and has been hospitalized twice in the last 60 days. The patient's medical history includes ischemic heart disease, chronic obstructive lung disease, and hypertension. Vital indicators are typical. A pulmonary examination reveals normal breathing effort, no crackles, and no peripheral edema. The patient asks to stay in the hospital for a few additional days and says, "I feel fine right now, but I am worried that if I go home, I might end up back in the hospital again." Which of the following responses to this patient's request is most appropriate?

A 4-year-old girl is sent to the emergency room by her day care facility because she has a fever, right ear ache, and is vomiting often. A bulging, hazy tympanic membrane is seen on examination, along with erythema, edema, and pain over the right mastoid. A CT scan demonstrates mastoid air cell opacification and bone septal damage. When the patient's parents arrive, they report that the patient has been suffering from recurring episodes of otitis media. The parents, however, refuse antibiotic therapy, arguing that "in our family, we think that natural healing approaches are superior than injecting up our children with drugs." Which of the following responses to the parents' remark is most appropriate?

A 68-year-old woman visits the office to inquire about lipid-lowering treatment. She was prescribed rosuvastatin six months ago after suffering a transient ischemic stroke, but her pharmacist notified the doctor a week ago that she had not completed her prescription for the previous three months. Otherwise, the patient is in good health and has had no recurring neurologic complaints. When questioned why she isn't taking her medicine, she responds, " "I'm OK without it. The ministroke was the worst thing that had ever occurred to me, and now that it's done, I don't want the medicine to remind me of my condition all over again." Which of the following responses to this patient's remark is most appropriate?

A 19-year-old man arrives at the office for treatment of a hand injury. "I was simply minding my own business at work when this dog bit me," he adds. The patient has founded a dog-fighting club and claims that his "entrepreneurial abilities" have made him "richer than a doctor." He has been dismissed from various jobs, most recently as a car salesperson, for arguing with employees and being routinely late for shifts. The patient states, "I was just a few minutes late a couple times. Doc, have you ever been late before?" He was a chronic truant in middle school and served time in a juvenile jail center for tampering with his teacher's automobile brakes after failing a class. Which of the following is the most likely diagnosis?

A 22-year-old woman, gravida 1 para 0, comes to the office for a prenatal visit at 16 weeks gestation.  The patient, who has not gained weight since her last visit 4 weeks ago, has occasional nausea with vomiting twice a week.  She has little appetite, which she attributes to mild indigestion, and her food consumption has decreased.  However, the patient craves ice and has been consuming it throughout the day for the last few months.  Medications include daily prenatal vitamins.  The patient was prescribed twice-daily iron for anemia but does not take it because it causes constipation.  She has no diarrhea, dysuria, chills, or fever.  She does not use tobacco.  Uterine fundus is consistent with a 16-week pregnancy.  Fetal heart tone is 140-149/min.  The patient's vital signs are within normal limits.  Which of the following is the most likely diagnosis?

A 22-year-old woman is brought to the emergency department for bizarre behavior over the past week.  Her parents state that she has been "talking nonsense" nonstop, laughing for no reason, and has not slept for several days.  During triage, the patient attempted to hit a staff member, resulting in administration of haloperidol.  While awaiting further evaluation, the parents alert the nurse that the patient is starting to "make weird faces" while sticking out her tongue.  Medical history is noncontributory, and the patient takes no medications.  Urine drug screen is positive for cannabis and opiates.   Which of the following is the most likely explanation for this patient's motor symptoms?

An 18-year-old woman arrives at the office to discuss the results of her tests. She was assessed one week ago for recurrent vulvovaginal discharge and stated that she was sexually active with two partners, occasionally taking oral contraception. The patient was counseled on sexually responsible behavior and tested for sexually transmitted infections. The HIV test results came back positive. She has no serious medical history, and she just uses oral contraceptives. The patient's family history is crucial since she has a mother who has schizophrenia and a paternal uncle who has alcohol use disorder and lives with them. She is noticeably disturbed after hearing her test results and the advice to begin antiretroviral medication. Which of the following is the most important intervention to promote adherence to treatment in this patient?

A 24-year-old man arrives at the office for opioid use disorder therapy. The patient has a 6-year history of heroin usage that he claims has cost him the majority of his funds. His employer has spoken to him about his volatile emotions and unreliable work performance, and he is now facing dismissal. The patient requests assistance, claiming, "I tried all I could to do this on my own. My parents have spent a significant amount of money on counseling. It works for a time, but I quickly return to using. They've had enough of me and refuse to see me any more. I don't want to use, yet the desire is overwhelming." The physician refers the patient to an opioid treatment program where he is started on maintenance therapy with methadone.  During the next followup appointment, he reports a marked reduction in his cravings.  Which of the following properties of the administered drug is most likely responsible for the improvement in this patient's condition?

A 45-year-old lady visits the doctor for a check-up on her type 2 diabetes mellitus. The current glycated hemoglobin level is 9%. The patient was just diagnosed with diabetes and was put on metformin twice daily. When the doctor inquires about her medicine, she responds, "I use it most of the time, but it's easy to forget when I'm feeling well." Which of the following statements is most acceptable to start a conversation regarding this patient's medication nonadherence?

An intern attends a neighborhood dinner party and recognizes a colleague who works in another department at the same hospital. Throughout the evening, she notices her colleague responding to a number of routine medical calls from the hospital and drinking many alcoholic beverages. Later that evening, the physician discovers that her colleague is delivering pharmaceutical prescriptions over the phone while slurring her voice. The physician approaches her colleague, requesting that on-call responsibilities be transferred for the benefit of patient care. He argues that he is alright, that he is not inebriated, and that his responsibilities finish in 30 minutes. Which of the following is the best course of action?

A 26-year-old lady is taken by her boyfriend to the emergency department for treatment of a fractured nose. She tells to her partner that she slipped and fell in the bathroom, striking her face on the countertop. When questioned if she feels insecure with her lover in private, the patient responds, "No, nothing is wrong. He merely gets irritated when he drinks too much." When asked how she got her nasal fracture, she responds, "He pushed me and I fell, but I'm confident it won't happen again." Which of the following medical comments is most suitable after analyzing the degree of the injuries?

A 52-year-old lady arrives at the clinic to discuss the findings of an abdominal CT scan. The patient declares, "I'm hoping the scan will reveal why I've been losing so much weight. What does it demonstrate?" The imaging suggests pancreatic cancer, according to the doctor. When she hears this, the patient begins to scream and clutches her head in her hands. Which of the following is the most suitable medical response?

A 33-year-old man was taken to the hospital after neighbors reported that he had been singing loudly and playing the piano "nonstop" for the last month. The patient believes his mood is "terrific," that he is related to the President, and that he is destined to be a famous performer. He makes unwanted sexual approaches at several of the female nurses while in the hospital. He has a history of 9 mental hospitalizations for mood and psychotic symptoms beginning at the age of 22. The patient has heard voices remarking on his appearance and believes that covert cameras have been watching him in between hospitalizations, but he has had no mood problems. Which of the following is the most likely diagnosis in this patient?

A primary care physician has been asked to speak to a local company. He works for a huge multi-specialty medical firm that he joined less than a year ago after finishing residency. The physician highlights the many medical specializations offered within the group, as well as the breadth of ancillary services accessible at the group's facilities, throughout the presentation. During the subsequent conversation, the physician discovers that the employer has been experiencing financial troubles. The firm desires to continue providing health care coverage to its employees but must cut costs. As a result, the employer wishes to arrange a contract in which the medical group provides treatment to all of the company's employees in exchange for a fixed monthly cost per employee. What payment method best reflects this sort of health care financing arrangement?

A 35-year-old man is taken to the hospital after suffering multiple injuries in a car collision. He had surgery to repair an open tibial fracture and a spiral humerus fracture. The tibial repair is effective, but the surgeon performs the procedure on the incorrect arm. Which of the following techniques is most likely to prevent a similar error?

A 40-year-old woman arrives at the clinic with new-onset genital lesions. She is discovered to have many genital warts in her vaginal region upon inspection. Otherwise, testing for sexually transmitted infections is negative. The patient admits to having an adulterous affair while on business. The physician receives a phone call the following week from the patient's spouse, who is not a patient at the office. He is aware that his wife has lately been examined and would like information about her health since he is concerned about his bodily issues. Which of the following is the most suitable medical response?

A 34-year-old man arrives at the clinic complaining of nasal congestion and coughing for the past five days. He claims to cough up thick, yellow phlegm on occasion and is concerned about his lack of progress. The patient states that he has previously gotten antibiotics for identical symptoms and that "antibiotics always seem to make me feel better quickly." The temperature is 37.2 degrees Celsius (99 degrees Fahrenheit), the blood pressure is 120/70 mm Hg, the pulse rate is 76 beats per minute, and the respirations rate is 18 beats per minute. The physical examination reveals pharyngeal erythema; the rest of the test, including the cardiovascular evaluation, is normal. Which of the following physician replies is most appropriate?