Exam 2: Behavioral Sciences

A 48-year-old deaf man arrives at the office for the first time. The patient has recently relocated to the neighborhood and is accompanied by a buddy with whom he communicates using American Sign Language. The physician is informed by the office staff that the patient has been communicating by reading lips, making gestures, and nodding his head in agreement. The buddy states at the outset of the visit that the patient has asthma and takes an inhaler as needed. The patient writes a note to the doctor saying that he would want to test a longer-acting inhaler. Which of the following is the most suitable next step in this patient's evaluation?

A 14-year-old child is brought in by his mother for a 6-month asthma exam. Although the patient's asthma is normally well managed with long-acting medications, he has bouts of exercise-induced bronchoconstriction and was prescribed a short-acting beta agonist. His mother got concerned when her son's physical education teacher phoned from school to report he was refusing to engage in class. When questioned, the patient stated that it was simpler to avoid exercising than it was to take an inhaler at school. His maternal grandparents had chronic obstructive pulmonary disease (COPD), his father had heart illness, and his mother had generalized anxiety disorder. The vital signs and physical examination are normal. Which of the following factors would most likely increase this patient's adherence with bronchodilator administration?

A 13-year-old male patient is brought to the physician to obtain a medical exemption letter for swim class. The patient stopped going to swim class due to "feeling uncomfortable in swim trunks." The patient's mother has a concern about his development since starting puberty about a year ago, she noticed that he recently bought women's underwear and shoes and went out to meet friends wearing makeup.  The mother further reports that her child has had mainly female friends since preschool and never enjoyed playing with "typical boy toys like cars" but instead preferred playing with dolls. The patient appears shy and in a depressed mood. Physical examination shows normal male external genitalia. There is scarce coarse, dark axillary and pubic hair. Upon questioning, the patient says "I am trapped in a male body. It just doesn't feel right to be a boy." Which of the following is the most likely explanation of this patient's behavior?

A 38-year-old man visits the office for an examination of wrist pain. He believes his ailments are caused by "typing all day, every day." The patient is a software developer who works from home to "avoid spending time conversing and connecting with coworkers." He seldom leaves his apartment and spends his free time on his computer, reading online forums about space travel and extraterrestrial life. When questioned about partnerships, he adds, "I've always preferred being alone." He had few companions and spent most of his childhood dissecting and reconstructing technological items. His affect is constrained, and his replies to queries are restricted. Which of the following is the most likely personality disorder in this patient?

A 32-year-old man arrives to the workplace with increased anxiousness since being promoted to a managerial position. Previously, he worked alone; now, he must communicate with a team of five employees and manage customer service problems. The patient claims that he feels apprehensive throughout the day and is afraid of saying anything humiliating or that his coworkers and customers would see his anxiousness and believe he is inept. He claims he was a timid and shy child who was constantly nervous while meeting new people. He socializes with a few pals, but he usually takes three or four alcoholic drinks before going out with them to feel more relaxed. The patient does not feel depressed, and his sleep and appetite are normal.  A medication with which of the following mechanisms of action would be most appropriate for this patient?

Her mother brings a 24-month-old daughter to the office because she is afraid of walking. According to the mother, "When she walks, she appears wobbly. She was walking so well until a few weeks ago, and now she's always falling over things." During the examination, the patient sits on the floor and claps her hands. She makes chattering sounds instead of answering inquiries. When her mother pushes her to move, the patient pulls herself up and walks with an uneven pace. The rest of the test is normal, except for abrasions on both knees caused by numerous falls, as explained by her mother. Both height and weight are in the 50th percentile. At a checkup 6 months ago, the patient had been saying 1- or 2-word phrases and walking without aid.  Which of the following neuropathic changes most likely underlies this patient's presentation?

A 30-year-old woman arrives to the office in a melancholy state. Since being turned over for promotion three weeks ago, the patient has been "disappointed and despondent." She has difficulty going asleep since she is preoccupied with what she could have done differently at work. The patient's appetite, energy, and concentration are not affected, and she still enjoys going out with friends and attending choir group. She has no substantial medical or mental health history. The vital signs and physical examination are normal. A course of psychotherapy is recommended, to which she responds, "Have you ever had depression or been in therapy, doctor?" Which of the following is the best response to this patient?

A buddy approaches a doctor and asks for a prescription for depressive medicine. The doctor has known this person since college and is aware that she has been treated for depression in the past. The buddy claims that she is merely "a little sad" as a result of work stress and relationship troubles, and that she would want to begin taking sertraline, which she had previously taken. She has a doctor, but she wants to avoid visiting him or her since it is tough to make an appointment and she has a hectic schedule. Which of the following responses is the most appropriate?

More incidents of expired drugs not being renewed are expected in the coming months. Finally, a woman receiving intravenous dobutamine for decompensated heart failure does not get the drug for 6 hours, causing her condition to deteriorate and ultimately in hypotensive shock. The hospital management forms a committee to investigate this occurrence. Which of the following is the best next step in resolving this issue?

Due to hostile conduct toward his fiancée, a 24-year-old man is transported to the emergency room by police and emergency medical services employees. He has no history of medical or psychological condition, according to her, and this conduct is new. The patient was aggressive and difficult to restrain throughout transport. He is anxious, disoriented, and bewildered right now, and he appears to be responding to internal stimuli. The temperature is 37.2 degrees Celsius (99 degrees Fahrenheit), the blood pressure is 170/96 mm Hg, the pulse rate is 118 beats per minute, and the respirations rate is 20 beats per minute. On the first neurologic examination, nystagmus and ataxia are observed. The patient refuses to participate in urine toxicology tests. After 8 hours at the emergency room, his symptoms begin to improve. He has no recall of what happened the night before. Which of the following substances is most likely causing the constellation of symptoms seen in this patient?

A physician on a rehabilitation unit notices that a patient is having an adverse response to a drug. The doctor requests nursing aid. When the nurse comes, the doctor directs her to provide "25 mg of diphenhydramine IV push." Which of the following nurse replies reduces the likelihood of communication errors?

A 35-year-old man visits the office for normal health maintenance. After divorcing his wife, the patient just relocated to "make a fresh start" and begin a new work. He has no chronic medical issues and has never had surgery. The patient is sexually active and has had six lovers in her lifetime. Which of the following questions should the physician ask to complete the rest of the sexual history?

A 78-year-old man with end-stage esophageal cancer is admitted to the hospital because he is very malnourished and failing to thrive. According to the patient's caregiver, he has been unable to eat or drink for the past three weeks. During that time, his weight plummeted from 72.6 kg (160 lb) to 63.5 kg (140 lb). His cancer has progressed to his lungs and liver. The patient does not want any further cancer therapy and states that he does not want any heroic measures or interventions to keep him alive. His doctor is thinking of referring him to hospice care. Which of the following is not a prerequisite for sending a patient to hospice care?

After being pushed into early retirement owing to poor job performance, a 55-year-old formerly healthy man is taken to the workplace by his wife. The patient used to be a financial planner, but he started missing critical deadlines and mismanaging his clients' money 6 months ago. During this period, he got increasingly angry and began to curse and disrespect his employees when they voiced worry about his performance. The patient has also become verbally aggressive toward his wife, although he appears oblivious to the pain he is causing. She has had to take charge of the money as well as the grocery shopping. She continues, "My spouse has developed a significant sweet tooth. He now consumes nearly two cartons of cookies every day." The physical exam is ordinary. This patient is most likely to have which of the following neuropathologic findings?

A 60-year-old man comes in for a surgical consultation for multivessel coronary artery disease. Following a comprehensive assessment and review of earlier records, the surgeon explains the suggestion for a coronary artery bypass graft, detailing the rationale for the procedure and offering a summary of the surgery, including risks and advantages. The surgeon next goes over what the patient may expect during his or her recuperation. Which of the following additional disclosures is required as part of the surgeon's informed consent discussion?

A 32-year-old man arrives to the office with crippling anxiety. The patient was just promoted to his company's headquarters, which required him to work on the building's 48th level. He feels panicked and dizzy as soon as he walks onto the elevator, sweats tremendously, and has heart palpitations. The patient is concerned that if he cannot control his anxiety, he will be forced to retire. His aversion to elevators stretches back to his youth. On weekends, he has one or two beers but does not use cigarettes or illegal substances. Which of the following long-term treatments is the most successful for this patient's condition?

A 39-year-old unkempt homeless lady arrives at the ER complaining of stomach discomfort. The woman has a heavy alcohol odor and appears dazed. She characterizes the abdomen discomfort as "very awful," but she cannot say when it began, where it is located, or what circumstances aggravate or alleviate it. She goes on to say that she does not have health insurance and cannot afford to pay for her care. What is the next best course of action in this situation?

A 33-year-old man arrives at the clinic for normal health maintenance. The patient expresses concern about his health after his father suffered a myocardial infarction a few months earlier at the age of 61. He has been eating well and exercising three to four times a week. The patient's medical history is irrelevant, and he or she is not taking any drugs. His aunt is a herbalist, and she recently gave him a supplement that is said to help prevent cardiovascular disease. The patient inquires whether it is safe to begin taking the supplement and produces a list of the contents, which includes plants unknown to the doctor. Which of the following responses is the most appropriate?

A 65-year-old man is brought to a busy community hospital's inpatient ward for worsening shortness of breath during the previous several days. He smoked for 40 years and was first diagnosed with chronic obstructive pulmonary disease exacerbation and treated as such. On admission, a chest x-ray reveals a substantial hilar opacity, and a CT scan confirms the existence of a 4-cm mass in the right hilum. During the informed consent procedure for bronchoscopy with biopsy, the patient asks, "Doc, please don't tell me what they discover, because if it's cancer, I don't want to know." Which of the following responses to this patient's request is most appropriate?

A 24-year-old man arrives to the office due to mood swings. For the past two months, he has been melancholy, irritated, and nervous virtually every day. The patient struggles to get out of bed in the mornings and to stay focused at work. He has no medical issues and does not use any drugs. The patient consumes 3 to 4 beers every day, with more on weekends. The doctor educates the patient on the relationship between drinking and mood disturbances. The patient says, "But it truly helps me unwind and relax after a hard day at work, and it makes falling asleep easier. It's also how I spend my weekends with my buddies. I don't see me quitting." Which of the following statements by the physician is the most suitable at this time?