Exam 2: Behavioral Sciences

A 47-year-old man visits the office for a check-up on his newly diagnosed hypertension. A month ago, he was administered a generic variant of lisinopril. An examination of the patient's medication container reveals 15 pills remained from a 30-tablet supply. Otherwise, his medical history is ordinary, and he is not on any other drugs. His blood pressure reading indicates no substantial improvement from a month ago. The serum chemistry panel, which includes potassium and creatinine, remains unchanged from previous results. The patient claims no side effects from the drug yet frequently fails to take it. Which of the following would be the most beneficial to this patient's medication adherence?

During influenza season, a 57-year-old lady with type 2 diabetes and asthma visits the doctor for a preventative checkup. The patient is an ethnic minority member who is accompanied by her daughter. The patient's medical issues are under control, and she is now symptom-free. The clinician explains that she is at high risk of seasonal influenza complications and suggests that she acquire the seasonal influenza vaccine. The patient declares, "I'm not confident in the vaccination. Because it's from the government, I don't believe it's safe for individuals like me." Which of the following medical actions is most appropriate?

A 32-year-old lady arrives at the emergency room seeking medicine for acute back pain. She has tried many over-the-counter medications and claims that only oxycodone has alleviated her discomfort. The patient was visited at a pain clinic a year ago, but she can't remember the name of the doctor and her prescription has run out. Obesity and a car accident 10 years ago are among her medical history. The temperature is 37.1 C (98.8 F), the blood pressure is 130/80 mm Hg, the pulse rate is 76 beats per minute, and the respirations rate is 16 beats per minute. A physical examination reveals no anomalies. A recent MRI revealed no abnormalities. The patient reports that her pain level is a ten on a scale of 0 to ten, and she becomes irritated when the doctor advises nonprescription pain medicine. Which of the following is the most appropriate next step by the physician?

A 26-year-old woman, gravida 1 para 0, is admitted to the hospital in active labor at 38 weeks gestation. Twelve hours after admission, she had a spontaneous vaginal birth of a newborn boy weighing 3.8 kg (8.4 lb) and receiving Apgar ratings of 8 and 9, respectively, at 1 and 5 minutes. The patient received no normal prenatal care. She does not have any chronic medical issues or drug allergies. Following birth, the patient is advised that erythromycin ointment will be required to avoid an eye infection and potential blindness caused by untreated gonorrhea. The patient claims that her son does not require therapy because she has never been exposed to a sexually transmitted virus.

A 17-year-old girl visits the office for an assessment of developing vaginal discomfort and discharge. In the last several months, she has had several sexual partners. The patient takes oral contraceptives and uses condoms seldom. She has no previous medical issues and does not use any other drugs. Urine pregnancy testing is negative, but gonorrhea testing is positive. The patient does not want her parents to know she is having sex and wonders whether the doctor would inform her parents about her visit today. Which of the following is the best way to deal with this patient?

A 21-year-old man arrives to the office with recurring ear leakage. His girlfriend is accompanying him. He communicates in English. On examination, the patient shows purulent otorrhea, a perforation of the tympanic membrane, and a pearly white mass behind the tympanic membrane, which is consistent with a large cholesteatoma. He is told that removing the tumor from his ear will need surgery. The patient nods momentarily but does not ask questions after hearing an explanation of the process and why it is necessary. He is also given information papers that include a written description of the treatment as well as directions on how to schedule surgery, which he promptly passes to his girlfriend, who begins reading them.  Review of the medical records shows he has been to the emergency department several times in the last year with this same concern and has not had a flu shot in the past 5 years.  Which of the following is the most appropriate course of action?

A 62-year-old woman arrives at the office for a routine exam. Her spouse perished in a bicycle accident that she observed five months ago. She has a low appetite, which has resulted in a weight reduction of 3.17 kg (7 lb), and she usually wakes up two hours before her alarm clock goes off. "My spouse always took care of the bills so I wouldn't have to worry," the patient says of having to manage the home finances. She no longer cycles, a habit she enjoyed with her husband, but she still volunteers at a children's hospital. There are no nightmares or suicidal thoughts in the patient. During the meeting, she sheds a few tears but grins while recalling a trip she spent with her spouse. Which of the following is the best explanation for this patient's condition?

A 24-year-old lady arrives at the clinic after experiencing repeated episodes of chest discomfort, palpitations, and shortness of breath in recent months. She has dizziness, diaphoresis, and hand paresthesias during certain bouts. The episodes last 5-10 minutes, and the patient is continuously concerned about when and where next one may occur. She states, "This continues happening, and no one can explain why. I'm afraid something is really wrong with me." The patient had visited the emergency room twice in the previous month for similar episodes; earlier assessment, which included a thorough metabolic profile, thyroid function tests, arterial blood gas analysis, ECG, cardiac enzymes, and a chest x-ray, revealed no abnormalities. The vital indicators are within normal ranges. Examination of the body. Which of the following is the most likely diagnosis?

A 27-year-old man exits a bar's men's room after smoking an unknown drug. He quickly gets disoriented and aggressive. The man makes jerky, uncontrolled movements with his limbs and strikes a bouncer who attempts to calm him down. When police and emergency medical workers come, he fights off four cops before being subdued, and he seems painless. The patient suffers visual hallucinations at the emergency room, is unable to comply with the questioning, and swings between agitation and drowsiness. He is hypertensive and tachycardic, with vertical nystagmus on examination. The patient refuses to participate in urine toxicology tests. Several hours later, when questioned by the emergency physician, he cannot recall the majority of the preceding events. Which of the following is the primary mechanism of action of the drug most likely used by this patient?

A 62-year-old woman presented for an appointment with a new physician. The receptionist welcomed her and asked her if she could fill out several forms regarding her history, as the physician is late due to an emergency. The patient accepted to fill them and waited in her seat. When she entered her appointment, the patient says" Instead of filling out useless forms, I think you are educated enough to take a proper history". The forms are not filled out and contain only her signature. When asked if there is something bothering her, she says " I am fine, there is nothing wrong". The patient's behavior is best described by which of the following?

A 62-year-old man and his wife visit the office for an examination of periodic chest discomfort. The doctor introduces herself to the patient and his wife and affirms that he is comfortable and not in any discomfort at the moment. "He brought a list of his prescriptions for you to check," the patient's wife says, "but I'm not sure he takes all of them on a regular basis." Which of the following is the most acceptable method for the physician to begin the medical interview after thanking them for bringing the list?

A 10-year-old child is brought to the pediatric clinic after exhibiting strange classroom conduct for the last year, which has gotten worse in recent weeks. Despite being largely silent, the patient occasionally interrupts the class with sniffling, frequent throat cleaning, and grunting sounds. His instructor claims that the youngster disrupts other classmates and has poor concentration in class. When he is tired, anxious, or enthusiastic, his actions escalate. The patient's parents are particularly concerned since he has few friends and is mocked by his peers. Recurrent otitis media as a child, atopic dermatitis, and an influenza illness 9 months ago all play a role in the medical history. His mother has a family history of rheumatoid arthritis and anxiety. Temperature is 36.7 C (98 F), pulse is 78/min, blood pressure is 110/72 mm Hg, and respirations are 14/min.  Physical examination shows frequent eye blinking and shoulder shrugging but is otherwise normal.  Which of the following is the most likely diagnosis?

A 29-year-old lady arrives to the emergency department complaining of abdominal discomfort and fever. A biker hit her in the stomach when she was crossing the street this morning. When the patient arrives, she informs the triage nurse that she does not have medical insurance. She does not have any chronic medical issues. The temperature is 38 degrees Celsius (100.4 degrees Fahrenheit), the blood pressure is 109/82 mm Hg, and the pulse rate is 88 beats per minute. The abdomen is swollen, and there is bruising, rebound discomfort, and guarding. The patient is advised that she need exploratory surgery to treat her problem. She refuses, yelling angrily, "I'm in pain, and I'm not going to be a test subject for this technology. You'd offer me anything that would genuinely heal me if I had insurance." In addition to clarifying the details of the surgical procedure with the patient, which of the following is the most appropriate response by the physician?

An ambulance transports a 74-year-old woman to the emergency department. She is joined by a friend who discovered the patient, who is confused and disoriented, lying on the floor of her flat. The patient is a widow with an adult daughter. Aplastic anemia was identified in her a year ago. Her illness has not responded well to immunosuppressive medication, necessitating several blood transfusions. The patient has a fever, is confused, and cannot answer to queries. A full blood count reveals severe pancytopenia. The patient wrote an advance directive 9 months ago, designating a friend as her health care proxy. The buddy informs the doctor that the patient does not wish to receive any future blood transfusions. The patient's daughter arrives and adamantly insists that the patient receive a blood transfusion, saying, "I discussed it with my mother a few weeks ago, and we decided that she should have everything done to prolong her life."  Which of the following is the most appropriate next step in patient care?

A 45-year-old lady walks in for a normal check-up. The patient is doing OK generally, but she adds that climbing the last flight of steps to her third-floor apartment has become more difficult. "Sometimes I have to pause at the landing to regain my breath," she admits. Medical history includes a cocaine use disorder that has been in remission for the past four years; otherwise, it is normal. The patient does not drink alcohol or use illegal substances. She has a 25-pack-year smoking history and has previously been advised to quit smoking. The patient declares, "I've tried countless times to quit. I can reduce down to a few smokes or half a pack for a day or two, but it becomes too tough after that." Which of the following is the most appropriate response by the physician regarding this patient's smoking?

A 71-year-old woman comes to the office due to a recent concentration difficulties.  She reports repeatedly reading the same page of material due to an inability to focus.  She also describes memory problems, stating that it "takes a while to remember another person's name."  The patient's medical history is significant for hypertension and type 2 diabetes mellitus.  These are well controlled through diet, exercise, and oral medications.  She lives alone and describes her mood as "good."  Blood pressure is 127/67 mm Hg and pulse is 65/min.  The physician decides to administer a brief cognitive test to assess her difficulty in concentrating.  Which of the following elements of cognitive testing would best assess for impaired attention and concentration in this patient?

A 43-year-old lady arrives at the clinic for a first consultation because she is experiencing chronic stomach discomfort, overall weakness, decreased appetite, and dizziness. She claims that the pain is wrecking her life and that her previous doctors may have overlooked something. The patient had been hospitalized three times in the last several years with identical symptoms. Despite comprehensive workups, including many abdominal CT scans and an exploratory laparotomy, no reason for the discomfort has been established. The patient has had persistent stomach discomfort since adolescence and is concerned that the over-the-counter medicines she is taking are inadequate. She has no mental diagnosis or a history of substance addiction. The physical exam, vital signs, and laboratory tests (including a chemical panel, complete blood count, and urinalysis) are all within normal ranges. Which of the following is the most appropriate next step in the management of this patient?

In a tertiary care hospital, a 66-year-old lady with rheumatoid arthritis and atrial fibrillation is scheduled for an elective right total knee arthroplasty. The patient largely speaks Spanish and understands just a little English. Using a qualified interpreter, informed permission is acquired during a preoperative clinic visit. The operating room is running behind schedule on the day of the surgery, and the patient's procedure is delayed by 3 hours. The trained interpreter is in the emergency department dealing with another patient and will be unavailable for an hour when the surgeon and circulation nurse visit the patient to confirm the site and side of the surgery. The patient speaks quickly and has a number of questions for the staff. The surgeon has completed a three-week course in medical Spanish, and the nurse can communicate in brief words in Spanish. The surgeon speaks to the patient in a combination of Spanish and English. As the surgeon speaks, the patient frequently nods. Which of the following best defines this encounter's patient-provider communication?

In the middle of the night, an 82-year-old man is admitted to the hospital. He is noncommunicative and suffers from a number of comorbidities, including end-stage lung cancer. The patient does not have a power of attorney or an advance directive on file. His long-term wife, who is with him in the hospital, has a lengthy talk with the physician in charge of his treatment. During the chat, she claims that the patient repeatedly told her not to resuscitate him if he was near death because he did not want to live "connected to machines or brain dead." She claims he simply want to die in peace when the time comes. What would be the most appropriate course of action if the patient enters ventricular fibrillation?

After being discovered sitting in the street drinking his own urine, a 25-year-old man is taken to the emergency department by ambulance. According to the patient's mother, he voiced concern about being observed by an undisclosed government agency a year ago, and as a result, he broke up with his girlfriend, quit his job, and unplugged his phone. The patient's mother has noted that he no longer appears to be interested in things that used to interest him, and she just discovered that he had relocated into the family garden shed with his dog. The patient is malodorous, unkempt, and laughs for no apparent reason when examined. He grows enraged afterwards and refuses to sit on a chair for the interview. The patient switches among unrelated topics and when asked where he lives says, "in the holy buffet of diplomacy."  Temperature is 36.7 C (98 F), blood pressure is 122/79 mm Hg, and pulse is 80/min.  Physical examination and laboratory evaluation, including urine toxicology, are unremarkable.  Which of the following is the most likely diagnosis in this patient?