Exam 2: Behavioral Sciences

A 38-year-old woman arrives at the clinic complaining of severe dysmenorrhea and tension headaches during the last three months. "It is more difficult than I imagined; I sometimes have to stay late to catch up on paperwork and am not sleeping very well," she says of her recent promotion to school principal. The patient is married and does not have any children. She falls into tears when answering inquiries about her sexual past. When the doctor asks what is bothering her, she covers her face and confesses she was sexually molested as a youngster. Which of the following is the best way to deal with the patient?

A 70-year-old woman visits the doctor for the first time. She complains of headaches and bad sleep. During the system evaluation, she also notes a sense of inadequate bladder emptying and constipation. The patient has had migraines and persistent sleeplessness in the past. Hypercholesterolemia and osteoarthritis are among her other medical issues. Her migraine meds include amitriptyline, simvastatin, diclofenac, and over-the-counter diphenhydramine for sleeplessness. Which of the following is the most suitable next step in this patient's care?

A 16-year-old girl is brought to the emergency department after being found in a confused state at a rest area along an interstate highway in Michigan. The patient was unable to answer questions from the police about her name, address, or any other information regarding her person. A telephone call with the police department of her hometown reveals that she had been reported missing three days ago by her husband. When her parents arrive, they report that their son was died due to an accidental drowning one week ago. The mother is concerned that her daughter seems to be unaware of her brother's death and believes she is "in denial."  Physical and neurological examinations show no abnormalities. On mental status examination, she is oriented only to time and place but not to person. Short-term memory is intact; she does not recognize her parents or recall important life events. Which of the following is the most likely diagnosis?

Her employer brings a 27-year-old lady to the emergency department because she has been more nervous and disorganized over the previous year. The patient is a housekeeper who has had increasing trouble executing her job duties. She has grown increasingly secretive over the last six months, and she has recently begun speaking in hushed tones because she fears listening devices are hidden in the walls. She began hiding food and personal items in closets and beneath mattresses during the last month. The patient does not drink alcohol or use illegal substances. The vital signs are steady, and the physical exam is uneventful. She switches subjects repeatedly during the conversation and rambles about voices pestering her. Which of the following additional mental status findings is most likely in this patient?

After vomiting during a party, a 25-year-old man is rushed to the emergency department by his wife. The patient admits to having four glasses of wine and a shot of vodka and claims to be feeling better today. The temperature is 37.8 degrees Celsius (100 degrees Fahrenheit), the blood pressure is 100/50 mm Hg, the pulse rate is 106 bpm, and the respirations rate is 14 /minute. The physical exam reveals blood-tinged vomitus on the patient's shirt and shoes. On palpation, abdominal examination indicates epigastric discomfort. The patient is aware, cooperative, and completely oriented during the mental status evaluation. The blood alcohol concentration is 70 mg/dL. (0.07 percent blood alcohol content). The doctor suggests that a full blood count, comprehensive metabolic panel, amylase, and lipase be performed. The patient argues that he is OK and wishes to be discharged. Which of the following is the most appropriate course of action?

After her overnight shift, a resident physician enters an elevator jammed with nurses and other hospital staff members on her way to morning signout. The team's medical student boards the elevator and inquires about the resident's shift. Throughout the interview, the student avoids mentioning the patient's name, instead asking, "Did the patient in Room 232 obtain her CT scan?" Which of the following responses to the student is the most appropriate?

Due to cellulitis, a 38-year-old lady is taken to the hospital for the night. The next morning, the hospitalist on call presents herself to the patient and inquires as to how she is doing. The patient screams angrily, "It's already midday, and I haven't had my breakfast yet. How am I meant to improve if you're starving me?" A normal diet has been ordered for the patient. Which of the following is the most suitable medical response?

A 13-year-old girl is brought to the emergency department by her mother after an episode of falling down on the ground during playing outdoor. When she found her, the patient seemed lethargic and disoriented and her speech was slurred.  Her condition slowly improved over the next 30 minutes; when the patient is evaluated in the emergency department an hour after the episode, she is alert, oriented, and able to speak clearly.  Temperature is 36.7 C (98.1 F), blood pressure is 102/65 mm Hg, and pulse is 62/min.  On physical examination, there are abrasions on the right forearm and shin and a rash around the nostrils and mouth.  The patient has no known medical history.  Which of the following substances is the most likely cause of this patient's symptoms?

A 52-year-old man walks into the office for a routine check-up. In the past, the patient had well-controlled hypertension and hyperlipidemia. He has a 35-pack-year smoking history and claims to consume 10-15 cigarettes daily. Lung cancer runs deep in his mother's family history. His father died of a stroke at the age of 65. When asked if he has considered quitting, the patient states that he is not ready to do so. He asserts, "I know I should, but I'm just too stressed out at work to give up smoking right now. To be honest, I probably smoke more than a pack of cigarettes every day." Which of the following is the most appropriate method to handle the patient?

A 5-year-old girl is brought to the office by her mother, who is anxious after watching her daughter repeatedly speaking to an empty chair in her room. The girl's medical history is relevant for preterm delivery at 36 weeks gestation but noncontributory in other ways. Her maternal grandparents suffered from a cerebrovascular accident and depression, while her father suffered from schizoaffective disorder. When questioned, the patient claims she sees her grandma at night and talks to her before going to bed. The grandma, who had resided in the family home for two months, died two months ago. For a few weeks after her grandmother's death, the youngster would cry and ask her parents when she would see her again.   Which of the following is the most likely diagnosis in this patient?

A 40-year-old lady arrives to the emergency room, concerned that she is suffering a heart attack. "I feel like I'm dying," she says, gripping her chest and breathing deeply. The temperature is 37.2 degrees Celsius (99 degrees Fahrenheit), the blood pressure is 125/86 mm Hg, the pulse is 110 beats per minute and regular, and the respirations are 18 beats per minute. On room air, the patient's pulse oximetry reads 98 percent. There are no abnormalities in the laboratory or on the ECG. Without treatment, the discomfort goes away in 10 minutes, and the patient recalls, "I was riding the bus home from work when my chest began to tighten. I'm glad my friend was nearby and able to assist me in getting to the hospital. What if she doesn't show up the next time?"

A 25-year-old lady arrives at the office for an initial assessment of her poor mood. The patient has been depressed and unable to sleep since relocating to a new apartment three weeks ago. She states, "My landlord does not let dogs in the building. I really miss my dog. I know my attitude would improve if I received a letter from you stating that my dog is welcome to live with me." The patient's dog is presently being cared for by her parents, who reside a few miles away. Which of the following physician remarks is the most appropriate?

A 16-year-old girl is brought to the office by her mother because she has been increasingly reluctant to go to school because of her appearance. The mother reports that her daughter has been worried about her weight and a light brown mark she has on her face. She spends up to 1 hour daily looking at herself in the mirror and meticulously putting on makeup to disguise the mark. The patient says, "I look disgusting with this mark, and I know everyone thinks the same, especially with me being so fat." She has recently quit the dance team, stopped meeting with her friends, and has been avoiding public events out of embarrassment. She has been reading articles on cosmetic surgery and says that she plans to have the mark removed. She appears anxious. She is 162 cm (5 ft 4 in) tall and weighs 55 kg (121 lb); BMI is 21 kg/m2. Vital signs are within normal limits. After removing her makeup, examination shows a 4-mm, light brown macule on the left cheek. Which of the following is the most likely diagnosis?

A 57-year-old man with amyotrophic lateral sclerosis (ALS) is taking part in a clinical study to test a new treatment. For the first appointment, the patient is joined by his wife. The research coordinator describes the trial and assures the wife that he believes the medicine will benefit people like her husband. He then informs her that additional volunteers are required for the study's success and asks if she would want to participate as a healthy control. Which of the following principles is at danger of being broken by the study coordinator in getting consent for the wife's participation?

A 66-year-old woman visits the clinic for a sarcoidosis check-up. Her lung function has deteriorated considerably over the last year, and her 12-month survival probability is less than 50%. When conversations about advance care planning and appointing a surrogate decision maker begin, the patient responds, "Why would I want to give my life away on paper? When the time comes, the Lord will take me." Which of the following is the most appropriate response?

A 19-year-old Hispanic lady arrives at the clinic complaining of nausea and stomach pain. She has difficulty describing her pain and usually gestures to her lower abdomen. When asked if she is pregnant or sexually active, the patient nods her head no. When asked when she had her last menstrual cycle, she nods and responds "now." She is a single woman who moved to the United States a few months ago. The physical examination reveals mild abdominal discomfort with no rebound or guarding and stable vital signs. The patient is sent home after being diagnosed with food poisoning. She is rushed to the emergency department by ambulance later that day after having significant stomach pain and loss of consciousness. A diagnosis of ruptured ectopic pregnancy is made.  Which of the following interventions would most likely have prevented the delay in diagnosis?

An 80-year-old woman is brought to the office for hypertension monitoring. The patient is given lisinopril, but she hasn't taken it in two weeks since she ran out. She attempted to contact her son to arrange for a refill but was unable to reach him. After her house was sold, the patient moved in with her son two months ago. She claims he spends the week at his girlfriend's house, therefore she has to locate neighbors who can take her about. A cerebrovascular accident with modest residual weakness on the left side is mentioned in the medical history. The temperature is 37 ° Celsius (98.6 ° Fahrenheit), the blood pressure is 156/88 mm Hg, and the pulse rate is 80 bpm. The patient is fully oriented.  Cardiopulmonary examination shows no abnormalities.  Gait and voluntary movements are normal.  On mental status examination, she appears tired and is wearing tattered clothing.  Which of the following is the most appropriate next step in management of this patient?

Due to an asthma exacerbation, a 4-year-old kid is brought to the emergency room by his mother. He has a history of poorly managed asthma, including noncompliance with medication and missed follow-up appointments. To maintain the family, the mother works two jobs and admits to having trouble getting the patient to appointments. Physical examination reveals a well-defined, spherical burn mark on the patient's thigh. When questioned about the burn, the patient responds, "That occurs every time I mess up. My father informed me." His mother corrects him, stating that the accident was caused by the youngster "playing with the cigarette lighter in the car." Which of the following is the best next step in this patient's care?