308 FINAL REVIEW QUESTIONS &
ANSWERS(RATED A+)
For which of the following patients would a comprehensive health history be
appropriate?
A) A new patient with the chief complaint of "I sprained my ankle"
B) An established patient with the chief complaint of "I have an upper respiratory
infection"
C) A new patient with the chief complaint of "I am here to establish care"
D) A new patient with the chief complaint of "I cut my hand" - ANSWERC) A new
patient with the chief complaint of "I am here to establish care"
You are running late after your quarterly quality improvement meeting at the hospital
and have just gotten paged from the nurses' station because a family member of one
of your patients wants to talk with you about that patient's care. You have clinic this
afternoon and are double-booked for the first appointment time; three other patients
also have arrived and are sitting in the waiting room. Which of the following
demeanors is a behavior consistent with skilled interviewing when you walk into the
examination room to speak with your first clinic patient?
A) Irritability
B) Impatience
C) Boredom
D) Calm - ANSWERD) Calm
Suzanne, a 25 year old, comes to your clinic to establish care. You are the student
preparing to go into the examination room to interview her. Which of the following is
the most logical sequence for the patient-provider interview?
a) Establish the agenda, negotiate a plan, establish rapport, and invite the patient's
story.
b) Invite the patient's story, negotiate a plan, establish the agenda, and establish
rapport.
c) Greet the patient, establish rapport, invite the patient's story, establish the agenda,
expand and clarify the patient's story, and negotiate a plan.
d) Negotiate a plan, establish an agenda, invite the patient's story, and establish
rapport. - ANSWERc) Greet the patient, establish rapport, invite the patient's story,
establish the agenda, expand and clarify the patient's story, and negotiate a plan.
You are interviewing an elderly woman in the ambulatory setting and trying to get
more information about her urinary symptoms. Which of the following techniques is
not a component of adaptive questioning?
A) Directed questioning: starting with the general and proceeding to the specific in a
manner that does not make the patient give a yes/no answer
B) Reassuring the patient that the urinary symptoms are benign and that she doesn't
need to worry about it being a sign of cancer
C) Offering the patient multiple choices in order to clarify the character of the urinary
symptoms that she is experiencing
,D) Asking her to tell you exactly what she means when she states that she has a
urinary tract infection - ANSWERB) Reassuring the patient that the urinary
symptoms are benign and that she doesn't need to worry about it being a sign of
cancer
A 23-year-old graduate student comes to your clinic for evaluation of a urethral
discharge. As the provider, you need to get a sexual history. Which one of the
following questions is inappropriate for eliciting the information?
A) Are you sexually active?
B) When was the last time you had intimate physical contact with someone, and did
that contact include sexual intercourse?
C) Do you have sex with men, women, or both?
D) How many sexual partners have you had in the last 6 months? - ANSWERA) Are
you sexually active?
A patient is describing a very personal part of her history very quickly and in great
detail. How should you react to this?
A) Write down as much as you can, as quickly as possible.
B) Ask her to repeat key phrases or to pause at regular intervals, so you can get
almost every word.
C) Tell her that she can go over the notes later to make sure they are accurate.
D) Push away from the keyboard or put down your pen and listen. - ANSWERD)
Push away from the keyboard or put down your pen and listen.
Schizoaffective Disorder - ANSWERSchizophrenia combined with another mood
disorder.
A 19-year-old college student, Todd, is brought to your clinic by his mother. She is
concerned that there is something seriously wrong with him. She states for the past
6 months his behavior has become peculiar and he has flunked out of college. Todd
denies any recent illness or injuries. His past medical history is remarkable only for a
broken foot. His parents are both healthy. He has a paternal uncle who had similar
symptoms in college. The patient admits to smoking cigarettes and drinking alcohol.
He also admits to marijuana use but none in the last week. He denies using any
other substances. He denies any feelings of depression or anxiety. While speaking
with Todd and his mother you do a complete physical examination, which is
essentially normal. When you question him on how he is feeling, he says that he is
very worried that Microsoft has stolen his software for creating a better browser. He
tells you he has se - ANSWERD) Schizophrenia
A 26-year-old violinist comes to your clinic, complaining of anxiety. He is a first chair
violinist in the local symphony orchestra and has started having symptoms during
performances, such as sweating, shaking, and hyperventilating. It has gotten so bad
that he has thought about giving up his first chair status so he does not have to play
the solo during one of the movements. He says that he never has these symptoms
during rehearsals or when he is practicing. He denies having any of these symptoms
at any other time. His past medical history is unremarkable. He denies any tobacco
use, drug use, or alcohol abuse. His parents are both healthy. On examination you
see a young man who appears worried. His vital signs and physical examination are
unremarkable.
, What type of anxiety disorder best describes his situation?
A) Panic disorder
B) Specific phobia
C) Social phobia
D) Generalized anxiety disorder - ANSWERC) Social phobia
A 24-year-old secretary comes to your clinic, complaining of difficulty sleeping,
severe nightmares, and irritability. She states it all began 6 months ago when she
went to a fast food restaurant at midnight. While she was waiting in her car a man
entered through the passenger door and put a gun to her head. He had her drive to a
remote area, where he took her money and threatened to kill her. When the gun
jammed he panicked and ran off. Ever since this occurred the patient has been
having these symptoms. She states she jumps at every noise and refuses to drive at
night. She states her anxiety has had such a marked influence on her job
performance she is afraid she will be fired. She denies any recent illnesses or
injuries. Her past medical history is unremarkable. On examination you find a
nervous woman appearing her stated age. Her physical examination is
unremarkable. You recommend medication and counseling.
What - ANSWERC) Post-traumatic stress disorder
A 32-year-old white female comes to your clinic, complaining of overwhelming
sadness. She says for the past 2 months she has had crying episodes, difficulty
sleeping, and problems with overeating. She says she used to go out with her friends
from work but now she just wants to go home and be by herself. She also thinks that
her work productivity has been dropping because she just is too tired to care or
concentrate. She denies any feelings of guilt or any suicidal ideation. She states that
she has never felt this way in the past. She denies any recent illness or injuries. Her
past medical history consists of an appendectomy when she was a teenager;
otherwise, she has been healthy. She is single and works as a clerk in a medical
office. She denies tobacco, alcohol, or illegal drug use. Her mother has high blood
pressure and her father has had a history of mental illness. On examination you see
a woman appearing her st - ANSWERC) Major depressive episode
A 23-year-old ticket agent is brought in by her husband because he is concerned
about her recent behavior. He states that for the last 2 weeks she has been
completely out of control. He says that she hasn't showered in days, stays awake
most of the night cleaning their apartment, and has run up over $1,000 on their credit
cards. While he is talking, the patient interrupts him frequently and declares this is all
untrue and she has never been so happy and fulfilled in her whole life. She speaks
very quickly, changing the subject often. After a longer than normal interview you find
out she has had no recent illnesses or injuries. Her past medical history is
unremarkable. Both her parents are healthy but the husband has heard rumors
about an aunt with similar symptoms. She and her husband have no children. She
smokes one pack of cigarettes a day (although she has been chain-smoking in the
last 2 weeks), drinks four to si - ANSWERB) Manic episode
A 35-year-old stockbroker comes to your office, complaining of feeling tired and
irritable. She also says she feels like nothing ever goes her way and that nothing
good ever happens. When you ask her how long she has felt this way she laughs
and says, "Since when have I not?" She relates that she has felt pessimistic about
ANSWERS(RATED A+)
For which of the following patients would a comprehensive health history be
appropriate?
A) A new patient with the chief complaint of "I sprained my ankle"
B) An established patient with the chief complaint of "I have an upper respiratory
infection"
C) A new patient with the chief complaint of "I am here to establish care"
D) A new patient with the chief complaint of "I cut my hand" - ANSWERC) A new
patient with the chief complaint of "I am here to establish care"
You are running late after your quarterly quality improvement meeting at the hospital
and have just gotten paged from the nurses' station because a family member of one
of your patients wants to talk with you about that patient's care. You have clinic this
afternoon and are double-booked for the first appointment time; three other patients
also have arrived and are sitting in the waiting room. Which of the following
demeanors is a behavior consistent with skilled interviewing when you walk into the
examination room to speak with your first clinic patient?
A) Irritability
B) Impatience
C) Boredom
D) Calm - ANSWERD) Calm
Suzanne, a 25 year old, comes to your clinic to establish care. You are the student
preparing to go into the examination room to interview her. Which of the following is
the most logical sequence for the patient-provider interview?
a) Establish the agenda, negotiate a plan, establish rapport, and invite the patient's
story.
b) Invite the patient's story, negotiate a plan, establish the agenda, and establish
rapport.
c) Greet the patient, establish rapport, invite the patient's story, establish the agenda,
expand and clarify the patient's story, and negotiate a plan.
d) Negotiate a plan, establish an agenda, invite the patient's story, and establish
rapport. - ANSWERc) Greet the patient, establish rapport, invite the patient's story,
establish the agenda, expand and clarify the patient's story, and negotiate a plan.
You are interviewing an elderly woman in the ambulatory setting and trying to get
more information about her urinary symptoms. Which of the following techniques is
not a component of adaptive questioning?
A) Directed questioning: starting with the general and proceeding to the specific in a
manner that does not make the patient give a yes/no answer
B) Reassuring the patient that the urinary symptoms are benign and that she doesn't
need to worry about it being a sign of cancer
C) Offering the patient multiple choices in order to clarify the character of the urinary
symptoms that she is experiencing
,D) Asking her to tell you exactly what she means when she states that she has a
urinary tract infection - ANSWERB) Reassuring the patient that the urinary
symptoms are benign and that she doesn't need to worry about it being a sign of
cancer
A 23-year-old graduate student comes to your clinic for evaluation of a urethral
discharge. As the provider, you need to get a sexual history. Which one of the
following questions is inappropriate for eliciting the information?
A) Are you sexually active?
B) When was the last time you had intimate physical contact with someone, and did
that contact include sexual intercourse?
C) Do you have sex with men, women, or both?
D) How many sexual partners have you had in the last 6 months? - ANSWERA) Are
you sexually active?
A patient is describing a very personal part of her history very quickly and in great
detail. How should you react to this?
A) Write down as much as you can, as quickly as possible.
B) Ask her to repeat key phrases or to pause at regular intervals, so you can get
almost every word.
C) Tell her that she can go over the notes later to make sure they are accurate.
D) Push away from the keyboard or put down your pen and listen. - ANSWERD)
Push away from the keyboard or put down your pen and listen.
Schizoaffective Disorder - ANSWERSchizophrenia combined with another mood
disorder.
A 19-year-old college student, Todd, is brought to your clinic by his mother. She is
concerned that there is something seriously wrong with him. She states for the past
6 months his behavior has become peculiar and he has flunked out of college. Todd
denies any recent illness or injuries. His past medical history is remarkable only for a
broken foot. His parents are both healthy. He has a paternal uncle who had similar
symptoms in college. The patient admits to smoking cigarettes and drinking alcohol.
He also admits to marijuana use but none in the last week. He denies using any
other substances. He denies any feelings of depression or anxiety. While speaking
with Todd and his mother you do a complete physical examination, which is
essentially normal. When you question him on how he is feeling, he says that he is
very worried that Microsoft has stolen his software for creating a better browser. He
tells you he has se - ANSWERD) Schizophrenia
A 26-year-old violinist comes to your clinic, complaining of anxiety. He is a first chair
violinist in the local symphony orchestra and has started having symptoms during
performances, such as sweating, shaking, and hyperventilating. It has gotten so bad
that he has thought about giving up his first chair status so he does not have to play
the solo during one of the movements. He says that he never has these symptoms
during rehearsals or when he is practicing. He denies having any of these symptoms
at any other time. His past medical history is unremarkable. He denies any tobacco
use, drug use, or alcohol abuse. His parents are both healthy. On examination you
see a young man who appears worried. His vital signs and physical examination are
unremarkable.
, What type of anxiety disorder best describes his situation?
A) Panic disorder
B) Specific phobia
C) Social phobia
D) Generalized anxiety disorder - ANSWERC) Social phobia
A 24-year-old secretary comes to your clinic, complaining of difficulty sleeping,
severe nightmares, and irritability. She states it all began 6 months ago when she
went to a fast food restaurant at midnight. While she was waiting in her car a man
entered through the passenger door and put a gun to her head. He had her drive to a
remote area, where he took her money and threatened to kill her. When the gun
jammed he panicked and ran off. Ever since this occurred the patient has been
having these symptoms. She states she jumps at every noise and refuses to drive at
night. She states her anxiety has had such a marked influence on her job
performance she is afraid she will be fired. She denies any recent illnesses or
injuries. Her past medical history is unremarkable. On examination you find a
nervous woman appearing her stated age. Her physical examination is
unremarkable. You recommend medication and counseling.
What - ANSWERC) Post-traumatic stress disorder
A 32-year-old white female comes to your clinic, complaining of overwhelming
sadness. She says for the past 2 months she has had crying episodes, difficulty
sleeping, and problems with overeating. She says she used to go out with her friends
from work but now she just wants to go home and be by herself. She also thinks that
her work productivity has been dropping because she just is too tired to care or
concentrate. She denies any feelings of guilt or any suicidal ideation. She states that
she has never felt this way in the past. She denies any recent illness or injuries. Her
past medical history consists of an appendectomy when she was a teenager;
otherwise, she has been healthy. She is single and works as a clerk in a medical
office. She denies tobacco, alcohol, or illegal drug use. Her mother has high blood
pressure and her father has had a history of mental illness. On examination you see
a woman appearing her st - ANSWERC) Major depressive episode
A 23-year-old ticket agent is brought in by her husband because he is concerned
about her recent behavior. He states that for the last 2 weeks she has been
completely out of control. He says that she hasn't showered in days, stays awake
most of the night cleaning their apartment, and has run up over $1,000 on their credit
cards. While he is talking, the patient interrupts him frequently and declares this is all
untrue and she has never been so happy and fulfilled in her whole life. She speaks
very quickly, changing the subject often. After a longer than normal interview you find
out she has had no recent illnesses or injuries. Her past medical history is
unremarkable. Both her parents are healthy but the husband has heard rumors
about an aunt with similar symptoms. She and her husband have no children. She
smokes one pack of cigarettes a day (although she has been chain-smoking in the
last 2 weeks), drinks four to si - ANSWERB) Manic episode
A 35-year-old stockbroker comes to your office, complaining of feeling tired and
irritable. She also says she feels like nothing ever goes her way and that nothing
good ever happens. When you ask her how long she has felt this way she laughs
and says, "Since when have I not?" She relates that she has felt pessimistic about
