POP & COMMUNITY HEALTH
1- A 14-year-old male presents to your office with a high fever that began suddenly. He
has a diffuse petechial rash and some nuchal rigidity on examination. A lumbar puncture
is performed, and gram-negative diplococci are found. You admit him to the
hospital.Which one of the following would be most appropriate at this time?
• a) Immediate chemoprophylaxis for his entire school
• b) Immediate vaccination of all contacts
• c) Chemoprophylaxis for family members and very close contacts only
• d) Isolation of all family members for 1 week
• e) No preventive measures until culture results are available
Show answer
Correct Answer: C
Explanation:
Meningococcal disease remains a leading cause of sepsis and meningitis. Those in
close contact with patients who have presumptive meningococcal disease are at
heightened risk. While secondary cases have been reported, they are rare because of
prompt chemoprophylaxis of household members and anyone directly exposed to the
index patient’s oral secretions. There is no need to isolate family members. The risk for
secondary disease among closest contacts is highest during the first few days after the
onset of illness in the index patient, mandating immediate chemoprophylaxis of those
exposed. The delay in immunity post vaccination makes it necessary to use other
preventive measures instead.
2- A 15 year old girl comes to the office because she has missed a menstrual period and
a home pregnancy test was positive. Bimanual examination discloses an enlarged
uterus, and a urine pregnancy test is positive. She is estimated to be approximately 6 to
8 weeks pregnant. You have been the family's physician since she was born. She asks
that you please not tell her parents. Which of the following is the most appropriate
immediate response?
• a) Attempt to persuade her to share the information with at least one adult
member of her family
• b) Explain that by law you are unable to maintain confidentiality
• c) Explore with her the reasons for her not feeling comfortable sharing the
information with her parents
• d) Point out that she will not be able to hide her pregnancy for very long
• e) Reassure her, but notify her mother after she leaves
Show answer
Correct Answer: C
Explanation:
Explore with the patient her reasons for not feeling comfortable with sharing this
information. In this manner, you can discuss specific reasons for her reluctance to
1
,involve her parents, and counsel her appropriately. An attempt to persuade her to share
the information with a parent may only exacerbate an already tenuous relationship with
her parents.Explaining that by law you are unable to maintain confidentiality is incorrect.
She requires counseling and telling her that you an unable to maintain confidentiality will
only make it more difficult for her to trust you. A minor is typically considered to be an
“emancipated minor” and capable of making independent medical decisions if they
become pregnant or have a sexually transmitted disease, therefore breaching
confidentiality is incorrect.Indicating that she will not be able to hide her pregnancy for
long is a nonproductive argument, and does not preempt a discussion. It is a clear
breech of doctor-patient confidentiality to reassure, and then notify a parent.
3- A 15 year old girl comes to your office and is asking for oral contraceptive pills
(OCP’s). What is the appropriate action?
• a) Advise and offer OCP
• b) Request a letter of parental consent
• c) Refuse to prescribe OCP
• d) Offer non-OCP alternative (eg abstinence, condom etc)
Show answer
Correct Answer: A
Explanation:
Medical treatment can be provided without parental consent (regardless of age) for the
following:
Family Planning Services.Pregnancy Care (including Prenatal Care).Emergency
Services (if it is impractical to obtain consent first if needed).Minor who is married to
someone 18 years or older.Treatment requested for a suspected STD.Any patient that is
less than 18 years of age, will require parental consent, unless they fit one of the above
categories. If they do they are now ‘emancipated’ minors.
4- A 16 year old girl comes to the emergency department because, she says,
"something is sticking out of my bottom since I had a bowel movement this morning."
She denies previous episodes, although for more than 1 year she has had occasional
difficulty passing stools. In response to your questions, she tells you that she moved
away from home more than a year ago and her parents contribute nothing to her
support. She has a 6 month old child, a part time job and lives with a 28 year old female
cousin. In order to follow the correct procedure for treating a minor, which of the
following is the most appropriate step prior to evaluating this patient's rectal problem?
• a) Accept the girl's consent as sufficient
• b) Obtain a court order permitting evaluation
• c) Obtain the written consent of at least two licensed physicians
• d) Obtain written consent from at least one of her parents
• e) Obtain written consent from her 28 year old cousin
Show answer
2
,Correct Answer: A
Explanation:
A small number of minors, particularly at older ages such as 16 or 17, may be
considered 'emancipated' or freed of the need to have parental consent for any medical
care. The criteria are that the minor is married, self-supporting and living independently,
in the military, or the parent of a child that they themselves support. The criteria for being
an emancipated minor relate to being no longer dependent on one's parents for
support.An emancipated minor is free to make health care decisions in all areas, not
only just STDs, prenatal care, contraception, or substance abuse.
5- A 20-year-old college student is anxious to avoid traveler’s diarrhea during a 4-week
visit to Central America. You would advise him that which one of the following is
generally safe?
• a) Baked foods such as breads
• b) Ice added to bottled beverages
• c) Fresh raw vegetables
• d) Fresh raw seafood products
Show answer
Correct Answer: A
Explanation:
Baked goods such as breads can generally be considered safe from most causes of
traveler’s diarrhea. Ice from local water sources is commonly contaminated, as freezing
does not kill most causes of traveler’s diarrhea. Raw vegetables are often contaminated
because human and animal wastes are commonly used for fertilizer. Alcohol is not an
effective disinfectant for traveler’s diarrhea pathogens. Raw fish and shellfish are high-
risk foods.
6- A 21 year old college student complains that the dean of her school is secretly taping
her conversations with her roommate “I’m sure of it!” she states emphatically. When
probed further she says that she didn’t always feel that way but ever since her roommate
(who also happens to be her sister) told her about how she is “being watched” she
started to feel paranoid. The next best step is to:
• a) Provide cognitive behavioural therapy for the patient.
• b) Counsel and treat both the patient and her sister together.
• c) Prescribe antipsychotic medication for the patient.
• d) Prescribe anxiolytic medication for the patient.
• e) Separate the sisters.
Show answer
Correct Answer: E
Explanation:
Folie à deux: This interesting pathology (shared delusional disorder or Folie à deux)
occurs when two people in close contact have the same delusional belief. It is most
3
, common in mother-daughter or sister-sister relationships. There is usually a dominant
and submissive relationship in which the dominant individual has an established
psychotic disorder and the submissive or dependent individual is desperately anxious to
be cared for and accepted by the dominant person. Treatment involves separating the
affected individuals and helping the submissive partner develop other/healthier means of
support. Sometimes antipsychotics medications are beneficial.
PEARL: When treating shared delusional disorder your first step is to separate those
involved.
7- A 21-year-old black female has been confused and delirious for 2 days. She has no
significant past medical history, and she is taking no medications. She recently returned
from a mission trip to Southeast Asia.
During your initial examination in the emergency department, she has several
convulsions and rapidly becomes comatose. Her temperature is 37.9˚C (100.3˚F). Her
blood pressure is 80/50 mm Hg. A neurologic examination shows no signs of meningeal
irritation. A cranial nerve evaluation is normal. There is a mild, bilateral, symmetric
increase in deep tendon reflexes. All other physical examination findings are
normal.Laboratory Findings:
Hemoglobin……………………………........…7.0 g/dL (N 12.0-16.0)
Hematocrit……………………………......….....20% (N 36-46)
WBCs……………………………….......…..…..6500/mm3 (N 4300-10,800)
Platelets………………………………........…...450,000/mm3 (N 150,000-350,000)
• a) Vitamin B12 deficiency
• b) Malaria
• c) Ehrlichiosis
• d) Sickle cell anemia
Show answer
Correct Answer: B
Explanation:
Clinical clues to the diagnosis in this case are an appropriately targeted recent travel
history, a prodrome of delirium or erratic behavior, unarousable coma following a
generalized convulsion, fever, and a lack of focal neurologic signs in the presence of a
diffuse, symmetric encephalopathy. The peripheral blood shows normochromic,
normocytic anemia with Plasmodium falciparum trophozoites and schizonts involving
erythrocytes, diagnostic of cerebral malaria. Treatment of this true medical emergency is
intravenous quinidine gluconate. Vitamin B12 deficiency is a predominantly peripheral
neuropathy seen in older adults. Ehrlichiosis causes thrombocytopenia but not hemolytic
anemia. Sickle cell disease presents with painful vaso-occlusive crises in multiple
organs. Coma is rare.
4
1- A 14-year-old male presents to your office with a high fever that began suddenly. He
has a diffuse petechial rash and some nuchal rigidity on examination. A lumbar puncture
is performed, and gram-negative diplococci are found. You admit him to the
hospital.Which one of the following would be most appropriate at this time?
• a) Immediate chemoprophylaxis for his entire school
• b) Immediate vaccination of all contacts
• c) Chemoprophylaxis for family members and very close contacts only
• d) Isolation of all family members for 1 week
• e) No preventive measures until culture results are available
Show answer
Correct Answer: C
Explanation:
Meningococcal disease remains a leading cause of sepsis and meningitis. Those in
close contact with patients who have presumptive meningococcal disease are at
heightened risk. While secondary cases have been reported, they are rare because of
prompt chemoprophylaxis of household members and anyone directly exposed to the
index patient’s oral secretions. There is no need to isolate family members. The risk for
secondary disease among closest contacts is highest during the first few days after the
onset of illness in the index patient, mandating immediate chemoprophylaxis of those
exposed. The delay in immunity post vaccination makes it necessary to use other
preventive measures instead.
2- A 15 year old girl comes to the office because she has missed a menstrual period and
a home pregnancy test was positive. Bimanual examination discloses an enlarged
uterus, and a urine pregnancy test is positive. She is estimated to be approximately 6 to
8 weeks pregnant. You have been the family's physician since she was born. She asks
that you please not tell her parents. Which of the following is the most appropriate
immediate response?
• a) Attempt to persuade her to share the information with at least one adult
member of her family
• b) Explain that by law you are unable to maintain confidentiality
• c) Explore with her the reasons for her not feeling comfortable sharing the
information with her parents
• d) Point out that she will not be able to hide her pregnancy for very long
• e) Reassure her, but notify her mother after she leaves
Show answer
Correct Answer: C
Explanation:
Explore with the patient her reasons for not feeling comfortable with sharing this
information. In this manner, you can discuss specific reasons for her reluctance to
1
,involve her parents, and counsel her appropriately. An attempt to persuade her to share
the information with a parent may only exacerbate an already tenuous relationship with
her parents.Explaining that by law you are unable to maintain confidentiality is incorrect.
She requires counseling and telling her that you an unable to maintain confidentiality will
only make it more difficult for her to trust you. A minor is typically considered to be an
“emancipated minor” and capable of making independent medical decisions if they
become pregnant or have a sexually transmitted disease, therefore breaching
confidentiality is incorrect.Indicating that she will not be able to hide her pregnancy for
long is a nonproductive argument, and does not preempt a discussion. It is a clear
breech of doctor-patient confidentiality to reassure, and then notify a parent.
3- A 15 year old girl comes to your office and is asking for oral contraceptive pills
(OCP’s). What is the appropriate action?
• a) Advise and offer OCP
• b) Request a letter of parental consent
• c) Refuse to prescribe OCP
• d) Offer non-OCP alternative (eg abstinence, condom etc)
Show answer
Correct Answer: A
Explanation:
Medical treatment can be provided without parental consent (regardless of age) for the
following:
Family Planning Services.Pregnancy Care (including Prenatal Care).Emergency
Services (if it is impractical to obtain consent first if needed).Minor who is married to
someone 18 years or older.Treatment requested for a suspected STD.Any patient that is
less than 18 years of age, will require parental consent, unless they fit one of the above
categories. If they do they are now ‘emancipated’ minors.
4- A 16 year old girl comes to the emergency department because, she says,
"something is sticking out of my bottom since I had a bowel movement this morning."
She denies previous episodes, although for more than 1 year she has had occasional
difficulty passing stools. In response to your questions, she tells you that she moved
away from home more than a year ago and her parents contribute nothing to her
support. She has a 6 month old child, a part time job and lives with a 28 year old female
cousin. In order to follow the correct procedure for treating a minor, which of the
following is the most appropriate step prior to evaluating this patient's rectal problem?
• a) Accept the girl's consent as sufficient
• b) Obtain a court order permitting evaluation
• c) Obtain the written consent of at least two licensed physicians
• d) Obtain written consent from at least one of her parents
• e) Obtain written consent from her 28 year old cousin
Show answer
2
,Correct Answer: A
Explanation:
A small number of minors, particularly at older ages such as 16 or 17, may be
considered 'emancipated' or freed of the need to have parental consent for any medical
care. The criteria are that the minor is married, self-supporting and living independently,
in the military, or the parent of a child that they themselves support. The criteria for being
an emancipated minor relate to being no longer dependent on one's parents for
support.An emancipated minor is free to make health care decisions in all areas, not
only just STDs, prenatal care, contraception, or substance abuse.
5- A 20-year-old college student is anxious to avoid traveler’s diarrhea during a 4-week
visit to Central America. You would advise him that which one of the following is
generally safe?
• a) Baked foods such as breads
• b) Ice added to bottled beverages
• c) Fresh raw vegetables
• d) Fresh raw seafood products
Show answer
Correct Answer: A
Explanation:
Baked goods such as breads can generally be considered safe from most causes of
traveler’s diarrhea. Ice from local water sources is commonly contaminated, as freezing
does not kill most causes of traveler’s diarrhea. Raw vegetables are often contaminated
because human and animal wastes are commonly used for fertilizer. Alcohol is not an
effective disinfectant for traveler’s diarrhea pathogens. Raw fish and shellfish are high-
risk foods.
6- A 21 year old college student complains that the dean of her school is secretly taping
her conversations with her roommate “I’m sure of it!” she states emphatically. When
probed further she says that she didn’t always feel that way but ever since her roommate
(who also happens to be her sister) told her about how she is “being watched” she
started to feel paranoid. The next best step is to:
• a) Provide cognitive behavioural therapy for the patient.
• b) Counsel and treat both the patient and her sister together.
• c) Prescribe antipsychotic medication for the patient.
• d) Prescribe anxiolytic medication for the patient.
• e) Separate the sisters.
Show answer
Correct Answer: E
Explanation:
Folie à deux: This interesting pathology (shared delusional disorder or Folie à deux)
occurs when two people in close contact have the same delusional belief. It is most
3
, common in mother-daughter or sister-sister relationships. There is usually a dominant
and submissive relationship in which the dominant individual has an established
psychotic disorder and the submissive or dependent individual is desperately anxious to
be cared for and accepted by the dominant person. Treatment involves separating the
affected individuals and helping the submissive partner develop other/healthier means of
support. Sometimes antipsychotics medications are beneficial.
PEARL: When treating shared delusional disorder your first step is to separate those
involved.
7- A 21-year-old black female has been confused and delirious for 2 days. She has no
significant past medical history, and she is taking no medications. She recently returned
from a mission trip to Southeast Asia.
During your initial examination in the emergency department, she has several
convulsions and rapidly becomes comatose. Her temperature is 37.9˚C (100.3˚F). Her
blood pressure is 80/50 mm Hg. A neurologic examination shows no signs of meningeal
irritation. A cranial nerve evaluation is normal. There is a mild, bilateral, symmetric
increase in deep tendon reflexes. All other physical examination findings are
normal.Laboratory Findings:
Hemoglobin……………………………........…7.0 g/dL (N 12.0-16.0)
Hematocrit……………………………......….....20% (N 36-46)
WBCs……………………………….......…..…..6500/mm3 (N 4300-10,800)
Platelets………………………………........…...450,000/mm3 (N 150,000-350,000)
• a) Vitamin B12 deficiency
• b) Malaria
• c) Ehrlichiosis
• d) Sickle cell anemia
Show answer
Correct Answer: B
Explanation:
Clinical clues to the diagnosis in this case are an appropriately targeted recent travel
history, a prodrome of delirium or erratic behavior, unarousable coma following a
generalized convulsion, fever, and a lack of focal neurologic signs in the presence of a
diffuse, symmetric encephalopathy. The peripheral blood shows normochromic,
normocytic anemia with Plasmodium falciparum trophozoites and schizonts involving
erythrocytes, diagnostic of cerebral malaria. Treatment of this true medical emergency is
intravenous quinidine gluconate. Vitamin B12 deficiency is a predominantly peripheral
neuropathy seen in older adults. Ehrlichiosis causes thrombocytopenia but not hemolytic
anemia. Sickle cell disease presents with painful vaso-occlusive crises in multiple
organs. Coma is rare.
4
