1. INTRODUCTION TO MEDICINE.
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
Which of the following statements concerning "practice guidelines" is correct?
A) Physicians must follow clinical practice guidelines to the letter in order to avoid malpractice lawsuits
B) Only guidelines that come from governmental agencies are relevant for the practicing clinician
C) Guidelines can protect patients from receiving substandard care
D) Guidelines are based on the premise that cost must be reduced in the practice of medicine
E) Guidelines can be expected to apply only to those patients in a "managed care" setting - ANSWER C)
Guidelines can protect patients from receiving substandard care.
Feedback: Explanation:
As the complexity of medicine increases, the difficulty of choosing amongst various diagnostic and
therapeutic approaches is a daunting challenge for even the most well-read physician. Professional
organizations including general medical groups, subspecialty associations, and government agencies
have been busily developing formal clinical practice guidelines to help physicians make sensible choices.
Guidelines may well prevent patients from receiving substandard care whether or not they are in a fee-
for-service, managed care, or indigent setting. Because practice guidelines cannot possibly take into
account the uniqueness of each individual and every specific permutation that may occur in the clinical
setting, in no way can or should they be followed to the letter. In generally all cases, the purpose of
clinical guidelines is not to make physicians more subject to lawsuits but rather to standardize and
improve care.
A 51-year-old married father of three presents with epigastric abdominal pain and weight loss.
Computed tomography (CT) of the abdomen reveals an extensive mid- pancreatic mass with obvious
liver metastases. Needle biopsy of one of the hepatic lesions is consistent with pancreatic
adenocarcinoma. At this point the patient's primary care physician should tell the patient
A) that a referral to an oncologist will be made
B) the nature of histology and refer the patient to an oncologist and defer discussion of the prognosis
C) to get his affairs in order as quickly as possible
D) that we now have effective therapy for pancreatic carcinoma
E) that he has an extremely serious life-threatening illness, but that all measures will be undertaken to
extend the quantity and quality of the patient's life - ANSWER E) that he has an extremely serious life-
, threatening illness, but that all measures will be undertaken to extend the quantity and quality of the
patient's life.
Feedback: Explanation:
One of the most important facets of being a physician is the communication of bad news, particularly to
a patient whose diagnosis represents great likelihood of premature death.
There is no one guiding principle of how to tell patients bad news. However, it makes sense to be honest
with the patient, tell as much information as the individual is capable of dealing with at any given time,
and to disclose things gradually rather than abruptly.
Hope should never be removed, yet ineffective therapies should not be inappropriately glorified.
Most of all, the dying patient needs to be treated with respect and dignity.
It is vital that the physician reassure the patient that compassionate care will be provided throughout the
course of the patient's illness; a fear of abandonment is often a grave concern in these situations.
A 35-year-old woman with a severe anxiety neurosis develops acute appendicitis. The primary care
physician, the surgical consultant, and the infectious disease consultant all recommend urgent
appendectomy. The patient wants to be treated only with antibiotics because she is concerned about the
risks of anesthesia. The patients states she understands the reasons for the physician's
recommendations and that she might die if she does not have this operation, yet she feels strongly that
this is what is best for her. At this point the most appropriate course of action would be to
A) call a psychiatrist
B) tell the patient that you cannot treat her and refer her to another hospital
C) declare the patient legally incompetent, restrain her, and perform surgery since it will be life saving
D) treat the patient with antibiotics
E) call a lawyer - ANSWER A) call a psychiatrist
Feedback: Explanation:
In general, patients who are conscious adults are considered legally competent to make decisions
affecting their health care. Competent patients must be able to express their choice as well as appreciate
the medical situation, the nature of the alternatives, and the risks, benefits, and consequences of each.
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
Which of the following statements concerning "practice guidelines" is correct?
A) Physicians must follow clinical practice guidelines to the letter in order to avoid malpractice lawsuits
B) Only guidelines that come from governmental agencies are relevant for the practicing clinician
C) Guidelines can protect patients from receiving substandard care
D) Guidelines are based on the premise that cost must be reduced in the practice of medicine
E) Guidelines can be expected to apply only to those patients in a "managed care" setting - ANSWER C)
Guidelines can protect patients from receiving substandard care.
Feedback: Explanation:
As the complexity of medicine increases, the difficulty of choosing amongst various diagnostic and
therapeutic approaches is a daunting challenge for even the most well-read physician. Professional
organizations including general medical groups, subspecialty associations, and government agencies
have been busily developing formal clinical practice guidelines to help physicians make sensible choices.
Guidelines may well prevent patients from receiving substandard care whether or not they are in a fee-
for-service, managed care, or indigent setting. Because practice guidelines cannot possibly take into
account the uniqueness of each individual and every specific permutation that may occur in the clinical
setting, in no way can or should they be followed to the letter. In generally all cases, the purpose of
clinical guidelines is not to make physicians more subject to lawsuits but rather to standardize and
improve care.
A 51-year-old married father of three presents with epigastric abdominal pain and weight loss.
Computed tomography (CT) of the abdomen reveals an extensive mid- pancreatic mass with obvious
liver metastases. Needle biopsy of one of the hepatic lesions is consistent with pancreatic
adenocarcinoma. At this point the patient's primary care physician should tell the patient
A) that a referral to an oncologist will be made
B) the nature of histology and refer the patient to an oncologist and defer discussion of the prognosis
C) to get his affairs in order as quickly as possible
D) that we now have effective therapy for pancreatic carcinoma
E) that he has an extremely serious life-threatening illness, but that all measures will be undertaken to
extend the quantity and quality of the patient's life - ANSWER E) that he has an extremely serious life-
, threatening illness, but that all measures will be undertaken to extend the quantity and quality of the
patient's life.
Feedback: Explanation:
One of the most important facets of being a physician is the communication of bad news, particularly to
a patient whose diagnosis represents great likelihood of premature death.
There is no one guiding principle of how to tell patients bad news. However, it makes sense to be honest
with the patient, tell as much information as the individual is capable of dealing with at any given time,
and to disclose things gradually rather than abruptly.
Hope should never be removed, yet ineffective therapies should not be inappropriately glorified.
Most of all, the dying patient needs to be treated with respect and dignity.
It is vital that the physician reassure the patient that compassionate care will be provided throughout the
course of the patient's illness; a fear of abandonment is often a grave concern in these situations.
A 35-year-old woman with a severe anxiety neurosis develops acute appendicitis. The primary care
physician, the surgical consultant, and the infectious disease consultant all recommend urgent
appendectomy. The patient wants to be treated only with antibiotics because she is concerned about the
risks of anesthesia. The patients states she understands the reasons for the physician's
recommendations and that she might die if she does not have this operation, yet she feels strongly that
this is what is best for her. At this point the most appropriate course of action would be to
A) call a psychiatrist
B) tell the patient that you cannot treat her and refer her to another hospital
C) declare the patient legally incompetent, restrain her, and perform surgery since it will be life saving
D) treat the patient with antibiotics
E) call a lawyer - ANSWER A) call a psychiatrist
Feedback: Explanation:
In general, patients who are conscious adults are considered legally competent to make decisions
affecting their health care. Competent patients must be able to express their choice as well as appreciate
the medical situation, the nature of the alternatives, and the risks, benefits, and consequences of each.
