Specialty consultation timing US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Specialty consultation timing. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Specialty consultation timing US Medical PG Question 1: A 36-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision. On arrival, she is unconscious. Her pulse is 140/min, respirations are 12/min and shallow, and blood pressure is 76/55 mm Hg. 0.9% saline infusion is begun. A focused assessment with sonography shows blood in the left upper quadrant of the abdomen. Her hemoglobin concentration is 7.6 g/dL and hematocrit is 22%. The surgeon decided to move the patient to the operating room for an emergent explorative laparotomy. Packed red blood cell transfusion is ordered prior to surgery. However, a friend of the patient asks for the transfusion to be held as the patient is a Jehovah's Witness. The patient has no advance directive and there is no documentation showing her refusal of blood transfusions. The patient's husband and children cannot be contacted. Which of the following is the most appropriate next best step in management?
- A. Administer hydroxyethyl starch
- B. Transfusion of packed red blood cells (Correct Answer)
- C. Consult hospital ethics committee
- D. Administer high-dose iron dextran
Specialty consultation timing Explanation: ***Transfusion of packed red blood cells***
- This patient is in **hemorrhagic shock** (tachycardia, hypotension, low hemoglobin, and hematocrit with evidence of active bleeding), requiring emergent blood transfusion to prevent irreversible organ damage and death.
- In an **emergency setting** with an **unconscious patient** and **no documented refusal** of blood products, the principle of **presumed consent** for life-saving treatment takes precedence, especially when next of kin cannot be reached.
*Administer hydroxyethyl starch*
- **Colloids** like hydroxyethyl starch can temporarily increase intravascular volume but do not provide oxygen-carrying capacity, which is critically needed for a patient with severe anemia and hemorrhagic shock.
- While useful for volume expansion, it is **not a substitute for blood products** in severe bleeding and can have adverse effects such as kidney injury.
*Consult hospital ethics committee*
- Consulting an ethics committee is appropriate for **complex ethical dilemmas** when there is time for deliberation and the patient's life is not in immediate danger.
- In this acute, life-threatening emergency, **delaying treatment** to consult an ethics committee would jeopardize the patient's life and is not appropriate.
*Administer high-dose iron dextran*
- **Iron dextran** is used to treat iron-deficiency anemia and works by supporting red blood cell production over several days to weeks.
- It is **ineffective in acute hemorrhagic shock** where immediate restoration of oxygen-carrying capacity is required.
Specialty consultation timing US Medical PG Question 2: A 40-year-old woman presents to her physician's home with a headache. She describes it as severe and states that her symptoms have not been improving despite her appointment yesterday at the office. Thus, she came to her physician's house on the weekend for help. The patient has been diagnosed with migraine headaches that have persisted for the past 6 months and states that her current symptoms feel like her previous headaches with a severity of 3/10. She has been prescribed multiple medications but is generally non-compliant with therapy. She is requesting an exam and urgent treatment for her symptoms. Which of the following is the best response from the physician?
- A. It sounds to me like you are in a lot of pain. Let me see how I can help you.
- B. Do not come to my house when you have medical problems. You should make an appointment.
- C. Your symptoms seem severe. Let me perform a quick exam to see if everything is alright.
- D. Unfortunately, I cannot examine and treat you at this time. Please set up an appointment to see me in my office. (Correct Answer)
- E. You should go to the emergency department for your symptoms rather than coming here.
Specialty consultation timing Explanation: ***Unfortunately, I cannot examine and treat you at this time. Please set up an appointment to see me in my office.***
- This response appropriately **maintains professional boundaries** by declining an unscheduled visit to the physician's private residence.
- While house calls are not inherently unethical, this situation is problematic because: the physician is unprepared, lacks proper medical equipment and documentation resources at home, and the patient's symptoms (3/10 severity, chronic migraine) do not constitute an emergency.
- This response is **empathetic yet firm**, redirecting the patient to appropriate care settings where proper examination, documentation, and treatment can occur.
- Setting this boundary prevents establishing an inappropriate precedent for future unscheduled home visits.
*It sounds to me like you are in a lot of pain. Let me see how I can help you.*
- While showing empathy, agreeing to treat the patient at home without preparation creates problems: **lack of proper medical equipment, diagnostic tools, and documentation resources**.
- This action **blurs professional boundaries** and sets an inappropriate precedent for future unscheduled patient interactions at the physician's home.
- The patient's severity (3/10) and chronic nature of symptoms do not justify an urgent unscheduled home examination.
*Do not come to my house when you have medical problems. You should make an appointment.*
- This response is **unprofessional and lacks empathy**, potentially damaging the patient-physician relationship.
- While the message about boundaries is appropriate, the **harsh tone** fails to provide compassionate guidance for the patient's concerns.
*Your symptoms seem severe. Let me perform a quick exam to see if everything is alright.*
- Despite acknowledging the patient's concern, performing an unscheduled exam at home is **inappropriate** due to lack of preparation, proper equipment, and resources for thorough assessment.
- This decision could lead to **inadequate care and documentation issues**, as the physician would be practicing in an unplanned setting without proper resources.
*You should go to the emergency department for your symptoms rather than coming here.*
- While this directs the patient to a medical facility, the patient has **3/10 severity** chronic migraine symptoms that do not constitute an emergency, making the ED an **inappropriate over-triage**.
- This response may come across as dismissive and could strain the patient-physician relationship, though it does maintain appropriate boundaries.
Specialty consultation timing US Medical PG Question 3: A 42-year-old woman presents to the emergency department with abdominal pain. Her pain started last night during dinner and has persisted. This morning, the patient felt very ill and her husband called emergency medical services. The patient has a past medical history of obesity, diabetes, and depression. Her temperature is 104°F (40°C), blood pressure is 90/65 mmHg, pulse is 160/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a very ill appearing woman. Her skin is mildly yellow, and she is in an antalgic position on the stretcher. Laboratory values are ordered as seen below.
Hemoglobin: 13 g/dL
Hematocrit: 38%
Leukocyte count: 14,500 cells/mm^3 with normal differential
Platelet count: 257,000/mm^3
Alkaline phosphatase: 227 U/L
Bilirubin, total: 11.3 mg/dL
Bilirubin, direct: 9.8 mg/dL
AST: 42 U/L
ALT: 31 U/L
The patient is started on antibiotics and IV fluids. Which of the following is the best next step in management?
- A. Nasogastric tube and NPO
- B. Supportive therapy followed by elective cholecystectomy
- C. FAST exam
- D. Emergency cholecystectomy
- E. Endoscopic retrograde cholangiopancreatography (Correct Answer)
Specialty consultation timing Explanation: ***Endoscopic retrograde cholangiopancreatography***
- The patient's presentation with **fever**, **jaundice**, **abdominal pain**, **hypotension**, and **tachycardia** (Reynolds' pentad) indicates **acute cholangitis**.
- **ERCP** is the best next step for **biliary decompression** and stone extraction in severe obstructive cholangitis to reduce morbidity and mortality.
*Nasogastric tube and NPO*
- While **NPO** (nothing by mouth) is standard for acute abdominal pain, a **nasogastric tube** is not typically indicated as a primary intervention for cholangitis unless there's associated vomiting or gastric distention.
- This step addresses symptoms but does not treat the underlying **biliary obstruction** and infection.
*Supportive therapy followed by elective cholecystectomy*
- **Supportive therapy** with antibiotics and IV fluids is already initiated but is insufficient for severe cholangitis requiring **urgent biliary drainage**.
- **Elective cholecystectomy** is performed after the acute infection has resolved, but not as an immediate intervention for an unstable patient with acute cholangitis.
*FAST exam*
- A **Focused Assessment with Sonography for Trauma (FAST)** exam is primarily used to detect **free fluid** (hemoperitoneum) in trauma patients.
- It is not indicated for the diagnosis or management of **biliary obstruction** or cholangitis in a non-trauma setting.
*Emergency cholecystectomy*
- **Emergency cholecystectomy** is generally reserved for complications like **gangrenous cholecystitis** or perforation, or after initial stabilization in acute cholecystitis.
- For **acute cholangitis**, the priority is **biliary decompression** first, which is typically achieved through ERCP, before considering cholecystectomy.
Specialty consultation timing US Medical PG Question 4: A 72-year-old man presents to the emergency department after a fall. The patient was found lying down on the floor in his room in his retirement community. The patient has a past medical history of Alzheimer dementia and a prosthetic valve. His current medications include donepezil and warfarin. His temperature is 97.7°F (36.5°C), blood pressure is 85/50 mmHg, pulse is 160/min, respirations are 13/min, and oxygen saturation is 97% on room air. The patient is started on IV fluids and a type and screen is performed. Laboratory values are ordered as seen below.
Hemoglobin: 13 g/dL
Hematocrit: 39%
Leukocyte count: 5,500 cells/mm^3 with normal differential
Platelet count: 225,000/mm^3
INR: 2.5
AST: 10 U/L
ALT: 12 U/L
A chest radiograph and EKG are performed and are within normal limits. A full physical exam is within normal limits. The patient's vitals are repeated. His temperature is 99.5°F (37.5°C), blood pressure is 110/70 mmHg, pulse is 90/min, respirations are 10/min, and oxygen saturation is 98% on room air. Which of the following is the best next step in management?
- A. CT scan (Correct Answer)
- B. Urgent blood transfusion
- C. Fresh frozen plasma
- D. Exploratory laparoscopy
- E. Exploratory laparotomy
Specialty consultation timing Explanation: ***CT scan***
- A patient with a **prosthetic valve** on **warfarin** and a fall is at high risk for **intracranial hemorrhage**, even without focal neurological deficits.
- While initial vitals improved after IV fluids, the mechanism of injury (fall) and medication profile warrant a **CT scan** of the head to rule out serious internal injury, especially given the history of dementia which might mask symptoms.
*Urgent blood transfusion*
- The patient's **hemoglobin (13 g/dL)** and **hematocrit (39%)** are within normal limits, indicating no acute need for blood transfusion due to hemorrhage.
- Transfusions are typically reserved for patients with significant blood loss or severe symptomatic anemia.
*Fresh frozen plasma*
- The patient's **INR of 2.5** is within the therapeutic range for a patient with a prosthetic valve on warfarin.
- There is no evidence of active bleeding or supratherapeutic anticoagulation that would necessitate the administration of **fresh frozen plasma (FFP)** to reverse anticoagulation.
*Exploratory laparoscopy*
- There are no clinical signs or symptoms, such as abdominal pain, distension, or evidence of intra-abdominal bleeding (e.g., declining hemoglobin, peritoneal signs), to suggest an indication for an **exploratory laparoscopy**.
- The patient's physical exam was described as normal.
*Exploratory laparotomy*
- Similar to laparoscopy, there is no clinical evidence of acute abdominal injury or hemorrhage, which would necessitate an **exploratory laparotomy**.
- This invasive procedure is reserved for cases with strong suspicion of significant intra-abdominal pathology or trauma.
Specialty consultation timing US Medical PG Question 5: A 30-year-old forest landscape specialist is brought to the emergency department with hematemesis and confusion. One week ago she was diagnosed with influenza when she had fevers, severe headaches, myalgias, hip and shoulder pain, and a maculopapular rash. After a day of relative remission, she developed abdominal pain, vomiting, and diarrhea. A single episode of hematemesis occurred prior to admission. Two weeks ago she visited rainforests and caves in western Africa where she had direct contact with animals, including apes. She has no history of serious illnesses or use of medications. She is restless. Her temperature is 38.0℃ (100.4℉); the pulse is 95/min, the respiratory rate is 20/min; and supine and upright blood pressure is 130/70 mm Hg and 100/65 mm Hg, respectively. Conjunctival suffusion is noted. Ecchymoses are observed on the lower extremities. She is bleeding from one of her intravenous lines. The peripheral blood smear is negative for organisms. Filovirus genomes were detected during a reverse transcription-polymerase chain reaction. The laboratory studies show the following:
Laboratory test
Hemoglobin 10 g/dL
Leukocyte count 1,000/mm3
Segmented neutrophils 65%
Lymphocytes 20%
Platelet count 50,000/mm3
Partial thromboplastin time (activated) 60 seconds
Prothrombin time 25 seconds
Fibrin split products positive
Serum
Alanine aminotransferase (ALT) 85 U/L
Aspartate aminotransferase (AST) 120 U/L
γ-Glutamyltransferase (GGT) 83 U/L
Creatinine 2 mg/dL
Which of the following is the most appropriate immediate step in management?
- A. Esophagogastroduodenoscopy
- B. Postexposure vaccination of close contacts
- C. Parenteral artesunate plus sulfadoxine/pyrimethamine
- D. Use of N95 masks
- E. Intravenous fluids and electrolytes (Correct Answer)
Specialty consultation timing Explanation: ***Intravenous fluids and electrolytes***
- The patient presents with **orthostatic hypotension**, internal bleeding (hematemesis, ecchymoses), and deranged renal function (elevated creatinine). These indicate significant **fluid loss** and potential **hypovolemic shock**, making immediate fluid resuscitation critical.
- **Ebola virus disease** (indicated by the travel history, symptoms, and positive filovirus genomes) often leads to severe dehydration due to fluid loss from vomiting, diarrhea, and internal bleeding, necessitating aggressive fluid and electrolyte replacement as a cornerstone of supportive care.
*Esophagogastroduodenoscopy*
- While the patient has hematemesis, her overall clinical picture with **severe coagulopathy** (elevated PT/aPTT, low platelets, positive fibrin split products) and **multisystem involvement** suggests a systemic bleeding disorder rather than a focal upper GI bleed that would be the primary target of an EGD.
- Performing an invasive procedure like EGD in a patient with severe coagulopathy and a highly contagious disease like Ebola (implied by filovirus detection) carries significant risks and is not the most immediate priority compared to stabilizing vital signs and correcting fluid deficits.
*Postexposure vaccination of close contacts*
- This is a crucial public health measure for **Ebola virus disease** but is a secondary step in management focused on prevention for others, not the immediate stabilization or treatment of the acutely ill patient.
- While important, it does not address the patient's immediate, life-threatening symptoms of hypovolemia, bleeding, and organ dysfunction.
*Parenteral artesunate plus sulfadoxine/pyrimethamine*
- This regimen is an antimalarial treatment. While the patient traveled to Western Africa, her symptoms and the detection of **filovirus genomes** rule out malaria as the primary diagnosis requiring this specific treatment.
- Administering antimalarials would delay appropriate supportive care for Ebola virus disease and is not indicated given the specific viral diagnosis.
*Use of N95 masks*
- **N95 masks** are important for healthcare worker protection given the patient's symptoms and confirmed filovirus. However, the question asks for the most appropriate *immediate step in management* of the patient's condition.
- While infection control is paramount, providing immediate direct patient care like fluid resuscitation takes precedence for the patient's survival over PPE considerations, assuming adequate PPE is already being donned by healthcare providers.
Specialty consultation timing US Medical PG Question 6: A 56-year-old man presents to the family medicine office since he has been having difficulty keeping his blood pressure under control for the past month. He has a significant medical history of hypertension, coronary artery disease, and diabetes mellitus. He has a prescription for losartan, atenolol, and metformin. The blood pressure is 178/100 mm Hg, the heart rate is 92/min, and the respiratory rate is 16/min. The physical examination is positive for a grade II holosystolic murmur at the left sternal border. He also has diminished sensation in his toes. Which of the following statements is the most effective means of communication between the doctor and the patient?
- A. “What is causing your blood pressure to be elevated?” (Correct Answer)
- B. “Have you been taking your medications as prescribed?”
- C. “Would you like us to consider trying a different medication for your blood pressure?”
- D. “You are taking your medications as prescribed, aren’t you?”
- E. “Why are you not taking your medication?”
Specialty consultation timing Explanation: ***“What is causing your blood pressure to be elevated?”***
- This is an **open-ended question** that encourages the patient to share their perspective, concerns, and potential reasons for the elevated blood pressure, fostering a **patient-centered approach**.
- It allows the physician to understand the patient's individual circumstances, medication adherence, lifestyle factors, or other contributing issues without being judgmental or leading.
*“Have you been taking your medications as prescribed?”*
- This is a **closed-ended question** that primarily elicits a "yes" or "no" answer, providing limited insight into the patient's actual adherence and the underlying reasons for non-adherence.
- While important, phrasing it this way might make the patient feel interrogated or judged, potentially hindering honest communication.
*“Would you like us to consider trying a different medication for your blood pressure?”*
- This question prematurely jumps to a solution without fully understanding the cause of the elevated blood pressure and the patient's perspective.
- It bypasses the crucial step of investigating potential reasons for poor blood pressure control, which could include non-adherence, lifestyle factors, or secondary hypertension, rather than necessarily a medication efficacy issue.
*“You are taking your medications as prescribed, aren’t you?”*
- This is a **leading question** that implies an expectation and can make the patient feel pressured to answer affirmatively, even if they are not consistently taking their medication.
- Such phrasing can create a defensive environment and discourage the patient from openly discussing adherence challenges.
*“Why are you not taking your medication?”*
- This is a **direct and accusatory question** that implies blame and can immediately put the patient on the defensive, making them less likely to be honest or forthcoming about their medication habits.
- It fails to create a supportive or collaborative atmosphere, which is essential for effective patient-physician communication.
Specialty consultation timing US Medical PG Question 7: A 54-year-old woman comes to the emergency department because of two episodes of bright red blood per rectum within the past day. She has a history of migraine, which is treated prophylactically with verapamil. She appears well and is hemodynamically stable. Cardiac exam reveals a regular heart rate without any murmurs or gallops. Lungs are clear to auscultation. Her abdomen is mildly tender without rebound or guarding. Digital rectal examination shows fresh blood on the glove. Laboratory studies show:
Hemoglobin 10.4 g/dL
Leukocyte count 5,000/mm3
Platelet count 175,000/mm3
Partial thromboplastin time 35 seconds
Serum
Na+ 140 mEq/L
K+ 3.7 mEq/L
Cl- 101 mEq/L
HCO3- 25 mEq/L
Mg2+ 1.8 mEq/L
A routine ECG shows a heart rate of 75/min, a normal axis, PR interval of 280 ms, QRS interval of 80 ms with a QRS complex following each p wave, and no evidence of ischemic changes. Which of the following is the most appropriate next step in management with respect to this patient's cardiovascular workup?
- A. Observation (Correct Answer)
- B. Atropine therapy
- C. Synchronized cardioversion
- D. Metoprolol therapy
- E. Pacemaker placement
Specialty consultation timing Explanation: ***Observation***
- The patient is currently **hemodynamically stable** despite the prolonged PR interval, indicating that the **first-degree AV block** is not causing immediate compromise.
- Continuation of **verapamil** (a calcium channel blocker) for migraine prophylaxis is the likely cause of the prolonged PR interval; however, in the absence of symptoms attributable to the AV block, observation is appropriate.
*Atropine therapy*
- **Atropine** is used to increase heart rate in **symptomatic bradycardia** or higher-degree AV blocks (second or third-degree) if the patient is unstable.
- This patient is **hemodynamically stable** with a heart rate of 75/min and has only a first-degree AV block, making atropine unnecessary.
*Synchronized cardioversion*
- **Synchronized cardioversion** is reserved for **unstable tachyarrhythmias** or some unstable bradyarrhythmias not responsive to chemical therapy.
- The patient's heart rate is 75/min, and she has **no evidence of an arrhythmia** requiring cardioversion; her prolonged PR interval is a conduction delay, not an arrhythmia.
*Metoprolol therapy*
- **Metoprolol** is a beta-blocker that would **further slow AV nodal conduction** and could potentially worsen the first-degree AV block or precipitate a higher-degree block.
- It is contraindicated as a treatment for AV block and would exacerbate the underlying issue caused by verapamil.
*Pacemaker placement*
- **Pacemaker placement** is considered for **symptomatic second-degree or third-degree AV block**, or in some cases of first-degree AV block if it progresses to a higher degree and causes severe symptoms.
- This patient has a **first-degree AV block** and is **asymptomatic** and **hemodynamically stable**, thus a pacemaker is not indicated at this time.
Specialty consultation timing US Medical PG Question 8: A 77-year-old man with a history of hypertension and a 46 pack-year smoking history presents to the emergency department from an extended care facility with acute onset of headache, nausea, vomiting, and neck pain which started 6 hours ago and has persisted since. He is alert, but his baseline level of consciousness is slightly diminished per the nursing home staff. His temperature is 99.0°F (37.2°C), blood pressure is 164/94 mmHg, pulse is 90/min, respirations are 16/min, and oxygen saturation is 98% on room air. The patient's neurological exam is unremarkable with cranial nerves II-XII grossly intact and with stable gait with a walker. He is immediately sent for a head CT which is normal. What is the most appropriate next step in management?
- A. Ultrasound
- B. Lumbar puncture (Correct Answer)
- C. Alteplase
- D. Ibuprofen, acetaminophen, metoclopramide, and diphenhydramine
- E. MRI
Specialty consultation timing Explanation: ***Lumbar puncture***
- The patient's symptoms (acute severe headache, nausea, vomiting, neck pain) and risk factors (hypertension, smoking history) are highly suggestive of a **subarachnoid hemorrhage (SAH)**, even with a normal initial **non-contrast head CT**.
- A **lumbar puncture (LP)** is the next critical diagnostic step to detect **xanthochromia** (due to bilirubin degradation from red blood cells) or elevated red blood cell count in the cerebrospinal fluid (CSF), which would confirm SAH.
- CT has approximately **95% sensitivity in the first 6 hours**, but sensitivity decreases over time, making LP essential when clinical suspicion remains high.
*Ultrasound*
- **Ultrasound** is not a standard diagnostic tool for acute neurological symptoms like severe headache or suspected SAH.
- It is primarily used for evaluating soft tissues, abdominal organs, and vascular structures like carotid arteries, but offers limited utility for intracranial bleeding.
*Alteplase*
- **Alteplase** (tissue plasminogen activator, tPA) is a thrombolytic agent used in acute ischemic stroke, characterized by focal neurological deficits due to arterial occlusion.
- Administering alteplase in the setting of headache and neck pain without focal deficits, while SAH is suspected, could be fatal as it would worsen bleeding.
*Ibuprofen, acetaminophen, metoclopramide, and diphenhydramine*
- This combination of medications is used for **symptomatic relief** of headache and nausea but does not address the underlying potentially life-threatening cause.
- Treating symptoms without a definitive diagnosis in suspected SAH could lead to delayed intervention and worse outcomes.
*MRI*
- While **MRI with specific sequences (FLAIR, GRE, SWI)** has high sensitivity for detecting SAH and is increasingly used in clinical practice, **lumbar puncture remains the traditional and most widely recommended next step** after a negative CT in suspected SAH.
- LP directly detects **xanthochromia** (present 6-12 hours after bleeding) and RBCs in CSF, providing definitive evidence of SAH.
- MRI may not always be readily available in the emergency setting, takes longer to perform, and requires patient stability and cooperation.
- For standardized exams, **LP is the classic correct answer** when CT is negative but clinical suspicion for SAH remains high.
Specialty consultation timing US Medical PG Question 9: A 65-year-old man is admitted to the hospital because of a 1-month history of fatigue, intermittent fever, and weakness. Results from a peripheral blood smear taken during his evaluation are indicative of possible acute myeloid leukemia. Bone marrow aspiration and subsequent cytogenetic studies confirm the diagnosis. The physician sets aside an appointed time-slot and arranges a meeting in a quiet office to inform him about the diagnosis and discuss his options. He has been encouraged to bring someone along to the appointment if he wanted. He comes to your office at the appointed time with his daughter. He appears relaxed, with a full range of affect. Which of the following is the most appropriate opening statement in this situation?
- A. Your lab reports show that you have an acute myeloid leukemia
- B. What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies? (Correct Answer)
- C. You must be curious and maybe even anxious about the results of your tests.
- D. I may need to refer you to a blood cancer specialist because of your diagnosis. You may need chemotherapy or radiotherapy, which we are not equipped for.
- E. Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?
Specialty consultation timing Explanation: ***"What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies?"***
- This **open-ended question** allows the patient to express their current knowledge and perceptions, which helps the physician tailor the discussion.
- It establishes a **patient-centered approach**, respecting the patient's existing understanding and preparing them for further information.
*"You must be curious and maybe even anxious about the results of your tests."*
- While empathic, this statement makes an **assumption about the patient's feelings** rather than inviting them to share their own.
- It is often better to ask directly or use more open-ended questions that allow the patient to express their true emotions, especially given their **relaxed demeanor**.
*"I may need to refer you to a blood cancer specialist because of your diagnosis. You may need chemotherapy or radiotherapy, which we are not equipped for.”"*
- This statement immediately introduces **overwhelming and potentially alarming information** (referral, chemotherapy, radiotherapy) without first establishing the diagnosis or assessing the patient's readiness to receive it.
- It prematurely jumps to treatment and logistics, potentially causing **unnecessary distress** before the patient has processed the core diagnosis.
*"Would you like to know all the details of your diagnosis, or would you prefer I just explain to you what our options are?""*
- While it attempts to assess the patient's preference for information, this question is a **closed-ended "either/or" choice** that might limit the patient's ability to express nuanced needs.
- It also prematurely introduces the idea of "options" without first explaining the diagnosis in an understandable context.
*"Your lab reports show that you have an acute myeloid leukemia"*
- This is a **direct and blunt delivery of a serious diagnosis** without any preparatory context or assessment of the patient's existing knowledge or emotional state.
- Delivering such news abruptly can be shocking and overwhelming, potentially **hindering effective communication** and rapport building.
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