Diagnostic parsimony (Occam's razor) US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Diagnostic parsimony (Occam's razor). These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Diagnostic parsimony (Occam's razor) US Medical PG Question 1: A mother presents to the family physician with her 16-year-old son. She explains, "There's something wrong with him doc. His grades are getting worse, he's cutting class, he's gaining weight, and his eyes are often bloodshot." Upon interviewing the patient apart from his mother, he seems withdrawn and angry at times when probed about his social history. The patient denies abuse and sexual history. What initial test should be sent to rule out the most likely culprit of this patient's behavior?
- A. Complete blood count
- B. Sexually transmitted infection (STI) testing
- C. Blood culture
- D. Urine toxicology screen (Correct Answer)
- E. Slit lamp examination
Diagnostic parsimony (Occam's razor) Explanation: ***Urine toxicology screen***
- The patient's presentation with **declining grades**, **cutting class**, **weight gain**, **bloodshot eyes**, and **irritability** are classic signs of **substance abuse** in an adolescent.
- A **urine toxicology screen** is the most appropriate initial test to detect common illicit substances, especially given the clear signs pointing towards drug use.
*Slit lamp examination*
- This test is used to examine the **anterior segment of the eye**, including the conjunctiva, cornea, iris, and lens.
- While the patient has **bloodshot eyes**, this specific test would be more relevant for ruling out ocular infections or injuries, not for diagnosing the underlying cause of systemic behavioral changes.
*Complete blood count*
- A **complete blood count (CBC)** measures different components of the blood, such as red blood cells, white blood cells, and platelets.
- A CBC is a general health indicator and while it can detect infections or anemia, it is not specific or sensitive enough to identify the cause of the behavioral changes described.
*Sexually transmitted infection (STI) testing*
- Although the patient denies sexual history, all adolescents presenting with certain risk factors or symptoms may warrant STI testing in a broader health assessment.
- However, in this scenario, the primary cluster of symptoms (poor grades, cutting class, bloodshot eyes, irritability) points more directly to substance abuse than to an STI.
*Blood culture*
- A **blood culture** is used to detect the presence of bacteria or other microorganisms in the bloodstream, indicating a systemic infection (sepsis).
- The patient's symptoms are not indicative of an acute bacterial bloodstream infection, and a blood culture would not be the initial test for the presented behavioral changes.
Diagnostic parsimony (Occam's razor) US Medical PG Question 2: A 65-year-old obese man presents to his primary care clinic feeling weak. He was in the military and stationed in Vietnam in his youth. His current weakness gradually worsened to the point that he had to call his son to help him stand to get on the ambulance. He smokes a pack of cigarettes every day and drinks a bottle of vodka a week. He has been admitted for alcohol withdrawal multiple times and has been occasionally taking thiamine, folic acid, and naltrexone. He denies taking steroids. His temperature is 98°F (36.7°C), blood pressure is 170/90 mmHg, pulse is 75/min, and respirations are 20/min. He is obese with a significant pannus. Hepatomegaly is not appreciable. Abdominal striae are present. His workup is notable for the following:
Serum:
Na+: 142 mEq/L
Cl-: 102 mEq/L
K+: 3.9 mEq/L
HCO3-: 25 mEq/L
BUN: 24 mg/dL
Glucose: 292 mg/dL
Creatinine: 1.5 mg/dL
Ca2+: 10.1 mg/dL
AST: 7 U/L
ALT: 14 U/L
24-hour urinary cortisol: 400 µg (reference range < 300 µg)
Serum cortisol: 45 pg/mL (reference range < 15 pg/mL)
A 48-hour high dose dexamethasone suppression trial shows that his serum cortisol levels partially decrease to 25 pg/mL and his adrenocorticotropin-releasing hormone (ACTH) level decreases from 10 to 6 pg/mL (reference range > 5 pg/mL). What is the best next step in management?
- A. MRI of the pituitary gland (Correct Answer)
- B. MRI of the adrenal glands
- C. Low-dose dexamethasone therapy for 3 months
- D. CT of the chest
- E. High-dose dexamethasone therapy for 3 months
Diagnostic parsimony (Occam's razor) Explanation: ***MRI of the pituitary gland***
- The elevated 24-hour urinary cortisol and serum cortisol levels, along with **partial suppression on the high-dose dexamethasone suppression test** and a decrease in ACTH, strongly suggest a pituitary source of **Cushing's disease**.
- An MRI of the pituitary gland is the appropriate next step to visualize an **adenoma** responsible for the excess ACTH production.
*MRI of the adrenal glands*
- An adrenal MRI would be indicated if the ACTH levels were **low or undetectable**, suggesting an adrenal tumor as the primary cause of Cushing's syndrome.
- Since ACTH levels decreased, but remained elevated, an adrenal origin is less likely.
*Low-dose dexamethasone therapy for 3 months*
- Dexamethasone therapy is not a treatment for Cushing's syndrome; instead, it is used as a **diagnostic tool** to assess cortisol suppression.
- Long-term administration of dexamethasone would mimic iatrogenic Cushing's syndrome and **exacerbate the patient's condition**.
*CT of the chest*
- A CT of the chest would be considered if an **ectopic ACTH-producing tumor** (e.g., small cell lung cancer) was suspected, which typically presents with very high ACTH levels and no suppression with high-dose dexamethasone.
- The partial suppression and lower ACTH levels make an ectopic source less likely in this case.
*High-dose dexamethasone therapy for 3 months*
- Similar to low-dose dexamethasone therapy, high-dose dexamethasone is a **diagnostic test**, not a long-term treatment for Cushing's syndrome.
- Such therapy would worsen the patient's condition and **does not address the underlying pathology**.
Diagnostic parsimony (Occam's razor) US Medical PG Question 3: A 52-year-old man comes to the physician because of a 3-week history of a cough and hoarseness. He reports that the cough is worse when he lies down after lunch. His temperature is 37.5°C (99.5°F); the remainder of his vital signs are within normal limits. Because the physician has recently been seeing several patients with the common cold, the diagnosis of a viral upper respiratory tract infection readily comes to mind. The physician fails to consider the diagnosis of gastroesophageal reflux disease, which the patient is later found to have. Which of the following most accurately describes the cognitive bias that the physician had?
- A. Framing
- B. Anchoring
- C. Visceral
- D. Confirmation
- E. Availability (Correct Answer)
Diagnostic parsimony (Occam's razor) Explanation: ***Availability***
- The physician recently seeing several patients with the common cold led to this diagnosis readily coming to mind, demonstrating how easily recalled examples can disproportionately influence diagnosis.
- This bias occurs when easily recalled instances or information (like recent cases of common cold) are used to estimate the likelihood or frequency of an event, even if other more relevant data exist.
*Framing*
- This bias occurs when the way information is presented (e.g., as a gain or a loss) influences a decision, rather than the intrinsic characteristics of the options themselves.
- The scenario does not involve the presentation of information in different ways to sway the physician's judgment.
*Anchoring*
- This bias involves relying too heavily on an initial piece of information (the "anchor") when making subsequent judgments, often leading to insufficient adjustment away from that anchor.
- While the physician initially considered a viral URI, the setup is more about the ease of recall influencing the decision rather than being stuck on an initial data point.
*Visceral*
- This is not a commonly recognized cognitive bias in the context of medical decision-making; "visceral" largely refers to emotional or intuitive feelings rather than a structured cognitive bias.
- Cognitive biases describe systematic patterns of deviation from norm or rationality in judgment, not merely emotional responses.
*Confirmation*
- This bias involves seeking, interpreting, favoring, and recalling information in a way that confirms one's pre-existing beliefs or hypotheses.
- The physician did not actively seek information to confirm the common cold diagnosis; rather, the diagnosis came to mind due to recent encounters, which aligns with availability bias.
Diagnostic parsimony (Occam's razor) US Medical PG Question 4: A 55-year-old man presents to his primary care physician for a new patient appointment. The patient states that he feels well and has no concerns at this time. The patient has a past medical history of hypertension, an elevated fasting blood glucose, and is not currently taking any medications. His blood pressure is 177/118 mmHg, pulse is 90/min, respirations are 16/min, and oxygen saturation is 97% on room air. Physical exam is notable for an obese man with atrophy of his limbs and striae on his abdomen. Laboratory values are notable for a blood glucose of 175 mg/dL. Which of the following is the best next step in evaluation?
- A. Hydrochlorothiazide
- B. MRI of the head
- C. Metformin
- D. Weight loss
- E. Dexamethasone suppression test (Correct Answer)
Diagnostic parsimony (Occam's razor) Explanation: ***Dexamethasone suppression test***
- The patient presents with **atrophy of the limbs** with concurrent **striae on the abdomen**, uncontrolled hypertension, and elevated blood glucose, which are all classic signs of **Cushing's syndrome**.
- A **dexamethasone suppression test** is the best initial diagnostic step to confirm Cushing's syndrome by assessing the body's cortisol regulation.
*Hydrochlorothiazide*
- While the patient has **hypertension**, treating the symptom without addressing the underlying cause (Cushing's syndrome) would be insufficient and potentially delay proper diagnosis.
- **Hydrochlorothiazide** is an antihypertensive, but without addressing the likely cortisol excess, blood pressure control will be challenging.
*MRI of the head*
- An **MRI of the head** (specifically the pituitary) would be considered after biochemical confirmation of Cushing's syndrome to localize a potential tumor, but it is not the initial diagnostic step.
- Imaging is performed *after* biochemical tests indicate cortisol excess, to differentiate between pituitary, adrenal, or ectopic causes.
*Metformin*
- The patient has **elevated blood glucose**, but initiating an antidiabetic medication like **metformin** before evaluating for Cushing's syndrome would be treating a symptom without identifying the root cause.
- Diabetes in this context is likely secondary to excess cortisol, so managing it effectively requires addressing the underlying endocrine disorder.
*Weight loss*
- While **weight loss** is generally beneficial for hypertension and diabetes, in the context of Cushing's syndrome with **limb atrophy** and **central obesity**, focusing solely on weight loss without addressing the hormonal imbalance would be ineffective.
- The characteristic fat redistribution in Cushing's syndrome makes simple weight loss difficult and less impactful until cortisol levels are managed.
Diagnostic parsimony (Occam's razor) US Medical PG Question 5: A 34-year-old female presents to her primary care physician with complaints of fevers, nausea/vomiting, and severe left flank pain that has developed over the past several hours. She denies any prior episodes similar to her current presentation. Physical examination is significant for a body temperature of 39.1 C and costovertebral angle tenderness. A urinalysis and urine microscopy are ordered. Which of the following findings on kidney histology would be expected in this patient?
- A. Enlarged, hypercellular glomeruli with 'wire-looping' of capillaries
- B. Neutrophils filling the lumens of the renal tubules (Correct Answer)
- C. Scarring of the glomeruli
- D. Interstitial fibrosis and lymphocytic infiltrate
- E. Thickening of the capillaries and glomerular basement membrane
Diagnostic parsimony (Occam's razor) Explanation: ***Neutrophils filling the lumens of the renal tubules***
- This patient's symptoms (fevers, nausea/vomiting, severe left flank pain, fever, and costovertebral angle tenderness) are highly suggestive of **acute pyelonephritis**, an infection of the kidney parenchyma.
- Histologically, acute pyelonephritis is characterized by an acute inflammatory infiltrate, primarily **neutrophils**, within the **renal tubules** and interstitial tissue, often forming **abscesses**.
*Enlarged, hypercellular glomeruli with 'wire-looping' of capillaries*
- This description is characteristic of **diffuse proliferative glomerulonephritis**, often associated with conditions like **systemic lupus erythematosus (SLE)**.
- The clinical presentation of sudden-onset severe flank pain and fever is not typical for glomerulonephritis, which usually presents with hematuria, proteinuria, and edema.
*Scarring of the glomeruli*
- **Glomerulosclerosis** (scarring of the glomeruli) is a feature of chronic kidney disease and various chronic glomerular disorders, not acute pyelonephritis.
- Patients with glomerular scarring typically present with signs of chronic kidney injury, such as persistent proteinuria and declining renal function, rather than acute infectious symptoms.
*Interstitial fibrosis and lymphocytic infiltrate*
- This is a hallmark of **chronic interstitial nephritis**, which can be caused by long-term drug use, autoimmune diseases, or chronic obstructive uropathy.
- While lymphocytes indicate inflammation, the presence of fibrosis suggests a chronic process, differing from the acute bacterial infection seen in pyelonephritis.
*Thickening of the capillaries and glomerular basement membrane*
- This finding is suggestive of various glomerular diseases, such as **membranous nephropathy** or **diabetic nephropathy**, where the glomerular basement membrane is significantly altered.
- Such conditions typically manifest with proteinuria and nephrotic or nephritic syndromes, not the acute infectious symptoms described.
Diagnostic parsimony (Occam's razor) US Medical PG Question 6: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?
- A. "Does the diarrhea typically precede the constipation, or vice-versa?"
- B. "Is the diarrhea foul-smelling?"
- C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
- D. "Are the symptoms worse in the morning or at night?"
- E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)
Diagnostic parsimony (Occam's razor) Explanation: ***Can you tell me more about the symptoms you have been experiencing?***
- This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis.
- In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions.
*Does the diarrhea typically precede the constipation, or vice-versa?*
- While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience.
- It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture.
*Is the diarrhea foul-smelling?*
- Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions.
- However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed.
*Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life*
- Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time.
- However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially.
*Are the symptoms worse in the morning or at night?*
- Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related.
- This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.
Diagnostic parsimony (Occam's razor) US Medical PG Question 7: 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?
Diagnostic parsimony (Occam's razor) 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.
Diagnostic parsimony (Occam's razor) US Medical PG Question 8: A 55-year-old man presents to the emergency department with fatigue and a change in his memory. The patient and his wife state that over the past several weeks the patient has been more confused and irritable and has had trouble focusing. He has had generalized and non-specific pain in his muscles and joints and is constipated. His temperature is 99.3°F (37.4°C), blood pressure is 172/99 mmHg, pulse is 79/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is unremarkable. Laboratory studies are ordered as seen below.
Hemoglobin: 9.0 g/dL
Hematocrit: 30%
Leukocyte count: 6,500/mm^3 with normal differential
Platelet count: 166,000/mm^3
MCV: 78 fL
Serum:
Na+: 141 mEq/L
Cl-: 103 mEq/L
K+: 4.6 mEq/L
HCO3-: 25 mEq/L
BUN: 20 mg/dL
Glucose: 99 mg/dL
Creatinine: 0.9 mg/dL
Ca2+: 10.2 mg/dL
Which of the following is the most likely diagnosis?
- A. Iron deficiency
- B. Heavy metal exposure (Correct Answer)
- C. Systemic lupus erythematosus
- D. Guillain-Barre syndrome
- E. Vitamin B12 deficiency
Diagnostic parsimony (Occam's razor) Explanation: ***Heavy metal exposure***
- The patient presents with **microcytic anemia** (Hemoglobin 9.0 g/dL, MCV 78 fL), **neuropsychiatric symptoms** (confusion, memory changes, irritability), **constipation**, **hypertension**, and **muscle/joint pain** - a constellation highly suggestive of **lead poisoning**.
- **Lead poisoning** classically causes **microcytic anemia** (due to inhibition of heme synthesis), **neurological symptoms** (encephalopathy, cognitive dysfunction), **GI symptoms** (constipation, abdominal pain/"lead colic"), and **hypertension**.
- The combination of **microcytic anemia with multisystem involvement** (CNS, GI, cardiovascular, musculoskeletal) points to **heavy metal toxicity** rather than simple iron deficiency.
- Confirmatory testing would include **blood lead levels** and **peripheral blood smear** (showing basophilic stippling).
*Iron deficiency*
- While **iron deficiency** causes **microcytic anemia**, it does NOT adequately explain the **neuropsychiatric symptoms** (confusion, irritability, memory changes), **hypertension**, or the **severe constipation**.
- Iron deficiency typically presents with **fatigue and weakness** but not the prominent **CNS dysfunction** seen in this patient.
- The **multisystem involvement** suggests a toxic or systemic process rather than simple nutritional deficiency.
*Systemic lupus erythematosus*
- While **SLE** can cause fatigue and joint pain, it typically presents with **malar rash, photosensitivity, serositis, and specific autoantibodies**.
- **SLE-associated anemia** is typically **normocytic** (anemia of chronic disease) or **hemolytic**, not microcytic.
- The lack of typical **autoimmune features** makes this diagnosis less likely.
*Guillain-Barre syndrome*
- **GBS** presents with **acute ascending paralysis** and **areflexia** following an infection.
- The patient's symptoms are **central** (confusion, memory issues), while **GBS affects the peripheral nervous system**.
- **GBS does not cause anemia** or the constellation of symptoms described.
*Vitamin B12 deficiency*
- **Vitamin B12 deficiency** causes **macrocytic anemia** (elevated MCV), not microcytic.
- The blood work shows **low MCV (78 fL)**, which rules out B12 deficiency.
- Neurological symptoms of B12 deficiency include **subacute combined degeneration** (posterior column dysfunction), **paresthesias**, and **gait disturbances**, distinct from the presentation here.
Diagnostic parsimony (Occam's razor) US Medical PG Question 9: A 27-year-old woman presents to the emergency department for fever and generalized malaise. Her symptoms began approximately 3 days ago, when she noticed pain with urination and mild blood in her urine. Earlier this morning she experienced chills, flank pain, and mild nausea. Approximately 1 month ago she had the "flu" that was rhinovirus positive and was treated with supportive management. She has a past medical history of asthma. She is currently sexually active and uses contraception inconsistently. She occasionally drinks alcohol and denies illicit drug use. Family history is significant for her mother having systemic lupus erythematosus. Her temperature is 101°F (38.3°C), blood pressure is 125/87 mmHg, pulse is 101/min, and respirations are 18/min. On physical examination, she appears uncomfortable. There is left-sided flank, suprapubic, and costovertebral angle tenderness. Urine studies are obtained and a urinalysis is demonstrated below:
Color: Amber
pH: 6.8
Leukocyte: Positive
Protein: Trace
Glucose: Negative
Ketones: Negative
Blood: Positive
Nitrite: Positive
Leukocyte esterase: Positive
Specific gravity: 1.015
If a renal biopsy is performed in this patient, which of the following would most likely be found on pathology?
- A. Diffuse capillary and glomerular basement membrane thickening
- B. Suppurative inflammation with interstitial neutrophilic infiltration (Correct Answer)
- C. Mesangial proliferation
- D. Focal and segmental sclerosis of the glomeruli and mesangium
- E. Granulomatous inflammation with epithelioid macrophages
Diagnostic parsimony (Occam's razor) Explanation: ***Suppurative inflammation with interstitial neutrophilic infiltration***
- The patient's symptoms (fever, chills, flank pain, dysuria, hematuria) and positive urinalysis (nitrite, leukocyte esterase, WBCs) are highly indicative of **acute pyelonephritis**, a bacterial infection of the kidney.
- A renal biopsy in acute pyelonephritis typically shows **suppurative (purulent) inflammation** characterized by an influx of **neutrophils** into the renal interstitium and tubules, representing acute inflammation.
- This is the hallmark pathological finding in acute bacterial pyelonephritis.
*Diffuse capillary and glomerular basement membrane thickening*
- This finding is characteristic of **membranous nephropathy**, a cause of nephrotic syndrome presenting with proteinuria and edema, not an acute infection.
- The patient's clinical presentation with fever, flank pain, and signs of bacterial infection does not align with membranous nephropathy.
*Granulomatous inflammation with epithelioid macrophages*
- **Granulomatous inflammation** is a chronic inflammatory pattern seen in conditions like **tuberculosis, sarcoidosis, or fungal infections**.
- The acute presentation, positive nitrites (indicating gram-negative bacteria), and clinical course are inconsistent with granulomatous disease, which would have a more indolent course.
*Mesangial proliferation*
- **Mesangial proliferation** is a feature of glomerular diseases like **IgA nephropathy** (which can present after upper respiratory infection) or lupus nephritis.
- While the patient has a family history of lupus, her acute infectious symptoms with positive nitrites indicate bacterial pyelonephritis, not a glomerular disease.
*Focal and segmental sclerosis of the glomeruli and mesangium*
- This finding is characteristic of **Focal Segmental Glomerulosclerosis (FSGS)**, a primary glomerular disease that typically presents with nephrotic syndrome (heavy proteinuria, edema, hypoalbuminemia).
- The patient's acute infectious symptoms and signs of urinary tract infection are inconsistent with FSGS.
Diagnostic parsimony (Occam's razor) US Medical PG Question 10: A 57-year-old man presents to the emergency department for weight loss and abdominal pain. The patient states that he has felt steadily more fatigued over the past month and has lost 22 pounds without effort. Today, he fainted prompting his presentation. The patient has no significant past medical history. He does have a 33 pack-year smoking history and drinks 4 to 5 alcoholic drinks per day. His temperature is 99.5°F (37.5°C), blood pressure is 100/58 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you see a patient who is very thin and appears to be pale. Stool fecal occult blood testing is positive. A CT scan of the abdomen is performed demonstrating a mass in the colon with multiple metastatic lesions scattered throughout the abdomen. The patient is informed of his diagnosis of metastatic colon cancer. When the patient conveys the information to his family he focuses his efforts on discussing the current literature in the field and the novel therapies that have been invented. He demonstrates his likely mortality outcome which he calculated using the results of a large multi-center study. Which of the following is this patient most likely demonstrating?
- A. Intellectualization (Correct Answer)
- B. Dissociation
- C. Rationalization
- D. Optimism
- E. Pessimism
Diagnostic parsimony (Occam's razor) Explanation: ***Intellectualization***
- This defense mechanism involves **focusing on the intellectual aspects** of a stressful situation, using logical reasoning and factual analysis to avoid experiencing distressing emotions.
- The patient demonstrates this by discussing **literature, novel therapies, and mortality statistics** regarding his metastatic colon cancer.
*Dissociation*
- **Dissociation** involves a mental process that causes a lack of connection in a person's thoughts, memory, and sense of identity.
- This patient is actively engaging with the information, not disconnecting from it.
*Rationalization*
- **Rationalization** is creating logical but false explanations for unacceptable thoughts, feelings, or behaviors to justify them.
- The patient is not trying to justify his actions or feelings, but rather to understand his disease intellectually.
*Optimism*
- **Optimism** is a disposition to look on the favorable side of events or conditions and to expect the most favorable outcome.
- While hope for novel therapies could be seen as optimistic, his detailed calculation of mortality outcomes is a realistic, rather than purely optimistic, approach.
*Pessimism*
- **Pessimism** is a tendency to see the worst aspect of things or believe that the worst will happen.
- The patient is engaging with the facts of his diagnosis, even calculating his mortality outcome, which is not necessarily a pessimistic but rather a realistic and intellectual approach.
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