Motivational interviewing techniques US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Motivational interviewing techniques. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Motivational interviewing techniques US Medical PG Question 1: A 23-year-old man presents to the emergency department with a chief complaint of being assaulted on the street. The patient claims that he has been followed by the government for quite some time and that he was assaulted by a government agent but was able to escape. He often hears voices telling him to hide. The patient has an unknown past medical history and admits to smoking marijuana frequently. On physical exam, the patient has no signs of trauma. When interviewing the patient, he is seen conversing with an external party that is not apparent to you. The patient states that he is afraid for his life and that agents are currently pursuing him. What is the best initial response to this patient’s statement?
- A. I think you are safe from the agents here.
- B. You have a mental disorder but don’t worry we will help you.
- C. I don’t think any agents are pursuing you.
- D. What medications are you currently taking?
- E. It sounds like you have been going through some tough experiences lately. (Correct Answer)
Motivational interviewing techniques Explanation: ***It sounds like you have been going through some tough experiences lately.***
- This response **acknowledges the patient's distress** and experience without validating or refuting their delusional beliefs.
- It helps establish **rapport** and encourages the patient to share more about their symptoms, which is crucial for assessment in a psychiatric emergency.
*I think you are safe from the agents here.*
- While intended to reassure, directly addressing the delusion can be perceived as dismissive and may **escalate the patient's paranoia** or agitation.
- It does not validate their *feelings* of fear, which are real to them, even if the source is delusional.
*You have a mental disorder but don’t worry we will help you.*
- This statement is **confrontational** and judgmental, labeling the patient immediately with a diagnosis.
- This approach can cause the patient to become defensive, shut down, or feel stigmatized, making further assessment and trust-building very difficult in the **initial interaction**.
*I don’t think any agents are pursuing you.*
- Directly **challenging a patient's delusion** is generally unhelpful in acute settings and can lead to increased agitation.
- It invalidates their subjective reality and can make them feel misunderstood or distrustful of the healthcare provider.
*What medications are you currently taking?*
- While important information, asking about medications is too premature as an *initial response* to a patient expressing severe paranoia and fear.
- This question comes across as dismissive of their current emotional state and **prioritizes medical history over emotional support** and rapport-building.
Motivational interviewing techniques US Medical PG Question 2: A 52-year-old man with a 20+ year history of smoking comes in today to talk about quitting. His wife has recently been trying to quit, and she wants him to quit with her. He has been resistant in the past, but he is now very willing to talk with you about it. Today, he seems like he really wants to make a change. What stage of change does this behavior correspond to?
- A. Action
- B. Preparation
- C. Precontemplation
- D. Maintenance
- E. Contemplation (Correct Answer)
Motivational interviewing techniques Explanation: ***Contemplation***
- The patient is **aware of the problem and willing to discuss quitting**, indicating he is seriously thinking about making a change.
- He "seems like he really wants to make a change" and is "very willing to talk" about it, which demonstrates **serious consideration** of behavior change.
- In contemplation stage, individuals intend to change **within the next 6 months** and are actively weighing pros and cons, but have not yet committed to concrete action plans.
- The patient has not mentioned setting a quit date or taking preparatory steps, which would be needed for the preparation stage.
*Preparation*
- This stage involves **commitment to action within 30 days** with concrete plans (e.g., setting a quit date, purchasing nicotine replacement therapy, joining a support group).
- The patient is only discussing and wanting to change, but has not yet made **specific plans or commitments** to quit.
- Simply being willing to talk does not indicate readiness for imminent action.
*Action*
- This stage involves **actively modifying behavior** or environment to overcome the addiction (e.g., has already stopped smoking).
- The patient is still actively smoking and has not yet initiated the quitting process.
*Maintenance*
- This stage is for individuals who have **successfully maintained behavior change for at least 6 months**.
- The patient has not yet quit smoking.
*Precontemplation*
- Individuals in this stage are **unaware or unwilling to acknowledge a problem** and have no intention of changing.
- The patient is clearly aware and willing to discuss the problem, moving well past this stage.
Motivational interviewing techniques US Medical PG Question 3: A 15-year-old female presents to her family physician for an annual school physical exam and check-up. She is accompanied by her mother to the visit and is present in the exam room. The patient has no complaints, and she does not have any past medical problems. She takes no medications. The patient reports that she remains active, exercising 5 times a week, and eats a healthy and varied diet. Which of the following would be the best way for the physician to obtain a more in-depth social history, including sexual history and use of alcohol, tobacco, or recreational drugs?
- A. Disallow the mother to be present in the examination room throughout the entirety of the visit
- B. Give the patient a social history questionnaire to fill out in the exam room
- C. Ask the mother to step outside into the hall for a portion of the visit (Correct Answer)
- D. Ask the patient the questions directly, with her mother still in the exam room
- E. Speak softly to the patient so that the mother does not hear and the patient is not embarrassed
Motivational interviewing techniques Explanation: ***Ask the mother to step outside into the hall for a portion of the visit***
- This approach allows the physician to speak with the adolescent **privately and confidentially**, which is crucial for obtaining sensitive information such as sexual history, drug use, and mental health concerns.
- Adolescents are more likely to disclose personal information when their parents are not present, fostering trust and ensuring **comprehensive history-taking** vital for their well-being.
*Disallow the mother to be present in the examination room throughout the entirety of the visit*
- This is an **overly restrictive** approach that might create tension or distrust between the physician, patient, and parent, especially at the start of the visit.
- While privacy is essential for sensitive topics, parental presence can be valuable for discussing general health, family history, and **treatment plans**, especially for younger adolescents.
*Give the patient a social history questionnaire to fill out in the exam room*
- While questionnaires can be useful for gathering basic information, they often **lack the nuance** of a direct conversation and may not prompt the patient to elaborate on sensitive issues.
- Furthermore, having the mother present while the patient fills out a questionnaire on sensitive topics still **compromises confidentiality** and may lead to incomplete or dishonest answers.
*Ask the patient the questions directly, with her mother still in the exam room*
- Asking sensitive questions with a parent present is **unlikely to yield truthful and complete answers**, as adolescents may feel embarrassed, judged, or fear parental disapproval.
- This approach compromises the **confidentiality** that is fundamental to building trust with adolescent patients.
*Speak softly to the patient so that the mother does not hear and the patient is not embarrassed*
- Speaking softly is **unprofessional** and still does not guarantee privacy, as the mother might still overhear parts of the conversation.
- This method also **fails to establish true confidentiality**, which is central to building rapport and encouraging open communication with adolescent patients about sensitive topics.
Motivational interviewing techniques US Medical PG Question 4: A 15-year-old girl is brought to the physician by her mother for an annual well-child examination. Her mother complains that the patient has a poor diet and spends most of the evening at home texting her friends instead of doing homework. She has been caught smoking cigarettes in the school bathroom several times and appears indifferent to the dean's threats of suspension. Two weeks ago, the patient allowed a friend to pierce her ears with unsterilized safety pins. The mother appeals to the physician to lecture the patient about her behavior and “set her straight.” The patient appears aloof and does not make eye contact. Her grooming is poor. Upon questioning the daughter about her mood, the mother responds “She acts like a rebel. I can't wait until puberty is over.” Which of the following is the most appropriate response?
- A. You should listen to your mother's concerns. You don't want to make poor choices early on or else you might end up on the streets.
- B. Would it be possible for you to step out for a few moments so that I can interview your daughter alone? (Correct Answer)
- C. Let's run a routine urine toxicology screen to make sure your daughter is not doing drugs.
- D. I am very concerned that your daughter is displaying signs of depression, and I'd suggest that she is seen by a psychiatrist.
- E. Your daughter displays normal signs of puberty. Being overly critical of your daughter is not helpful.
Motivational interviewing techniques Explanation: ***"Would it be possible for you to step out for a few moments so that I can interview your daughter alone?"***
- This approach respects the adolescent's **autonomy** and provides a safe space for her to disclose sensitive information without parental presence.
- Adolescents are more likely to be **candid** about risky behaviors like smoking, substance use, or sexual activity if they feel their privacy is protected.
*"You should listen to your mother's concerns. You don't want to make poor choices early on or else you might end up on the streets."*
- This response is **confrontational** and judgmental, which is likely to alienate the patient and shut down communication.
- It also uses **fear tactics** rather than fostering trust and a therapeutic relationship.
*"Let's run a routine urine toxicology screen to make sure your daughter is not doing drugs."*
- While drug use is a concern given her risky behaviors, immediately suggesting a **toxicology screen** without building rapport can feel accusatory and escalate distrust.
- It's often more effective to establish communication first before moving to definitive testing, especially in a well-child visit where drug use has not been directly admitted.
*"I am very concerned that your daughter is displaying signs of depression, and I'd suggest that she is seen by a psychiatrist."*
- While some of the patient's behaviors (poor grooming, aloofness, indifference) could be consistent with **depression**, immediately jumping to a diagnosis and referral without a direct interview is premature.
- It can also be perceived as labeling and might be rejected by the patient and mother without further exploration.
*"Your daughter displays normal signs of puberty. Being overly critical of your daughter is not helpful."*
- This response dismisses the mother's valid concerns about genuinely **risky behaviors** (smoking, unsterilized piercing, indifference to consequences) as "normal puberty."
- It also implicitly criticizes the mother, which can damage the therapeutic alliance with both the parent and the patient.
Motivational interviewing techniques US Medical PG Question 5: An orthopaedic surgeon at a local community hospital has noticed that turnover times in the operating room have been unnecessarily long. She believes that the long wait times may be due to inefficient communication between the surgical nursing staff, the staff in the pre-operative area, and the staff in the post-operative receiving area. She believes a secure communication mobile phone app would help to streamline communication between providers and improve efficiency in turnover times. Which of the following methods is most appropriate to evaluate the impact of this intervention in the clinical setting?
- A. Plan-Do-Study-Act cycle (Correct Answer)
- B. Failure modes and effects analysis
- C. Standardization
- D. Forcing function
- E. Root cause analysis
Motivational interviewing techniques Explanation: ***Plan-Do-Study-Act cycle***
- The **Plan-Do-Study-Act (PDSA) cycle** is a structured, iterative model used for continuous improvement in quality and efficiency, making it ideal for evaluating the impact of a new intervention like a communication app.
- This cycle allows for small-scale testing of changes, observation of results, learning from the observations, and refinement of the intervention before full implementation.
*Failure modes and effects analysis*
- **Failure modes and effects analysis (FMEA)** is a prospective method to identify potential failures in a process, predict their effects, and prioritize actions to prevent them.
- While useful for process improvement, FMEA is typically performed *before* implementing a change to identify risks, rather than to evaluate the impact of an already implemented intervention.
*Standardization*
- **Standardization** involves creating and implementing consistent processes or protocols to reduce variability and improve reliability.
- While the communication app might contribute to standardization, standardization itself is a *method of improvement* rather than a method for *evaluating the impact* of an intervention.
*Forcing function*
- A **forcing function** is a design feature that physically prevents an error from occurring, making it impossible to complete a task incorrectly.
- An app that streamlines communication does not act as a forcing function, as it facilitates a process rather than physically preventing an incorrect action.
*Root cause analysis*
- **Root cause analysis (RCA)** is a retrospective method used to investigate an event that has already occurred (e.g., an adverse event) to identify its underlying causes.
- This method is used *after* a problem has manifested to understand *why* it happened, not to evaluate the *impact* of a new intervention designed to prevent future problems.
Motivational interviewing techniques US Medical PG Question 6: A 20-year-old man comes to the physician because of decreasing academic performance at his college for the past 6 months. He reports a persistent fear of “catching germs” from his fellow students and of contracting a deadly disease. He finds it increasingly difficult to attend classes. He avoids handshakes and close contact with other people. He states that when he tries to think of something else, the fears “keep returning” and that he has to wash himself for at least an hour when he returns home after going outside. Afterwards he cleans the shower and has to apply disinfectant to his body and to the bathroom. He does not drink alcohol. He used to smoke cannabis but stopped one year ago. His vital signs are within normal limits. He appears anxious. On mental status examination, he is oriented to person, place, and time. In addition to starting an SSRI, which of the following is the most appropriate next step in management?
- A. Cognitive-behavioral therapy (Correct Answer)
- B. Psychodynamic psychotherapy
- C. Motivational interviewing
- D. Interpersonal therapy
- E. Group therapy
Motivational interviewing techniques Explanation: **Cognitive-behavioral therapy**
- **Cognitive-behavioral therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the most effective psychotherapy for **obsessive-compulsive disorder (OCD)**, which this patient's symptoms strongly suggest.
- CBT helps patients challenge distorted thoughts and gradually expose themselves to feared situations while preventing compulsive rituals, thus breaking the cycle of obsessions and compulsions.
*Psychodynamic psychotherapy*
- This therapy focuses on **unconscious conflicts** and **past experiences** to understand current symptoms.
- While it can be helpful for some mental health conditions, it is generally **less effective** than CBT for the specific, highly ritualized symptoms of OCD.
*Motivational interviewing*
- **Motivational interviewing** is a patient-centered counseling style designed to address **ambivalence about change** and enhance intrinsic motivation.
- It is often used in substance abuse or lifestyle changes, but it does not directly teach coping skills for OCD symptoms or address the underlying thought patterns.
*Interpersonal therapy*
- **Interpersonal therapy (IPT)** focuses on the patient's **current interpersonal relationships** and social functioning.
- While social difficulties can arise from OCD, IPT does not directly target the obsessions and compulsions that are central to the disorder.
*Group therapy*
- **Group therapy** can provide support and a sense of community, but for a severe condition like OCD, **individual therapy** (especially CBT/ERP) is typically recommended first due to the highly individualized nature of obsessions and compulsions.
- It may be a complementary approach, but usually not the most appropriate initial next step given the intensity of the patient's symptoms.
Motivational interviewing techniques US Medical PG Question 7: A 30-year-old computer scientist receives negative feedback on a recent project from his senior associate. He is told sternly that he must improve his performance on the next project. Later that day, he yells at his intern, a college student, for not showing enough initiative, though he had voiced only satisfaction with his performance up until this point. Which of the following psychological defense mechanisms is he demonstrating?
- A. Acting out
- B. Countertransference
- C. Projection
- D. Displacement (Correct Answer)
- E. Transference
Motivational interviewing techniques Explanation: ***Displacement***
- **Displacement** is a defense mechanism where a person redirects strong emotions, especially negative ones like anger, from the original source to a substitute target that is perceived as less threatening.
- The computer scientist's anger, initially generated by criticism from his senior associate, is redirected to his intern, who is a safer target.
*Acting out*
- **Acting out** involves expressing unconscious emotional conflicts or impulses through behavior, often inappropriate or destructive, rather than through words or feelings.
- While yelling at the intern is a behavior, the primary motive here is redirecting an emotion, not expressing a hidden conflict or impulse without awareness.
*Countertransference*
- **Countertransference** refers to the therapist's emotional reactions to a patient, rooted in their own unresolved conflicts, and is specific to the therapeutic relationship.
- This scenario involves an individual's reaction to workplace stress, not a dynamic within a therapeutic setting.
*Projection*
- **Projection** is attributing one's own unacceptable thoughts, feelings, or impulses to another person.
- In this case, the computer scientist isn't attributing his own poor performance or anger to the intern; rather, he is _redirecting_ his anger.
*Transference*
- **Transference** is the unconscious redirection of feelings and attitudes from a person in the past (e.g., a parent) to a person in the present (e.g., a therapist or boss).
- This scenario involves a direct reaction to a current stressor and redirection of emotion, not the reliving of past relationship dynamics with a new figure.
Motivational interviewing techniques US Medical PG Question 8: A 67-year-old man comes to the physician for a routine examination. He does not take any medications. He drinks 6 to 7 bottles of beer every night, and says he often has a shot of whiskey in the morning “for my headache.” He was recently fired from his job for arriving late. He says there is nothing wrong with his drinking but expresses frustration at his best friend no longer returning his calls. Which of the following is the most appropriate initial response by the physician?
- A. I'm sorry that your friend no longer returns your calls. What do you think your friend is worried about? (Correct Answer)
- B. I'm sorry to hear you lost your job. I am concerned about the amount of alcohol you are drinking.
- C. I'm sorry to hear you lost your job. Drinking the amount of alcohol that you do can have very negative effects on your health.
- D. I'm sorry that your friend no longer returns your calls. It seems like your drinking is affecting your close relationships.
- E. I'm sorry that your friend no longer returns your calls. Do you feel that your drinking has affected your relationship with your friend?
Motivational interviewing techniques Explanation: ***"I'm sorry that your friend no longer returns your calls. What do you think your friend is worried about?"***
- This response acknowledges the patient's expressed **frustration** about his friend, which is a point of **distress** he has brought up.
- By asking what the friend is worried about, the physician invites the patient to reflect on the potential impact of his drinking from an external perspective, fostering **insight** without being confrontational.
*"I'm sorry to hear you lost your job. I am concerned about the amount of alcohol you are drinking."*
- While addressing the job loss is empathetic, immediately stating concern about his drinking can be confrontational and may lead the patient to become **defensive**, especially since he denies a problem.
- This approach might **shut down** further discussion rather than encourage it, as the patient has already stated "there is nothing wrong with his drinking."
*"I'm sorry to hear you lost your job. Drinking the amount of alcohol that you do can have very negative effects on your health."*
- This response is **judgmental** and directly highlights the negative consequences of his drinking, which the patient has already dismissed.
- Presenting medical facts about health effects at this stage, before establishing rapport and insight, is likely to be met with **resistance** and make the patient less receptive to further conversation.
*"I'm sorry that your friend no longer returns your calls. It seems like your drinking is affecting your close relationships."*
- This statement is a direct accusation, implying the physician knows the cause of the friend's actions and directly links it to the patient's drinking.
- Such a direct link is likely to be perceived as **judgmental** and can make the patient feel attacked, leading to defensiveness and a breakdown in communication.
*"I'm sorry that your friend no longer returns your calls. Do you feel that your drinking has affected your relationship with your friend?"*
- While this question is good, asking directly if his drinking has affected the relationship may elicit a **denial**, as the patient has already shown **lack of insight** regarding his drinking problem.
- A more open-ended question about what the friend is "worried about" is less threatening and more likely to encourage the patient to consider the connection himself.
Motivational interviewing techniques US Medical PG Question 9: A 54-year-old male comes to the clinic to initiate care with a new physician. He has no complaints at this time. When taking his history, the patient says his medical history is notable for diabetes and hypertension both of which are well managed on his medications. His medications are metformin and lisinopril. A review of systems is negative. While taking the social history, the patient hesitates when asked about alcohol consumption. Further gentle questioning by the physician leads the patient to admit that he drinks 5-6 beers per night and up to 10-12 drinks per day over the weekend. He says that he has been drinking like this for “years.” He becomes emotional and says that his alcohol is negatively affecting his relationship with his wife and children; however, when asked about efforts to decrease his consumption, the patient says he has not tried in the past and doesn’t think he has “the strength to stop”. Which of the following stages of change most accurately describes this patient’s behavior?
- A. Contemplation (Correct Answer)
- B. Maintenance
- C. Preparation
- D. Precontemplation
- E. Action
Motivational interviewing techniques Explanation: ***Contemplation***
- The patient acknowledges his problem behavior (alcohol consumption) and its negative impact on his family, indicating an awareness of the issue.
- He expresses a desire for change ("strength to stop") but has not yet committed to taking action or made concrete plans, which is characteristic of the contemplation stage.
*Maintenance*
- This stage involves actively sustaining new behaviors and preventing relapse over a long period (typically 6 months or more).
- The patient admits he has not tried to decrease his consumption, ruling out any active behavior change or sustainability.
*Preparation*
- In this stage, individuals are ready to take action within the next month and have often developed a plan for change.
- The patient explicitly states he hasn't tried to reduce his alcohol intake and doesn't feel he has "the strength to stop," indicating a lack of readiness for immediate action or planning.
*Precontemplation*
- Individuals in this stage are unaware or unwilling to acknowledge that a problem exists and have no intention of changing their behavior in the foreseeable future.
- The patient clearly recognizes his drinking as a problem affecting his family, which distinguishes him from someone in precontemplation.
*Action*
- This stage involves actively modifying one's behavior, environment, or experiences to overcome problems.
- The patient has not made any efforts to decrease his alcohol consumption, meaning he has not yet entered the action phase.
Motivational interviewing techniques US Medical PG Question 10: A 30-year-old man with schizophrenia stabilized on clozapine presents to establish care at a new clinic. Records show stable psychiatric symptoms for 2 years. Routine urine drug screen is positive for cocaine. He admits to using cocaine 2-3 times monthly at parties but denies it affects his functioning. He has maintained employment, housing, and medication adherence. He refuses substance use treatment, stating 'it's recreational and under control.' His last clozapine level was therapeutic. Evaluate the management approach balancing psychiatric stability, substance use, and patient autonomy.
- A. Mandate substance use treatment as condition for continuing clozapine
- B. Switch to long-acting injectable antipsychotic with lower risk profile
- C. Discontinue clozapine due to medication non-compliance and substance use risk
- D. Continue clozapine with harm reduction counseling, more frequent monitoring, and motivational interviewing for substance use (Correct Answer)
- E. Involuntarily hospitalize for dual diagnosis treatment program
Motivational interviewing techniques Explanation: ***Continue clozapine with harm reduction counseling, more frequent monitoring, and motivational interviewing for substance use***
- The patient has been **psychiatrically stable** on clozapine for two years and maintains high functioning; discontinuing a life-saving medication for **treatment-resistant schizophrenia** due to intermittent substance use risks severe decompensation.
- A **harm reduction** approach utilizing **motivational interviewing** addresses the cocaine use without damaging the therapeutic alliance, while **increased monitoring** manages potential risks like a **lowered seizure threshold** or cardiac strain.
*Mandate substance use treatment as condition for continuing clozapine*
- Coercive strategies often lead to **patient dropout** and treatment non-adherence, which could result in a relapse of psychosis.
- Medical ethics prioritize **patient autonomy**; treatment mandates are generally reserved for situations where the patient lacks capacity or poses an immediate danger.
*Switch to long-acting injectable antipsychotic with lower risk profile*
- **Clozapine** is uniquely effective for patients who have failed other treatments; switching a stable patient to a **long-acting injectable (LAI)** may lead to a loss of symptom control.
- The patient's **medication adherence** is already documented as excellent, so the primary benefit of an LAI—improving compliance—is not a current clinical priority.
*Discontinue clozapine due to medication non-compliance and substance use risk*
- The patient is actually **compliant** with his clozapine regimen, as evidenced by his **therapeutic drug levels** and stable psychiatric status.
- Discontinuation represents a high-risk clinical decision that ignores the **biopsychosocial stability** the patient has achieved despite his recreational drug use.
*Involuntarily hospitalize for dual diagnosis treatment program*
- **Involuntary hospitalization** requires the patient to be a **danger to self or others** or be gravely disabled, none of which apply to this stable, employed individual.
- Forced treatment for substance use is not legally supported in this context and would be a significant overreach that violates **civil liberties**.
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