Healthcare provider self-care — MCQs

A 19-year-old woman comes to the physician because of a 2-day history of difficulty sleeping. She worries that the lack of sleep will ruin her career prospects as a model. She has been coming to the physician multiple times over the past year for minor problems. She is dressed very extravagantly and flirts with the receptionist. When she is asked to sit down in the waiting room, she begins to cry and says that no one listens to her. When she is called to the examination room, she moves close to the physician, repeatedly intends to touch his cheek, and makes inappropriate comments. She does not have a history of self-harm or suicidal ideation. Which of the following is the most likely diagnosis?

A 59-year-old man comes to the physician for a follow-up examination after being diagnosed with localized prostate cancer 3 weeks ago. The physician is delayed because of an emergency with another patient; miscommunication between the physician and his staff created further delays. When he enters the patient's room, the patient angrily expresses, “Do you realize that I waited 45 minutes in the waiting room, despite arriving on time, and that I've now waited another half an hour in this exam room? I am dying; do you have no respect for my time?” Which of the following is the most appropriate response by the physician?

A psychiatrist receives a call from a patient who expresses thoughts of harming his ex-girlfriend. The patient describes a detailed plan to attack her at her workplace. Which of the following represents the psychiatrist's most appropriate legal obligation?

A 37-year-old man presents to his primary care physician because he has been experiencing episodes where he wakes up at night gasping for breath. His past medical history is significant for morbid obesity as well as hypertension for which he takes lisinopril. He is diagnosed with sleep apnea and prescribed a continuous positive airway pressure apparatus. In addition, the physician discusses making lifestyle and behavioral changes such as dietary modifications and exercise. The patient agrees to attempt these behavioral changes. Which of the following is most likely to result in improving patient adherence to this plan?

A 25-year-old man comes to the physician because of palpitations, sweating, and flushing. Since he was promoted to a manager in a large software company 6 months ago, he has had several episodes of these symptoms when he has to give presentations in front of a large group of people. During these episodes, his thoughts start racing and he fears that his face will “turn red” and everyone will laugh at him. He has tried to avoid the presentations but fears that he might lose his job if he continues to do so. He is healthy except for mild-persistent asthma. He frequently smokes marijuana to calm his nerves. He does not drink alcohol. His only medication is an albuterol inhaler. His pulse is 78/min, respirations are 14/min, and blood pressure is 120/75 mm Hg. Cardiopulmonary examination shows no abnormalities. On mental status examination, the patient appears worried and has a flattened affect. Which of the following is the most appropriate next step in management?

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 14-year-old girl presents to the emergency room complaining of abdominal pain. She was watching a movie 3 hours prior to presentation when she developed severe non-radiating right lower quadrant pain. The pain has worsened since it started. She also had non-bloody non-bilious emesis 1 hour ago and continues to feel nauseated. Her temperature is 101°F (38.3°C), blood pressure is 130/90 mmHg, pulse is 110/min, and respirations are 22/min. On exam, she has rebound tenderness at McBurney point and a positive Rovsing sign. She is stabilized with intravenous fluids and pain medication and is taken to the operating room to undergo a laparoscopic appendectomy. While in the operating room, the circulating nurse leads the surgical team in a time out to ensure that introductions are made, the patient’s name and date of birth are correct, antibiotics have been given, and the surgical site is marked appropriately. This process is an example of which of the following human factor engineering elements?

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 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 38-year-old woman comes to the physician for the first time because of a 2-year history of lower back pain and fatigue. She also says that she occasionally feels out of breath. Her symptoms are not associated with physical activity. She has seen multiple physicians over the past year. Extensive workup including blood and urine tests, abdominal ultrasound, MRI of the back, and cardiac stress testing have shown no abnormalities. The patient asks for a medication to alleviate her symptoms. Which of the following is the most appropriate response by the physician?