Motivational interviewing techniques — MCQs

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 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 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 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?

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 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 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 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 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 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.