A 79-year-old male presents to your office for his annual flu shot. On physical exam you note several linear bruises on his back. Upon further questioning he denies abuse from his daughter and son-in-law, who live in the same house. The patient states he does not want this information shared with anyone. What is the most appropriate next step, paired with its justification?
ABreach patient confidentiality, as this patient's care should be discussed with the daughter as she is his primary caregiver
BSee the patient back in 2 weeks and assess whether the patient's condition has improved, as his condition is not severe
CDo not break patient confidentiality, as elder abuse reporting is not mandatory
DDo not break patient confidentiality, as this would potentially worsen the situation
EBreach patient confidentiality, as this patient is a potential victim of elder abuse and reporting is mandated in most states
An unconscious 22-year-old woman is brought to the emergency department by police after being found in a park. Physical examination reveals torn clothing and evidence of sexual assault. Which of the following is the most appropriate first step in collecting forensic evidence?
AContact law enforcement
BBegin prophylactic antibiotics
COrder toxicology screening
DDocument injuries photographically
EObtain written consent from family
A 25-year-old man comes to the physician for severe back pain. He describes the pain as shooting and stabbing. On a 10-point scale, he rates the pain as a 9 to 10. The pain started after he lifted a heavy box at work; he works at a supermarket and recently switched from being a cashier to a storekeeper. The patient appears to be in severe distress. Vital signs are within normal limits. On physical examination, the spine is nontender without paravertebral muscle spasms. Range of motion is normal. A straight-leg raise test is negative. After the physical examination has been completed, the patient asks for a letter to his employer attesting to his inability to work as a storekeeper. Which of the following is the most appropriate response?
A“Yes. Since work may worsen your condition, I would prefer that you stay home a few days. I will write a letter to your employer to explain the situation.”
BYou say you are in severe pain. However, the physical examination findings do not suggest a physical problem that can be addressed with medications or surgery. I'd like to meet on a regular basis to see how you're doing.
CI understand that you are uncomfortable, but the findings do not match the severity of your symptoms. Let's talk about the recent changes at your job.
DThe physical exam findings do not match your symptoms, which suggests a psychological problem. I would be happy to refer you to a mental health professional.
EThe physical exam findings suggest a psychological rather than a physical problem. But there is a good chance that we can address it with cognitive-behavioral therapy.
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