Title: Usmle Step 1 MCQ's # 17
Subject: Behavioral Science
Q NO 17: A 1 6-year-old girl comes to see her physician for a standard physical examination prior to attending summer camp. The examination is unremarkable. The girl tails within the normal range for height and weight. The physician notes that she has had menses for the past4years.Asthe girl is getting dressed, the physician sits and completes the required forms for the camp. When handed the completed forms, the girl thanks the physician and says, “Just one more thing. Could you also give me a prescription for birth control pills? I’m going to camp with my boyfriend and want to be prepared. And please, please, don’t tell my parents!” The physician’s most appropriate reply would be which of the following?
A. “Before I write you that type of prescription, I’d like to examine your boyfriend first.”
B. “How long have you been having sexual relations with your boyfriend?”
C. “I can only give you a prescription like that if I have your parents’ permission. Let’s set up a time to talk with them.”
D. “I wish you would reconsider. Sex before marriage can be yew complicated.”
E. “I’ll be glad to give you the prescription, but I want you to discuss things with your parents first.”
F. “I’ll be happy to give you a prescription, but let’s talk about some important issues first.”
“I’ll make a decision about the prescription after I have a discussion with you and your boyfriend. When should we schedule that?”
‘H. “I’m pleased that you are responsible enough to be prepared. I’ll be happy to give you the prescription and see no reason to tell your parents.”
Explanation:
The correct answer is F. Core to this question is the contrast between what the laws allow and what the good practice of medicine demands. Simply doing what the law allows is not enough. The physician must act in such a way as to anticipate the needs of the patient even beyond the manifest presentation.
Under the partial emancipation rules any minor between the ages of 15 and 17 can make medical decisions for themselves in four areas without parental involvement or notification. The four areas are: STD treatment substance abuse treatment birth control and prenatal care. Under this rule, the law allows the physician to write this girl the prescription for birth control pills without parental notification. However, the best answer requires more from the physician. The girl is so certain to become sexually active that she asks for birth control pills. Surely she needs something more from the physician than just a prescription. She needs counseling, advice, and information about other birth control methods especially barrier methods. The prescription should not be given without the discussion of these issues first. Note that the physician’s job is not to lecture here, but to find out what the girl already knows and to give her what ever information she is lacking.
The girl is the patient. The boyfriend (choice A) is not. This is not a request that is usually made before giving a birth control prescription and it is inappropriate here.
This question (choice B) maybe asked in the course of a discussion, possibly to determine if the girl should be screened for any sexually transmitted diseases, but it is an inappropriate lead-off comment.
Choice C is not what the law says, and so the physician is lying. However, encouraging the girl to discuss these issues with her parents is a good idea.
This response sets a moralistic scolding tone (choice D) . It is not the physician’s job to tell the girl what her conduct should be. Rather the girl should be provided with information and a listening ear it she has any questions.
The parents (choice E) need not be involved. The idea behind partial emancipation is to encourage behavior important for public health. It every girl had to ask her parents, she might hesitate to do so, and the number of out-of-wedlock births would rise.
Encouraging the girl to discuss important issues with her boy friend is a good idea.Mandating that it must happen, and in the physician’s presence (choice G) is unduly intrusive.
Yes, you can write the prescription, but more is required than is in choice H . Discussion, counseling, advice, and information should also be dispensed.
Subject: Behavioral Science
Q NO 17: A 1 6-year-old girl comes to see her physician for a standard physical examination prior to attending summer camp. The examination is unremarkable. The girl tails within the normal range for height and weight. The physician notes that she has had menses for the past4years.Asthe girl is getting dressed, the physician sits and completes the required forms for the camp. When handed the completed forms, the girl thanks the physician and says, “Just one more thing. Could you also give me a prescription for birth control pills? I’m going to camp with my boyfriend and want to be prepared. And please, please, don’t tell my parents!” The physician’s most appropriate reply would be which of the following?
A. “Before I write you that type of prescription, I’d like to examine your boyfriend first.”
B. “How long have you been having sexual relations with your boyfriend?”
C. “I can only give you a prescription like that if I have your parents’ permission. Let’s set up a time to talk with them.”
D. “I wish you would reconsider. Sex before marriage can be yew complicated.”
E. “I’ll be glad to give you the prescription, but I want you to discuss things with your parents first.”
F. “I’ll be happy to give you a prescription, but let’s talk about some important issues first.”
“I’ll make a decision about the prescription after I have a discussion with you and your boyfriend. When should we schedule that?”
‘H. “I’m pleased that you are responsible enough to be prepared. I’ll be happy to give you the prescription and see no reason to tell your parents.”
Explanation:
The correct answer is F. Core to this question is the contrast between what the laws allow and what the good practice of medicine demands. Simply doing what the law allows is not enough. The physician must act in such a way as to anticipate the needs of the patient even beyond the manifest presentation.
Under the partial emancipation rules any minor between the ages of 15 and 17 can make medical decisions for themselves in four areas without parental involvement or notification. The four areas are: STD treatment substance abuse treatment birth control and prenatal care. Under this rule, the law allows the physician to write this girl the prescription for birth control pills without parental notification. However, the best answer requires more from the physician. The girl is so certain to become sexually active that she asks for birth control pills. Surely she needs something more from the physician than just a prescription. She needs counseling, advice, and information about other birth control methods especially barrier methods. The prescription should not be given without the discussion of these issues first. Note that the physician’s job is not to lecture here, but to find out what the girl already knows and to give her what ever information she is lacking.
The girl is the patient. The boyfriend (choice A) is not. This is not a request that is usually made before giving a birth control prescription and it is inappropriate here.
This question (choice B) maybe asked in the course of a discussion, possibly to determine if the girl should be screened for any sexually transmitted diseases, but it is an inappropriate lead-off comment.
Choice C is not what the law says, and so the physician is lying. However, encouraging the girl to discuss these issues with her parents is a good idea.
This response sets a moralistic scolding tone (choice D) . It is not the physician’s job to tell the girl what her conduct should be. Rather the girl should be provided with information and a listening ear it she has any questions.
The parents (choice E) need not be involved. The idea behind partial emancipation is to encourage behavior important for public health. It every girl had to ask her parents, she might hesitate to do so, and the number of out-of-wedlock births would rise.
Encouraging the girl to discuss important issues with her boy friend is a good idea.Mandating that it must happen, and in the physician’s presence (choice G) is unduly intrusive.
Yes, you can write the prescription, but more is required than is in choice H . Discussion, counseling, advice, and information should also be dispensed.
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