Friday, 30 November 2012

Usmle Step 1 MCQ’s # 26

Title: Usmle Step 1 MCQ’s # 26
Subject:
Behavioral Science

Q NO 26: A 41-year-old married woman of Asian decent becomes pregnant with her first child. During the course of routine prenatal care, the women undergoes a series of tests checking on her health and the health of the fetus. The results of the tests suggest the woman is in good health, but strongly indicate that her child will be born with Down syndrome. When informed of this result the woman becomes visibly upset and begins to cry. “How could this happen to me?” she says, “God must be punishing me!” At this point the physician’s best reply would be which of the following?

A. “I don’t think God has anything to do with this. This sort of thing just happens some of the time.”
B. “I know it is hard to heard this kind of news, but let me assure you that you are still young enough to have other children.”
C. “Let’s take a moment to reflect and pray together for guidance.”
D. “Sometimes God works in mysterious ways that we can not understand. We just have to try to keep our faith.”
E. “Take some deep breaths and try to relax. When you collect yourself, we can talk about how you want to proceed.”
F. “Tell me a bit more about why you think God is punishing you.”
G. “The chances for Down syndrome are simply higher when a woman your age becomes pregnant. That’s why we run these tests.”
H. “The real issue before us is, how do you want to proceed? Do you want to carry the child to term or explore other options?”


Explanation:
The correct answer is F. The core issue here is that the physician needs more information. In particular, he needs to find out about the patient’s beliefs about how the world works and why things happen. Simply imposing his own beliefs, rational or scientific as they may be, does not allow an understanding of how the patient perceives the world. Understanding how the patient sees the world is essential for conveying to her the reasons for Down syndrome, and helping her make a thoughtful decision as to what to do next.
This response may state the physician’s views, which may be contradictory to those of the patient. The problem to be solved here is not how to convince the patient to see things as the physician does (choice A), but for the physician to understand how the patient sees the world.
This response seeks to empathize, and reassure the patient. In doing so, however, it makes an unwarranted assumption that the reason for the woman’s distress is a fear of not being able to have more children (choice B). Whether this is the woman’s chief concern or not is unknown. Ask how the patient sees the world first before trying to make the patient feel better about that world.
Whereas facilitating the tree expression of a patient’s religious beliefs (choice C) is always a good idea, the physician does not yet know what this patient’s beliefs are. The physician is inappropriately directing a course of action, rather than first eliciting from the patient what she would consider appropriate.
This response uses Catholic theology to try to provide comfort to the patient (choice D). If the patient shares this belief system, it may well be effective. If the patient has different beliefs, it will be well shy of the mark and may even cause confusion rather than comfort. Ask before assuming.
This response uses behavior techniques to try to calm the patient (choice E) . While a positive end in its own right, this approach does not help the physician understand how to interact with the patient when she is calm. In addition, this type of suggestion, without context, may convey the impression that the physician simply wants the patient to be calm, but not that he wants to understand the reasons for her distress.
This response risks being perceived as blaming the patient (she is too old), and it does nothing to gain an understanding of how the patient sees the world (choice C)
This response ignores the patient’s distress and the religious issues raised (choice H) Yes, some decisions need to be made, but the physician needs to find out about the patient’s beliefs to have the ability to frame the various options.

Source: http://www.usmleworldwide.com/blog/?p=289

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