Title: Usmle Step 1 MCQ’s # 35
Subject: Behavioral Science
Q NO 35: A 25-year-old HIV-positive woman gives birth to a 6-pound baby boy at a local health clinic. The woman has received no prenatal care. She is ecstatic about the birth, holds the child closely, and talks softly to the child every chance she gets. Tests performed to assess the child’s HIV status return positive results. When told of these results, the new mother appears unfazed, and says that she will just have to be an even better mother to” help the child through this.” She requests a consultation with a breast-feeding counselor because she says, “I want to make sure I do this right.” The physician tells her that breast-feeding is not advisable, to which she replies,” I know that breast-feeding is best, and I want the best for my baby.” The physician’s best reply would be which of the following?
A. “I’m pleased that you are taking your responsibilities so seriously. I’ll arrange an appointment with the breast-feeding counselor for you myself.”
B. “If you insist on breast-feeding your child, the courts will remove the child from your custody.”
C. “If you really love your child, you will do what is best and not breast-feed.”
D. “It is important that you listen to me carefully. Breast-feeding increases the risk to your child. You must not do it.”
E. “It’s wonderful to see how happy you are. We can talk a bit more about these things alter you’ve has some rest and have recovered from the birth.”
F. “Let me explain. A positive test when the child is this young is not definitive. But if you breast-feed your child, you greatly increase the chances of your child contracting HIV.”
DIG. “Yes, breast-feeding is best in most circumstances, but given your HIV status, I strongly advise against it.”
Explanation:
The correct answer is F. Although all children of HIV-positive mothers will test positive at birth due to the mother’s antibodies, the congenital transmission rate is just under 20%. Women who are HIV-positive should not breast-feed.Breast-feeding increases the chances of congenital transmission to a considerable degree. A number of legal precedents exists in which courts have actually taken custody away from mothers who insist on breast-feeding. Making sure the woman knows this is essential. However, how the woman is told is also important. Authoritarian commands and simple unsupported advice are not the best answer. Instead, explain the reasons for the recommendation in a way that make clear the risk to the child if the advice is not followed.
Choice A is incorrect because breast-feeding greatly increases the chance of the child contracting HIV and is, therefore, not to be allowed.
Choice B is a true statement, but said in a way that is harsh and punitive. The woman is threatened with the loss of her child without a clear explanation as to what the underlying issue is.
Choices C and G tells the patient what the physician advises, but does not explain the reasoning. The patient needs full information, not advice or commands.
The tone of this response (choice D) is one of talking down to the patient. It is a tone that one might use with a child, not with an adult. In addition, the physician does not explain the difference between a positive test result and the child actually having HIV.
The issue must be addressed at once. She may want to breast-feed from the beginning. As a general rule, putting off the conversation until later is not the best answer (choice E) Deal with the issue now.
Source: http://www.usmleworldwide.com/blog/?p=730
Subject: Behavioral Science
Q NO 35: A 25-year-old HIV-positive woman gives birth to a 6-pound baby boy at a local health clinic. The woman has received no prenatal care. She is ecstatic about the birth, holds the child closely, and talks softly to the child every chance she gets. Tests performed to assess the child’s HIV status return positive results. When told of these results, the new mother appears unfazed, and says that she will just have to be an even better mother to” help the child through this.” She requests a consultation with a breast-feeding counselor because she says, “I want to make sure I do this right.” The physician tells her that breast-feeding is not advisable, to which she replies,” I know that breast-feeding is best, and I want the best for my baby.” The physician’s best reply would be which of the following?
A. “I’m pleased that you are taking your responsibilities so seriously. I’ll arrange an appointment with the breast-feeding counselor for you myself.”
B. “If you insist on breast-feeding your child, the courts will remove the child from your custody.”
C. “If you really love your child, you will do what is best and not breast-feed.”
D. “It is important that you listen to me carefully. Breast-feeding increases the risk to your child. You must not do it.”
E. “It’s wonderful to see how happy you are. We can talk a bit more about these things alter you’ve has some rest and have recovered from the birth.”
F. “Let me explain. A positive test when the child is this young is not definitive. But if you breast-feed your child, you greatly increase the chances of your child contracting HIV.”
DIG. “Yes, breast-feeding is best in most circumstances, but given your HIV status, I strongly advise against it.”
Explanation:
The correct answer is F. Although all children of HIV-positive mothers will test positive at birth due to the mother’s antibodies, the congenital transmission rate is just under 20%. Women who are HIV-positive should not breast-feed.Breast-feeding increases the chances of congenital transmission to a considerable degree. A number of legal precedents exists in which courts have actually taken custody away from mothers who insist on breast-feeding. Making sure the woman knows this is essential. However, how the woman is told is also important. Authoritarian commands and simple unsupported advice are not the best answer. Instead, explain the reasons for the recommendation in a way that make clear the risk to the child if the advice is not followed.
Choice A is incorrect because breast-feeding greatly increases the chance of the child contracting HIV and is, therefore, not to be allowed.
Choice B is a true statement, but said in a way that is harsh and punitive. The woman is threatened with the loss of her child without a clear explanation as to what the underlying issue is.
Choices C and G tells the patient what the physician advises, but does not explain the reasoning. The patient needs full information, not advice or commands.
The tone of this response (choice D) is one of talking down to the patient. It is a tone that one might use with a child, not with an adult. In addition, the physician does not explain the difference between a positive test result and the child actually having HIV.
The issue must be addressed at once. She may want to breast-feed from the beginning. As a general rule, putting off the conversation until later is not the best answer (choice E) Deal with the issue now.
Source: http://www.usmleworldwide.com/blog/?p=730
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