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59 year old comes to a physician with fatigues, maliase,and anorexia since losing his job 3 months ago. Serumy-glutamyltra..(GGT) activity is increased. Which of the following is most approriate to initiate a discussion about his use of alcohol
a. do you think you are a problem drinker
b.how much do u drink in a typical week
c. is there something you haven't told me so far
d. what is your favorite drink
e. you are not a drinker, are you?
At times they say dont ask leading questions... at times they say ask leading question... I just cant allow 1 of my question to go wrong in this confusion.. can anyone.. plssssssssssssssss explain this.... when to ask a LEADING Question.. and When NOT... and what do we EXACTLY mean by OPEN ENDED questions.. its like answer can be anything... right not just yes or no types.. pls explain....
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this q i also have a doubt........In kaplan notes we have that we shud ask CAGE qs to an alcoholic.........but dr esha says BBB is the right answer
cant help.....behav is like that....this is just the beginning reach4stars........u will face more horrible qs and outrageous answers in later nbmes
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in real life matters, whenever its clear that the pt is a substance abuser ( no matter what, alcohol, drugs..) you confront him directly with HOW MUCH do you drink/use drugs..
its not necessary anymore to ask him if he uses it or not, cuz, most likely, he will deny using it given that he didn't mention it voluntarily by himself from the beginning..
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You want to initiate a discussion with the patient. You are not going into any details yet. You just ask the patient directly how much does he drink. This question is non judgemental and doesnt go into any details of his drinking problem.
Do you think you are a problem drinker would offend the patient.
Is there something u havent told me so far implies that the patient is holding out on you. IT could anger the patient and he could also be confused because he may not be aware that alcoholism is the core of his physical symptoms here.
What is your fav drink is a ridiculous question!
You are not a drinker, are you.....sounds like if you are a drinker, then shame on you! You know what I mean...
Its all about looking at each of the options and seeing which sounds the best. Which sounds most appropriate. There arent really any concrete rules.
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Thanks a lot Stalin, Er12 and IA..
I have now understood that you cant do much about BHS.. just follow ur intitution and hit the answer..
IA .. your explaination is woderfull... actualy I had cut down my answers to either B or C, then with B , I thought that its like directly accusing him and labeling him as a drinker..!! so I thought of C.. anyways thanks a lot..!!
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NBME 2, b 3 Q 10
A 45 year old woman with rhuematoid arthritis calls the physician on a Saturday mornin because she cannot turn the bathroom faucet due to pain and weakness in her hands and wrists she is tearful and says."My husband has already left for work and my hands are too weak to turn the water on,it hurts too much and now I can't even take a bath " Which of the following is most appropiate response ?
a.-"come to the office right away and I will give you a cortisone shot "
b.-" I know this must be difficult,perhaps a plumber may be able to help you"
c.-"I sympathize with you,unfortunately,it looks like your only option is to wait until your husnabd comes home "
d.-"many people with rheumatoid arthritis have difficulty turning faucets,perhaps you would be interested in joining a support group"
e.-"people with rheumatoid arthritis often feel that their independence has been los because of their pain,perhaps a tool with a long handle would help"
I chose for E As i think it shows compassion... but the key says... A ...
IA, stalin, others can u pls explain...
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I chose EE too! lol....they all sound wrong and E sounded the least wrong! lol...
But the answer key says A somehow, which i think is stupid! I mean how can we just give her a cortisone shot every time she calls and says she has pain! Besides if she is in too much to open the faucet, she is probably in too much to get dressed and come to the clinic!!!!!
I dont know!! I hate those questions!
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Ha ha Ha ha Ha ha .. I agree with you IA.. I dont know what does USMLE wants out of us.. Imagine being in a clinic and patient calls with a similar complaint.. I cant just tell her to come to come to the clinic for a cortisone shot...and I agree with you that I cant give her cortisone shot each time she complains of pain...
and in STEP 2 CS its said that the DOC should ask the patient if she wants some medical person to go to her home,, (as stated in the question that she is alone.. )
May be the key is wrong.. I still go with E...!! thanks..!!
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