08-20-2007, 08:18 PM
The following vignette applies to the next 2 items.
A 67-year-old woman with a 2-month history of cough was admitted to the hospital after chest x-ray film and CT scan showed a lung mass with suspected mediastinal extension. Biopsies obtained during bronchoscopy and mediastinoscopy showed poorly differentiated squamous cell carcinoma in the peritracheal lymph nodes. A pulmonary consultant has determined that the tumor is inoperable, and that the only available treatment is palliative radiation therapy. The patient has been informed of the diagnosis by you and others, but when you see her now in your office she seems unclear about what she has been told.
Item 1 of 2
33. Given the patient's uncertainty about the details of her diagnosis, which of the following is the most appropriate next step?
A
) Ask the pulmonologist to explain the diagnosis to her
B
) Assume that she is depressed and begin antidepressant pharmacotherapy
C
) Give her the phone number for the American Cancer Society
D
) Recommend that she bring family members with her to her visit next week
E
) Recommend that she obtain a second opinion
Item 2 of 2
34. The patient returns to the office for follow-up 2 weeks later. She requests copies of her medical records and angrily states, "Doctor, I think you're wrong. I've been praying and I know I don't have cancer." Which of the following is the most appropriate response?
A
) "I told you that all of your years of smoking would put you at risk for lung cancer."
B
) "I would be happy to go over all of the reports with you; I appreciate that this is a difficult diagnosis to accept."
C
) "The request for medical records can only come through your attorney."
D
) "The sooner you accept this diagnosis, the sooner we can get on with appropriate therapy."
E
) "We are having a case conference later today with the pulmonary and radiation therapy specialists; maybe you would like to attend to hear their opinions about your disease."
A 67-year-old woman with a 2-month history of cough was admitted to the hospital after chest x-ray film and CT scan showed a lung mass with suspected mediastinal extension. Biopsies obtained during bronchoscopy and mediastinoscopy showed poorly differentiated squamous cell carcinoma in the peritracheal lymph nodes. A pulmonary consultant has determined that the tumor is inoperable, and that the only available treatment is palliative radiation therapy. The patient has been informed of the diagnosis by you and others, but when you see her now in your office she seems unclear about what she has been told.
Item 1 of 2
33. Given the patient's uncertainty about the details of her diagnosis, which of the following is the most appropriate next step?
A
) Ask the pulmonologist to explain the diagnosis to her
B
) Assume that she is depressed and begin antidepressant pharmacotherapy
C
) Give her the phone number for the American Cancer Society
D
) Recommend that she bring family members with her to her visit next week
E
) Recommend that she obtain a second opinion
Item 2 of 2
34. The patient returns to the office for follow-up 2 weeks later. She requests copies of her medical records and angrily states, "Doctor, I think you're wrong. I've been praying and I know I don't have cancer." Which of the following is the most appropriate response?
A
) "I told you that all of your years of smoking would put you at risk for lung cancer."
B
) "I would be happy to go over all of the reports with you; I appreciate that this is a difficult diagnosis to accept."
C
) "The request for medical records can only come through your attorney."
D
) "The sooner you accept this diagnosis, the sooner we can get on with appropriate therapy."
E
) "We are having a case conference later today with the pulmonary and radiation therapy specialists; maybe you would like to attend to hear their opinions about your disease."