Friday, 28 December 2012

Usmle Step 1 MCQ's # 13

Title: Usmle Step 1 MCQ's # 13
Subject: Behavioral Science

Q NO 13: Over the past 10 years, a 15-year-old boy has been taking medication that has successfully controlled his severe asthma. He has had no exacerbations in the past two years. His parents come to see the boy’s physician seeking her advice. The boy has recently declared that he does not want to take his asthma medication any longer. Instead, he believes that changing his diet to one that is tree of all “toxins” is all that is required to limit his exacerbations. The parents want to know what they should do. What action should the physician take next?

A. Arrange to speak with the boy and ask him the reasons for his decision
B. Arrange to speak with the boy and convince him that he must stay on his medication
C. Have the boy evaluated by a pulmonologist and follow the recommendations of the specialist
D. Take the boy off his medication and monitor him closely in case there are any adverse reactions
E. Tell parents that you will switch the boy to a newly available medication
F. Tell the parents that it is essential that their son stay on his medications and that they must convince him to do so

The correct answer is A. Before reaching any treatment recommendation or encouraging either the parents or the boy to take any particular course of action, the physician needs more information. All he knows is the boy’s views as represented by the parents. The boy is old enough to express himself and articulate his reasons, so the physician should go directly to the source. Getting enough information before you act is a good rule for the exam, and a good rule for medical practice.
Speaking with the boy is the right idea. But walking into the conversation with an agenda of selling a particular course of action (choice B) is likely to lead to confrontation, not communication. Be open-minded and hear what the boy’s experience and reasons have been.
This is your patient, and you should make the required decisions. The rule:” Never pass off,” applies here. Giving your patient to someone else (choice C) will yew rarely be a right answer on the Step 1 exam.
Taking the boy off his medication (choice D) is premature. Talk to the boy and get his views before deciding on any course of action.
Choices E and F not only force a solution before all the relevant information is known, they force the parents to do the work of the physician, namely, talking directly with the patient. Yes, the parents, at this age, have the final say regarding treatment choices, but cooperation of the patient is essential for adequate treatment of asthma.

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