question

anxious patient

answer

encourage patient to talk about his feelings ask about things causing anxiety give reasonable assurance

question

angry patient

answer

stay calm don't be scared ask about reason for the anger give reasonable answers

question

crying patient

answer

allow patient to express feelings wait in silence for him to finish offer a tissue show empathy place hand on shoulder "would you like to tell me about it?"

question

patient in pain

answer

show compassion offer help don't repeat painful maneuvers if patient does not allow to touch --> explain you need to perform maneuver and give reassurance

question

patient who can't pay

answer

reassure the patient that you will provide care anyway offer referal to a social worker

question

patient who refuses to answer

answer

explain why it is important if patient still refuses, skip maneuver or question and document it on PN

question

hard of hearing patient

answer

face patient directly to allow him to read lips speak slowly use gestures if hearing loss is unilateral, sit closer to hearing side

question

patient doesn't know medications or I don't recognize medications

answer

ask if patient has prescription or a written list

question

phone encounter

answer

press speaker button to call the patient no physical exam needed, so leave blank on PN

question

how to handle challenging questions

answer

be honest and diplomatic restate the issue in different words don't give a final diagnosis don't give false reassurance if answer is not known, say so

question

"I can't afford the cost of staying in the hospital. I have no insurance. Just give me something to relieve the pain, and I will leave."

answer

"I know that you are concerned about medical costs, but your life will be in danger if you don't have surgery. Let our social workers help you with the cost issues."

question

"Should I tell my sexual partner about my venereal disease?"

answer

"Yes. There is a chance that you have already transmitted the disease to your partner, or he/she may be the source of your infection. The important step is to have you both evaluated and appropriately treated."

question

An anxious patient who you suspect has been abused asks, "Why are you asking me these questions?"

answer

"I am concerned that domestic abuse may be involved. My goal is to make sure that you are in a safe environment and that you are not a victim of abuse."

question

A patient recently diagnosed with HIV asks, "Do I have to tell my wife?"

answer

"I know that it's difficult, but doing so will allow you and your wife to take the appropriate precautions to treat and prevent the transmission of the disease."

question

An elderly patient says, "I think that it is normal at my age to have this problem" (impotence), or "I am just getting old."

answer

"Age may play a role in the change you are experiencing in your sexual function, but your problem may have other causes that we should rule out, such as certain diseases (hypertension, diabetes) or certain medications. We also have medications that may improve your sexual function."

question

"I read in a journal that the treatment of this disease is herbal compounds."

answer

"Herbal medicines have been suggested for many diseases. However, their safety and effi cacy may not always be clear-cut. Let me know the name of the herbal medicine and I will check into its potential treatment role for this disease."

question

"I am afraid of surgery."

answer

"I understand your feelings. It is normal and very common to have these feelings before surgery. Is there anything specific that you are concerned about?"

question

A patient who has a serious problem (unstable angina, colon cancer) asks, "I want to go on a trip with my wife. Can we do the tests after I come back?"

answer

"I know that you don't want to put off your trip, but you may have a serious problem that may benefit from early diagnosis and management."

question

"I did not understand your question, doctor. Could you repeat it, please?"

answer

Repeat the question again slowly. If the patient still doesn't comprehend the question, ask if there is any specific word he didn't understand and try to explain it or use a simpler one.

question

"What is a bronchoscopy?" (MRI, CT, x-ray, colonoscopy)

answer

Explain the meaning using simple words. For example, "Bronchoscopy is using a thin tube connected to a camera to look into your respiratory airways and parts of your lungs," or "An MRI is a machine that uses a big magnet to obtain detailed pictures of your brain or body."

question

"What do you mean by 'workup'?" "It means all the tests that we are going to do to help us make the final diagnosis."

answer

A patient who is late in seeking medical advice asks, "Do you think it is too late for recovery?" "I am glad that you came for help. We will do our best and hope for the best."

question

A patient with pleuritic chest pain asks, "Is this a heart attack? Am I going to die?"

answer

"Given your current presentation, my suspicion for a heart attack is low. It is more likely that inflammation of the membranes surrounding your lungs is causing your pain, and this is usually not a life-threatening condition. However, we still need to do some tests to

question

"Do you think I have colon cancer?" "Do you think I have a brain tumor?" "Do I have endometrial cancer?"

answer

"That is one of the possibilities, but there are other explanations for your symptoms that we should rule out before making a diagnosis."

question

"My friend told me that you are a very fi ne doctor. That's why I came to you to refill my prescription."

answer

"I am flattered, but since this is your first visit, I can't give you a refill without reviewing your history to better understand your need for this medication. I will also need to do a physical exam and perhaps order some tests."

question

"Will my insurance cover the expenses of this test?"

answer

"I'm not sure, but I can refer you to a social worker who does have that information. If necessary, I can write a note to your insurance company indicating the importance of this test."

question

A person who wants to return to work at a job that can negatively affect his health asks, "Can I go back to work?"

answer

"Unfortunately, work may actually worsen your condition. Therefore, I would prefer that you stay at home for now. I can write a letter to your employer explaining your situation."

question

"Do you think that this tumor I have could become malignant?"

answer

"We really won't know until we remove the mass and get a pathology report on it."

question

"Since I stopped smoking, I have gained weight. I want to go back to smoking in order to lose weight."

answer

"There are healthier ways to lose weight than smoking, such as exercise and diet. Smoking will increase your risk of cancer, heart problems, and lung disease."

question

A patient with a shoulder injury says, "I am afraid of losing my job if my shoulder doesn't get better."

answer

"We will do our best to help you recover from your shoulder injury. With your permission, I will

question

"Will I ever feel better, doctor?"

answer

The answer differs depending on the prognosis of the disease and can vary from "Yes, most people with this disease are completely cured" to "Complete cure may be difficult at this advanced stage, but we have a lot to offer in terms of controlling the symptoms and improving your quality of life."

question

A person who has a broken arm asks, "Doctor, do you think I will be able to move my arm again like before?"

answer

"It is hard to tell right now, but those fractures usually heal well, and with physical therapy you should regain the normal range of motion of your arm."

question

"I think that life is full of misery. Why do we have to live?"

answer

"Life can be challenging. Is there something in particular that is bothering you? Have you thought of ending your life?" You can then continue screening for depression.

question

A young man with multiple sexual partners and a recent-onset skin rash says, "I am afraid that I might have AIDS."

answer

"Having multiple sexual partners does put you at risk for HIV infection, but this rash may be due to many other causes. I agree that we should do an HIV test on you in addition to a few other tests."

question

A patient who needs hospitalization says, "My child is at home alone. I have to leave now."

answer

"I understand your concern about your child, but right now staying in the hospital is in your best interest. One of our social workers can make some phone calls to arrange for child care."

question

"Do you have anything that will make me feel better? Please, doctor, I am in pain."

answer

"I know that you're in pain, but I need to know what's causing your pain in order to give you the appropriate treatment. After I am done with my evaluation, we can decide on the best way to help manage your pain."

question

A patient you believe is pretending (malingering) says, "Please, doctor, I need a week off from work. The pain in my back is terrible."

answer

"I know that you are uncomfortable, but after examining you, I don't find disability significant enough to keep you out of work. I plan to prescribe pain medication and exercises, but a big part of your recovery will be continuing your normal daily activities."

question

"Stop asking me all these stupid questions and just give me something for this pain."

answer

"I know that you're in pain, but I need to determine the cause of the pain in order to give you the right treatment. After I am done with my evaluation, we will give you the appropriate treatment."

question

"So what's the plan, doctor?"

answer

"After we get the results of your tests, we will meet again. At that time, I will try to answer any questions you may have."

question

"Do you think I will need surgery?"

answer

"I will try to manage your problem medically, but if that doesn't work, you may need surgery. We can see how things go and then try to make that decision together in the future."

question

A female patient has only one sexual partner, and she is diagnosed with an STD. She asks you, "Could he possibly be cheating on me?"

answer

"You most likely contracted this infection from your partner. It would be best to talk to your partner about this to clear things up. He needs to be tested and treated, or else you risk becoming reinfected."

question

A patient is shouting angrily, "Where have you been, doctor? I have been waiting here for the whole day."

answer

"I am sorry you had to wait so long. We had some unexpected delays with a few of the earlier patients this morning. But I'm here now, and I will focus on you and your concerns."

question

An educated 58-year-old woman asks, "I read in a scientific journal that hormonal replacement therapy causes breast cancer. What do you think of that, doctor?"

answer

"It appears to be true. Studies show a slight increase in the risk of developing breast cancer after four years of combination estrogen and progesterone use for hormonal replacement therapy. The current recommendations are to use hormonal replacement therapy solely for the relief of hot fl ashes, and only for a limited period of time."

question

"Did I have a stroke?"

answer

"We don't know yet. Your symptoms could be explained by a small stroke, but we need to wait for the results of your MRI."

question

"Do I have lung cancer?"

answer

"We don't know at this point. It is a possibility, but we still need to do additional tests."

question

An African-American man with sickle cell anemia presents with back and chest pain and says, "Please, doctor, I need some Demerol now or I will die from pain."

answer

"I know that you are in pain, but I need to ask you a few questions first to better understand your pain. Then we will get you medicines for your pain."

question

A patient with symptoms of a common cold says, "I think I need antibiotics, doctor."

answer

"It appears that you have a viral common cold. Antibiotics do not treat viruses, and they have adverse effects that could even make you feel worse. We should focus on treating your symptoms."

question

"My mother had breast cancer. What is the possibility that I will have breast cancer, too?"

answer

"You are at increased risk, but it doesn't mean that you will get it. There are other risk factors that need to be considered, and regular screening tests will be very important."

question

A 55-year-old man says, "I had a colonoscopy six years ago, and they removed a polyp. Do you think that I have to repeat the colonoscopy?"

answer

"Yes, it should be repeated. We need to screen for more polyps, and in this way we hope to prevent the development of colon cancer."

question

A patient with headache or confusion asks, "Do you think I have Alzheimer's disease?"

answer

"I don't know. Alzheimer's is one of several possible causes that we will investigate."

question

"Can I get pregnant even though my tubes are tied?"

answer

"There is no single contraceptive method that is 100% effective. The risk of pregnancy after tubal ligation is less than 1%, but it is a real risk."

question

A woman who is in her first trimester of pregnancy with vaginal bleeding asks, "Do you think I am losing my pregnancy?"

answer

"Bleeding early in pregnancy increases your risk of losing the pregnancy, but at the same time, most women who have bleeding carry the pregnancy to term without problems."

question

"My brother has colon cancer. What are the chances that I will have colon cancer as well?"

answer

"Some types of colon cancer are hereditary, and you may be at increased risk, but it doesn't mean that you will get colon cancer for sure. I need to get more information about your personal and family history to determine your level of risk."

question

A patient with palpitations says, "My mother had a thyroid problem; do you think it is my thyroid?"

answer

"It's possible. We always check a thyroid blood test, but we will also consider many other possible causes of palpitations."

question

"Obesity runs in my family. Do you think that this is why I am overweight?"

answer

"Genes play an important role in obesity, but lifestyle, diet, and daily habits are also major factors influencing weight. These factors can be used in a way that can help you lose weight."

question

A young man with dysuria asks, "Do you think I have an STD?"

answer

"That is one of the possibilities. We will do some cultures to fi nd out for sure, and we will also check a urine sample, since your symptoms may be due to a urinary tract infection."

question

"I am drinking a lot of water, doctor. What do you think the reason is?"

answer

"This may simply be due to dehydration, or it may be a sign of a disease such as diabetes. We need to do some tests to determine the cause."

question

A patient with COPD asks, "Will I get better if I stop smoking?"

answer

"Most patients with your condition who stop smoking will experience a gradual improvement in their symptoms, in addition to a significantly decreased risk of lung cancer in the future."

question

A patient with possible appendicitis is asking for a cup of water to drink.

answer

"I am sorry, but I can't give you anything to eat or drink right now. You may need emergent surgery, and anesthesia is much safer if your stomach is completely empty."

question

A patient with infectious mononucleosis asks, "Can I go back to school, doctor?"

answer

"Now that you have recovered from the acute stage of the disease, you can go back to school, but I want you to stay away from any strenuous exercise or contact sports, as you may rupture your spleen."

question

smoker patient

answer

pg. 72

question

alcoholic patient

answer

pg. 72

question

patient with uncontrolled diabetes

answer

pg. 72

question

sexually promiscous patient

answer

pg. 73

question

depressed patient

answer

pg. 73

question

patient with STD

answer

pg. 74

USMLE Step 2 CS First Aid – Difficult Patients – Flashcards

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