E***a
发帖数: 60 | 1 A 27-year-old woman with alcohol dependence and major depressive disorder
tells the physician that she has been repeatedly physically and emotionally
abused by her current partner. Which of the following is the most
appropriate initial response by the physician?
A ) "Battering only grows worse over time. For your safety and self-esteem,
it is in your best interest to leave this relationship."
B ) "Do you feel it is safe for you to return home?"
C ) "Is there any way you can keep him from getting so angry?"
D ) "There may be a correlation between your history of alcoholism and the
abuse. If you take some steps to stop your alcohol intake, the abuse may
possibly subside."
E ) "Why do you think your partner abuses you?"
B or E, why? | g*******g
发帖数: 196 | | E***a
发帖数: 60 | 3 why? safety is not the priority for patient? Thanks for any elaboration. | y**s
发帖数: 563 | 4 major depression 有些病人有妄想，病人的话有些是妄想出来的.So E is correct.
【在 E***a 的大作中提到】
: why? safety is not the priority for patient? Thanks for any elaboration.
| w***e
发帖数: 269 | 5 这是旧的NBME的一道题吧。答案是B.我知道网上B和E争来争去没有定论，好多人偏向E.
但是BRS behavior science上有一道一样的题，答案是B.而且psychosis 并不是major
depression的一个典型的表现。BRS-behavior science p210
5. A 40-y e ar-old w om an com e s to the e m e rge ncy room w ith bruise s
on he r right che e k and a de e p lace ration abov e he r
right e y e . The w om an, w ho note s that she has had "a proble m w ith
alcohol" for m ore than 10 y e ars, state s that he r
husband hit he r be cause she did not hav e dinne r on the table w he n he
cam e hom e from w ork. Afte r tre ating he r injurie s,
the m ost appropriate que stion for the phy sician to ask is
(A) "Would you describe yourself as an alcoholic?"
(B) "Why do you think your husband abuses you?"
(C) "Do you think it is safe for you to return home to your husband?"
(D) "Would you like to talk about your problem with alcohol?"
(E) "Did your father abuse your mother?"
(F) "Do you think your drinking has had a negative effect on your marriage?"
(G) "Would you like some information on Alcoholics Anonymous?"
The answ e r is C. The most important thing for the physician to do is to
ensure the safety of this abused patient. T herefore,
questioning the woman about whether it is safe for her to return home should
be the initial intervention. | A*******s
发帖数: 9638 | 6 作为一个临床医生，首先不要有预设立场。B显然是肯定了病人的说法，而E是完全客观
的。
E.
major
s
【在 w***e 的大作中提到】
: 这是旧的NBME的一道题吧。答案是B.我知道网上B和E争来争去没有定论，好多人偏向E.
: 但是BRS behavior science上有一道一样的题，答案是B.而且psychosis 并不是major
: depression的一个典型的表现。BRS-behavior science p210
: 5. A 40-y e ar-old w om an com e s to the e m e rge ncy room w ith bruise s
: on he r right che e k and a de e p lace ration abov e he r
: right e y e . The w om an, w ho note s that she has had "a proble m w ith
: alcohol" for m ore than 10 y e ars, state s that he r
: husband hit he r be cause she did not hav e dinne r on the table w he n he
: cam e hom e from w ork. Afte r tre ating he r injurie s,
: the m ost appropriate que stion for the phy sician to ask is
| w***e
发帖数: 269 | 7 I respectfully disagree. 1)A physician is always an advocate for the patient
, not anybody else. For example, if a patient needs an organ transplant (and
for practical reasons, meets whatever criteria it requires), the physician
should always fight for that organ for the patient, even though it may
represent potential harm to another person (live donor). 2) the pillar of a
physician-patient relationship is trust. That's why physician has the
privilege to ask patients questions other professions won't /can't ask,
their family arrangement, sexual practice etc.The assumption is that patient
trust the physician can act on his/her best interest. Based on these two
points, in this case,the physician, as the advocate of the patient who
should act on the best interest of the patient, should be asking :"is it
safe for you to return home?". | g*******g
发帖数: 196 | 8 这两道题不是一样的，
第一题，，只是病人主观称述emotion abuse，没有具体怎么abuse，而且问的是医生的
initial response。
第二题，有physical abuse的身体受伤的具体客观事实，然后是after treatment，医
生问病人是否感到安全。
E.
major
s
【在 w***e 的大作中提到】
: 这是旧的NBME的一道题吧。答案是B.我知道网上B和E争来争去没有定论，好多人偏向E.
: 但是BRS behavior science上有一道一样的题，答案是B.而且psychosis 并不是major
: depression的一个典型的表现。BRS-behavior science p210
: 5. A 40-y e ar-old w om an com e s to the e m e rge ncy room w ith bruise s
: on he r right che e k and a de e p lace ration abov e he r
: right e y e . The w om an, w ho note s that she has had "a proble m w ith
: alcohol" for m ore than 10 y e ars, state s that he r
: husband hit he r be cause she did not hav e dinne r on the table w he n he
: cam e hom e from w ork. Afte r tre ating he r injurie s,
: the m ost appropriate que stion for the phy sician to ask is
| A*******s
发帖数: 9638 | 9 你说的都是对的，但你看清这个题的问题：the most appropriate Initial ....
相信一个有ETOH问题的病人你会后悔的，信不信由你。：）
patient
and
physician
a
【在 w***e 的大作中提到】
: I respectfully disagree. 1)A physician is always an advocate for the patient
: , not anybody else. For example, if a patient needs an organ transplant (and
: for practical reasons, meets whatever criteria it requires), the physician
: should always fight for that organ for the patient, even though it may
: represent potential harm to another person (live donor). 2) the pillar of a
: physician-patient relationship is trust. That's why physician has the
: privilege to ask patients questions other professions won't /can't ask,
: their family arrangement, sexual practice etc.The assumption is that patient
: trust the physician can act on his/her best interest. Based on these two
: points, in this case,the physician, as the advocate of the patient who
| E***a
发帖数: 60 | 10 网上的讨论说E为open ended question,因此可以得到更多有关病人的信息。这道题争
议挺大的，更加不知道哪个对了。 | | | D*****N
发帖数: 39 | 11 答案只能是B.
如果选E, "Why do you think your partner abuses you?" 病人可能的回答是"
Because I am not a good partner; I do not keep our house clean; I do not
prepare meal". 或者"Because I am a alcoholic; I drink every day and I do not
do anything at home; I ..." 根据这些回答, 大概没有人知道"most appropriate
initial response" 是什么。况且, "Why do you think your partner abuses you?"
含有责备的成分, 比较恰当的说法是"Can you tell how your partner abuses you"。
在USMLE考题里, 病人说什么都是可信的,
如果选B, "Do you feel it is safe for you to return home?" 病人的回答只有两
种。第一是"Yes, I feel safe to return home". 下一步的处理没有悬念。第二是"No
, I don't feel safe to return home". 至此, "the most appropriate initial
response
" 只能是将病人安置在安全的地方。此题就是考这种不怕一万,就怕万一的情况。好比"
worst headache"时的subarachnoid hemorrhage。即使病人有酗酒,说谎,妄想或者迫害
, 万一你将这个病人放回家, 而病人被她的partner杀死, 后果就不说了。 | A*******s
发帖数: 9638 | 12 如果这个partner是female，你也这么想？
【在 D*****N 的大作中提到】
: 答案只能是B.
: 如果选E, "Why do you think your partner abuses you?" 病人可能的回答是"
: Because I am not a good partner; I do not keep our house clean; I do not
: prepare meal". 或者"Because I am a alcoholic; I drink every day and I do not
: do anything at home; I ..." 根据这些回答, 大概没有人知道"most appropriate
: initial response" 是什么。况且, "Why do you think your partner abuses you?"
: 含有责备的成分, 比较恰当的说法是"Can you tell how your partner abuses you"。
: 在USMLE考题里, 病人说什么都是可信的,
: 如果选B, "Do you feel it is safe for you to return home?" 病人的回答只有两
: 种。第一是"Yes, I feel safe to return home". 下一步的处理没有悬念。第二是"No
| d*****x
发帖数: 96 | 13 E吧。病人有alcohol abuse,如果没有的话，可以选B | g*n
发帖数: 538 | 14 I choose B. I will take immediate action for B no matter she is telling
truth or not. But for the others, I will send her to whoever can address the
issue.
emotionally
,
【在 E***a 的大作中提到】
: A 27-year-old woman with alcohol dependence and major depressive disorder
: tells the physician that she has been repeatedly physically and emotionally
: abused by her current partner. Which of the following is the most
: appropriate initial response by the physician?
: A ) "Battering only grows worse over time. For your safety and self-esteem,
: it is in your best interest to leave this relationship."
: B ) "Do you feel it is safe for you to return home?"
: C ) "Is there any way you can keep him from getting so angry?"
: D ) "There may be a correlation between your history of alcoholism and the
: abuse. If you take some steps to stop your alcohol intake, the abuse may
| y**s
发帖数: 165 | 15 您老歧视妇女？
【在 A*******s 的大作中提到】
: 如果这个partner是female，你也这么想？
| M***D
发帖数: 249 | 16 According to Tarasoff law, a physician or a health care provider has the "
duty to warn" based on his/her best judgment. Answer E will provide more
information about the patient's boyfriend's physical and emotional abusive
behaviors. For example, if the boyfriend is anti-social or is a psychopath,
then the physician shall report him to law enforcement or other authorities
to have this boyfriend removed from the community for the safety concerns
not only for the patient but also for other people (including the boyfriend'
s own safety). Remember the Virginia Tech massacre? The shooter Seung-Hui
Cho's parents had never felt dangerous to keep him at home or sent him to
Virginia Tech, but he killed 32 people in TWO separate attacks TWO hours
apart before committed suicide on campus.
emotionally
,
【在 E***a 的大作中提到】
: A 27-year-old woman with alcohol dependence and major depressive disorder
: tells the physician that she has been repeatedly physically and emotionally
: abused by her current partner. Which of the following is the most
: appropriate initial response by the physician?
: A ) "Battering only grows worse over time. For your safety and self-esteem,
: it is in your best interest to leave this relationship."
: B ) "Do you feel it is safe for you to return home?"
: C ) "Is there any way you can keep him from getting so angry?"
: D ) "There may be a correlation between your history of alcoholism and the
: abuse. If you take some steps to stop your alcohol intake, the abuse may
| A*******s
发帖数: 9638 | 17 I guess you will take immediate action instead of asking question B. The
answer yes or no really does not matter, right?
The point is that you have to take your action whenever you hear the
complain like that, but not the first step. Listen to her story first then
take your action.
the
【在 g*n 的大作中提到】
: I choose B. I will take immediate action for B no matter she is telling
: truth or not. But for the others, I will send her to whoever can address the
: issue.
:
: emotionally
: ,
| M***D
发帖数: 249 | 18 Besides "duty to warn" as a physician, the patient's depression and alcohol
dependece may be "reactive"---they may be caused by the repeated abuse from
her partner, so I will choose E to get more information. |
|
