X.Problem Solving

Each of the numbered items in this section is followed by possible answers. Try to select the one lettered answer or completion that is best in each case, discuss it with your partner(s) and comment on your choice trying to prove your decision:

1) An 8-year-old boy with acute lymphoblastic leukemia has had three relapses over the past 2 years. The only available treatment is experimental chemotherapy. Without treatment, the child is unlikely to survive for more than 6 weeks; with treatment his prognosis is unknown. The parents do not want further treatment for their son and wish to take him home; the child also says he wants to go home. Which of the following is the most appropriate course of action?

A) Discharge the child against medical advice;

B) Discharge the child routinely;

C) Petition the court for an order for treatment;

D) Report of the parents to the child protective services for medical neglect.

2) A nurse is hospitalized for appendectomy at the medical center where she is employed. One week after discharge, the assistant hospital administrator asks the surgeon who performed the procedure about the final diagnosis. Which of the following is the most appropriate response on the part of the surgeon?

A) Answer, because it will expedite handling of insurance issues at the medical center;

B) Answer, because as an employee of the medical center the administrator has access to information about patients;

C) Answer, because of the possibility of spreading misinformation about the patient;

D) Decline to answer, because the administrator is not a medical doctor;

E) Decline to answer, because the information is confidential.

3) An asymptomatic 3-year-old boy is brought to the physician for a routine examination. Small, inguinal lymph nodes are palpable; no other abnormalities are noted. Which of the following is the most appropriate next step?

A) Schedule a routine follow-up examination;

B) Urine culture for bacteria;

C) Tape test for pinworms;

D) Monospot test;

E) Complete blood test.

4) A 10-month-old girl, who happily allowed herself to be held when her grandmother visited 2 months ago, now cries when her mother tries to put her in her grandmother’s arms. The most likely explanation is that the child has

A) Been maltreated by the grandmother;

B) Begun to develop problem with socialization;

C) Normal stranger anxiety;

D) A sense of poor relationship between the mother and the grandmother;

E) Separation anxiety disorder.

5) An 8-year-old boy needs to be coaxed to go to school and often, while there, complains of severe headaches or stomach pain. Sometimes his mother has to take him home because of his symptoms. At night, he tries to sleep with his parents. When they insist he sleeps in his room, he says there are monsters in his closet. This history is most consistent with

A) Childhood schizophrenia;

B) Normal concerns of latency-age children;

C) Separation anxiety disorder;

D) Socialized conduct disorder;

E) Symbiotic psychosis.

6) A 70-year-old widower has ecchymosys, perifollicular petechiae, and swelling of the gingival. His diet consists primarily of cola and hot dogs. The most likely diagnosis is

A) Beriberi;

B) Kwashiorkor;

C) Pellagra;

D) Rickets;

E) Scurvy.

7) A 12-year-old girl has incurable muscular dystrophy and has been in a persistent vegetable state for 5 years. Her parents are actually eager to take her to Switzerland to end her life as assisted dying is legal there. Opponents of euthanasia, or ‘mercy killing’, argue that legalization would lead to abuse and call for doctors who participate to be struck off. Those people who are against euthanasia suppose that Public Health Care Service has to organize better palliative care and more hospices for the terminally ill to allow such patients to die with dignity. Which of the following is true to the situation?

A) It’s not correct to continue the critically ill girl’s suffering;

B) You would agree to assist in the death of such a child to end the useless existence;

C) You are against the parents’ position;

D) You are constantly trying to find some experimental drug to help to improve the girl’s condition.

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