Doctor-Patient Issues Quizzes - Part 2 (22 test)

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Question 1

You are caring for a 55-year-old man who recently has complained of chest His electrocardiogram is abnormal, and you feel he should have a cardiac catheterization. After explaining the risks and benefits to him, he refuses the intervention. Which of the following responses best demon- strates the tenets of professionalism in this case?

A	Respect the patient’s choice and continue to explore his reasons for refusing treatment
B	Explain to him that you think he is making a bad decision, and try to convince him to change his mind
C	Consult the ethics committee of the hospital
D	Consult a psychiatrist to determine the patient’s competency
E	Discharge the patient from your practice because of the poor doctor-patient relationship you have with him

Question 1 Explanation:

Convincing a patient to change his mind disregards patient autonomy. Consulting an ethics committee andDoctor-Patient Issues Answers 43 evaluating the patient’s competency are unnecessary at this point. Discharging the patient from your practice for disagreeing with you would be inappropriate.

Question 2

You are caring for a 38-year-old man with metastatic He thor- oughly understands his condition, and realizes that he has only a few months to live. He asks that you do not tell his wife about his prognosis, as “she won’t be able to take it.” The patient’s wife sees you in the hallway and says, “tell me the truth . . . how is his condition?” Which of the following responses best reflects an ethically sound course of action?

A	Tell her the truth about the situation because she has a right to know
B	Tell her the truth because you have the legal obligation to do so
C	Consult the ethics committee to help you make the decision
D	Do not tell the patient’s wife, but inform her that you will not tell her husband about the conversation you’ve just had
E	Do not tell the patient’s wife, but make an effort to encourage an open dialogue between her and her husband

Question 2 Explanation:

Patient confidentiality demands that you maintain safeguards related to the disclosure of patient information. This is dictated by the patient, even if the wife is the other person in the communication triad.

Question 3

The practice where you are working cares for a wide variety of Of the following, which subgroup is most likely to explore and use complementary and alternative medicine (CAM)?

A	Children
B	College students
C	Men
D	Women
E	The elderly

Question 3 Explanation:

Rates of CAM use are significant in all populations, but studies have shown that women are consistently more likely to explore and use CAM. Women are frequently central to the health care decisions made in a family, and when surveyed, 49% of women have used CAM. Other surveys have shown that 50% of patients with cancer or HIV will use unconventional medical practices at some point during their illness. CAM is gaining public interest, and becoming increasingly popular in the United States.

Question 4

You are treating a 75-year-old Caucasian man with benign prostatic hyperplasia (BPH). He would like to consider an herbal medication to con- trol his Which of the following is the best option for this condition?

A	Ginkgo biloba
B	Hypericum (St. John’s wort)
C	Saw palmetto
D	Garlic
E	Glucosamine

Question 4 Explanation:

Systematic reviews of controlled trials have shown that saw palmetto is as effective as finasteride in relieving symptoms of BPH. However, its use did not result in a decreased prostate volume. Gingko biloba has been studied in people with dementia, and garlic has been studied in people with heart disease. A number of placebo-controlled trials have shown that St. John’s wort may be effective in the treatment of depression. Glucosamine is a natural medicine that is primarily used to help arthritis symptoms.

Question 5

Traditional therapies have offered limited benefit to a 55-year-old woman who suffers from migraine headaches, and she asks you about alternative She currently takes 325 mg of enteric-coated aspirin a day, and paroxetine, 20 mg daily. Which of the following has the lowest risk of toxicity or harm?

A	St. John’s wort
B	Megavitamins
C	Macrobiotic diet
D	Gingko biloba
E	Acupuncture

Question 5 Explanation:

When discussing complementary and alternative medicine, physicians should help patients make informed choices. Many practices, including acupuncture, biofeedback, homeopathy, and meditation are low risk if used by competent practitioners. Many herbal substances can interact with traditional medications and cause harm. St. John’s wort can cause serotonin syndrome when used with a selective serotonin reuptake inhibitor like paroxetine. Megavitamins carry with them the risk of toxicity. Special diets, including the macrobiotic diet (high complex carbohydrate, low fat, vegetarian diet) may have harmful effects, including undesirable changes in weight and bowel habits. Gingko biloba has antiplatelet effects, and may cause bleeding when taken with aspirin.

Question 6

You know that many of your patients have tried complementary and alternative medicines (CAMs), but also know that patients may not reveal this to their What percentage of patients that use complemen- tary and alternative medicine practices reveal this information to their con- ventionally trained physicians?

A	Less than 5%
B	Approximately 10%
C	Approximately 30%
D	Approximately 50%
E	More than 50%

Question 6 Explanation:

There is a major communication gap between physicians and the public regarding CAM practices. More than 70% of patients that use CAM do not reveal this to their conventional physicians. Often, they fear reprisal from their physician. If physicians are open to hearing about therapies, and react to the knowledge in a nonjudgmental fashion, patients will feel more comfortable sharing the information, and patient care will be improved.

Question 7

Of those patients who use CAM, how many use it as their exclusive treatment modality?

A	Less than 5%
B	Approximately 10%
C	Approximately 30%
D	Approximately 50%
E	Most patients who use CAM practices use them exclusively

Question 7 Explanation:

The overwhelming majority of patients who use CAM use it as an adjunct to more traditional western therapies. Less than 5% use CAM exclusively. In general, patients who use CAM do not harbor an “antiscience” sentiment. Patients who use CAM do not include a disproportionate number of uneducated, poor or mentally ill representatives. Often, the attraction to CAM is philosophical, and is consistent with the patient’s overall health beliefs.

Question 8

After a prolonged fight with metastatic breast cancer, your patient decides to forego further attempts at curative treatment and focus on palliative She has tried nonsteroidal anti-inflammatory agents and acetaminophen for management of her chronic bone pain, but this has been ineffective. Which of the following would be the best initial pain management regimen?

A	Dexamethasone or another steroid to get the pain under control then scheduled nonsteroidal anti-inflammatory medications to maintain pain control
B	A fentanyl patch at the lowest dose that controls the pain
C	Five milligrams of immediate release morphine sulfate every 4 hours, with a dose every 2 hours as needed
D	Sustained release morphine sulfate, with immediate release morphine used for breakthrough pain
E	A patient-controlled analgesia device using opioids

Question 8 Explanation:

The World Health Organization published guidelines for pain control in 1996. These guidelines have been well-studied and lead to effective pain control in most situations. In general, failing nonopioid pain control should lead to the use of opioid analgesics. Steroids have limited, if any, use in chronic cancer pain. Fentanyl patches, even at the lowest dose, may be excessive in opiate naïve patients, and should never be used alone. Most start with immediate release morphine sulfate to determine a baseline need. This can be converted to sustained release quickly, and titrated based on pain control. Patient-controlled analgesia devices have an important role, but require intravenous or subcutaneous administration, and should not be used firstline, unless pain is extreme.

Question 9

Your patient has terminal cancer with a life expectancy of less than 3 You are managing her chronic cancer pain with morphine sul- fate. She has been stable for weeks, but is requiring increasing amounts of opiates to maintain pain control. Which of the following statements is true regarding this situation?

A	The patient’s disease is progressing and you should increase her medication dosage
B	The patient’s disease is progressing and you should change medications
C	The patient is developing tolerance and you should increase her medication
D	The patient is developing tolerance and you should maintain the dosage of medication to avoid dependence
E	The patient is developing tolerance and you should slowly withdraw medication

Question 9 Explanation:

Managing chronic cancer pain with opiates is often concerning for physicians. Many fear addiction and are concerned about causing harm. It is important to remember that there is no specific limit to opioid dose, and medications should be titrated to pain control or development of significant side effects. Fear of addiction should not hinder the use of opiates in this situation. Addiction is a rare occurrence in patients with terminal illness, especially in patients without a history of drug abuse. In patients on previously steady doses, dose escalation generally means the disease is progressing rather than tolerance. Tolerance, like addiction, is rarely seen.

Question 10

You are caring for a 68-year-old man who, one month ago, developed a The rash consisted of grouped vesicles on erythematous bases in a dermatomal pattern. You effectively treated the rash, but the patient com- plained of a persistent burning and itching pain in the same area as the rash. The pain is significant and keeps him from sleeping. What is the best approach for long-term pain management in this patient?

A	Nonsteroidal anti-inflammatory agents
B	Opiate analgesics
C	Steroids
D	Anticonvulsants
E	Selective serotonin reuptake inhibitors

Question 10 Explanation:

Neuropathic pain, like that described from shingles in this question, frequently requires opioids in the short term, but often requires the use of other medications for longterm relief. Commonly used medications includes tricyclic antidepressants, anticonvulsants (valproic acid, carbamazepine, gabapentin are the most common), and antihistamines. The data on using selective serotonin reuptake inhibitors are unconvincing.

Question 11

You are caring for a 65-year-old man with lung He was diag- nosed 4 months ago, and is not expected to live for more than 2 months. He is experiencing dyspnea. His chest x-ray shows progression of his can- cer, and his pulse oximetry shows a room air oxygen saturation of 94%. Which of the following is most likely to relieve his symptoms?

A	Opioids
B	Nebulized morphine
C	Steroids
D	Benzodiazepines
E	Albuterol

Question 11 Explanation:

Dyspnea, like pain, is a subjective sensation. It can be present in the absence of hypoxia. Opioids can relieve breathlessness associated with advanced cancer by an unclear mechanism. Nebulized morphine isn’t more effective than placebo. Steroids and albuterol are useful for dyspnea caused by bronchospasm, but that is unlikely in this case. Anxiolytics, like benzodiazepines and buspirone, may help if anxiety is a significant component, but that is usually expressed by patients as a feeling of “choking” or “suffocation.”

Question 12

You are caring for a 68-year-old man who has had colon cancer for 3 Therapies have been unsuccessful, and he has chosen palliative care only. He complains of excessive fatigue, feeling tired after minimal activity,

and lacking energy to perform the activities of daily living. He denies depression, and feels he is handling his diagnosis well with the support of his family and friends. His laboratory evaluation is normal, except for mild anemia. Which of the following therapies would be most likely to help his symptoms?

A	Transfusion
B	Nutritional supplementation
C	Selective serotonin reuptake inhibitors
D	Sedative hypnotics
E	A psychostimulant like methylphenidate

Question 12 Explanation:

Excessive fatigue seen with end-stage cancer may result from direct tumor effects, paraneoplastic neuropathy, or tumor involvement of the CNS. It is often an effect of therapy. When no specific cause is apparent, as in this question, therapy is difficult. Transfusion is unlikely to be beneficial given his hemoglobin level. There is no evidence that the patient has a nutritional deficit, and supplementation may not be helpful. Although fatigue is frequently seen as a symptom of depression and may respond to selective serotonin reuptake inhibitor therapy, in this case it is unlikely. Sleeping pills would not help unless insomnia is the cause. A short course of steroids or a psychostimulant can increase energy and improve mood.

Question 13

You are treating a 60-year-old patient with end stage ovarian You are concerned that she may be developing depression. Which of the fol- lowing would be the most reliable symptom of depression in this patient?

A	Loss of appetite
B	Fatigue
C	Insomnia
D	Sadness
E	Anhedonia

Question 13 Explanation:

It is commonly assumed that all patients with cancer are, and should be, depressed. Physicians often do not recognize depression because they feel they would be depressed in the same situation. While neurovegetative symptoms are a compelling indication of depression in the physically healthy patient, they may be less reliable for the diagnosis of depression in patients with advanced cancer. Loss of appetite may be due to therapy, fatigue may be due to insomnia from untreated pain. Sadness may be appropriate, given the diagnosis. Anhedonia is a useful, if not the most useful symptom to monitor. Also helpful are hopelessness, guilt, and a wish to die.

Question 14

You are caring for a 39-year-old woman who is dying of breast Her family wonders how to recognize the symptoms of impending death. Which of the following is a reliable sign that death is near in this patient?

A	Delirium
B	Desire to communicate with loved ones
C	Limited attention span
D	Desire for favorite food
E	Increased attention to dates and time

Question 14 Explanation:

As death approaches, there are several signs that portend its arrival. Delirium may be a result of medication, and by itself is not a good indicator. Other indicators are: • Remaining bedbound • Confusion • Cool and mottled extremities • The “death rattle” • Decreased hearing/vision • Difficulty swallowing • Decreased conversation • Decreased oral intake • Disorientation to time • Drowsiness progressing to somnolence for extended periods • Dry mouth • Hallucinations • Increased distance from all but a few intimate others • Decreased attention span • Profound weakness

Question 15

You are making a home visit to a 68-year-old man with terminal can- His family says that his breathing seems to be labored. Upon evalua- tion, you know that this is the “death rattle” that often signals approaching death. Which of the following drugs would be most useful in controlling this symptom?

A	Atropine
B	Ketorolac
C	Lorazepam
D	Haloperidol
E	Thorazine

Question 15 Explanation:

Atropine can decrease secretions and help the “death rattle.” Other medications that may be useful include scopolamine, glycopyrolate, mycosamine, or morphine. Ketorolac may help pain, lorazepam may help restlessness, haloperidol and thorazine may help agitation and hallucinations, both of which are also symptoms of impending death

Question 16

A 19-year-old sexually active homosexual male asks you about his risk for He is currently asymptomatic and unsure of his immune sta- tus. Which of the following would you recommend?

A	Vaccination against Hepatitis A only
B	Vaccination against Hepatitis B only
C	Vaccine against Hepatitis C only
D	Vaccinations against both Hepatitis A and B
E	Vaccinations against both Hepatitis B and C

Question 16 Explanation:

The unique health needs of gay men may often be overlooked by physicians, especially if not alert to appropriate and sympathetic sexual history-taking. Since Hepatitis A is transmitted orally/fecally, and many gay men participate in oral/anal sexual activity, vaccination against Hepatitis A is appropriate. Since hepatitis B is transmitted through blood and body fluids, and sometimes by anal intercourse, Hepatitis B vaccination is indicated. There is no vaccination against Hepatitis C.

Question 17

A 26-year-old homosexual man presents with blood on the toilet paper when Examination of the anal mucosa reveals this:

(Reproduced, with permission, from Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 5th ed. New York: McGraw-Hill, 2005: 891.)

Which of the following statements is true regarding this condition?

A	This condition is rarely seen in men who are not immunocompromised
B	The patient’s physician should consider anal cytologic screening with a Papina- colau (Pap) test
C	The patient should be treated with intramuscular penicillin once a week for 3 weeks
D	The patient should be treated with valciclovir
E	The patient should be treated with one dose of azithromycin

Question 17 Explanation:

The picture above represents infection with Human Papilloma Virus (HPV). The prevalence of this infection is high, and in one study, 65.9% of HIV negative gay men were found to be positive for anal HPV. Penicillin treats syphilis, valciclovir treats herpes and azithromycin treats Chlamydia and gonorrhea (high doses of azithromycin are needed to treat gonorrhea than Chlamydia). Men infectedDoctor-Patient Issues Answers 47 with HPV have been shown to have anal dysplasia, and cytologic screening should be considered for gay men positive for HPV.

Question 18

A 30-year-old gay male asks you about how his sexuality impacts his cancer Which of the following statements most accurately reflect his risk for cancer?

A	Homosexual men have an increased rate of oral cancer
B	Homosexual men have an increased rate of colon cancer
C	Homosexual men have an increased rate of liver cancer
D	Homosexual men have an increased rate of testicular cancer
E	Homosexual men have an increased rate of anal cancer

Question 18 Explanation:

The increase in anal cancer in homosexual men is due to the increase in anal HPV infection seen in the gay male population. This is even seen in men without HIV. The other cancers listed do not seem to have an increased incidence in gay men.

Question 19

You are caring for a 42-year-old lesbian She has recently left a 10-year monogamous relationship, and is concerned about her risk for vaginal and other infections, once she resumes sexual activity with a new partner. Which of the following is true regarding her concern?

A	The rate of sexually transmitted infections (STIs) among lesbians is less than the rate in heterosexual women
B	The rate of genital warts is higher in lesbians than in heterosexual women
C	The rate of bacterial vaginosis is higher in lesbians than in heterosexual women
D	The rate of genital herpes is higher in lesbians than in heterosexual women
E	Sexually active lesbians have a lower prevalence of HIV than women who have sex exclusively with men

Question 19 Explanation:

Generally, lesbians are felt to be at less risk for STIs than heterosexual women. However, most studies indicate comparable rates of STIs between lesbians and heterosexual women. Interestingly, the type of STI is different. Genital warts and genital herpes are more common in heterosexuals, with bacterial vaginosis being more common in lesbians. There is a mistaken belief that lesbians are not at risk for acquiring HIV. However, it has been shown that sexually active lesbians have a higher prevalence of HIV than women who have sex exclusively with men.

Question 20

You are caring for a 40-year-old lesbian with no family history of breast She asks you about her risk of having breast cancer. Which of the following is true regarding breast cancer among lesbian women?

A	Breast cancer rates do not differ between lesbians and heterosexual women
B	Breast cancer rates are higher among lesbians because of nonparity
C	Breast cancer rates are higher among lesbians because of obesity
D	Breast cancer rates are higher among lesbians because of alcohol and tobacco use
E	Breast cancer rates are lower among lesbians because they generally use oral contraceptives less

Question 20 Explanation:

Survey data from almost 12,000 women found no difference in breast cancer rates between lesbians and heterosexual women. Intuitively, one would think cancer rates would be higher because of nulliparity and higher rates of obesity. However, welldesigned prospective studies have not been done to establish that as fact.

Question 21

You are caring for a 25-year-old She asks you about Papinaco- lau (Pap) testing in lesbian women. Which of the following is true about cervical cancer screening in this population?

A	Lesbians do not need Pap testing
B	Lesbians do not need Pap testing, except if they are smokers
C	Lesbians need Pap testing, but less frequently than heterosexual women
D	Lesbians should be screened for cervical cancer at the same intervals that are recommended for heterosexual women
E	Lesbians should be screened for cervical cancer more frequently than hetero- sexual women

Question 21 Explanation:

Cervical cancer may be less prevalent in women who have never had heterosexual vaginal intercourse, however even in women reporting that they have never had sex with a man, up to 20% were found to have HPV DNA. Also, many physicians assume selfreported lesbians to have never had sex with a man, when some studies have reported that up to 79% of lesbians have reported having sex with a male in the past. Therefore, physicians should follow Pap smear screening guidelines in place for all women regardless of the woman’s reported sexuality.

Question 22

You are taking the complete history of a patient new to your The patient is dressed as a woman, but is biologically male. Further history reveals that the patient takes female hormones and is considering sexual reassignment surgery. What term best describes this person’s condition?

A	Cross dresser
B	Bigender
C	Transvestite
D	Transsexual
E	Transgender

Question 22 Explanation:

Transgender is an umbrella term describing a group of people who cross culturally defined gender categories. Cross dressers wear the clothes of the other gender, but may not completely identify with that gender. Bigender individuals identify with both genders. Transvestites dress as another gender, but have not considered surgery. Transexuals wish to change their sex, and have considered or undertaken surgery

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1.You are caring for a 55-year-old man who recently has complained of chest His electrocardiogram is abnormal, and you feel he should have a cardiac catheterization. After explaining the risks and benefits to him, he refuses the intervention. Which of the following responses best demon- strates the tenets of professionalism in this case?

Respect the patient’s choice and continue to explore his reasons for refusing treatment
Explain to him that you think he is making a bad decision, and try to convince him to change his mind
Consult the ethics committee of the hospital
Consult a psychiatrist to determine the patient’s competency
Discharge the patient from your practice because of the poor doctor-patient relationship you have with him

2. You are caring for a 38-year-old man with metastatic He thor- oughly understands his condition, and realizes that he has only a few months to live. He asks that you do not tell his wife about his prognosis, as “she won’t be able to take it.” The patient’s wife sees you in the hallway and says, “tell me the truth . . . how is his condition?” Which of the following responses best reflects an ethically sound course of action?

Tell her the truth about the situation because she has a right to know
Tell her the truth because you have the legal obligation to do so
Consult the ethics committee to help you make the decision
Do not tell the patient’s wife, but inform her that you will not tell her husband about the conversation you’ve just had
Do not tell the patient’s wife, but make an effort to encourage an open dialogue between her and her husband

3. The practice where you are working cares for a wide variety of Of the following, which subgroup is most likely to explore and use complementary and alternative medicine (CAM)?

Children
College students
Men
Women
The elderly

4. You are treating a 75-year-old Caucasian man with benign prostatic hyperplasia (BPH). He would like to consider an herbal medication to con- trol his Which of the following is the best option for this condition?

Ginkgo biloba
Hypericum (St. John’s wort)
Saw palmetto
Garlic
Glucosamine

5. Traditional therapies have offered limited benefit to a 55-year-old woman who suffers from migraine headaches, and she asks you about alternative She currently takes 325 mg of enteric-coated aspirin a day, and paroxetine, 20 mg daily. Which of the following has the lowest risk of toxicity or harm?

St. John’s wort
Megavitamins
Macrobiotic diet
Gingko biloba
Acupuncture

6. You know that many of your patients have tried complementary and alternative medicines (CAMs), but also know that patients may not reveal this to their What percentage of patients that use complemen- tary and alternative medicine practices reveal this information to their con- ventionally trained physicians?

Less than 5%
Approximately 10%
Approximately 30%
Approximately 50%
More than 50%

7. Of those patients who use CAM, how many use it as their exclusive treatment modality?

Less than 5%
Approximately 10%
Approximately 30%
Approximately 50%
Most patients who use CAM practices use them exclusively

8. After a prolonged fight with metastatic breast cancer, your patient decides to forego further attempts at curative treatment and focus on palliative She has tried nonsteroidal anti-inflammatory agents and acetaminophen for management of her chronic bone pain, but this has been ineffective. Which of the following would be the best initial pain management regimen?

Dexamethasone or another steroid to get the pain under control then scheduled nonsteroidal anti-inflammatory medications to maintain pain control
A fentanyl patch at the lowest dose that controls the pain
Five milligrams of immediate release morphine sulfate every 4 hours, with a dose every 2 hours as needed
Sustained release morphine sulfate, with immediate release morphine used for breakthrough pain
A patient-controlled analgesia device using opioids

9. Your patient has terminal cancer with a life expectancy of less than 3 You are managing her chronic cancer pain with morphine sul- fate. She has been stable for weeks, but is requiring increasing amounts of opiates to maintain pain control. Which of the following statements is true regarding this situation?

The patient’s disease is progressing and you should increase her medication dosage
The patient’s disease is progressing and you should change medications
The patient is developing tolerance and you should increase her medication
The patient is developing tolerance and you should maintain the dosage of medication to avoid dependence
The patient is developing tolerance and you should slowly withdraw medication

10. You are caring for a 68-year-old man who, one month ago, developed a The rash consisted of grouped vesicles on erythematous bases in a dermatomal pattern. You effectively treated the rash, but the patient com- plained of a persistent burning and itching pain in the same area as the rash. The pain is significant and keeps him from sleeping. What is the best approach for long-term pain management in this patient?

Nonsteroidal anti-inflammatory agents
Opiate analgesics
Steroids
Anticonvulsants
Selective serotonin reuptake inhibitors

11. You are caring for a 65-year-old man with lung He was diag- nosed 4 months ago, and is not expected to live for more than 2 months. He is experiencing dyspnea. His chest x-ray shows progression of his can- cer, and his pulse oximetry shows a room air oxygen saturation of 94%. Which of the following is most likely to relieve his symptoms?

Opioids
Nebulized morphine
Steroids
Benzodiazepines
Albuterol

12. You are caring for a 68-year-old man who has had colon cancer for 3 Therapies have been unsuccessful, and he has chosen palliative care only. He complains of excessive fatigue, feeling tired after minimal activity,

Transfusion
Nutritional supplementation
Selective serotonin reuptake inhibitors
Sedative hypnotics
A psychostimulant like methylphenidate

13. You are treating a 60-year-old patient with end stage ovarian You are concerned that she may be developing depression. Which of the fol- lowing would be the most reliable symptom of depression in this patient?

Loss of appetite
Fatigue
Insomnia
Sadness
Anhedonia

14. You are caring for a 39-year-old woman who is dying of breast Her family wonders how to recognize the symptoms of impending death. Which of the following is a reliable sign that death is near in this patient?

Delirium
Desire to communicate with loved ones
Limited attention span
Desire for favorite food
Increased attention to dates and time

15. You are making a home visit to a 68-year-old man with terminal can- His family says that his breathing seems to be labored. Upon evalua- tion, you know that this is the “death rattle” that often signals approaching death. Which of the following drugs would be most useful in controlling this symptom?

Atropine
Ketorolac
Lorazepam
Haloperidol
Thorazine

16. A 19-year-old sexually active homosexual male asks you about his risk for He is currently asymptomatic and unsure of his immune sta- tus. Which of the following would you recommend?

Vaccination against Hepatitis A only
Vaccination against Hepatitis B only
Vaccine against Hepatitis C only
Vaccinations against both Hepatitis A and B
Vaccinations against both Hepatitis B and C

17. A 26-year-old homosexual man presents with blood on the toilet paper when Examination of the anal mucosa reveals this:

(Reproduced, with permission, from Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 5th ed. New York: McGraw-Hill, 2005: 891.)

Which of the following statements is true regarding this condition?

This condition is rarely seen in men who are not immunocompromised
The patient’s physician should consider anal cytologic screening with a Papina- colau (Pap) test
The patient should be treated with intramuscular penicillin once a week for 3 weeks
The patient should be treated with valciclovir
The patient should be treated with one dose of azithromycin

18. A 30-year-old gay male asks you about how his sexuality impacts his cancer Which of the following statements most accurately reflect his risk for cancer?

Homosexual men have an increased rate of oral cancer
Homosexual men have an increased rate of colon cancer
Homosexual men have an increased rate of liver cancer
Homosexual men have an increased rate of testicular cancer
Homosexual men have an increased rate of anal cancer

19. You are caring for a 42-year-old lesbian She has recently left a 10-year monogamous relationship, and is concerned about her risk for vaginal and other infections, once she resumes sexual activity with a new partner. Which of the following is true regarding her concern?

The rate of sexually transmitted infections (STIs) among lesbians is less than the rate in heterosexual women
The rate of genital warts is higher in lesbians than in heterosexual women
The rate of bacterial vaginosis is higher in lesbians than in heterosexual women
The rate of genital herpes is higher in lesbians than in heterosexual women
Sexually active lesbians have a lower prevalence of HIV than women who have sex exclusively with men

20. You are caring for a 40-year-old lesbian with no family history of breast She asks you about her risk of having breast cancer. Which of the following is true regarding breast cancer among lesbian women?

Breast cancer rates do not differ between lesbians and heterosexual women
Breast cancer rates are higher among lesbians because of nonparity
Breast cancer rates are higher among lesbians because of obesity
Breast cancer rates are higher among lesbians because of alcohol and tobacco use
Breast cancer rates are lower among lesbians because they generally use oral contraceptives less

21. You are caring for a 25-year-old She asks you about Papinaco- lau (Pap) testing in lesbian women. Which of the following is true about cervical cancer screening in this population?

Lesbians do not need Pap testing
Lesbians do not need Pap testing, except if they are smokers
Lesbians need Pap testing, but less frequently than heterosexual women
Lesbians should be screened for cervical cancer at the same intervals that are recommended for heterosexual women
Lesbians should be screened for cervical cancer more frequently than hetero- sexual women

22. You are taking the complete history of a patient new to your The patient is dressed as a woman, but is biologically male. Further history reveals that the patient takes female hormones and is considering sexual reassignment surgery. What term best describes this person’s condition?

Cross dresser
Bigender
Transvestite
Transsexual
Transgender

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Doctor-Patient Issues Quizzes – Part 2 (22 test)

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