USMLE Step 2 CS: Challenging Questions

A patient who needs emergent surgery says, "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." "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." 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." 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." 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- "Not necessarily. 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, such as hypertension and diabetes, or certain medications. We also have medications that may improve your sexual function." "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 efficacy 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." "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?" 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. Also, it is possible you could suffer complications from the problem while you are on vacation if we do not effectively deal with it before you leave."