USMLE Step 2 CS 2023- Challenging Questions Answered 100%

"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." - ANSWER-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." "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." - ANSWER-"Should I tell my sexual partner about my venereal disease?" "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." - ANSWER-An anxious patient who you suspect has been abused asks, "Why are you asking me these questions?" "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." - ANSWER-A patient recently diagnosed with HIV asks, "Do I have to tell my wife?" "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." - ANSWER-An elderly patient says, "I think that it is normal at my age to have this problem" (impotence), or "I am just getting old." "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." - ANSWER-"I read in a journal that the treatment of this disease is herbal compounds." "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?" - ANSWER-"I am afraid of surgery." "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." - ANSWER-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?" 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. - ANSWER-"I did not understand your question, doctor. Could you repeat it, please?" 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." - ANSWER-"What is a bronchoscopy?" (MRI, CT, x-ray, colonoscopy) "It means all the tests that we are going to do to help us make the final diagnosis." - ANSWER-"What do you mean by 'workup'?" "I am glad that you came for help. We will do our best and hope for the best." - ANSWER-A patient who is late in seeking medical advice asks, "Do you think it is too late for recovery?" "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 confirm the diagnosis and rule out heart problems." - ANSWER-A patient with pleuritic chest pain asks, "Is this a heart attack? Am I going to die?" "That is one of the possibilities, but there are other explanations for your symptoms that we should rule out before making a diagnosis." - ANSWER-"Do you think I have colon cancer?" "Do you think I have a brain tumor?" "Do I have endometrial cancer?" "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." - ANSWER-"My friend told me that you are a very fine doctor. That's why I came to you to refill my prescription." "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." - ANSWER-"Will my insurance cover the expenses of this test?" "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." - ANSWER-A person who wants to return to work at a job that can negatively affect his health asks, "Can I go back to work?" "We really won't know until we remove the mass and get a pathology report on it." - ANSWER-"Do you think that this tumor I have could become malignant?" "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." - ANSWER-"Since I stopped smoking, I have gained weight. I want to go back to smoking in order to lose weight." "We will do our best to help you recover from your shoulder injury. With your permission, I will communicate the situation to your employer." - ANSWER-A patient with a shoulder injury says, "I am afraid of losing my job if my shoulder doesn't get better." 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." - ANSWER-"Will I ever feel better, doctor?" "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." - ANSWER-A person who has a broken arm asks, "Doctor, do you think I will be able to move my arm again like before?" "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. - ANSWER-"I think that life is full of misery. Why do we have to live?" "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." - ANSWER-A young man with multiple sexual partners and a recent-onset skin rash says, "I am afraid that I might have AIDS." "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." - ANSWER-A patient who needs hospitalization says, "My child is at home alone. I have to leave now." "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." - ANSWER-"Do you have anything that will make me feel better? Please, doctor, I am in pain." "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." - ANSWER-A patient you believe is pretending (malingering) says, "Please, doctor, I need a week off from work. The pain in my back is terrible." "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." - ANSWER-"Stop asking me all these stupid questions and just give me something for this pain." "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." - ANSWER-"So what's the plan, doctor?" "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." - ANSWER-"Do you think I will need surgery?" "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." - ANSWER-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?" "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." - ANSWER-A patient is shouting angrily, "Where have you been, doctor? I have been waiting here for the whole day." "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 flashes, and only for a limited period of time." - ANSWER-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?" "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." - ANSWER-"Did I have a stroke?" "We don't know at this point. It is a possibility, but we still need to do additional tests." - ANSWER-"Do I have lung cancer?"