You have just received test results confirming that a 78-year-old patient has metastatic lung cancer. She informs you she does not want to know the results of the tests and is “leaving it in God’s hands.” You know that additional issues need to be explored, such as her desire for chemotherapy and hospice care.
Which one of the following is the most appropriate strategy for determining her wishes?
Correct Answer D:
In a patient-centered approach to communication regarding end-of-life care, a patient’s wishes to not know about a diagnosis or prognosis should be respected. However, it is reasonable to ask the patient to name a proxy with whom you may discuss the issues (choice D). The other options listed do not respect the patient’s desire to not know her diagnosis or prognosis.
An example of a fiscal policy would be:
Correct Answer E:
Public policy can be broken down into 3 main categories: Fiscal, Legislative and Social policy. Fiscal policy (example e) can be adopted to impose additional costs for undertaking unhealthy behaviors in hopes of creating an economic deterrent. Options (a) & (d) are examples of Legislative policies, in which, legal deterrents are put in place to reduce certain risky behaviors. Options (b) & (c) are examples of Social policies in which a system is put in place to create an environment of reasonable and equitable opportunity in hopes of supporting individuals across all socioeconomic statuses.
PEARL: Fiscal policy imposes an additional cost burden to unhealthy behaviors.
A 4-year-old male is brought to your office for evaluation of fever, coryza, and cough. On examination, the child appears mildly ill but in no respiratory distress. His temperature is 37.4°C (99.3°F) and other vital signs are within the normal range. HEENT examination is significant only for light yellow rhinorrhea and reddened nasal mucous membranes. Lung auscultation reveals good air flow with a few coarse upper airway sounds. While performing the examination you note multiple red welts and superficial abrasions scattered on the chest and upper back. When you question the parents, they tell you the marks are where “the sickness is leaving his body,” and were produced by rubbing the skin with a coin.
This traditional healing custom is practiced principally by people from which geographic region?
Correct Answer B:
Coin rubbing is a traditional healing custom practiced primarily in east Asian countries such as Cambodia, Korea, China, and Vietnam. The belief is that one’s illness must be drawn out of the body, and the red marks produced by rubbing the skin with a coin are evidence of the body’s “release” of the illness. These marks may be confused with abuse, trauma from some other source, or an unusual manifestation of the illness itself.
You test a patient’s muscles and find that his maximum performance consists of the ability to move with gravity neutralized.
This qualifies as which grade of muscle strength, on a scale of 5?
Correct Answer C:
Muscle strength is scored on a scale of 0 to 5:
You are a member of a committee at your local hospital that has been asked to develop measures to reduce the incidence of postoperative methicillin-resistant Staphylococcus aureus (MRSA) infections.
Which one of the following would be most effective for preventing these infections?
Correct Answer D: Nosocomial infections are a significant factor in morbidity and cost in the health care field. Methicillin resistant Staphylococcus aureus (MRSA) has rapidly increased in frequency, first being found only at tertiary centers, then local hospitals, and now in the outpatient setting. Of those who are found to be colonized, either at the time of hospitalization or later by a routine culture, 25% will develop a MRSA infection. However, a recent study showed that of 93 patients who became infected with the organism, 57% were not colonized at the time of infection. The study also attempted to screen all patients for MRSA on admission, but found that even though 337 previously unknown carriers were found (in addition to those already known to harbor the organism), there was not a significant decrease in the rate of MRSA infections during the study. Although MRSA infections can be serious, they comprise only 8% of nosocomial infections in the hospital, and concentrating prevention efforts only on MRSA has little effect on that 8%, and no effect on the 92% of infections caused by other organisms. Iatrogenic complications arise from trying to treat MRSA carriers, including both drug reactions and the development of other resistant organisms. Costs related to attempts at prophylaxis also go up. Culturing all hospital employees has not been proven to be of value, as employees can pick up the organism after screening, and also can spontaneously eradicate the organism without treatment. The best way to prevent complications and postoperative infections is to aggressively advocate universal and frequent hand washing and room cleaning, and use good isolation techniques and methods of preventing infection, such as strict catheter and intravenous tubing protocols.
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