Behavioral Aspects of Respiratory Difficulty

Question 1

A 50-year-old man is discussing his smoking history with his physician. He tells the physician that he has been smoking about 40 cigarettes a day for the past 30 years. Which of the following indicates the number of pack years the man has been smoking?
A) 20
B) 30
C) 40
D) 60

Answer 1

Correct answer is D. Pack years is calculated by dividing the number of cigarettes/day (40) by the number of cigarettes in a pack (20), and multiplying that number (2) by the number of years (30), which results in 60 pack years.

Question 2

A 20-year old man presented to his family physician for a routine physical. Because the patient had both a family history of lung cancer and a number of risk factors for smoking, the physician decided to refer the man to the clinic’s smoking prevention program. Which of the following patient characteristics would LEAST likely be a risk factor?
A) Diagnosis of ADHD
B) An introverted personality
C) Problem drinking
D) The presence of a depressive disorder

Answer 2

2) Correct answer is B. Extraversion, not introversion, is a risk factor for smoking.

Question 3

A 57-year-old woman has been diagnosed with COPD. In one of her follow-up visits, she tells her doctor that her breathing difficulties make her feel either hopeless or panicked. She says she worries all the time, and the worry drags her down and makes her want to give up. Which of the following statements would be most helpful in beginning a conversation about the patient’s emotional state?
A) “What you are describing are symptoms of depression and anxiety.”
B) “Breathing difficulties can be extremely challenging, and your distress is understandable.”
C) “It is important for you to get help with your emotional concerns.”
D) “Worry will only make your breathing problems worse, so try to avoid those feelings.”

Answer 3

Correct answer is B. Before providing a diagnosis or treatment recommendation, normalizing the emotions helps the patient feel understood and more receptive to further discussion.

Question 4

A 49-year-old man tells his physician, “I haven’t smoked in a year, but I have a class reunion coming up, and my buddies love to pull out the cigarettes when we get together. I want to make sure I don’t light up, because that would be a slippery slope back to addiction.” Which of the following represents the patient’s stage of change regarding his smoking habit?
A) Contemplation
B) Preparation
C) Action
D) Maintenance

Answer 4

Correct answer is D. The man has quit smoking, and is focused on preventing relapse, indicating that he is in the maintenance stage of change.