Quiz's: Q & A Flashcards
What action should be taken if the probability of disease is below your treatment threshold but not below your testing threshold?
a. Stop doing tests related to that specific disease
b. Initiate management of that disease
c. Further investigation (questions, physical exams, labs etc)
d. Consider if the threshold might be too low, based on the balance of test harms and benefits
c. Further investigation (questions, physical exams, labs etc)
A naturopathic doctor is considering whether their patient, who experiences frequent headaches, is having migraines. After discussing the patient’s goals and values, the naturopathic doctor considers a treatment threshold of 50% to be reasonable for recommending riboflavin. After further questioning, they estimate the probability of migraines is 60%. What action is now appropriate?
a. There is insufficient information here; likelihood ratios would be needed
b. Consider migraine an active alternative
c. Consider migraine to be excluded
d. Recommend riboflavin
d. Recommend riboflavin
Which of the following would cause the “treatment zone” to expand (i.e. move the treatment threshold lower)
a. There is a safe and inexpensive test with a very high LR available to further assess the probability of the condition in question
b. The probability of disease is low, so the threshold must move down to meet it if treatment is to occur
c. The available treatments for the condition in question are expensive and risky
d. The condition is serious and unlikely to resolve on its own
d. The condition is serious and unlikely to resolve on its own
You are considering what further information you would seek in order to be able to treat a condition. You note the following:
There could be serious consequences for this patient if the condition in question went untreated
The test you are considering is expensive, provides relatively little information, and exposes the patient to substantial discomfort
The treatment you are considering is safe, relatively effective, and inexpensive
How will these factors influence your treatment threshold?
a. There is not enough information here. A pretest probability would be required
b. They will not effect the threshold; only further evidence could do this
c. They will move to expand the management (“treat”) area
d. They will move to expand the testing area
c. They will move to expand the management (“treat”) area
Two naturopathic doctors agree on the probability that a patient has PCOS but disagree about a certain treatment. One says it is warranted and the other says it is not. What is the source of their disagreement?
a. The disagree about the source of the evidence that brought them to the same probability
b. One of them thinks the probability is actually much higher than the other does
c. The probability is beyond the treatment threshold for one of them but not the other
d. For one of them, PCOS is an active alternative and for the other it has been ruled out
c. The probability is beyond the treatment threshold for one of them but not the other
A student in a teaching clinic describes a patient’s chief concern as follows:
Mr. Grosse is a 24-year-old man with unilateral temporal headaches that began, apparently spontaneously, 3 months ago. He describes the pain as “stabbing” and localized. He rates it as 7/10 (10 = worst). The headaches are occasionally accompanied by nausea and tiredness. He finds that rest can make the headaches better and they’re worse with vigorous exercise.
What aspect of the history of the present illness has been left out?
a. Radiation
b. Family history
c. Timing
d. Alcohol use
c. Timing
A naturopathic doctor is seeing a new patient who is experiencing abdominal pain. They are trying to learn about the patient’s past medical history. What question would be most appropriate?
a. Are you concerned about your prognosis?
b. Has anyone else in your family had gastrointestinal issues?
c. How often and for how long do you exercise in the course of a week?
d. Do you have any medical conditions?
d. Do you have any medical conditions?
A naturopathic doctor is completing an intake for a new patient, who is complaining of itchy, red eyes, and asks the following question: “Have you been experiencing a cough”? Which element of the patient history are they most likely conducting?
a. Past surgical history
b. Review of systems
c. History of caffeine use
d. Sexual history
b. Review of systems
A naturopathic doctor wants to investigate their patient’s social history. What should they ask about?
a. Character of their pain
b. Exercise
c. Family history
d. Expectations for treatment
b. Exercise
What makes the patient history valuable?
a. It has a favorable balance of information obtained compared with burdens imposed
b. Despite the fact that 8% of diagnoses are made through history alone, the process does not require lab work or exposure of the patient’s body to physical exams
c. The cost of the clinician’s time is worth the relatively high harm of potential emotional trauma from a detailed history
d. The fact that the evidence obtained from a history is always weak is offset by the fact that the harms are relatively minor
a. It has a favorable balance of information obtained compared with burdens imposed
What should a naturopathic doctor do as part of setting the stage in a medical interview?
a. Indicate how much time is available
b. Obtain data from patient accessories such as jewelry
c. Make the patient comfortable and put them at ease
d. List the issues the patient wants to discuss
c. Make the patient comfortable and put them at ease
What should a naturopathic doctor do as part of eliciting a patient’s chief concern and setting the agenda for the visit?
a. Reflect on their own emotions
b. Forecast what they would like to have occur during the intake
c. Minimize barriers to communication
d. Ensure that there is privacy and that the patient is ready
b. Forecast what they would like to have occur during the intake
How does patient centered interviewing differ from clinician-centered interviewing
a. In patient-centered interviewing, the patient takes the lead in the interaction, whereas in clinician-centered interviewing, the clinician does
b. In patient-centered interviewing, the clinician differentiates potential conditions the patient may be suffering from, whereas in clinician-centered interviewing, the patient does this
c. In clinician-centered interviewing, the clinician asks open-ended questions, whereas in patient centered interviewing, the patient asks open-ended questions
d. In clinician-centered interviewing, the clinician elicits the patient’s experience of disease, whereas in patient-centered interviewing, the clinician elicits the patient’s symptoms
a. In patient-centered interviewing, the patient takes the lead in the interaction, whereas in clinician-centered interviewing, the clinician does
Which of the following utterances from a clinician would be most suited to the middle of a patient interview?
a. “How is the pain affecting your ability to function at work?”
b. “People feeling this kind of pain sometimes find it affects their mood.”
c. “Would you describe your pain as sharp, or stabbing?”
d. “Please continue.”
c. “Would you describe your pain as sharp, or stabbing?”
What issue does patient-centered interviewing address, leading to better medical interviews?
a. People with medical issues tend to have one concern for which they book visits
b. Telling one’s symptom story can be therapeutic
c. Patients often seek care for symptoms rather than experiences
d. It allows clinicians to focus on gathering information about specific symptoms
b. Telling one’s symptom story can be therapeutic
