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Interview Questions for the Physician Candidate

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561. Psychosocial and Environmental Pregnancy Risks (Follow-up)

shown to have environmental and genetic components. Two determinations must be made when a physician responds to a patient's concerns about a specific exposure: (1) whether any quantity of the toxicant has known adverse effects on reproduction in humans and (2) whether the substance is present in sufficient quantity to affect the patient or population exposed. This issue is complicated in humans by the high natural spontaneous abortion rate of 15-30%, which makes determining the specific (...) in the pregnant woman is usually associated with a high level of anxiety for the woman, her family, and, often, the physician. 2014 study also showed that there is a deficiency in both emergency department (ED) and obstetric/gynecologic physicians' knowledge when counseling women about the risks of diagnostic imaging in pregnancy. [ ] A number of modalities may be required for diagnosis and treatment of exposures in pregnancy. It is necessary to balance the benefits of such procedures with an accurate

2014 eMedicine.com

562. Bipolar Affective Disorder (Overview)

with susceptibility to bipolar disease in a cohort of 41 Finnish families. [ ] MAFD5 is located at 2q22-q24, and MAFD6 is located at 6q23-24. Interestingly, evidence suggests a strong interaction between genes located in these 2 regions. It has been concluded that the candidate gene in the MAFD5 locus shows epistatic interaction with the MAFD6 risk locus. [ ] MAFD7 is located at 22q12.1 and was detected using microsatellite markers in a North American population; a large region on 22q12 was associated (...) %), bipolar disorder type II (BPII) (1.1%), and subthreshold bipolar disorders (2.4–4.7%). [ ] International statistics Globally, the lifelong prevalence rate of bipolar disorder is 0.3–1.5%. In cross-sectional, face-to-face household surveys of more than 61,000 adults across 11 countries, Merikangas et al, using the World Mental Health version of the World Health Organization Composite International Diagnostic Interview, version 3.0, determined that the aggregate lifetime prevalences were 0.6% for BPI

2014 eMedicine.com

563. Autistic Spectrum Disorders (Overview)

-by-case basis. (See Treatment.) Practice guidelines The American Academy of Child and Adolescent Psychiatry's practice guidelines for the assessment and treatment of children and adolescents with ASD include the following recommendations: [ , ] Questions about core symptoms of ASD should be a routine part of psychiatric and developmental assessments of young children. If screening reveals significant ASD symptomatology, a thorough evaluation should be performed and possible comorbid diagnoses should (...) with an ongoing seizure disorder requires treatment because maternal seizures can result in serious morbidity and mortality for the mother and the fetus. To stop anticonvulsant therapy when a woman with a seizure disorder becomes pregnant to avoid teratologic effects may precipitate uncontrolled seizures that may be fatal to the mother and the fetus. Therefore physicians treating women with child-bearing potential can appropriately initiate frank conversations about future pregnancies. Juvenile myoclonic

2014 eMedicine.com

564. Amyotrophic Lateral Sclerosis (Overview)

of a faulty regulatory gene product responsible for motor network maintenance, or failure to regulate such a product, may account for the specific disintegration of the motor network. MicroRNAs are particularly attractive candidates for this role. The affirmation of spread substantiates the concept of a biologic focal onset for ALS. This in turn lends credibility to the concept of a focal trigger for ALS onset that generates the production of 1 or more agents of spread. [ ] Under this hypothesis, disease (...) , and the level of knowledge of the person being interviewed. [ ] In addition, first-degree relatives of patients with apparently sporadic disease have an increased risk of ALS. The overall lifetime risk of ALS in these relatives is low, however (approximately 1 in 50). [ ] Familial cases A family history of ALS is obtained in about 5% of cases and is often consistent with a Mendelian autosomal dominant pattern of inheritance. While most cases of familial ALS are indistinguishable from sporadic disease

2014 eMedicine.com

565. Obsessive-Compulsive Disorder (Follow-up)

? Share cases and questions with Physicians on Medscape consult. (...) , as the effectiveness of these exercises requires that the patient experience a significant level of discomfort and then not respond with his or her characteristic rituals. A patient may benefit from a self-help book in conducting ERP (eg, Foa and Reid, 2001 [ ] ), and workbooks are available for CBT as well. When recommending such a book, the treating physician should be familiar with its content. A related approach, described by Dr. Jonathan Grayson, focuses on getting the patient to accept living

2014 eMedicine.com

566. Obesity (Follow-up)

prevention As with all chronic medical conditions, effective management of obesity must be based on a partnership between a highly motivated patient and a committed team of health professionals. This team may include the physician, a psychologist or psychiatrist, physical and exercise therapists, dietitians, and other subspecialists, depending on the comorbidities of the individual patient. Scientific evidence indicates that multidisciplinary programs reliably produce and sustain modest weight loss (...) , should be used as adjuncts to behavioral modification to reduce food intake and increase physical activity when this is possible. Drugs may amplify adherence to behavior change and may improve physical functioning such that increased physical activity is easier in those who cannot exercise initially. Patients who have a history of being unable to successfully lose and maintain weight and who meet label indications are candidates for weight loss medications. To promote long-term weight maintenance

2014 eMedicine.com

567. Lung Cancer, Non-Small Cell (Follow-up)

chemotherapy. [ ] Patients with stage IIIB and IV NSCLC are usually offered chemotherapy with the option of surgery. Molecular-targeted therapy plays an increasingly important role in the treatment of advanced NSCLC. Radiation is a reasonable option for treatment in patients who are not candidates for surgery. The role of adjuvant radiation therapy after resection of the primary tumor remains controversial. See the table below, as well as . Because most NSCLC cannot be cured with currently available (...) group also had less depressive symptoms, and fewer patients in this group received aggressive end-of-life care. [ ] Emergency Treatment All patients thought to have lung cancer should be encouraged to obtain follow-up care with their primary care physician. In almost all cases, document the possible diagnosis and discuss it with the patient. Definitive treatment of the underlying cancer is not the purview of the emergency department (ED). Emergency treatment is based on symptoms. In cases of upper

2014 eMedicine.com

568. Nutritional Management in the Rehabilitation Setting (Follow-up)

from oral to enteral to parenteral, as follows: Oral nutrition This is the starting point of all interventions. It consists of dietary change, as well as the addition of between-meal snacks and nutritional supplements. Enteral nutrition A patient with a functional gastrointestinal (GI) tract is a candidate for enteral support when he or she will not, should not, or cannot take nutrition orally. Enteral feeding can be nasogastric or nasoduodenal/nasojejunal or can be administered via gastrostomy (...) practice. It is often necessary at a minimum to do a mini-nutritional assessment of the patient at the point of admission into a rehabilitation unit, since poor nutritional status could lead to greater debility and an inability to fully participate in intensive in-patient rehabilitation therapies. Assessments include the following: Nutrition Screening Initiative (NSI) (1990): This tool offers bilevel screening, using the Body Mass Index (BMI) and a subjective interview on level I. Anthropometric data

2014 eMedicine.com

569. Hysterectomy (Follow-up)

Procedures Procedures 2002 1839938-overview Procedures Procedures 2002 1839957-overview Procedures Procedures 2002 270723-overview Procedures Procedures Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) ; injury to the bowel, bladder, or ureter; nerve damage; and urinary tract infection. Candidates for this surgery include those who have fibroids, abnormal or heavy bleeding, chronic pelvic pain, endometriosis, adenomyosis (endometrial tissue that has infiltrated the myometrium), uterine prolapse, cancer of the reproductive organs, or pelvic inflammatory disease. Vaginal hysterectomy In a vaginal hysterectomy, the uterus is removed through the vaginal introitus. Prior to surgery, the patient is given

2014 eMedicine.com

570. Prerhinoplasty Facial Analysis

legal liability, and better surgical outcomes. [ ] In the preoperative interview, the surgeon seeks answers to the following questions [ ] : What are the patient’s expectations? Are the expectations realistic and reasonable? Do I have the ability to fulfill these expectations? Can the patient be satisfied? Patients seeking cosmetic changes to the nose are generally psychiatrically normal, but a brief psychiatric assessment is wise. Body dysmorphic disorder is a psychiatric condition involving (...) -6006740 Slideshow Slideshow 2010 http://reference.medscape.com/slideshow/bodymodifications-6006954 Slideshow Slideshow 2010 http://reference.medscape.com/slideshow/acne-vulgaris-6006454 Slideshow Slideshow 2001 /viewarticle/896690 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult.

2014 eMedicine Surgery

571. Hearing Aids

858001-overview Procedures Procedures 2002 849233-overview Procedures Procedures 2001 /viewarticle/889211 Journal Article Journal Article 2001 /viewarticle/908860 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) of children with hearing loss. In the past two decades, recommendations for universal neonatal hearing screening resulted in numerous articles regarding the tests, the efficacy of testing, the role of the audiologist in amplification, and the importance of early intervention programs. [ , , , , , , , , , , , ] The role of the primary care physician cannot be overemphasized. In many instances, the otolaryngologist develops a long-term relationship with patients and their families, caring for the patients

2014 eMedicine Surgery

572. Rehabilitation of Persons With Spinal Cord Injuries (Diagnosis)

of a physiatrist (ie, a physician who specializes in physical medicine and rehabilitation) or a physician with a subspecialty certification in spinal cord medicine. While each team member has primary responsibilities, any member of a properly functioning interdisciplinary team can contribute to the resolution of any problem. SCIRehab project The , a 5-year project led by the Rocky Mountain Regional Spinal Injury System (RMRSIS) at Craig Hospital, used practice-based evidence (PBE) research to identify (...) the rehabilitation interventions most strongly associated with positive outcomes. The aim of the SCIRehab project was to provide detailed information on treatments delivered by rehabilitation disciplines and to contribute to outcomes-based guidelines for clinical decision-making. The SCIRehab project included 1376 patients with acute SCIs, with outcome data being abstracted from medical records (clinical outcomes data) at six SCI rehabilitation facilities and obtained from patient interviews at 6 and 12 months

2014 eMedicine Surgery

573. Implantable Hearing Devices

858001-overview Procedures Procedures 2002 849233-overview Procedures Procedures 2001 /viewarticle/889211 Journal Article Journal Article 2001 /viewarticle/908860 News News Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) in the care of children with hearing loss. In the past two decades, recommendations for universal neonatal hearing screening resulted in numerous articles regarding the tests, the efficacy of testing, the role of the audiologist in amplification, and the importance of early intervention programs. [ , , , , , , , , , , , ] The role of the primary care physician cannot be overemphasized. In many instances, the otolaryngologist develops a long-term relationship with patients and their families, caring

2014 eMedicine Surgery

574. Blepharoplasty, Subciliary Approach

, nor should it be the result of a sudden decision. Patients must fully comprehend the objectives and limitations and the possible complications of the surgery. In the initial encounter with a candidate for blepharoplasty, open questions are important to clarify and understand the motivation and final expectations. Aptitude, general appearance, manner of dress, presence, expression, tone of voice, and behavior are extremely important. The surgeon should determine in this particular interview (...) to the surgeon the exact reason for their requests. Open questions are ideal in the first encounter with potential candidates. Do not assume anything. The following open questions are appropriate to initiate the conversation: What can I do for you? How can I help you? Tell me why you made an appointment with my office? These types of open questions help put the patient at ease and open up discussion, which facilitates better initial contact. They usually help reveal the patient's true motivations

2014 eMedicine Surgery

575. Xenotransplantation

under the sterile conditions required to minimize contamination by shared pathogens. Most investigators agree that pigs have the potential to be the prime candidates for organ donation. Pigs are plentiful, are quick to mature, breed well in captivity, have large litters, and have vital organs roughly comparable in size to those of humans. Because they are already being used in the consumer market, their use in xenografting is less likely to elicit major objections from society. Because humans have (...) (patient-physician) levels. Because the risk is societal and not merely individual, the decision whether to undertake the procedure involves more than ensuring the ability of the surgeon and the transplant team, the capacity of the institution, and the willingness of the patient. In situations in which the risks are collective, the public must be educated about the risk and must be involved in the decision-making process. Therefore, the first part of the decision-making process must occur at the level

2014 eMedicine Surgery

576. Drug-Induced Hepatotoxicity (Follow-up)

drug reactions result in or death. Drug-induced hepatic injury is the most common reason cited for withdrawal of an approved drug. Physicians must be vigilant in identifying drug-related liver injury because early detection can decrease the severity of hepatotoxicity if the drug is discontinued. The manifestations of drug-induced hepatotoxicity are highly variable, ranging from asymptomatic elevation of liver enzymes to fulminant hepatic failure. Knowledge of the commonly implicated agents (...) is not familiar with the drug or if any question remains about the safety of continuing a drug, consultation with a hepatologist should be considered. Elevated aminotransferase levels with acute hepatocellular injury Drug-induced liver injury is designated hepatocellular if the ALT levels are increased to more than twice the upper limit of the reference range, with alkaline phosphatase levels that are within the reference range or are minimally elevated. Elevation of aspartate aminotransferase (AST) greater

2014 eMedicine.com

577. Cancer and Rehabilitation (Follow-up)

provide services to patients throughout the course of illness, during all stages. Treatment plans must be individualized to meet each patient's unique and specific needs. Physicians Professional clinicians composing the interdisciplinary team include physicians from several specialties. Primary care physicians, surgeons, radiation oncologists, and medical oncologists make active and concurrent contributions to rehabilitation efforts to manage the disease process. The physiatrist, a specialist in PM&R (...) of the disease are simultaneous. Cancer rehabilitation is an emerging field within PM&R and it has many unique characteristics that may require specialized fellowship training. Fellowship training programs teach physicians to evaluate the functional needs of cancer patients during treatment and follow-up. Cancer rehabilitation is a challenging and rewarding field since it combines many aspects of medicine, such as inpatient and outpatient care, patient continuity of care, clinical assessment, diagnostic

2014 eMedicine.com

578. Anxiety Disorders (Follow-up)

& Conditions 2002 290955-overview Diseases & Conditions Diseases & Conditions 2001 http://www.medscape.com/resource/anxiety-disorders Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) -enabled headphones and the first CES managed through an app. [ ] Deciding which treatment or combination of treatments to prescribe depends on a careful interview and assessment of the patient's goals and level of pathology. The outcome of treatment is determined by several factors, including the following: Specific type of anxiety disorder Severity of diagnosis level of functioning prior to onset of symptoms Degree of motivation for treatment Level of support (eg, family, friends, work, school

2014 eMedicine.com

579. Body Dysmorphic Disorder (Follow-up)

Disorder What to Read Next on Medscape Related Conditions and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to Psychiatrists Recommended 2002 286227-overview Diseases & Conditions Diseases & Conditions 2002 916933-overview Diseases & Conditions Diseases & Conditions 2002 290955-overview Diseases & Conditions Diseases & Conditions 2001 http://www.medscape.com/resource/anxiety-disorders Need a Curbside Consult? Share cases and questions with Physicians (...) the effectiveness of escitalopram vs placebo with regards to relapse prevention. Escitalopram delayed time to relapse and fewer escitalopram-treated subjects relapsed than did placebo-treated subjects. In addition, body dysmorphic disorder severity significantly improved during the additional six months of escitalopram treatment following acute response, and more than one-third of escitalopram-treated subjects experienced further improvement. [ ] Use of SSRIs in pediatric patients Physicians are advised

2014 eMedicine.com

580. Sudden Unexpected Death in Epilepsy (Diagnosis)

-overview Diseases & Conditions Diseases & Conditions 2002 1181649-overview Diseases & Conditions Diseases & Conditions 2002 1138154-overview Diseases & Conditions Diseases & Conditions 2002 1140724-overview Diseases & Conditions Diseases & Conditions Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult. (...) vulnerability to cardiac arrhythmia. [ ] Seizure threshold also might diminish, leading to rebound effect and increase in seizure frequency. Patients on multiple antiepileptic drugs had a significantly higher rate of SUDEP than patients with epilepsy who were not on multiple antiepileptic drugs. Also, a questionable role has been attributed to recent sudden changes in medication regimen of patients. Genetic predisposition The following genes have been studied in SUDEP autopsy cases: KCNQ1 , SCN1A , LQTS

2014 eMedicine.com

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