1. A 42-year-old woman, who is a patient of yours, comes to the office to discuss her 18-year-old daughter, who is also your patient. She found a prescription for oral contraceptive pills for her daughter that was written by you. She is very upset that you would write such a prescription and demands that you stop. She says her daughter is too young for contraceptive pills and accuses you of contributing to her disrespectful behavior. She is furious and threatens to sue you and report you to the medical board. She yells, “You are the worst doctor I have ever met and you should be barred from practicing medicine ever again.” Which of the following is the most appropriate response at this point?
(A) “If you don’t calm down, I will have a psychiatrist commit you.”
(B) “If you want to sue me, here is my lawyer’s phone number.”
(C) “Please calm down; I will not give your daughter any more prescriptions if you stop yelling.”
(D) “You may have some psychiatric issues. I can refer you to a psychiatrist if you like.”
(E) “You sure are angry. If you want to be angry, it’s OK with me.”
2. You are covering patients for another physician and are about to see a 19-year-old woman who returns for a follow-up visit from two days ago. Looking through her chart, you see that she presented at the previous visit with amenorrhea. She began menarche at age 13, and she used to have regular 28-day menstrual cycles until about five months ago. She denies any smoking, alcohol or illicit drug use. She is not sexually active, and a pregnancy test at her last visit was negative. She is a college student and enjoys running, cheerleading and gymnastics. As part of the laboratory workup from her previous visit, a follicle-stimulating hormone (FSH) level is reported as 2.6 mIU/mL. What is the most likely cause of her amenorrhea?
(A) Alcoholism
(B) Anorexia nervosa
(C) Gonadotropin-secreting pituitary tumor
(D) Premature ovarian failure
(E) Turner syndrome
3. A 33-year-old woman is seen in the clinic for assessment of long-standing insomnia. Her condition began in her early 20s when she was in the midst of a “messy divorce.” She had always considered herself a light sleeper but since her divorce, her sleeplessness seems to have worsened. She feels tired, tense and agitated throughout the day and has trouble performing her duties as a certified public accountant due to her frequent inability to concentrate. She tries diligently to fall asleep in her bedroom at a regular and reasonable hour but is rarely successful even though she feels “totally exhausted.” She often eventually falls asleep while reading a book in her living room. Her friends find her complaint of insomnia strange, because she often falls asleep while watching a movie or during short rides in cars or subway vehicles. Vital signs are normal. Physical ex-amination reveals an obviously tired-appearing woman with slightly pale, cool dry skin, mildly reddened eyes, and stiffness of the upper arms. What is the most likely diagnosis?
(A) Fixed delusional disorder
(B) Idiopathic insomnia
(C) Psychophysiologic insomnia
(D) Rapid eye movement (REM) sleep behavior disorder
(E) Sleep state misperception