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There was a question about this in Uworld. for *stubborn* patients who are "not ready to quit" just yet you use the motivational approach. The technique acronym is OARS: Open ended questions, Affirmation, Reflect, Summarize.
Additionally the guy himself says "I know smoking is bad for me" Like he knows its bad, he doesnt care, but give him nicotine replacement and maybe he'll quit...
I didn't think nicotine replacement was a good answer choice b/c if he isn't ready to quit then why would he agree to use alternatives.
People who smoke and are addicted like the feel of the cigs and environmental ques. Using replacements would be more challenging. The second best answer choice would have been Rx.
why not detail the long-therm health effects of smoking?
@ titanesxvi: I assume because they always like the most "open ended" response.
If you start detailing the long term effects, the patient might interpret that as attempting to convince, and might resist or feel pressured. By having the patient elucidate what they consider pros and cons, you allow it to be an open discussion.
Also because the patient states he already knows smoking hurts him in the long run so it may come off as lecturing on something he already knows. I view this as what is the least-judgmental way to facilitate the patient moving on to the next step of the stages of change model largely of their own volition.
i choose the option c which is initiate a pulmunary function test. why is that a wrong choice?
@usmlehulk - he's asymptomatic, knows it is not good for him in the long run, but is not quite ready to make a change. It is best to talk with him about the pros/cons of cessation so that maybe he will make the decision to quit smoking soon.
Ordering a pulmonary function test is not going to be useful. Let's say it's decreased. Ok, so what? It doesn't change management in this patient right now.
Think of it as motivational interviewing
Still don't like the answer given that the patient already stated that he knows that it can do him harm in the long run. It seems like overkill.
I usually look for the hilar manifestation, when considering sarcoidosis, or the skin manifestations. Personally, I thought Sjogren's when I read this.
@seracen I can see why you thought Sjogren, but I think Sjogren would have more emphasis on dryness of mucus membranes and eyes (technically the question stem does say "anterior chamber of the eye", but Sjogren is more like the surface of the eye so "anterior chamber" is a weird way to put it - usually that refers more to uveitis). Also, choroid plexus (whether that refers to eye or brain... tbh idk about that yet), but either way, doesn't really fit Sjogren. Kidney involvement is also rather rare with that I believe.
Wouldn't nitrates be a faster acting drug here? That was my take-away anyway. One is more acute, the other for long term maintenance.
I also believe it's because CCBs have minimal effect on venous beds and would not cause a significant decrease on preload.
decrease of cardiac preload is another word of Venodilation, so Nitrates primarly venodilators. CCB dilate arteria more than veins
also, verapamil is the one that causes constipation. But Verampamil is non-dyhydropiridine, so it works more on the heart than the vessels