Sample vignette and questions
PLEASE USE THE BLANK TEMPLATES THAT FOLLOW TO SUBMIT YOUR VIGNETTE
AND YOUR QUESTIONS
Gail, a 16 year old adolescent female accompanied by her mother is arriving at the pediatrician's
office with complaints of nausea, once or twice recent vomiting, lack of appetite, weight reduction of
about 12 lbs the last eight months, lack of menstrual cycle for the last 2 months, and moderate to
high anxiety regarding her situation. Upon being interviewed alone by the physician, she discloses
that for the last 4 months, she has been involved in sexual relations with her 17 year old boyfriend,
information that her mother is not aware off. Her mother shared that her 11 yo son has had a version
of the flu about 3weeks ago, and had to stay home from school for a few days due to nausea and
vomiting. She is wondering if Gail has been also exposed to the flu virus...
1.
According the information presented, Gail's signs and symptoms indicate the following
diagnostic profile:
(A The possibility of the flu, the possibility of pregnancy, family relational problems
)
(B Anxiety resulting from the possibility of pregnancy, Substance abuse, Anorexia Nervosa or
)
Bulimia
(C The possibility of the flu, The possibility of pregnancy, Depression
)
(D The possibility of the flu, The possibility of pregnancy, Anxiety resulting from the
)
possibility of pregnancy
2.
Considering the information presented, what course of action would the pediatrician consider
in order to make an accurate diagnosis?
(A thorough medical examination, A pregnancy test, A thorough interview with Gail to assess
)
other masked problems
(B An anxiety and depression assessment, A physical examination, Interview the boyfriend
)
(C Interview the brother, Pregnancy test, A thorough medical examination
)
(D Interview the boyfriend' s parents, A pregnancy test, Assess Gail's weight loss
)
3.
Assuming that Gail's menstrual irregularity was restored, her anxiety was reduced since she was
not pregnant, she recovered from the flu, and her weight stabilized to a healthy range, what
areas should the pediatrician emphasize in order to assist Gail effectively?
(A Educate her about proper protection and the risks for STIs, Increase emotional awareness
)
and discuss effective coping skills, Educate her about open communication with the
boyfriend
(B Educate her about proper protection and the risks for STIs and pregnancy, Discuss effective
)
coping skills, Suggests spending less time with the boyfriend
(C Educate her about proper protection and the risks for STIs and pregnancy, Increase
)
emotional awareness and discuss effective coping skills, Discuss healthy weight
control(exercise),and open family communication
(D Increase emotional awareness, Recommend she drops the boyfriend, Recommend she eats
)
more fruits and vegetables.
Answer 1: option 4. Rationale: Although Gail has not disclosed to her mother her sexual
involvement, there is no indication that they are having family problems, thus option 1 is not correct. It
might be possible that Gail is using substances to cope with her anxiety, but there is no indication in the
vignette that this is a problem. We also do not have enough information to consider Anorexia
Nervosa(due to weight loss) or Bulimia (due to vomiting), thus option #2 is wrong. Gail might be
experiencing some mild feelings of depression, but her anxiety whether she is pregnant or not,
dominates the picture, making option #3 not the correct answer.
Answer -2 : option 1. Rationale: Interviewing the boyfriend, his parents and the brother make
options 2,3, and 4 weak. The physician will rule out pregnancy in order to alleviate anxiety, and
through the medical exam will assess the causes of amenorrhea.
Answer -3: option 3 Rationale: Option 3 summarizes some of the logical suggestions the
pediatrician will discuss with Gail to prevent future problems.
VIGNETTE TEMPLATE
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Answer-1:
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TEMPLATE FOR THE 3 MULTIPLE-CHOICE QUESTIONS
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Answer-1:
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