Managing Multiple Morbidities

Chapter 4 Managing Multiple Morbidities




Clinical Case Problem 1 A Case of Discontinuous Maximus


A new patient presents to your office after moving to your community from a different state. She is a 55-year-old, recently divorced marketing executive with a history of recent-onset diabetes, long-standing hypertension, moderate obesity, and depression. She smokes half a pack of cigarettes per day, gets insufficient exercise, travels often, and follows an erratic diet. She complains of headaches that are worsening with stress and seasonal allergies, intermittent fatigue with snoring and daytime somnolence, and hot flushes. She is taking six medications from six different physicians she has irregularly seen in her previous locale, but she has not been seen in follow-up by any of them for the past 4 months.



Select the best answer to the following questions




1. Given her symptom complex, at this time she is likely to need the services of which of the following subspecialists?


a. cardiologist

b. psychiatrist

c. sleep specialist

d. endocrinologist

e. none of the above

On examination, vital signs are blood pressure, 150/85 and pulse, 85/minute. Body mass is 30. She appears well developed, overnourished, neat, and well spoken. There are boggy nasal passages, nicotine staining on her buccal mucosa, clear lungs, and a normal-sounding heart. Abdomen is obese; skin is warm and dry. Extremities are without clubbing, cyanosis, or edema. Peripheral pulses are normal and symmetric. Affect is appropriate, but mood seems depressed.




2. What laboratory data would you like to obtain at this time?


a. complete blood count (CBC), comprehensive metabolic profile (CMP), lipid profile, and electrocardiogram (ECG)

b. CBC, CMP, lipid profile, hemoglobin A1c, and ECG

c. CBC, CMP, lipid profile, hemoglobin A1c, ECG, and thyroid-stimulating hormone

d. CBC, CMP, lipid profile, hemoglobin A1c, and chest radiograph

e. No new testing is necessary at this time; obtain old records first

3. Results from the Medical Outcomes Study suggest which of the following is (are) true regarding systems of care for this patient?


a. optimal clinical outcomes are best achieved when care is provided by a generalist

b. optimum clinical outcomes are best achieved when care is provided by subspecialists

c. costs of care and resource use tend to be lower when care is provided by generalists

d. similar clinical outcomes are achieved when care is provided by either a generalist or subspecialists

e. c and d

4. This case points out that which of the following is (are) among the skills needed to manage patients with multiple morbidities?


a. the capacity to thrive on managing complex medical problems

b. the ability to integrate all of the medical and personal issues facing an individual

c. the ability to break down medical terms and complex medical issues to make it easier for patients to understand

d. the capacity to know and understand an individual’s limitations, problems, and personal beliefs when deciding on a treatment

e. all of the above

5. In addition to reviewing all her current medications, obtaining any previous medical records you can, and ordering some laboratory data, your next step in management should include which of the following?


a. assessing the patient’s understanding of her health problems

b. getting a sense of the patient’s priorities in dealing with her health problems

c. reordering all her medications and stressing the importance of compliance

d. identifying community resources that can be brought to bear in a treatment plan

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Managing Multiple Morbidities

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