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(A)
(B)
(C)
(D)
(E)
"Can you keep me alive until my daughter graduates from medical school"
"Damn you doctor, you should have caught this earlier!"
"Doctor, you must be wrong."
"I think it is time that I make a will and say good-bye to everyone."
"It's no use, I always lose and get the short end of the stick."
46. The correct answer is C. Kubler-Ross’s Death and Dying sequence is a stepwise process
with five identified stages, which occur in the following order: 1) Denial, 2) Anger, 3) Bargaining, 4)
Sadness, and 5) Acceptance. "Doctor you must be wrong" is the correct answer since it reflects
the patient's inability to accept the information and indicates the denial of the first stage.
"Can you keep me alive until my daughter graduates from medical school" (choice A), is a
statement from the third, or bargaining, stage.
"Damn you doctor, you should have caught this earlier" (choice B) is a statement from the
second, or anger, phase.
"I think it is time that I make a will and say good-bye to everyone" (choice D) reflects the patient's
acceptance of the reality and is a statement from the fifth phase (acceptance).
"It's no use, I always lose and get the short end of the stick" (choice E) is a statement from the
fourth phase (sadness).
47. A 44-year-old businessman presents to a physician because of a markedly inflamed and
painful right great toe. He states that he just returned from a convention, and noticed increasing
pain in his right foot during his plane trip home. Physical examination is remarkable for swelling
and erythema of the right great toe as well as small nodules on the patient’s external ear.
Aspiration of the metatarsal-phalangeal joint of the affected toe demonstrates needle-shaped
negatively birefringent crystals. Which of the following agents would provide the most immediate
relief for this patient