Counseling Tech Quiz Questions

a. Ask them what they have been told about CMT

A 20 year old man and his family are seen for genetic counseling to discuss his recent diagnosis of Charcot-Marie-Tooth (CMT) disease. After introductions, which of the following would be the BEST next step for the GC to take?

a. Ask them what they have been told about CMT

b. Explain the recurrence risks of CMT

c. Collect a family and medical history

d. Review the results of his genetic testing

a. Engage the husband in the decision making process

A 22 year old woman who is 20 weeks pregnant had a fetal ultrasound which showed spina bifida. After the GC discusses the possible diagnosis and the unpredictable nature of the outcome, the woman expresses her reluctance to terminate the pregnancy. Her husband remains very quiet and says that he will go along with his wife's decision. Which is the BEST approach for the GC to take?

a. Engage the husband in the decision making process

b. Support the woman's decision

c. Refer the couple for family therapy

d. Suggest that the couple continue this discussion at home

b. discuss strategies for talking about this diagnosis with girls her age

A genetic counselor meets with the parents of a 15-year-old girl who was recently diagnosed with Turner syndrome. The parents do not want their daughter to be informed about her diagnosis because they feel that it will upset her and they prefer to wait and tell her themselves when they think that she is ready. Which of the following is the BEST approach by the counselor.

a. honor the parents' request because the patient is a minor

b. discuss strategies for talking about this diagnosis with girls her age

c. insist they share the diagnosis with their daughter as soon as possible

d. encourage the parents to join the local Turner syndrome support group

b. 1, 2, and 4 only

A genetic counseling student has just seen a couple whose first trimester screening result showed a 1 in 5 chance for the fetus to have trisomy 18. During the session, the husband made several disparaging comments about his wife and stated, "Of course she wants a CVS, she always worries about everything!" By the end of the session, the student was very angry with the husband. As she discusses the case with her supervisor, she realizes the husband reminded her of her own father. Which is the BEST approach for the supervisor to take with this student?

1. encourage her to engage in self-reflection

2. help her identify the source of her feelings

3. discuss with her ways to minimize transference

4. share with her that this reaction is not unusual

a. 1, 2, and 3 only

b. 1, 2, and 4 only

c. 1, 3, and 4 only

d. 2, 3, and 4 only

a. The beneficence and nonmaleficence of this father outweighs his children's autonomy

A patient recently molecularly diagnosed with hemochromatosis insists that his three healthy children (all under the age of 18) also be tested. Which of the following statements is false?

a. The beneficence and nonmaleficence of this father outweighs his children's autonomy

b. Testing of asymptomatic children for autosomal recessive, adult-onset conditions is generally not recommended

c. Testing should be delayed until his children are adults to preserve their autonomy and provide informed consent

d. Test results could potentially make his children vulnerable to health insurance discrimination

a. "Although you are both here to discuss possible causes of your losses, it seems as though you may not be in the same place emotionally with regards to becoming pregnant again."

You are seeing Mr. and Mrs. Peters because they have a history of four first trimester miscarriages, the most recent of which occurred two weeks ago. Mrs. Peters is quiet and will not make eye contact with you. When you ask them what they hope to get out of their genetic counseling session, Mr. Peters tells you that that they want to become pregnant again as soon as possible but that their doctor recommended they have genetic counseling first to find out why the losses have happened so that they can prevent it happening again.You notice Mrs. Peters is now crying. What is the best first response?

a. "Although you are both here to discuss possible causes of your losses, it seems as though you may not be in the same place emotionally with regards to becoming pregnant again."

b. "I don't want to upset you more but I am worried that you may have unreasonable expectations as we are many times unable to identify the cause of recurrent miscarriages."

c. "I know it doesn't seem like it now, but even after multiple miscarriages, most couples are able to have healthy children."

d. "It is always your decision, but I feel like it may be too soon for you to think about being pregnant again because Mrs. Peters has obviously not emotionally recovered from your last loss."

a. "An unexpected pregnancy can bring a lot of anxiety. Tell me a little bit more about what is scaring you"

You receive a phone call at the teratogen line from Ms. Williams. She identifies herself as a 21 year old who is pregnant for the first time. This is an unplanned pregnancy. She is a senior in college and attended a Halloween party where she had 3 or 4 drinks before learning of the pregnancy. She is concerned about fetal alcohol syndrome and says, "I really did not know I was pregnant, I am so scared". The next best response is to say:

a. "An unexpected pregnancy can bring a lot of anxiety. Tell me a little bit more about what is scaring you"

b. "It is normal to have a few drinks before you find out you are pregnant. For most people we do not see any problems from early alcohol exposure"

c. "Was this the only time that you had alcohol in the pregnancy?"

d. "We think that a few drinks early in pregnancy appears to be safe, so I want to reassure you not to worry so much"

a. "I can only imagine how hard it is to find out that you baby is sick and to have to consider ending a much wanted pregnancy"

Mrs. Davis and her husband were seen today at your clinic for a routine second trimester anatomy scan. She is a 33 y/o G1P0 patient who underwent IVF to become pregnant. Unfortunately, hydrops was seen on ultrasound today. After your discussion of the prognosis, the couple states that they feel as though they will terminate the pregnancy given the poor prognosis. You describe a bit about the D&E procedure and about stopping the heart prior to the D&E. Mrs. Davis says "I don't know if I can go through with stopping the heart. It feels like I am killing my baby" What is the best first response?

a. "I can only imagine how hard it is to find out that you baby is sick and to have to consider ending a much wanted pregnancy"

b. "If you are unsure about ending the pregnancy, you can take some time and we can talk again in a few days"

c. "There are other options for inducing labor that we can discuss if you think that being able to see the baby and say goodbye would be helpful for you"

d. "Unfortunately, it is something the doctor has to do but you do not have to watch"

a. "Many women on anti-seizure medications are worried about what harm they can cause to their baby, but I encourage you to discuss the right plan for you with your doctor because not being on seizure medication has risks as well."

Ms. Jones is having genetic counseling for her history of seizures. During your initial contracting, she tells you that she stopped all of her antiseizure medication as soon as she found out she was pregnant. You ask if she discontinued her medication on her own or at the advisement of her physician. She tells you that she decided to stop on her own because she did the same thing with her son and he's doing well and she didn't have a seizure even once during that pregnancy. What is the most appropriate first response?

a. "Many women on anti-seizure medications are worried about what harm they can cause to their baby, but I encourage you to discuss the right plan for you with your doctor because not being on seizure medication has risks as well."

b. "You should consider going back on your medication because having a seizure during your pregnancy can be more harmful to the fetus than the medication."

c. "I understand that you want to minimize any risks the medications might have to your pregnancy but, unfortunately, just because you didn't have a seizure last time you stopped your medication, doesn't mean that you won't this time."

d. "When deciding whether or not you should discontinue your anti-seizure medication, it is important to think about your health as well as your baby's health."

a. Assess the situation and patient's emotional state before responding to her question.

You are talking to a woman who is currently pregnant, and today's ultrasound noted hydrops. You are discussing the option of amniocentesis. You ask the patient if she has any questions, and she says, "Did the ultrasound say if it's a boy or a girl. I'm hoping for a girl." The next BEST step is...

a. Assess the situation and patient's emotional state before responding to her question.

b. Let the patient know that the amniocentesis can tell her the gender of the fetus.

c. Ask the patient why she is hoping for a girl.

d. Imagine that the patient does not understand what is going on, so you explain hydrops again.

c. Hypothesize how the husband may be feeling.

The patient and her husband are coming to see you for prenatal counseling since the patient is 38 years old. Her husband, a medical resident, walks through the office door first and asks, "Who is this doctor we are seeing? I've never heard of him before. How long has he been working here? What is a genetic counselor? You're not a doctor are you?" What do you do next?

a. You tell the husband to calm down and stop yelling.

b. You explain how the clinic works and tell the husband that they do not have to have genetic counseling.

c. Hypothesize how the husband may be feeling.

d. Use advanced empathy to label how the husband is feeling.

a. Point out that she looks upset even though she says she is fine.

A patient comes to see you for genetic counseling. Her sister was recently diagnosed with breast cancer at age 35. The contracting part of the session goes smoothly, but when you start explaining genetic testing, you notice that the patient's eyes are red and she keeps looking away. You ask her how she feels, and she says she feels fine. Your next step is...

a. Point out that she looks upset even though she says she is fine.

b. To continue discussing the possible results with genetic testing.

c. Ask the patient if she wants genetic testing.

d. Tell the patient it's okay to be worried about her sister.

d. Encourage the patient to tell you more about how she feels about the role of God's will in her child's diagnosis

Several weeks ago, your clinic evaluated a newborn for Down syndrome, and now the chromosome results confirm the diagnosis. You are explaining the results to the mother, and she says, "God gave me this child, and God never gives people something they can't handle." Your next BEST step is...

a. Respect the patient's religious beliefs and move on.

b. Explain that Down syndrome is sporadic in etiology, and no one can cause it to happen.

c. Acknowledge that faith can be a good source of support, and ask the patient about her sources of support.

d. Encourage the patient to tell you more about how she feels about the role of God's will in her child's diagnosis

b. You sense that the patient is afraid, and you ask her if she feels scared.

You are seeing a patient to give her the results of her BRCA testing. The testing found a variant of uncertain significance in the BRCA1 gene. You ask the patient how she feels about this result, and she tells you, "Well, I am getting my ovaries removed. The surgery is scheduled for next week." How do you respond?

a. You decide that she doesn't understand what a variant is, so you try to explain again.

b. You sense that the patient is afraid, and you ask her if she feels scared.

c. You feel that the patient is being too quick in making decisions and ask her why she is being so hasty.

d. You believe the patient is over-reacting so you ask her to take a deep breath and tell you why she is over-reacting.

c. Explore what about the D&E procedure sounds the most appropriate for her and her situation followed by a review of its limitation to make sure it is an acceptable limitation for your patient.

A woman has a routine anatomy scan in your clinic at 19w5d which revealed significantly shortened long bones and a small, bell-shaped chest. You and your MFM are concerned about a lethal skeletal dysplasia. After speaking with your patient, your patient has elected to terminate her pregnancy. After presenting your patient with both D&E and Induction of pregnancy options, your patient elects to have a D&E. Which of the following is most correct when considering how to respond to your patient's decision?

a. Explore whether or not your patient wants to have more children and if not, the topic of postnatal evaluation is not as important.

b. Validate your patient's decision to proceed with a D&E and let her know that she will not be able to have a postnatal evaluation after the procedure, which is not medically necessary and acceptable not to have.

c. Explore what about the D&E procedure sounds the most appropriate for her and her situation followed by a review of its limitation to make sure it is an acceptable limitation for your patient.

d. Tell your patient she may choose what she feels most comfortable with but in your opinion, she needs to have an induction so an autopsy may be performed in order for a diagnosis and recurrence risk to be determined.

e. Tell your patient she has made the appropriate decision to have a D&E and assist her in scheduling her procedure.

d. Assess why your patient feels as though her husband might talk her out of her decision and the underlying reasons behind why she might be trying to hurry the process along.

Following a diagnosis of trisomy 18 by amniocentesis, your patient has elected to proceed with termination of pregnancy. She tells you that she would like to have a TOP by D&E as soon as possible. You ask her about her husband's thoughts as you remember him being out of town at your initial consultation. She responds that he is still out of town and she wants to hurry and have the D&E before he comes back and makes her change her mind. What is the most appropriate next step?

a. Inquire about the patient's support system when her husband is not in town.

b. Ask if she is okay going against her husband's wishes and the impact that might have on their relationship. If she says she is okay with the possible impact, go ahead and schedule her D&E.

c. Schedule her D&E as soon as possible since it is legally her decision whether or not to have a termination.

d. Assess why your patient feels as though her husband might talk her out of her decision and the underlying reasons behind why she might be trying to hurry the process along.

e. Suggest a follow-up genetic counseling appointment for a time when her husband will be back in town. If he will not be back in town for a while, you may offer a conference call option to discuss your patient's and her husband's choices prior to scheduling a D&E.

c. Call her back and validate the feelings she has been having. Suggest and provide options for a local mental health provider that specializes in grief counseling.

A patient you saw two months ago for a prenatal diagnosis of Down syndrome by amniocentesis leaves you a voicemail. She tells you that since her termination, she has been feeling extremely sad and depressed and can't seem to move past it. You felt very connected to this patient during the diagnosis and while planning her induction. You even went to visit her in the hospital after her induction was over. You remember being very emotionally drained during the two weeks of interaction with her and feel tired just thinking about calling her back. What is the most appropriate next step?

a. Have your office staff call her back to make an appointment for follow-up genetic counseling with you within the next week as you feel discussing these things informally over the phone is not appropriate

b. Call her back, let her know that what she is feeling is normal and that over time, her sadness will lessen and she will feel ready to have more children.

c. Call her back and validate the feelings she has been having. Suggest and provide options for a local mental health provider that specializes in grief counseling.

d. Do not call her back as you have already gotten too involved.

e. Call her back and talk to her about the feelings she's been having lately, validate those feelings and give advice on what to do next to help her move through the grief process based on your past patients' experiences. In addition, you make a plan to call and check on her every two weeks.

e. Validate the difficult decision that she has to make and elicit from her how she generally makes difficult decisions in her life and discuss whether or not that process would work in this situation.

Following a diagnosis of anencephaly on a 16 week ultrasound, your patient is paralyzed by the option to terminate her pregnancy. She tells you that she can't go through with a termination as she is deeply religious. However, she tells you in the next breath that she can't imaging carrying a baby for 5 more months knowing that he's going to die. Which of the following is the most appropriate response to your patient's inability to make a decision?

a. Ask her what type of support she has from her family, friends and church and what their opinions would be of her if she chose to terminate her pregnancy.

b. Validate her feelings a let her know that many patients of yours who are religious are still able to chose termination and they all do relatively well after making their decision.

c. Let her know that there is no "right" decision and that you will support whatever decision she makes.

d. Tell her that she shouldn't have to make this decision alone and encourage her to include her husband and family.

e. Validate the difficult decision that she has to make and elicit from her how she generally makes difficult decisions in her life and discuss whether or not that process would work in this situation.

c. Probe further about Mrs. Smith's concerns about amniocentesis so that the counselor can set an agenda for the session

Mrs. Smith is a G3P2 38 year old Caucasian female who is 18 weeks pregnant and being seen for genetic counseling today to discuss the option of amniocentesis. When the genetic counselor opens the session by asking Mrs. Smith about what she understands about why she has been referred to genetics, Mrs. Smith responds that she is not sure why her doctor sent her since she does not want an amniocentesis. The next best step for the genetic counselor is to:

a. Agree with Mrs. Smith that the appointment is unnecessary and end the session.

b. Proceed to an explanation of Mrs. Smith's age related risk in order to explain why her doctor sent her

c. Probe further about Mrs. Smith's concerns about amniocentesis so that the counselor can set an agenda for the session

d. Tell Mrs. Smith that the amniocentesis is optional but that she needs to tell her about it to make certain that she has informed consent about why Mrs. Smith is declining.

a. Availability

After further discussions with Mrs. Smith, you learn that her best friend recently had a miscarriage after amniocentesis. Mrs. Smith feels the risk of miscarriage is high. Using what she knows about her friend to make a decision about amniocentesis in an example of what heuristic?

a. Availability

b. Anchoring

c. No answer text provided.

d. Representativeness

a. Common language

After further discussions with Mrs. Smith (from question 1), you learn that her best friend daughter has a disability, which she refers to as a handicap. When you take the family history, you ask if there are any handicapped individuals in the family. This is an example of using what type of counseling technique?

a. Common language

b. Attending

c. Reflection

d. Simplification

a. Comment that Mrs. Steinberg seems to feel anxious talking about her diagnosis.

Mrs. Steinberg is a 41 year old Ashkenazi Jewish woman with breast cancer who is being seen to evaluate the likelihood of a BRCA 1 or 2 mutation in her family. The genetic counselor observes that Mrs. Steinberg is very put together and has a notebook out to take notes during the session. As they begin to take the family history and discuss Mrs. Steinberg's cancer diagnosis, the counselor notices that Mrs. Steinberg clutches her notebook and begins to tap her foot. The next best step for the genetic counselor is to:

a. Comment that Mrs. Steinberg seems to feel anxious talking about her diagnosis.

b. Ask Mrs. Steinberg if there is information in her notebook that would be helpful to their discussion.

c. Ignore the potential cues and move forward so that the counselor can finish the session in the time allotted.

d. Increase the speed of questions in taking the family history, since Mrs. Steinberg seems to be bored with having to tell her story again.

a. Content and Affect Reflection

Kellie, the genetic counseling intern, is observing a results disclosure for Fragile X syndrome with a 4 year old boy and his mother. After hearing the news, the mother says "This is all my fault" to which the counselor responds "It sounds as though you are feeling guilty because this is a change passed down on the mother's side". This is an example of what type of psychosocial comment?

a. Content and Affect Reflection

b. Minimal encourager

c. Paraphrasing

d. Redirecting

e. Validating

e. Paraphrasing

Ms. Wallace is a 39 year old Caucasian female who presents for genetic counseling due to an extensive family history of breast and ovarian cancer. When asked about how she feels about her risk, Ms. Wallace states that "I have always assumed I would just get cancer. I mean all the women in my family get it so it must very high". The counselor responds "It sounds as though you have been worried that your risk is high". This is an example of:

a. Minimal encourager

b. Content and Affect Reflection

c. Redirecting

d. Validating

e. Paraphrasing

b. Tell her that it is a difficult choice but what you hear her saying is that she most concerned about the risk for miscarriage and that she would keep the pregnancy regardless so that declining the amniocentesis seems like what is best for her.

You have been counseling a delightful 25 year old G1P0 woman who is screen positive for Down syndrome on a quadruple marker screen with a 1 in 75 risk. You have just finished explaining the risks, benefits, and limitations of amniocentesis to her during which time she has expressed concern about the risk with the test and has indicated she would not terminate regardless. You ask how she is feeling about the amniocentesis. She then leans in to you and says "What would you do?" The best response would be to:

a. Tell her that you would do the amniocentesis but what is right for you may not be right for her.

b. Tell her that it is a difficult choice but what you hear her saying is that she most concerned about the risk for miscarriage and that she would keep the pregnancy regardless so that declining the amniocentesis seems like what is best for her.

c. Tell her that you cannot answer that question and that she has to decide what is best for her.

d. Tell her you do not think she should do the amniocentesis.

d. "Unfortunately, the lab work has confirmed our fears that Josephine has a very serious condition called Trisomy 18."

Mr. and Mrs. Rodriguez are the parents of a one-day old infant girl named Josephine. Josephine was born with multiple congenital anomalies, including a heart defect, horseshoe kidney and rocker-bottom feet. She has a flat occiput and clenched hands. Results of the FISH analysis confirm the suspicion that Josephine has Trisomy 18. Which of the following is the best way to break the news to the parents?

a. "I have been looking through Josephine's chart and I see that she has had a number of tests so far, including an echocardiogram that showed a ventricular septal defect, a renal ultrasound that showed a stump horseshoe kidney, and she has an ultrasound of her head scheduled. I am from genetics and I also noticed that her hands are not positioned correctly and she has misshapen hands and feet. These are all characteristics of Trisomy 18."

b. "Mr. and Mrs. Smith there were a number of problems with Josephine that made us think that she has a fatal condition called Trisomy 18."

c. Umm, so what we are thinking is that there could be this genetic condition called Trisomy 18 and the preliminary tests show that this is what the baby has but we need the final result to confirm it.

d. "Unfortunately, the lab work has confirmed our fears that Josephine has a very serious condition called Trisomy 18."

d. Acceptance

You return a few days later to see the Rodriquez family (a family who just found out their child has trisomy 18). Mr. Rodriquez says, "We have been saying many prayers to God, just asking that she lives long enough to leave the hospital and come home and spend time with her brothers and sisters before she dies". This is an example of what stage of grief?

a. Anger

b. Bargaining

c. Denial

d. Acceptance

e. Depression

f. Hopr