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NBME 21 Answers

nbme21/Block 4/Question#38 (reveal difficulty score)
A 62-year-old woman is brought to the ...
Instruct the patient to keep notes and lists to help her memory ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +7  upvote downvote
submitted by โˆ—chandlerbas(118)
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The researchers found that people who participated in mentally challenging activities most often, both early and late in life, had a slower rate of decline in memory compared to those who did not engage in such activities. Even when people had plaques and tangles and other signs of damage to their brains, mental stimulation seemed to help protect memory and thinking skills, accounting for about 14 percent of the difference in decline beyond what would be expected (Prashanthi Vemuri, PhD, Elizabeth C. Mormino, PhD: โ€œCognitive Stimulating Activities to Keep Dementia at Bay.โ€ Neurology, Vol 81. 2013)

also the way i see it, AD pts have problems with hippocampus (i.e. short term memory power house) so keeping notes and lists or whatevvaa might help slow their cognitive decline as theyll be keeping the hippocampus more active

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 +3  upvote downvote
submitted by โˆ—niboonsh(409)
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i got this question right but why couldnt it be ginko biloba?

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nor16  and why no therapy, i.e. cognitive training` +
jessica_kaushal  first step is to make the patient's environment accomodating for the patient. +3
jessica_kaushal  first step is to make the patient's environment accomodating for the patient. +
tryntofigritout  Because this is a western medicine test. Even though it has shown great protection against AD and memory protection, this test won't allow that. I initially clicked on ginko but thought to myself... na this test doesn't accept an eastern idea. so clicked on the one I know they wanted me to say, and I got it right. ha +7
mumenrider4ever  Wikipedia says "Gingko extract has also been studied in Alzheimer's disease, but there is no good evidence that it has any effect." https://en.wikipedia.org/wiki/Ginkgo_biloba#Traditional_medicine +4
skonys  The only TCM that is actually used in western med is clove oil for pain from dry-socket in 3rd molar extractions. We even use a fancy product called "socket paste" which is literally collagen and clove oil. Fun fact: Ginko Biloba is the only species in it's genus. I'm fun at parties +1



 +1  upvote downvote
submitted by โˆ—paperbackwriter(161)
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Not sure what the implication was regarding the assisted living facility (I never thought of them as a last resort situation), because it has been shown that social activities are incredibly beneficial in slowing down the progression of dementia. I suppose she is in the early stages of disease and doesn't warrant anything so drastic like moving just yet.

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 +1  upvote downvote
submitted by โˆ—kevintkim4(4)
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When I read "ginkgo biloba" as my answer choice (E) I thought I was getting delirious lmao

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 +0  upvote downvote
submitted by โˆ—lovebug(62)
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really curious about why not (C) Suggest that the couple to a therapist together.? T.T

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drdoom  thou shall not punt nor refer thy patient to another +5
lovebug  Oh, thank you! +
drdoom  yeah, think about it this way: the Step exams are here to certify โ€œthis person can practice medicine in your state without supervision.โ€ even the most worshipped and glorified neurosurgeons have to pass the Steps. thatโ€™s because, at the end of the day, all responsibility (and liability) falls on the physician of record. โ€œthe buck stops here,โ€ as they say. so, the Step needs to assess that you can make a decision when no one else is around. it couldnโ€™t do that if it allowed you to choose โ€œrefer this problem to someone else.โ€ +3
csalib2  @drdoom fantastic point. never thought of it that way. +
lovebug  @drdoom THX! very sweet explanation! +



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