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NBME 21 Answers

nbme21/Block 2/Question#18

A 34-year-old woman comes to the physician because ...

“I’m concerned about how bad you’ve been feeling lately. Have you had any thoughts about death or wanting to be dead?”

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 +3  upvote downvote
submitted by yotsubato(234),

Well thats a really crude way to screen for depression...





 +1  upvote downvote
submitted by neonem(243),

This is a postpartum mood disturbance, a pretty common disorder that has to have an onset within 4 weeks of delivery to be termed as such. Postpartum blues is the most mild, with a 50-85% incidence rate (per FA 2018), usually resolves within 10 days and treatment is only supportive but need to follow-up to assess for possible postpartum depression. Postpartum depression = 10-15% rate, characterized by depressed affect, anxiety, poor concentration for greater than 2 weeks and needs to be treated w/ CBT + SSRI. I think the question is getting at screening for this and a potentially more problematic complication, postpartum psychosis.

thisisfine   Found this difficult because FA characterizes "thoughts of harming baby or self" as postpartum psychosis - which is super rare, and doesn't fit this case. Also, CBT is first line treatment for postpartum depression - so I still like the offer to refer to a therapist as the best choice. +1  
d_holles  Same @thisisfine. +1  




 +0  upvote downvote
submitted by consuela_salon(1),

what I got from this question: NEVER (99% of the time) refer a patient to see anyone