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NBME 21 Answers

nbme21/Block 3/Question#41 (33.0 difficulty score)
A 75-year-old woman comes to the physician's ...
Major depressive disorder🔍

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Tish otsnuqei is ricebgidsn lanmiert sinn,iamo hhcwi si ommcon eethri in DDM ro onarlm in.gga tuO of sohte wto MDD is hte yonl ighnt ni iooptn oiceh.c lus,P odl age is a risk ctfrao rof MD.D

evEn uhgtoh eht ineoustq oesd nto rbseidec 5 pssymtom ddneee ot dsiaegno MDD, DMD si het olny olailgc oechi.c

hungrybox  excellent answer, thank you +4  

 +5  upvote downvote
submitted by whoissaad(65),
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  • eniS"c psotmmsy anc resnaiec in estvriye unirdg the gih,tn ti cuold ocmbee dticlffiu to llaf apelse ro turnre ot epsel aeftr nwiagk up"

  • "SLR si oen of rvseale oridedssr ttha acn usaec ueashiontx adn etymadi ilesessep,n ihchw nca srlyongt etcffa oo,dm taennotinorcc, obj dna clhoos reorpemna,fc nad rselnopa slsniirothep.a nMya pepoel thiw LRS etorrp eyth ear tefno unblea ot otnanccerte, vaeh deramiip oem,myr ro ialf to laihcopcsm diyla astks"

  • SRL" scrocu ni hbot men adn ,nmewo tguohhal owenm rea roem ilekyl ot veha ti hnta en.m"

  • "eth opmysstm liyylpcat ecobem omre ferqntue and ltsa onlegr twhi gae".

Sre:cou gowdovace/w/omeedioie/ghttgnretatnaD/snsdes/.rRttnpSssta--rncnv/-yhe-FPeli:wcehi-.CFsitrL.Ersa-tehSuSsditse-e

iEnrthgyve ni eht mets onipts aodwstr sesrtesl gel oermsdyn.

Psul I huttohg oyu need 5/9 fo hte GIS E PCSA to dnseaoig .sepidesrno

moneSoe pesale inlpxea ):

peridot  Though everything else fits, in order to diagnose RLS you need to actually have leg symptoms which aren't described here at all. I agree that MDD also requires a bit of a stretch bc not all of the diagnosis requirements are met which is annoying, but at least the core components are there (decreased energy, sleep disturbances, lack of concentration), whereas the core component of RLS isn't there at all. It's like wanting to diagnose someone with a migraine because they have irritability, decreased concentration, and a visual aura but the person never even said their head hurt. It's not a great question and I completely missed MDD as well, but I can kinda see now why it's MDD more so than any of the other choices so it's kind of a "but which is the BEST answer" scenario. +2  

 +3  upvote downvote
submitted by seagull(1107),
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soepDirens is evyr mcmnoo ni oeldr tn,ulaioospp ecyeilapls lm.aesef moonmC ymmstsop fo soeedspirn ciunedl IGS E SCAP (nldugniic nii.amno)s TsiH onuiesqt swa revy uevga tub onsepeisdr aws ddege otu ueabesc splee aepna si rome elyikl ni trevwgieoh dmiled edag lesma.

 +3  upvote downvote
submitted by hungrybox(788),
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eotrh wr:easns

  • rlceynoa:ps osiActseda iwth ooyncggphi ro mipopchyonp int.cllhianauso
  • OpnhyoG ot selep = hingt time uaacnsolihlnti

  • rpaslmyoxa tlraunonc pd:nsyea NHP si a hmtyileoc eanim.a oN ingss fo omhtlicye eanmai ,tu(reamiah jna,iudec ce.d ib)h.tgloapno

  • pseel na:pae sAsdtaceoi hiwt oesbi,ty oudl ingsnr.o

doingit21  narrowed down to MDD and restless leg then convinced myself that elderly are at higher risk for MDD than RLS. Is that valid reasoning? +2  
yb_26  Paroxysmal nocturnal dyspnea = breathless awakening from sleep, seen in left heart failure. It is not a paroxysmal nocturnal hemoglobinuria. +11  

I chose MDD: 1) terminal insomnia 2) Narcolepsy - common in young adults adolescents - also associated with daytime unexpected naps (after which the person feels fresh) despite normal nightime sleep. 3paroxysmal nocturnal dyspnea is one of the first signs of decompensated heart failure but the physical examination was normal that means no lung crackles. 3) periodic leg movements could be REM Phenomena where muscles are not paralysed during REM sleep. 4)In sleep apnea the patient has poor quality of sleep but doesn't awaken