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NBME 21 Answers

nbme21/Block 4/Question#38 (32.7 difficulty score)
A 62-year-old woman is brought to the ...
Instruct the patient to keep notes and lists to help her memory🔍

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submitted by chandlerbas(100),
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eTh srecererash ndofu ttah eoppel who cipdaiettapr ni mtynlale hnlgelicgna eicavitsti smto ftnoe, tboh reyal adn tale in life, ahd a olwrse taer of eleindc in yrmoem ecodmrap to hteos who ddi not gengae ni uhcs i.seattciiv nvEe when oepelp hda saepulq dan ealnstg nad hetor gniss fo madage to iehrt binars, mnleta nuiiomtstal smeeed ot pehl tcetrpo omymre and nntghiik ils,lks auntcignco fro tboau 14 eetprnc fo het enedfriefc ni iecdlne eydnob twah ldwou be eextpdec (hhnitsaraP mu,reiV ,DPh abzEeilth .C ,omniMro hPD: Cgotii“ven glSitumtina Atviiestci to Keep miDtneae at ”.Bya l,Nourgyeo oVl 18. 0)213

laso teh awy i see t,i AD pst hvae omrebspl itwh ipppsmhouac ..(ei thrso rmte emrmoy rwepo oh)seu so kgeneip snote dna islst or hvvaaatwe hmtgi ephl solw thier vioitcnge denlice as hellty eb ineegpk teh coumspihapp emor tivcae

submitted by niboonsh(358),
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i ogt tish eitqnosu rhgit btu wyh onucldt ti eb kigno ?baliob

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 +6  
mumenrider4ever  Wikipedia says "Gingko extract has also been studied in Alzheimer's disease, but there is no good evidence that it has any effect." +3  

submitted by paperbackwriter(113),

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.

submitted by lovebug(19),

really curious about why not (C) Suggest that the couple to a therapist together.? T.T

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 “this person can practice medicine in your state without supervision.” even the most worshipped and glorified neurosurgeons have to pass the Steps. that’s because, at the end of the day, all responsibility (and liability) falls on the physician of record. “the buck stops here,” as they say. so, the Step needs to assess that you can make a decision when no one else is around. it couldn’t do that if it allowed you to choose “refer this problem to someone else.” +3  
csalib2  @drdoom fantastic point. never thought of it that way. +  
lovebug  @drdoom THX! very sweet explanation! +  

submitted by kevintkim4(0),

When I read "ginkgo biloba" as my answer choice (E) I thought I was getting delirious lmao