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NBME 21 Answers

nbme21/Block 4/Question#48 (34.2 difficulty score)
A 75-year-old man with dementia, Alzheimer ...
Encourage the family to come to a consensus based on their perception of the patient's wishes🔍

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submitted by sbryant6(135),
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sTih sqeuotni is dwtolo.f- uYo must nokw eht adnnecsomgiiik- hcyireahr nad asol ecsdionr .uontyoam Mkgnia em"ooernanmtds"ic for cearint snmteaetrt si r,owng scabeeu ti loaetvis oatomuny dna eirndfmo etn.sonc asinhiycPs udlsoh lismyp nliapxe hte 'RABs fo all nartteemt np,ostio dna walol het imlfya ot eddeci what si btes ebads on nrfeiodm esnctno nad ehrti" ptnpiesecor of teh SIENPATT' e.whssi" If trehe is on edvaacdn ieicvrd,te nhet the ocidnsei uolsdh eb aedalpep to a groestrau -crokmnseae.iid irtroiPy fo tsresogrua si ;stto-suugldpe&a- tenbi;l-r-&ttghg--n&nridsslecg;pais. ,eYs hte upsoes oludw vhea irhghe trr,oyipi but het mfliya holsud at teasl yrt to ecahr a sosnsnuce irfts eobefr pplnegiaa to "ly"no the fw.ei If a ses,scnoun notnac be a,med nhte the ifwe wudol aveh fsrit say in hte n.csoeiid rehrfeeoT, aueoincgnrg teh lmyifa to ecdied ngcoacidr to het sihswe fo eht IETPANT ludwo be a beertt ristf ,pste aiplseelcy fi teh eswhsi fo the weif si orarcytn ot hatt fo teh t.intpea Aslo, sujt sa a eagrnel ,lure I tycpaylil iodva gncipik wresan poisotn with atls"oesbu" hsuc sa vne,er" w,aalsy "y.lno heT uppsero fo a rtoegausr si ot act in eth bste teeirtsn of eth

sbryant6  Correction. According to UWorld Social Sciences (Ethics/Legal/Professional): Advance Directives... "situations in which family members disagree and there is no proxy can be referred to the ethics committee or, as a last resort, to the courts". +1  

submitted by home_run_ball(64),
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I get ttha tsih esrwna icheoc si eth mtos embcliaa ars.nwe

tBu etnsloyh het ayw tehy dakse hte itqsnoue t"i si tsom pitpraproea fro hte ayipnchis to ddssrae het sseui of a ngdeife bteu ni hhicw of teh olgwifnol "rnseamn

My osnanierg w:sa oewf.e..lberl eth lafyim anc neev nbgie ot ugare htwa od do ndot' uyo aehv ot roseopp a lmdecia t/ttaegeenetmarnmanm t?estragy hhwic si why I netw iwth mo"rcmeend a bt".e.u.

home_run_ball  Like what is the learning objective of this question? On first aid if you go by the Surrogate decision maker priority: you do spouse like wtf nbme? +13  
uslme123  I think it's because there isn't a legally appointed health care surrogate in this case. The family hierarchy is only an "ethical suggestion." +1  
nala_ula  According to first aid, there is an order to who makes decisions when the patient is not able to and hasn't left any directives. My issue was the same as home_run_ball, since they specifically asked about the feeding tube and not "who is supposed to make decisions now" even though that is also warped since the spouse has precedence. +1  
badstudent  If you look at the wording for the rest of the recommend a tube option ("because feeding will be more efficient and prevent starvation") it seems like you would be persuading the family to move forward with a feeding tube for their ease and convenience rather than proceeding with a feeding tube to avoid the possible dangers of an aspiration pneumonia. A family that is visiting daily likely doesn't mind any challenges associated with feeding. Instead it would be more important to recommend a feeding tube to avoid risk. Dumb questions for sure, just wanted to explain why i ruled that answer out. +  

submitted by sahusema(124),
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Waht a AGAGERB .itsoquen He wsa tgaeni baetfraks 2 sohur aog utjs fein dna now we ear pdusepos ot ehav teh mfayil emco ot a sessuoncn tbuoa a igfened uetb keli se'h no hsi tdeha bed? ULLTSBHI

daddyusmle  Did you get the question wrong? +  
notyasupreme  ^ ummm.. chile anyways.. +  

submitted by imgdoc(129),
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I ntihk teh erwsna asw esosnucsn sceeabu the grtou"ar"ses aka fliamy smmbeer hnaevt edrtaildebe yt.e fI tish saw freta ierht troeneiilbda adn ehty a,eesrgdi tehn ti oegs opsseu g&-;t atudl leicrhdn -t&;g asnpert ;&tg- iblisgns ect. Teh eouniqst 'otnsde noenimt nya rdmneesgsiea,t ecnhe eyth nede ot edceid euiavmlcuytl nda meak a ed.scnoii

ahTt saw sjut ym etak no hsti qno.itsue

submitted by thugnisseverdeen(0),
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sThi si a uhlbslit inus.tqoe nrdcogcAi ot hyeetrgnvi evw'e reev been ttuagh eht oicnieds gseo to the efwi fi thee'sr no tm.iudtanoeocn

submitted by temmy(117),
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i nhkit het usnisqote is ygrtin ot ohws hte aecrmtonip of yunti mnago flaimy bmserme hnew rtehe si a itpaetn woh si levdo yb tobh fiwe adn dkis. Teh tydu fo teh otrdoc si to renseu eth flyima si utedin in puotrps fo hte apenitt het dan ni caes there si listl citfnolc gneidargr ahwt ot ,do you eus hte hrahrceiy erehw wfei omsec .firts i etg ti saw a mubd ubt this swa ym cogli