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NBME 23 Answers

nbme23/Block 3/Question#13 (37.7 difficulty score)
A 65-year-old man with a history of gout ...
I will authorize the permit, but I recommend that you continue with regular exercise and only use the permit when you are having severe pain.🔍

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submitted by usmle11a(73),
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ehT iceldam enqmseurtier to ntibao a imtepr ryav yb te,tsa tub ear aluulys fndneoci ot isifcpce ypset fo sstlaideiibi ro coi.tndosin esheT as a lareneg rlue euclndi teh use fo ayn sisitavse ecvdie hcus sa a lwhcree,iha ctrhsecu, or eacn, as llew sa a ssingim gel or oot.f Soem sastet alos ldcuine nirtcae ,avlucarisordac pni,a ro aoirrrtyeps iiot.odnncs bAtou hfla fo US ttaess 2)(6 encluid ldbnensis as a gliqinfuay liaiyitsbd eginblan eht sepnor to ainotb a iisaltidyb rapingk etpimr orf esu sa a sr,pegnsae nda 41 ettsas ndlcuei a labesddi nhad sa a guqliyafni dtiiibsla.y Fuor tstaes dinelcu ,dssfneea adn owt ssaett riagn(Vii and eNw )okYr ncidelu malten iellssn ro epmlleadvtneo listidasieib sa lgiuqayifn edsiilitsabi

rou gyu sues a acen ..s.o

btw i gto it ownrg :) seuca i thhtogu it si pu to the DMV

usmle11a  also it is the dr who decides the eligibility then sends it to the DMV disability --> Dr --> DMV +4  
peridot  I'm not sure if I'm being here or if the test question changed, but I don't see anywhere in the stem that says that the patient uses a cane? I even ctrl+F the word "cane" lol. I picked referring to PM&R specialist for full assessment cause I figured that another pattern is to always gather more info, but I guess that's not the case here T_T +4  
azibird  It does NOT say he uses a cane. +2  
sonofarathorn  I can also confirm that there was no cane involved. I repeat, NO CANE. +4  

submitted by aladar50(40),
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eTh apotnitmr nghti fro msot fo het theics tnsuesoqi are ot look for teh earnsw ewehr you rae iebgn teh ctmtse/osni eoiofrpansls hlewi negsiperct het iapnett’s nomytau,o ,iecbnfeenec eccenamonile-n,f tc.e Mots fo eth seccoih rehe erew rtieeh ytacacrsou ro lybiaascl ngbei nmae ot hte .tatniep heT cerroct ioehcc is to hpel eht aeintpt ubt laso aieottmv meht to utnicoen pysaichl yeaphtr adn to lnoy seu teh emptir sa tltlie as snar.ceyes A rmaisil neiqutos cwhi(h I hknti swa no MBEN 32 -- tyeh rae indk fo nebglidn et)gterho asw eht one wehre the eittpna hda stet sseultr atht diacientd he had accrne ubt hte rstndiee sdai ont ot tuoi)larlyn(v eltl him lntiu het oonlgiotcs ceam in rtael that ady, adn het tepntai ekdsa oyu obtau teh .usrstel uYo ’ndot wtna ot the iel ot hte teiptna dna sya you dno’t wnok or htat eh sedn’to evha c,anrce btu ouy osal nod’t antw to eb abudesitnniro ot het estendisr’ abrenes)lao( qe.eturs

drdoom  @aladar Your response is good but it’s actually mistaken: You *never* lie to patients. Period. In medicine, it’s our inclination not to be insubordinate to a “superior” (even if the request sounds reasonable -- “let’s not inform the patient until the oncologist comes”) but *your* relationship with *your* patient takes precedence over your relationship with a colleague or a supervisor. So, when a patient asks you a question directly, (1) you must not lie and (2) for the purposes of Step 1, you mustn’t avoid providing an answer to the question (either by deferring to someone else or by “pulling a politician” [providing a response which does not address the original question]). +2  
drdoom  As an addendum, legally speaking, you have a contractual relationship with your patient, *not with another employee of the hospital* or even another “well-respected” colleague. This is why, from a legal as well as moral standpoint, your relationship with someone for whom you provide medical care takes precedence over “collegial relationships” (i.e., relationships with colleagues, other providers, or employers). +  
imnotarobotbut  @drdoom, it's not about lying to the patient but it would be wrong for an inexperienced medical student to give the patient their cancer diagnosis, or for a doctor to give a cancer diagnosis if they feel that the patient should be seen by oncology. In fact, the correct answer that the question that was referred to by aladar50 says that you do NOT give the patient their cancer diagnosis even if they asked you directly about it. +1  
charcot_bouchard  Dont give it to him. DOnt lie to him that yyou dont know. Tell him let me get the resident rn so we can discuss together Best of both world +4