need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (โ€œpredict me!โ€)

Retired NBME 23 Answers

nbme23/Block 4/Question#35 (reveal difficulty score)
A 17-year-old girl with type 1 diabetes ...
Acknowledge the patient's reasons for missing insulin injections ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags:

 Login (or register) to see more


 +5  upvote downvote
submitted by โˆ—niboonsh(409)
get full access to all contentpick a username

One of the questions in the uworld practice test 2 actually touched on this.

motivational interviewing: indication
  • substance use disorders
  • other behaviors in patients who are not ready to change
principles
  • acknowledge resistance to change
  • address discrepancies between behavior and long term goals
  • enhance motivation to change
  • nonjudgmental
Technique (OARS)
  • Ask Open-ended questions (encourage further discussion)
  • Give Affirmations
  • Reflect and Summarize main points
get full access to all contentpick a username



 +4  upvote downvote
submitted by emh(11)
get full access to all contentpick a username

You need to acknowledge and discuss the reason for missing. Some people - young women mostly, intentionally restrict insulin therapy to lose weight. It's called diabulimia. They manage their glucose levels right before the blood draw so that their glucose is normal on the labs, but the HA1c doesn't lie.

get full access to all contentpick a username
rozeng  But didn't he acknowledge already by asking her and getting also a relatively relevant response? +



 +1  upvote downvote
submitted by โˆ—hopsalong(32)
get full access to all contentpick a username

I get this is a fluffy question and acknowledging the patient's reasons for missing insulin injections is the cuddliest, but I feel like this answer tows the line a bit. You don't want to say that missing doses is ok, but you also don't want to be mean to patient either. I thought this answer (A) was condoning her missing the injections, so I picked (C). In retrospect, I guess acknowledge means talk about/focus the conversation around.

get full access to all contentpick a username
dentist  I would say: "I understand why you are missing injections, but you're going to have a BAD TIME IF YOU KEEP MISSING INJECTIONS" +4
alexxxx30  @dentist, I was searching for that answer as well, but it wasn't there so I picked C ahahaha +
123ojm  you would definitely do C as well. key word is "initial step" +
meja2  I believe that C is wrong since data suggests that teenagers tend to focus on the current situation, rather than long term, so if you want to initiate a change in behaviour its best to discuss how the behaviour affects their CURRENT situation. Option C would be to discuss long term effects. +1
fatboyslim  I think by acknowledging the patient's reasons they mean to say something like "yeah it's not always easy to remember to take ur insulin on time every day, especially when you don't immediately feel the effects of not taking the insulin" etc. In contrast to saying they are right about it. It's just about telling the patient "I hear you and I know it can be difficult". I think this concept applies to any non-compliant patient. +



Must-See Comments from nbme23

ferrero on Precapillary resistance
yotsubato on 99%
sne on Triglyceride
sajaqua1 on Area labeled โ€˜Dโ€™ (Spinothalamic tract, right)
stinkysulfaeggs on Hypoglycemia
hayayah on Iris
soph on Peak inspiratory pressure (alveolar): ...
seagull on Area labeled โ€˜Cโ€™ (Cranial nerve 8: ...
water on Dietary change
wired-in on 28.8
beeip on Binding of permeable ligand to nuclear ...
thomasalterman on Hypoglycemia
yotsubato on Inhibition of the cytochrome P450-dependent ...
seagull on Decreased sodium bicarbonate reabsorption in ...

search for anything NEW!