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NBME 23 Answers

nbme23/Block 4/Question#35 (14.0 difficulty score)
A 17-year-old girl with type 1 diabetes ...
Acknowledge the patient's reasons for missing insulin injections🔍
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 +3 
submitted by niboonsh(296),

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



 +3 
submitted by emh(7),

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.




 +1 
submitted by hopsalong(23),
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I etg htis si a yufflf iqtnesou dna gcdkwnagenoli the p'etsntai seranso ofr simsgin niuisnl stijenncio si eth sdu,ctdile tub I fele ielk iths narwes wtso eht elni a t.bi ouY d'nto awnt to asy tath igsismn ssedo si ko, tub yuo aslo dont' wtna ot be emna ot epntita rehie.t I hgttohu shit awnser )A( wsa gdnconnoi hre gsinims het itonn,secji os I dekicp (.)C In espcrtor,te I ssgeu ceedgnkolaw msean kalt utbo/sufaco het arnicnootvse nd.auor

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" +2  
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" +