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NBME 24 Answers

nbme24/Block 2/Question#6 (31.7 difficulty score)
A 50-year-old woman is admitted to the ...
Factitious disorder🔍,📺

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submitted by seagull(1579),
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hsiT is a eicn oaarcpph ot ftynediigni nad riantegt atiiutofsc dei.rrdos


cinnapie  Not all heros wear capes +  
privwill  Mother of mine strongly believes in this method of treatment... +10  
aisel1787  lmao +1  

submitted by drschmoctor(98),

How does one differentiate factitious disorder from being thirsty w poor impulse control?

therealslimshady  If you're asking how to rule out diabetes insipidus, I think it's because: Diabetes insipidus is caused by a lack of ADH effect, so they will be peeing out too much water, thus making them dehydrated and hyperosmolar (thirsty). This CHF patient is presenting with signs of fluid overload +3  
an_improved_me  I think that ADH also has affects on central structures that increase thirst? Or is that only Angiotensin II? +  

submitted by sunshinesweetheart(82),
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cuate traecneibxoa of CFH laeds ot drdeecu OC g&--;t mcveloeyhrpi tr,imhoaneayp dyob ceerpsive it as myiohvpcloe (os uoy xpetec hihg ADH) micton"[osno- saleeer of ]AH"D

  • htsi pt si yicaillcnl vepmroyclieh ee(dma, re,asl edsintedd ecnk esi)nv

  • rnieu lhsuod be otaedtncecrn Om(sU tg;100& )smO/gkm ceseuba sknydie lhudos be enif and ADH is nidog sti ,jbo jtsu htwi dba ntofmroiani

  • fi enuir is ielt,ud 'sit otn ,CFH s'it eichgpocysn c(an eb eaudcs by rahhcseziopni or afttsiucoi ds)eiordr

lets' asy she sn'awt zacry nda lyelar swa nahgvi FCH e-cnoareibxt a tx htwi itceudri and lfdui irtionrsect sa htye &dd--tig; oten thta yuo nac olsa eus panavt usgdr orf -eCdHarleFt tpnyomcairhe ravoimypehel lckb(o ADH) &;gt-- olhsud auesc the eirun ot eb duilte ihhwc wlil decreu eht evyomleparih nad reduce tlsa oenitprors ot roectrc the npihryaoeamt

arnodm saibtede psiusdnii sied neto for yghpsnecoic iioslpyD(dapI xd si hmtrno,rerinaaeap/yml ielmoapy,ovh idteul nuier )ml;mO&/gts10k0

  • can sola sue eht awert aiertdnoivp etts orf a tp wtih uypioral and dpsaoyliip

;gt-&- fi runie onetcnsea,rct si't chcnioypgse

g&t--; if it deos nto eaennocct,tr iegv sdssieermnop nad if it retencnctosa = caltren ID, seod nto rnoncaeetc = nperecniohg DI

submitted by am4140(1),

This is a BS question - I still picked the “right” answer because nothing else made sense, but this is not how this happens in real life. Having taken care of a million of these patients, they’re not trying to fake a disease or symptoms -> they’re thirsty and selfish with no ability to regulate their own behavior, and they throw temper tantrums and ring the call bell all day long asking for water - they’re definitely not hiding their water consumption. I’ve even seen people get desperate enough to drink out of the toilet because they’re “dying of thirst.”