NBME 24 Discussion of the diagnosis with the patient privately (NBME Answers)

Retired NBME 24 Answers

nbme24/Block 3/Question#13 (reveal difficulty score)
An 83-year-old woman is brought to the ...
Discussion of the diagnosis with the patient privately 🔍 / 📺 / 🌳 / 📖
tags: syphilis ethics repeat

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submitted by ∗peqmd(75)

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inqueost si ingsak t'wahs the estb tenx estp nto ieylraecsns atwh is eht tbse soiagnidtc ,stpe whhic is ehwomsta of Sept 2 attooirn hsefl tqnosuei r(of peeopl who tkeas pteS 1 aeftr .i)nttrasoo ,TLRD etbs XETN spet si tkal ot erh trsfi ta mmniimu uoy ened ot idmeeetrn fi hes has tpycac.ai

leWih the pitntea hsa tpryte bad :MEMS

.B sI eht sbet next pts.e oYu deen to ssdicus ithw ehr .tifrs t;=&g rdemieent hre nieiodcs ikmgan cyacpita ;=tg& nhet oeercpd herhwte to isdcsus htwi erh agtredhu )A.(

amruLb rtepcnuu si teh stbe cidgnstioa tesp. e,woreHv ni itsh sqetuoni yereh't niksga uoy ahtw you eend to od to enve pdceeor to hsti p.tes .eI. egt reh caiytcpa tehn uyo cna eoepdcr to aubr.lm shTi is csuabee barmul prcuetun si eorm ansvveii dan yl'ulo need to aessss actycipa sa lwel as egt tiereh rhe if( seh hsa p)acaiytc or hu.gaetdr

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+1 upvote downvote
submitted by centeno(3)

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I ohuttgh thta teh nogitivce tmamrpniie uodlc eb eht aminofatnsiet of enroslyphu.isi In tadidon,i het dotroc dlhsou alkt clreidty to eth tinptae ot kecch fro laxeus .uabes

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j44n heT amxmuim MESM eocsr is 03 .tsipon A soecr of 20 to 24 tsggusse ldim it,meaden 13 to 20 gusstseg emortdae tem,deani dna ssel hant 12 nstiediac everse ede.mnita On arvaeg,e teh EMMS eorsc of a erspno whit 'szmeirelAh seidlcne atoub two ot ufro pnsito ahec r.yahee s oyln ash lmid eatidm.ne I ahd to olko isht pu hes oldcu llits rntiea reh acicpaty +1

All patients, including those with dementia, should be assumed to possess the decisional capacity to make medical decisions unless the physician determines the patient does not possess decisional capacity.

+/- namesthegame22(13)

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submitted by ∗lispectedwumbologist(122)

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anC ybonyda nelpaxi thsi ?eno I tpu eeaptder setst escbaue I sudesma an ea8-ldr3-oy oanmw is an uuslanu amcdoigephr rfo isyl.hsip

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m-ice 83 mtigh seem na mcnomuno ,ega but we o'ntd konw ofr user her lusexa .itorsyh hSe onyl cnlerety (8 otsmnh )goa etdatsr oshgwin mose ignss fo limd ivotcgine pmnmar.itie eSh ash lla tehse streusl ipmylnig htat ehs has ihyspil,s os het msot lyekli awrens is htat ehs hsa p,shyiisl os ew souhdl peask to ehr evlyrtpia batuo rhe lsxeua ryosiht. heT ssett nd'ot eaclinreyss aensm seh got lyssihpi very e,ylrnect t'si lboipses 'shse adh lsiyihps rfo a heliw adn envre gto ertdte.a +5

mousie I andtesnrud tath she oudcl slispyob heva ssiyphil tub I sloa ptu rpeaet estts caebuse I kown ehter aer a wfe stghni thta can cesua lfeas viositep RVDsL tub fi seh laos has a + RPR edso tshi ekam a FP ssle ?kliely dAn sola fi esh sha mlid gctniiove rnmtmaeipi uoy tlils dusssci ihtw her otn erh utgaredh rroctec ?... +4

m-ice ihsT yetdfielni cdluo eb a fesla esi,toivp tub reofbe ew tawn to cdorneis it to be a lsafe v,eptosii we duhslo latk to eth ptienat tauob ti ravytepil. uAsgisnm tath tis' a lsafe epsotiiv beeofr iasgnk teh npateit uboat it dulco eyald reantttem of hre hsiylpsi. hTse'er a nechac ehs idn'dt wnta ot siedsloc reh esuaxl hirosty in frnto of erh rdguehat ro beyam ehs swa esaebasrrmd or iddt'n khint ti saw apmionrtt to noim dn A .n te yu'ore ltslayueob tr,igh seh nylo ash dlim cingtvoei tmimenairp, os ew most eyitildfne douhsl tkla ot teh tanptei aleno htouitw hre gedtahru s.ifrt +4

seagull eSh sah endtae.im ehS d'netso ahev eth ccyapati ot treemiedn reh nwo raec 0/232( M.)EM I efel the arutehgd lusodh ahev the owrd no eth earc seicn andmGar yllkei oe'sdnt heva the caicypat to dtdnasuner her oatncis. +5

sajaqua1 omrF twah I r,ebmeerm temnadei is ltypclyia a miainotbcon fo ridpmeai mmeyor **nda dmarpeii uoghtth csssoerp.e eTreh is thnngoi ot diticean htat eth nptetai sah iipmrade gutthoh sc,sroeeps nad teh ymmroe miiamenrtp si lony .limd ehT tnpeati nca slilt anreyolbsa adsi ot eb t,moeepcnt nda os hre tiaevpr ftrannmiooi hdlsuo be cisddusse ihwt her n.leoa +12

yotsubato erldE aerc ohsme ro redelly iosucmimnte lcautlya ehav a hhig aetr of SsTD. sTnru ,out hwen oyu utp a hbcnu of ewevocrdddodwi/i udalst orehttge in a ymcuimnto tehy haev xes. +12

yotsubato oilnyAait,ldd ouy oulshd rceetps hte virpyca of a ptcteneom altdu ihwt di"lM rmoyem" aetrimnpim. I wnko I udcol aveh lidm eoymmr amtpirenim icgdonniesr het capr I rgotef ntsguiyd rfo spte 1 +14

drdoom @ugeasll mtaedine ≠ scnabee of pteeencmco -- the two are eerptasa ecpotsnc dna aehv to be deeluatva i.nedneenptdly ese =thnistb4m//eru0ne:io/s0mhc.Di.rhlgp/.v?o03u7d and io3:sitg/pcr10h4ivnm/ue.slu.mDb=o//teh.drh?6n7 +3

wowo sola ttnirmoap to to,ne d) reepadet estts si sloa retcncoir as hte cniliaghoramomiegttnu ssyaa si a omiryorfcnta eplreanotm tets g(anol the ames ilnse sa TSFAA)B- -hrauytet/hlwrhwr3/hahi/l.t/aswtmw:f9oh.pb8lgoe5 +5

sunshinesweetheart alos.... I inkth we nca semasu htat eeatr"dpe et"tss manse paeret DR,VL ton ii"aoadntdl stset ot reul uto aefls pvsiso"tei +2

imtiredofstudying the netrei pinot fo tish tsqeuoin is tath when uoy ese an DST in an ndeuexcpet idhgeacpmro cidl(,erhn ele)dl,ry TINKH XASLUE UEABS +

23 of 30 is mild dementia by DSM V , still has capacity to answer basic questions , and STD in childs and elderly ALWAYS think ABUSE FIRST

+2/- usmlecrasherss(27)

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submitted by ahd_ve(7)

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hte mnai aogl for hsit quoeistn is doiva scgndssiiu issues ihtw eiavtrlse tthuoiw eth tnpastie’ psiomrein.s tbu omes eopelp rwee yepeld odkechs to see tath a mtrnohedrag ash sy.iplihs Bwt I eelav a kinl of a rcsehera taobu Clnclaii iliyttU of eht aen-ltiinMM Stutas Enitnxomaia hWne issnAsseg M-oniiDkgaiensc a .caipyCt94071mas7j/11h/09ld7gicor01a888n:up//su//sb2.29eaos.7b7.otpt3

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submitted by komodo(4)

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I ithkn one fo eht ifssnocuno rehe si htat the onhuaclgignimemrotiat asasy dn'eots elyiaescnsr etaciind recurtn fnontecii with lshisyip, ebscaeu lroemtpean stest nca yast ivoeitps neev for arsye rftae mtrneatte (a.0h00t/tnm2Pwrs//nit.9ocv/wCeb/lgps/lMc2.n.im:pich5w )htTa in mocbo wtih het ryve low RRP ttrie cudlo edniaict teardet hisyips.l So layerl hte bets nhigt ot od odwul eb to ska the aeinttp erytldic autob ti beoefr uyo waste ietm indgo splyiosb assycnuneer steigtn dn(a I uwdol itiyldfnee kas reh eyitdclr insec tosm eoplpe on'dt alkt uatob riteh STsI tihw itreh lncdihre)

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+0 upvote downvote
submitted by ∗deathbystep1(21)

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ponoit B) (teh cotcrer onoipt sa rep n)bem teh: epantti ash a inmi nametl ttesa fo /2033, so taht lshodu emna ahtt she 'tisn ebacalp fo gkinma hre now odniceis!s so swhta eth ntipo in tinkalg to reh atevirypl owhtitu her ?ehgrtdua

ootipn A) is ongrw ceseuba ouy tanc just edih teh ongdiisas mfro eth tptaine and rshae it whit hte imflay

potnoi C m;p&a o)uyD otncan iesgraddr teh stet or treeap teh stet as thob het ttse rae sptev,oii RPR is a sernengci stte hitw essl yeicsfpctii but manouotcliihrtgniaemg is a higlyh ipeisfcc tste os ehs dyfinelte hsa siphyls!il

oopnit E) tseond eakm sense aesbecu yhw lowud ouy do uramlb urtcnpeu rof p?h!ysislli

i kihnt hyte fgtroo to igve an opnito )F jsut rkfneia ettra reh fro iyh!s!!lilsp

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saturdaynightpalsy aisnPtet" wthi sduceepts elrsioipsynuh ohsdul oudergn mualrb cunerutp nad etqsbeusun DLV,R F-ASBTA anodr/ PRC of leaeirconsprb l"iudf per ym teson dan teh tetne Luibrmrna tuurcenp is seud ot ainsgode soelusi,niyphr os thas't hwta I p.ut +2

saturdaynightpalsy To dad ot tt,ah I dintd oechos eht rhtoe nwsaers uyo detsil rof eht esam oraesns uyo ils.etd +1

ac3 wichh of eth nfwolgiol si eht TXEN EBTS SETP aeinmgn uyo ltdwnuo anwt to umpj agthrsti to a blrmua uptuercn eclyspaile nhwe teerh rea rnswae ohcices htta sggeust dnsiigscsu hte dgssinoai tihw hte atnteip i.trfs fI uoy ntew to eth rotcod and yeht odaisgen oyu yeth llwi ssdcsui ihst twhi yuo freboe gnirrdoe ndloiatdia tigt.ens +1

yerpderp 2303/ is laos stuj lmid cgietivon niepmratmi os I utjs ohtghut esh lsilt dah siiendco kagnim abaitlciyp sa 20/34 is tllsi lnmora +3

cbreland erA we eepdxetc ot entipetrr CMI oscsre +

madamestep dilM oyemmr priammneti oeds TNO nmea eesdardec mniecadgosi-ikn ptac.iyac nA 83 arye odl wiht na ltsaom almnor lmntae stauts exma who mebya ahs a wne ioyerdnfb ta ehr ugrsnni meho brlobapy lo'twund twan erh dahugret ot oknw ttha seh sha an T.IS nAd if shit si edrel saeu,b do'yu slao atnw ot lkta to her eypratvil to ees fi 'hsse s.afe oN taetrm tw,ha ldoer sdtalu htiw midl natemied rae ltils alrmno oepple nda you eedn to ssssae eitrh kanciemdinio-gs catpiyca cndseioi ot .deciinso iThs anmow ostm iyekll has the ayapitcc ot eieddc fi hes wtasn ot neurgdo ipsylsih mtret.tnea +

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