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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eniouqst si sgkain hawst' het esbt etxn pets otn lcaseirseny thwa is teh sebt tdsiacigon tesp, ihchw is smohwtea of eStp 2 riatnoot hsfle sotuiqen fo(r oelepp owh etksa etSp 1 frate ot).nsortia LDRT, etsb TXNE tsep is tkla ot hre sfrti ta inmumim yuo edne to iteemdren fi seh sah .cciapyat

Welih eht enittap sah rpeytt bad MEMS:

.B sI eht setb texn t.esp uYo eedn to csdsusi wtih her itfrs. g=t&; derteemin her sdioicen namgki yacpiatc &=tg; then reopcde hwtrhee ot icdsssu tihw hre edugthar .()A

armbuL nrutpcue is teh btes ogadciitsn stpe. e,wrevoH ni ihst eisqntou 'tyhere angski uyo hwta you nede to od to enve ecderpo to tsih .tpse e..I get her caiaycpt ethn yuo nac ceorepd ot bl.uarm Tihs si eebacus lurmba puuntcer is emro viniaves nda ll'you eedn to sssase iyctacpa as lelw sa tge ehitre erh i(f she sah )iptyacac ro ghue.adtr

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submitted by centeno(3)

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I hguttho ttha het invtgiceo airimemptn cldou eb hte sminantotiafe of ihnlsyireos.up nI doia,tdin eth octord sloudh ktal eyltcdir to het tpaenti ot ehkcc rof leasux b.suae

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j44n eTh iummmxa MSEM scero si 30 .noistp A srceo of 02 to 42 sesgtsgu limd dt,niamee 13 to 20 stusgegs ereamdot einmte,ad dan ssle atnh 21 sciteanid sereev aidn.etme nO aaege,vr teh MEMS ocres of a senrpo iwht 'hmAzeselri idlesnec ouatb wot to four ntpsoi caeh hser e.ya onyl sha idlm einae.tmd I ahd to oklo hsti up hse dcuol sllit atneri reh icatpyac +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(14)

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submitted by ∗lispectedwumbologist(122)

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Cna obnyyda naiexlp ihst o?en I ptu dapeeetr etsst aecbuse I esmdusa na eyao-r-8dl3 anomw is na lnsuuua gradeohicpm for plihs.isy

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m-ice 38 igmth seme an ooucmnnm ea,g ubt ew t'don nkow rof usre ehr uasxel othisy.r Seh nyol ntelreyc (8 omstnh aog) teratds whsinog moes ngssi of dmil einvgcoit niirmap.tem Seh sah lal ethes ultrses piyginlm atth esh ash ihplsiy,s so the otms lleiyk resawn si htta she has hsliyp,is so ew houlsd ksepa to reh lvprateiy botau ehr lxusea .hirtsyo hTe sestt dnot' yelcnrsseia nsmea hse got pshlisyi rvey e,eynrlct t'si epsisobl es'sh dha psiylsih rof a lweih nad erven ogt tradte.e +5

mousie I rdutsannde thta hes odclu ibspoyls ehav sipisyhl btu I soal upt eraept ttsse aeesucb I oknw heert are a ewf gthisn hatt nac seacu lfsae voesiitp DRLVs btu if ehs alos hsa a + PRR soed thsi maek a PF elss llyi?ek ndA asol if she has diml egiitcvon inmeptrami yuo lltis dscssui twhi ehr ton ehr utdergah etcrcor ?... +4

m-ice Tish ynfelidtei oulcd be a fasel ,peotivsi but oeferb ew wtna ot rciodsen ti to be a safle etoiisvp, ew hludso kalt ot the iatenpt bouat it apirl.tvey nmisgsAu atht st'i a elsfa oispevti eebfro gnkisa het inepatt toaub ti uclod yeald tmeaternt of reh hl.sysipi Tse'ehr a cnehca hes indd't tanw ot scolisde reh exaslu sohiytr in ofrnt of her aurhdtge or meyba she saw asdreamrbes or i'ddnt nkiht it aws tprminota ot onA.d ent i mn yr'uoe llaueoytbs ghtri, hes lnyo has limd itivencgo tmi,ipnraem so we mtso dnyteieilf hsuold tlka to the ntaptie anloe tiuhotw reh grehatdu sitr.f +4

seagull eSh hsa ae.miendt eSh estno'd avhe het paytcaci ot drmtienee her onw erac (3022/ M)EM. I eefl the rdthugae ohsldu haev teh rwdo no eht ecra inecs aGamnrd ieklyl ot'dsen aveh het aiypcatc to unerdtsnda her s.iaotnc +5

sajaqua1 rmFo htwa I emre,brme mindeaet is cyiyltpal a tmaicbninoo of meiaprid mymroe d*n*a pmdiaire hottuhg osesspcer. erThe is ihonngt ot itiacdne taht eht ettpani ash rdaimiep hutoght pcr,eesoss nad teh emymor nrimmapeti is only mldi. ehT tntaeip acn tllsi aoasyernbl dasi ot be eonepmttc, adn os ehr eiarvtp nfionotiamr dshulo eb eucdsidss with ehr anleo. +12

yotsubato deErl erca hsmeo or dleryle tmomnuseiic yuacltal evha a high tare fo .sTDS srTun u,ot enhw yuo upt a bncuh fo dweoi/deiddrwcov sltuda hegrttoe ni a coimuntmy thye evah sxe. +12

yotsubato lidAtoayild,n uoy oduhsl eetpcrs het cprayvi fo a tetcnepom dltua wiht M"lid orymm"e ameimrt.ipn I okwn I uoldc heva imld mymreo emnrmaitip isnoigdrcen eht aprc I otergf ydintsug fro setp 1 +14

drdoom ae@llugs eedmnita ≠ nbesaec fo eemcntopec -- hte wot ear asaretpe cptcsone and have ot eb eauadelvt pednlney.ientd see /toothih=ugd:0burv/limemDnsn/3.rei/0s4pch..?07 adn nhish/u:4ov=cD.1r/r/3gsi.u.bp6o?t7lneim/edht0m +3

wowo sola traotminp ot tnoe, )d rteaedpe estst is aosl eitorccnr as eht atnieiagutimhmcloongr sasya si a cairnoymftro mrlepotane tets la(gon teh same esnli sa FT-A)BSA .wawh5:tae/wr/p.l3hhhiraot/lmtfbow8yt9h/s-reuhlg +5

sunshinesweetheart .ola.s.. I ktnih ew acn sasmeu that ape"deter "estts amsen tpaere LRDV, tno ddalti"iaon stest to relu otu afsel "sioevsipt +2

imtiredofstudying the iterne pniot of isht tqusneio is ahtt hwen uoy ese na TDS ni an nepuedxtce rdeopghacim lihnced,r( lee,drl)y IHTNK ASLXUE EUBSA +

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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het mnai aogl fro isth siuqteon is dvaoi ssinugcisd sisseu hwti asitevrle itouwht eht tensipa’t .oiipssrenm tub osme plopee weer yepeld cdkshoe to ese tath a dtmaegrhnro ash ys.sipilh wtB I eaelv a knil of a csrerhea aubot liacCnil titiyUl fo het Mi-naleiMtn attsSu Entoiaaixmn hWne ssAsingse ais-eicgDMkoinn .cCaytapi hrn92sos1.u1pima/1lu/j/78/2/t3:cbbo877e0./og048pa9.s0ts7d97a1

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submitted by komodo(4)

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I ikhnt eno fo teh ifnnucsoos rhee si thta het gnohliinamauictetorgm aassy stodn'e aecirlsneys cidetnia cunertr itnofneci tihw ,syiplihs acesbue onltmarepe ttsse nac tyas pitoveis eevn fro yaers fetar tentmtrea (iwe9./sn/05n0btoMr/ignma/tc2h0.mtsciwph:C2.wlPc/v.l/phtT )a in oomcb wtih the very lwo PRR ietrt ouldc ciineatd rteaedt pislih.sy So llyear eth estb ihgtn to od odwul be ot aks hte npteati edlrytic otbua ti erofeb yuo seatw tmei idgon spsylobi syrenusaenc tsgietn (dna I lodwu idyntefiel aks ehr eyirdctl cisen most plpeeo dn'ot lkat buaot their sITS hiwt rihet iedcnlrh)

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submitted by ∗deathbystep1(21)

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noitpo B) the( tcrecro pontoi as per en)mb t:he tneaipt hsa a inim tnmeal staet of /03,32 so atth odushl eman that hse t'sni alcaepb fo gnimak erh nwo ossdne!iic so stwha eth pnoit in akginlt ot ehr rvtleaipy ihwttuo erh tureg?hda

onpoit A) si ognwr ubecsea yuo nact ujst ideh teh onisdisga rfmo teh anittpe dan arehs it with eht alyimf

toniop C &m;ap uD)oy tncano eariddgrs het test or aerpte eth tets sa htob het tset ear tpi,sieov RRP is a recisegnn ttes ithw sels iytieicfspc tbu nmcroiatgtomlhanueigi si a higylh escfipci etst os hes eyniedlft hsa ish!llyips

optnoi E) etodsn akme snees eseuabc wyh uldow you od raumlb npcuuetr for shlsiyp?l!i

i itnkh yhte forotg to egvi an onpoit F) juts feikrna etatr erh fro lspyii!l!!hs

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saturdaynightpalsy tnitasP"e hitw psudecets yplsiursienho uohdsl uerongd arbmul cpnuetru dan senebsqutu LDRV, TFBA-AS dno/ar RPC fo aclieorsbpren iudfl" rep ym nseot dan het bn eranrLutemti cutrenpu is dseu to ogdaenis rpniyohie,ulss os tats'h tahw I pu.t +2

saturdaynightpalsy oT dda to t,tha I nddti seocoh the oterh rswaens ouy eisldt for teh ames ransoes uyo ts.dile +1

ac3 ihwch of eth goofllniw si teh XENT BTSE SPET emnngai ouy tnduwol wnat ot pmju ahtirsgt to a aumbrl uunrtpce pcalyeiles ehwn heter rae awrsen osihcec hatt stsuegg gisuicdsns the ndasigsoi wthi hte netiatp sftr.i fI ouy tnew to het dctoro nda etyh ignoesad yuo ethy wlli sdscisu sthi ihtw uoy eefobr gedrroin niaaoilddt ngtte.si +1

yerpderp 2/033 is sloa sjut dlmi evocinigt mimriantep so I jtus httuogh hse lilts ahd ndsiieco mkgnia tlayipacbi as /2430 si llits nloamr +3

cbreland rAe ew epxedcet ot teniprret IMC secrso +

madamestep dMil rymome emrnpamiti oeds TNO naem eeddascer iim-cgisedankno c.iyptaca An 38 yrae dol htwi na maoslt marnlo nmaelt stutas axme who myeab has a ewn ynefdorib ta ehr gnrsniu emoh blaobypr nl'dowtu twna her terhugda to nkwo ahtt hes sah na TI.S And if tshi si derel euas,b oudy' olsa antw ot ltka to erh rtvpaleyi ot see if eh'ss .sfae oN ramtet ,awth ordle dsatul hwit idlm adtmenie ear litsl malonr epleop dan uoy eden ot essssa eirht oegniikdncsima- ciytpcaa ienodsci to iisdo.cen hTsi noamw omts liyelk ash hte acptcyai ot cddeei fi seh wants ot egorudn islypsih nttrt.eema +

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