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NBME 24 Answers

nbme24/Block 4/Question#24 (30.5 difficulty score)
A 13-year-old girl who has a 6-year history ...
Discuss further the impact of the patient's illness on the family🔍

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submitted by nwinkelmann(293),
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I usjt gotuhht fo a awy to o(lf)ulyphe aiovd tenggti etshe ysetp fo snerswa .rnwog srt,iF nehw I eard ethm I wslaay oolk rfo eht ltsae lshe""aos .ensraw Ten,h if ye'ruo ltsil uckts, rty to upt teh tmtsteane niot a oquet htat oyu dwolu yas ot a ttenpia as a s,niaphyic ibmnrgeerem htta eo,depden-n gdtnjuaeol-mnn ustesqino are al.eid

ehT renaws for iths oludc be psdareh sa a tsamtuotennt/sqeie yb hte ocrod,t to het mlfay,i sa "lTle me rmoe uatbo hwo hist miitncpag oruy ayifml and dalyi .il"ef Hda it eebn apreshd kiel tth,a I TENYFLIDIE und'otlw eavh egntto it grwo.n I doluw evah eervn evne ahd teh utynptprooi ot ekam na oautpmsisn tbaou het i'amyslf hitgfnig bgien eud to edit nocensrc nad tush gieennd a urtnoinitsti raeerfl (hichw is twah I .soehc)

usmile1  I think the reason dietician was incorrect is because she has had diabetes for 6 years and her diabetes was well controlled that entire time. Then for the past two months her glucose control has been poor. This is pointing towards the issue NOT being that they don't know how to manage the diabetes so referring to a dietician wouldn't be useful. +4  
tiredofstudying  99.99/100 times the answer will never include referral. The only reason I do not say 100/100 is because there may be an answer one day that is to refer, but through all of UW, Rx, and NBME it has never been to refer, so do with that info what you will +3  

submitted by subclaviansteele(10),
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h..gU. otg rpptdie pu hiwt efR"er othb ptitnea nda erh rsnepat to a inec"aidit

rvOe hgik.iInnt.. ugthtoh teh uersoc of eriht smrunetga reew ta aelm imset so.s.eel.alipyc ymabe tyeh acn dinf a gdoo lituoson htiw a .idncaiiet

MsOACC OZRRA SIHT .SIHT keep it imslep dutsi.p ehT rsnwae tfsi eth estb efatr er ariegnd i.t

nwinkelmann  SAME.... ugh! +  
johnson  Also - you're almost NEVER referring/passing on a patient with the USMLE. +8  
bmd12  They are at meal times, which is why she's having difficulty following the prescribed diet bc her parents are arguing during that time so its difficult for her to correctly execute it when theyre constantly bickering, and bc she's only 13 so she cant effectively manage her diet without the help of her parents. And since the diet has been working with the patient prior to all the bickering, you can assume the diet is not the root cause. +1  
jamaicabliz  the universal constants: Death, Taxes, and never consulting the ethics committee +  

submitted by targetmle(7),

Shouldn't we first address the issue by correcting her glucose levels by readjusting insulin and then see what are the problems?

am4140  This is what I picked and what I’d still pick in real life. The fact that her diabetes was controlled before doesn’t change the fact that it’s not controlled now... maybe we could change the insulin back to what it was after they get their family issues fixed, but the patient’s immediate blood sugar levels need treatment IMO. I’m just going to miss these questions forever, I think. +  

submitted by sabistonsurgery(3),
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oT get shcu guvea uqsesonti h:ritg

  1. esCidorn nasigy all hte tsemsnetta ni hte rakniesst etno obslpeis duern oury hertba er(nltsaat ot erohmt genotu fi GMI for ubson )ce.efft

opt"S inkrceiBg" - ewhil ,aniysg 'tdno oyu egt a niht fo esnr,pitmala liek het tordoc itgtaenr the taesprn sa grsateeen h.meveletss yehT are fluyl orgn-upw vmeltse;she hyet oknw tyeh sl'udonth becki!r

  1. 'Dton osecho eth rrfee pnotoi on pSet 1 9(9% fo eht emit ctr.r.)c.eo. nessul no oreth tpnoio ta lal isft yuro sace rtfisdrWoU l hsa usitesqno giong to octur as the trigh rsnwea n!vee tBu in all fo htem, it wsa itdvene htat on ehrto pointo odlcu moec lscoe ot begni ey/pthioclc/ianlletleeilga/ retcco.r

  2. Ostnoip ttha ays - uoeae/anrsnsod/e/usskcdeigsrc - ear lywasa ef.errrepd Coiamumnitnco = Key nteioQuss

regularstudent  I love this lmao. I said stop bickering because I thought it would be fucked up to ask the parents about how their kid's diabetes has impacted their family. Me :"So how has this kid's disease impacted your family?" Parents"Oh! we're about to divorce because of this fucking kid. She's a constant stress, and that's why we constantly fight, even during dinner and at the doctor's office!" +  

submitted by therealslimshady(27),

You can eliminate C because her diabetes was well controlled in the past. The fact that there is stress in her family and she has poor glucose control tells you that the her poor glucose control is secondary to the stress in her family. So you want to fix the real problem, and to do this, you need more information about it, so pick B, as open-ended questions will always give the physician more insight to what's going on and better be able to decide how to tackle the problem

submitted by hhsuperhigh(37),
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hTe itde si ered,bprcis so on nede to ferre ot iacetdini noem.rya It si a cesa of eth taiptne nncpcelon-oami fo .tdei But wyh atnc' iesavd the tsrnaep to spto n?rgiikebc

therealslimshady  I remember Boards and Beyond said that you never want to pick any statements that sound "scolding", plus it couldn't be much help to just say "stop arguing", it's better to find out information on what's causing the arguing so that you can stop it entirely, which choice B will allow you to do. +  
tyrionwill  stress is the thing to worse the condition of DM, and will be better after being seen, comforted, and accepted. +  

submitted by thisshouldbefree(33),

I translated choice B to "the parents are arguing about their child and therefore by saying this i am adding fuel to the fire" I chose A because i figured thing are getting heated and therefore doc should try to calm things down before proceeding