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NBME 24 Answers

nbme24/Block 4/Question#24

A 13-year-old girl who has a 6-year history of type ...

Discuss further the impact of the patient's illness on the family

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 +2  upvote downvote
submitted by nwinkelmann(94),

I just thought of a way to (hopefully) avoid getting these types of answers wrong. First, when I read them I always look for the least "asshole" answer. Then, if you're still stuck, try to put the statement into a quote that you would say to a patient as a physician, remembering that open-ended, non-judgmental questions are ideal.

The answer for this could be phrased as a question/statement by the doctor, to the family, as "Tell me more about how this impacting your family and daily life." Had it been phrased like that, I DEFINITELY wouldn't have gotten it wrong. I would have never even had the opportunity to make an assumption about the family's fighting being due to diet concerns and thus needing a nutritionist referal (which is what I chose).

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. +  




 +1  upvote downvote
submitted by subclaviansteele(2),

Ugh... got tripped up with "Refer both patient and her parents to a dietician"

Over thinking...I thought the source of their arguments were at meal times especially...so maybe they can find a good solution with a dietician.

OCCAMs RAZOR THIS SHIT. keep it simple stupid. The answer fits the best after re reading it.

nwinkelmann  SAME.... ugh! +  
johnson  Also - you're almost NEVER referring/passing on a patient with the USMLE. +1  




 +0  upvote downvote
submitted by hhsuperhigh(1),

The diet is prescribed, so no need to refer to dietician anymore. It is a case of the patient non-compliance of diet. But why can't advise the parents to stop bickering?