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 +0  (nbme21#45)

don't forget about the Mg block! . . . . . .

 +1  (nbme21#39)

I obviously thought that the main thing for capacity is to understand the severity and prognosis of her medical condition BUT I thought this was a trick question because they asked "if the mental examination finding showed..." and the stem failed to mention anything about her orientation to place or time. dumb

drdoom  Stem actually states, “On questioning, the patient does not know the date [time], the name of the hospital [place], or the name of her nurse who had just introduced himself [person].” So, pt *is* actually disoriented to time and place (Choice A). That is definitely concerning -- as would be depressed mood (Choice E) and the other choices -- but “inability to understand severity and prognosis” is **the most concerning** since that is the very definition of capacity. Inability to understand = lack of capacity.
sahusema  So by the logic of the question, if someone understands the severity of their medical condition AND happens to also be disorientated to place and time. Go ahead and do sx on them, it's fine.

 +3  (nbme21#31)

why? like does my med school suck or am I just that dumb cuz we never learned anything like this

sklawpirt  I think its just that the patient is CONSCIOUSLY experiencing chest pain. Because he is consciously feeling the pain and would be able to directly point to it (and that it is not referred visceral pain) it has to be a somatic afferent nerve fiber. This narrows it down exclusively to the intercostal nerve exc;usively. https://en.wikipedia.org/wiki/Intercostal_nerves IMportant to the patients "right sided chest pain" is his history of MVA and x-ray confirming multiple rib fractures. I think this is correct? Does that make sense ? All of the other choices do not carry SA fibers in that area

 +4  (nbme21#29)

tinidazole preferred due to single dose

sweetmed  or metronidazole
niboonsh  what would his diagnosis be tho?
lostweightthxnorovirus  @niboonsh Giardia I believe. the trophozoite is pictured in the problem and has a classic "shield-like" appearance. FA 2019 pg. 155 has more information and the sketchy for it was really good!
nwinkelmann  Per FA, DOC for giardia = metronidazole. MOA of metronidazole = formation of toxic free radical metabolites in the bacterial cell wall that damage DNA making it bactericidal and antiprotozoal. Metro treats = GET GAP = giardia, entamoeba, trichomonas, Gardnerella, anaerobes (below diaphragm), and H. pylori (as an alternative to amoxicillin in PCN allergy). Adverse effects = disulfiram-like reaction, HA, and metallic taste. I didn't know what Tinidazole is, and found out it is of the same drug class as Metronidazole, so makes sense why it would also be used for Giardia. For the purpose of the UMSLE 1, though, I think metronidazole would be DOC (especially because tinidazole isn't in FA).

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