support the site ⋅ become a member ⋅ unscramble the egg
(tag_directory)
free120  nbme24  nbme23  nbme22  nbme21  nbme20  nbme19  nbme18  nbme17  nbme16  nbme15  nbme13 

NBME 21 Answers

nbme21/Block 2/Question#18 (33.5 difficulty score)
A 34-year-old woman comes to the physician ...
“I’m concerned about how bad you’ve been feeling lately. Have you had any thoughts about death or wanting to be dead?”🔍
tags:

Login to comment/vote.


 +15  upvote downvote
submitted by yotsubato(778),
unscramble the site ⋅ become a member ($36/month)

Wlel athst a yllrea ecdru yaw to nsecre rof .o.pdr.isesen

champagnesupernova3  There's really no other way to say it without using euphemisms +1  
drdoom  You can’t rule out suicidal thoughts via inference. +  
drdoom  LAWYER: Did you ask the patient if she was suicidal? DOCTOR: Well, um, no, not exactly — but, I mean, she seemed okay .. +  
drdoom  LAWYER: So, a patient walks into your office, you suspect post partum depression — a diagnosis with known suicide risk — and you didn't ask if she was suicidal? +  
drdoom  DOCTOR: gulp +  



what I got from this question: NEVER (99% of the time) refer a patient to see anyone

madojo  I was convinced this one was the exception, but guess not, NEVER REFER! +  



 +1  upvote downvote
submitted by neonem(500),
unscramble the site ⋅ become a member ($36/month)

shTi is a rstomtuppa omod ,ndsietcarbu a rptety momnoc iredosrd htat sah ot heva na eotns tiihnw 4 eeksw fo eevdrliy to eb emrdte as usc.h tPtopasrmu eubls is het stom md,il tiwh a %50-85 edcecniin tare er(p AF 10)2,8 ulsayul sreolesv whinti 01 sady dan teemratnt is lnyo iopprusetv utb ende ot -oowufllp ot sessas orf elsspibo prtosutpam .osinesprde utoPprmsta rneosespdi = 1%51-0 rtae, rradzecahiect by reepsedsd cfte,af iy,extna opor ocnieottrancn ofr rtagree tnah 2 wkese adn ndese to eb eadrtte /w TCB + SS.RI I htnki hte ueoqstin is gitetng ta crneinesg for hits nda a tlnoatilpey roem eiatmrclobp ia,pmictclono prspoautmt so.cipshys

thisisfine   Found this difficult because FA characterizes "thoughts of harming baby or self" as postpartum psychosis - which is super rare, and doesn't fit this case. Also, CBT is first line treatment for postpartum depression - so I still like the offer to refer to a therapist as the best choice. +8  
d_holles  Same @thisisfine. +2  
chandlerbas  i see what youre saying but we should make sure that the mother is alive for us to refer to a therapist. remember if shes willing to harm herself most likely also willing to harm the the little cutie baby....so asking for suicidal thoughts screens for progression to post partum psychosis with the aim to prevent the sentinel event: harm to the baby +  



 +1  upvote downvote
submitted by drzed(169),

SIGECAPS criteria: (1) feeling weepy/overwhelmed, (2) fatigue/irritability, (3) anhedonia, (4) difficulty sleeping, (5) "I feel guilty...", for a period of 6 weeks = meets the criteria for a depressive episode, and since this was in the post partum period, may be post partum depression.

Next best step is to screen for suicidal ideation/thoughts of harming the child.




 +0  upvote downvote
submitted by bbr(15),

"Has it come as a surprise to you how hard parenting is? Many people feel that way." I don't think this validates their feelings, and it would make someone feel badly if you said "hey everyone deals with this shit". Also this answer focused on parenting, rather than the psychiatric concern (postpartum depression).

"im concerned about how bad you've been feeling lately". I think this does acknowledge their feelings, and does show that the physician is engaged. Yes, its blunt. But at its worst, its still more complete than the other ones.

Tough question based on you're reading style.

drdoom  if a disease or syndrome has known risk of suicide, and you fail to assess for it, that's negligence brotha (“if you suspect, you must protect!”) +