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NBME 21 Answers

nbme21/Block 3/Question#39

A 74-year-old woman with mild dementia is admitted ...

Inability to understand the severity and prognosis of her medical condition

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submitted by drdoom(207),

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 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.





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. +  




Time, place, name → assesses orientation → to see if pt is for example intoxicated or not

Decision making capacity is based off of whether the patient understand her diagnosis and is making an informed consent → she knows and understands