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NBME 23 Answers

nbme23/Block 3/Question#9

A male newborn is delivered at term to a ...

Ask the mother and sister to leave the room and inform the parents of the abnormality

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 +12  upvote downvote
submitted by yotsubato(520),

This is a question about patient privacy. The patient here is the child. The proxy for the patient is the mother and father. They must know whats wrong. Sister and mother are just lookyloos, and parents may not want to tell them (stupid I know, but whatever) so you send them out and then tell the parents the situation.

dr.xx  agreed +  
thepromise  so you're not gonna conceal the abnormality and act like its their fault? since they touched it last +14  
tinydoc  How on earth would they expect the parents to conceal a malformed upper extremity from the grandmother and the aunt of the child in a family that is close enough to allow these people to be in the room during the delivery. As always the ethics questions seem to make sense in retrospect, but always seem to have a ludicrous action on your part that you wouldnt do in practice. +8  
llamastep1  It's not just conceal but it's a private and sad moment, gotta give the parents some time to process it. +  

If the abnormality was something more life threatening, wouldn't the first action be to call the pediatrician? I was thinking, limb extremity might mean something else more serious was happening too --> need pediatrician right away to dx.

tinydoc  I thought about that but then I ruled it out as with the NBME ethics questions the answer is almost never to defer to someone else. The question doesn't ever tell you what type of doctor you are for you to be referring to a different more specialized physician. Also I assume that they think if there was something wrong you could handle it. +2  
llamastep1  Out of all the questions (UWorld,NBMEs etc.) I can only think of 1 question where you had to refer. +