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NBME 23 Answers

nbme23/Block 4/Question#35

A 17-year-old girl with type 1 diabetes mellitus ...

Acknowledge the patient's reasons for missing insulin injections

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submitted by emh(2),

You need to acknowledge and discuss the reason for missing. Some people - young women mostly, intentionally restrict insulin therapy to lose weight. It's called diabulimia. They manage their glucose levels right before the blood draw so that their glucose is normal on the labs, but the HA1c doesn't lie.





 +0  upvote downvote
submitted by niboonsh(81),

One of the questions in the uworld practice test 2 actually touched on this.

motivational interviewing: indication
  • substance use disorders
  • other behaviors in patients who are not ready to change
principles
  • acknowledge resistance to change
  • address discrepancies between behavior and long term goals
  • enhance motivation to change
  • nonjudgmental
Technique (OARS)
  • Ask Open-ended questions (encourage further discussion)
  • Give Affirmations
  • Reflect and Summarize main points




I get this is a fluffy question and acknowledging the patient's reasons for missing insulin injections is the cuddliest, but I feel like this answer tows the line a bit. You don't want to say that missing doses is ok, but you also don't want to be mean to patient either. I thought this answer (A) was condoning her missing the injections, so I picked (C). In retrospect, I guess acknowledge means talk about/focus the conversation around.

dentist  I would say: "I understand why you are missing injections, but you're going to have a BAD TIME IF YOU KEEP MISSING INJECTIONS" +