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NBME 24 Answers

nbme24/Block 2/Question#6 (33.7 difficulty score)
A 50-year-old woman is admitted to the ...
Factitious disorder🔍,📺

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submitted by seagull(1677),
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hsiT si a cien rpoaphac to gifdtynneii dan negttiar ftucastioi s.eidrdro


cinnapie  Not all heros wear capes +  
privwill  Mother of mine strongly believes in this method of treatment... +12  
aisel1787  lmao +1  

submitted by drschmoctor(106),
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oHw eosd oen fnttreediaefi iasocttufi oirdrsde romf bnieg ittshyr w orop lpismue ltncoor?

therealslimshady  If you're asking how to rule out diabetes insipidus, I think it's because: Diabetes insipidus is caused by a lack of ADH effect, so they will be peeing out too much water, thus making them dehydrated and hyperosmolar (thirsty). This CHF patient is presenting with signs of fluid overload +4  
an_improved_me  I think that ADH also has affects on central structures that increase thirst? Or is that only Angiotensin II? +1  

submitted by sunshinesweetheart(94),
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eauct bnaxicoaeter fo FHC dlase to decredu CO &t-;-g vlmphicroeye oaa,inyhmtpre odby csireeevp ti sa mypihovcloe (os uyo cetexp hhig )DAH [n-oos"imonct eeleras fo DHA]"

  • ihts pt is clniayllic eriyvpelochm ea(edm, esa,rl iddsdetne nkec veni)s

  • eunri oldshu be tdetcronenac OmU(s 0g&t10; /gkm)msO seabceu siekndy dsulho be neif dna DAH is nogid tis bj,o sjut thiw abd iaontmofrin

  • fi iunre is ,edulit 'tsi not F,CH t'is nesyohpccgi a(cn be auedcs by ashrzinicpohe or ctsatuiiof dedorrsi)

tels' sya hes 'wtsan cayrz adn alelry aws nvagih HCF anor ibx-caeet tx whti decriuti dan fdlui notcirserti as yhet t&;gid-d- eotn ttah ouy anc slao sue apavtn rugsd for d-aCltHrFee ancyhtproemi eryolmiphvea bkol(c DA)H -&t-;g ohdlsu ecsau hte unrie to be utdlie wcihh wlli edrecu het lhiaeeymoprv adn ceudre aslt ostneoirrp to ercotrc eth pmaoaethrniy

ndaorm dateesbi npisiisdu eisd oten for senhgicypoc aD(slop ipdIiy dx si o/arap,mnylnteehmarri vio,lemophya euidtl uirne s/Om)t10&0gmk;l

  • acn aols seu the wetar vrtpadnieoi estt rfo a pt with lpuioary adn ioyaipslpd

;tg--& fi ureni cansrotentec, is't gchcsponyei

-;g-t& fi it odes otn arteecnon,ct vgie snpssdoimere dan if it etcnsractone = ratnlec D,I eods ton eanctroecn = ineeogprhcn DI

submitted by am4140(5),

This is a BS question - I still picked the “right” answer because nothing else made sense, but this is not how this happens in real life. Having taken care of a million of these patients, they’re not trying to fake a disease or symptoms -> they’re thirsty and selfish with no ability to regulate their own behavior, and they throw temper tantrums and ring the call bell all day long asking for water - they’re definitely not hiding their water consumption. I’ve even seen people get desperate enough to drink out of the toilet because they’re “dying of thirst.”

homersimpson  I think you're thinking of psychogenic polydipsia bruh, slightly different pathophys +