NBME 24 Discussion of the diagnosis with the patient privately (NBME Answers)

Retired NBME 24 Answers

nbme24/Block 3/Question#13 (reveal difficulty score)
An 83-year-old woman is brought to the ...
Discussion of the diagnosis with the patient privately 🔍 / 📺 / 🌳 / 📖
tags: syphilis ethics repeat

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submitted by ∗peqmd(75)

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senqotui is aknigs atws'h hte btes xnte tsep nto rnesyesilac wath si eht esbt iicsodgnat pste, whchi si tmwheaos of tpeS 2 atotiron slhef qiestnou (rof epopel how aetks peSt 1 refta o.ot)ntasri ,LDRT estb NETX ptse is ktla to her sifrt at nimummi uoy eden to edteemrni fi seh ash apccy.tai

Wlihe teh tnieatp sha pyetrt bda S:MME

.B sI eht sbet exnt tp.es Yuo ende to dsssuic wthi erh .sfrit t&=g; imederent ehr nisidoce gmiank paactyci =;&tg nteh cepored wehrteh to udscsis ihwt erh utdgaerh A.()

aurLmb upernutc is teh stbe iinsoatcgd sept. r,oHwvee in iths unsqtioe ther'ey nksgia oyu tawh uyo ndee ot do ot eenv eoecdrp ot tihs s.ept .I.e gte reh capyiact hetn you nca oceperd ot lm.urba shTi is asebeuc mlrabu nuprcteu is eorm vvsniiea dna u'olly need ot sssaes yipcaact sa lwel sa get eteihr hre (fi esh sha yactpc)ai or tu.ergdha

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submitted by centeno(3)

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I hotuhgt ttah the icvgitnoe anetiimrpm loudc be teh emtfsoaitnain of yhuo.islnriesp In ti,daiodn teh coortd dlshuo tlka drytceli ot the pteanit ot ekchc rof axusle sa.ueb

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j44n heT maumxim EMSM orsec si 30 tnspo.i A ersco of 02 to 42 gtsusesg mild inedm,eat 13 to 02 essgutsg tmoreaed iemndta,e nad ssle than 21 diesctani eevesr mtdeenia. On aaree,gv eht MSME rceso of a posnre iwht 'eArleismhz ceeldnis btoau wot ot four sptoni ceha erh.y sea loyn sha dmli ditme.nae I ahd ot okol tsih up ehs oldcu stlil iarten hre caayitpc +1

All patients, including those with dementia, should be assumed to possess the decisional capacity to make medical decisions unless the physician determines the patient does not possess decisional capacity.

+/- namesthegame22(13)

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submitted by ∗lispectedwumbologist(122)

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Cna baoydny apneilx shti neo? I tpu eetredpa tsets suaebec I uassmed na oeayl8-dr-3 omnaw si na usalnuu mhgercpaido ofr pi.syihsl

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m-ice 38 imtgh seme na ncomunmo g,ea btu ew d'ont konw for seru erh elaxsu o.shyirt ehS ynol renetlyc 8( sthnmo oa)g tadrset nisohwg meos ginss fo imdl etivcnogi niat.imrpme She ash lal thsee results lmiyngip htat she sha ls,ishpyi os the msto lekyil reasnw is ahtt hes has sypihisl, os we douslh akesp to her pvayelrit oautb her ualexs sio.hytr hTe setts t'ond senalicyesr nsaem hse tog yihsipsl very lren,eyct ist' sloispbe seh's had lhisypsi fro a wihel and envre got e.trtdae +5

mousie I drnatndsue ttha hse oulcd yibplsos evha lsyhipis utb I oals ptu peetar ettss beeacsu I kwon eerht rae a ewf ntghis thta can scuae leafs etsoiivp DVsLR tbu fi hse lsao hsa a + RRP eosd hits eamk a FP essl l?ykile Adn also if esh ahs dilm niicogvet penmiartmi yuo ltils ssuidsc ihtw hre tno erh geauthrd ccrreot ...? +4

m-ice sThi defyneitli odluc be a sefla ieovpst,i utb eborfe we tanw to eoricdns it ot eb a faesl iivtseo,p ew luodsh alkt to eth nattpei butoa ti retavpyli. muiAngss htat tis' a elsaf evptiois ebfeor aikgsn the eaptint tbuao ti oludc yaedl atnteremt of ehr yipshs.il sTh'eer a hacecn hes 'intdd nwat ot celodsis hre eluxas thiysor in fotrn fo hre eatruhdg ro mbeay hse asw earresdbmsa or n'ddti khtni ti saw otpmnairt to ndnmo.eti An ru'yoe yeaoslltub ,tirgh she nlyo hsa ldmi gvoiceitn iaie,rnmtpm so we tsom neylieifdt oulhsd klat ot eht tipenta oelna tohwuit her gdruaeth fisr.t +4

seagull eSh sha daemiet.n eSh eotnds' eavh teh yatacipc ot teeneirmd rhe onw crea 230/2( .MME) I flee eht hudgaert sohudl vhae teh odwr on eht cera encis Gmranad lkiley 'nesodt eavh teh ctaaicyp ot ddneasnutr reh stona.ic +5

sajaqua1 orFm thaw I brreeme,m meeatnid si tliypacyl a nitacimbono fo admierip eomyrm da**n rmiiepad tthouhg sepsrceo.s erhTe si hnotnig ot ndatieci atht hte eaptitn ash aridiemp hhuottg cesesro,ps dan hte erommy inmepimrat si nlyo dil.m The ptniaet nca stlil aslnaoreyb sida to be petm,otcne and os hre ptraiev omtinafniro olhdus be suiscddes ihtw rhe nlao.e +12

yotsubato Elrde raec omseh ro yllered estumociimn alytaluc heva a hhig rtea fo TDsS. srTun uot, hewn you utp a nubch of rdec/iiddwodevwo sduatl ttohereg in a icnuytomm etyh evha ex.s +12

yotsubato oAtyai,idnlld yuo ulsdho etpescr hte yrvpaci of a eepmcntot tluad twih "Mild myrom"e pt.mnemriia I kown I uodcl evah ldim oermmy aempnimtir cieonindrsg teh crpa I rftgoe gnuyistd orf pest 1 +14

drdoom @sgullea deatmine ≠ beescna fo epeomnctce -- het two era pteaarse cspteocn dan eavh to be vaeldaeut pedi.eyndennlt ese t3hdrDmlsvoihb/hi=un/70ru/04sp0.moc/eg.e:?ni.t dna ts.hn.m?oi/1:6em.uirdb/0tlgu3ecih=/4ro7vDnshp/ +3

wowo sola irapnttmo ot o,etn d) epareted tsest si lsoa iccrnorte as teh haouaenmorticlimtnggi syaas is a nrcfmaortoyi aermenoltp ttes n(laog hte easm nseli as FBAS-T)A /w/8hliuehhobwalgthrr.m.w3/hsw-to:fpl5yte/9tarha +5

sunshinesweetheart ...alos. I nhkit ew nca ssaemu ttha deeetpra" e"tsst emnsa aetepr RDV,L ton a"tnldoiadi tsets ot uerl uto lesaf ivpos"ites +2

imtiredofstudying the eirten pinto fo tshi usqiteno si tath henw uoy ees na DTS in an tecedpxuen daoegrpcimh lnr,edh(ci )el,yrled KNIHT XUALES EUSAB +

23 of 30 is mild dementia by DSM V , still has capacity to answer basic questions , and STD in childs and elderly ALWAYS think ABUSE FIRST

+2/- usmlecrasherss(27)

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submitted by ahd_ve(7)

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het mina olag rfo hsti itnoueqs si vdaio iusgnsscdi sisuse iwth airtlvees otihwut eht ’ettipsna moerisi.psn btu esom poeple eerw eylped hdeoksc to ees ttah a traremgnhdo ahs syih.psil wtB I evlea a nilk fo a ahecersr tboua lCilinca ytiltUi fo the MlaneMtnii- sttaSu mnnoxtaaEii heWn seAsgssni DiMekonics-igna i apyca.tCa8dl7b/os9a40:s19i1j0rap.up3hse28.9/7o1t7mt7gu/7/2./bc0son8/1

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submitted by komodo(4)

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I ihntk neo fo teh ocosiunsnf hree si taht eth caatnnilieorihogugmtm syasa o'stdne eenyisrascl iadticne cruetrn iinnocfet iwth ,lshisiyp aeebucs oaepenrlmt sttse acn ayts tiioveps neve rfo erasy trfae ttatrnmee (ip/wnp/i/cchcM9.w.:n20ew0ob2s/m/a.vP5ht/itlrl.s0mgtnC)ht aT ni bmooc ihtw the ryve low RRP etrit odlcu tanceiid retadet .slihiysp oS arlley het best hgnti to do dlouw be ot aks the inpttea lrdictey btoau it reefbo you etswa meit dniog sspoibly cusnaeyesrn tnteigs (nad I luowd feelintdiy aks her dtrcylie cneis toms oeeplp o'ntd talk utoab irhte SIsT hiwt trihe criedn)hl

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submitted by ∗deathbystep1(21)

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noiotp B) (eht rrccote tpoion sa rpe nm)eb th:e pntieta ash a inmi naemlt etsta fo 0,332/ so tath sdhlou name atht she 'nsit ealcabp of ingakm her won icod!ssnei so tshaw hte itonp ni gnlitak to erh iplveytra thituwo her trde?hagu

tonoip A) si rgwno bauseec oyu cnat sujt hdei eht ssngdioia rofm eth tpineat nad eashr it iwht hte ymailf

poinot C pa&;m )uyDo aconnt sadriergd teh tste ro eaeptr eht tste as othb eth tset rea eoistpi,v RPR si a niernegsc estt wtih ssel sieciifpcyt but iattocgaiogunnmemlirh is a lyhgih fipesicc estt os esh ndyeltfie sha hpl!iisyls

pooint E) sdtnoe akem ssene uebaecs ywh ouwdl you od brulma nupteruc rof hsly!sliip?

i kinth etyh orfogt ot vieg an nptioo F) sutj nikfera aertt hre rfo s!ylsp!i!hli

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saturdaynightpalsy esa"nttiP htwi dteusecps oiipyrshuslne dsulho grnedou lrmabu uupecnrt nda qssteeunub RLDV, BA-ATSF odr/na PCR of ilecrnrposbae lufd"i rpe ym noset adn hte uLrtbmitnernea prcueunt si euds ot adegions lnuos,eprhiisy so 'tahts athw I u.pt +2

saturdaynightpalsy To dad to ,atht I tndid choeos hte thore seasrnw ouy iestld for eth aems eoassrn ouy .dselit +1

ac3 wichh fo hte wgiflnloo si eth NXET SBET PETS igamenn you dtlnuow awtn ot ujpm tghsirat ot a bulamr cutneupr lelscaieyp wnhe erteh rea sewnar ehiscco ttha gtssgeu sngsducisi eth sosidinga wthi eth ntitaep tsifr. fI oyu newt to het trodoc adn they ieanogsd yuo tyhe liwl cssudsi sthi thiw oyu beeofr enrdgior ltaiidando .ginttes +1

yerpderp 332/0 is oasl ujts dilm ngietcoiv iinmreamtp os I tjus gttuohh hse llits adh iidnsoce ianmgk laiiyptbca sa 20/43 si lltsi naolmr +3

cbreland reA we xeepctde ot rnieetprt IMC essrco +

madamestep ldMi mymero iitammprne dose NTO mnae ecreasdde somnigdei-kiacn ccaayp.ti nA 38 reay dlo whit an oltams aomlnr tlamne assttu xmea who yabem hsa a new dbfrieony at ehr insrnug ehmo rybbpaol nt'wodlu wtan ehr tuedargh ot nkwo hatt ehs hsa na IST. Adn if stih is reedl a,ebus ydou' also wnta ot ltak ot ehr yvtarielp ot ees if s'esh sfae. No tmaetr t,haw dorle dutals ithw mdil itmdeaen are istll malorn epeopl nda uoy eden ot esssas rteih kncgismo-dieian caytpaci indcisoe to si.iecnod shTi ownam toms leykli ahs hte yptcciaa ot eceddi if hse awstn to rgdouen hsiypsli e.rtttname +

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