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

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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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stnouqie si aknsig th'swa het tesb netx tesp otn snalseryeic waht is the best isaoicdngt ,ptes ihchw is samthoew fo eStp 2 torainto sefhl unqitseo fr(o olppee who etkas tepS 1 traef .orsat)oitn T,RDL tesb TNXE pest is atkl to erh tfris ta nimimum you eedn ot treineemd fi ehs ahs aacyct.ip

Whlie eth itatnpe sah ptryet dba M:MES

B. Is het estb etxn pts.e uoY ened ot iscssud twih reh rtsif. =&tg; ieeremdnt hre siieodnc kaginm iactapyc ;t=&g tenh pecorde wrhheet ot dusscsi twih reh hduatreg .(A)

abuLmr rncpeuut is hte setb tgndisaico tesp. ew,rvoHe in thsi ueqoisnt yrhe'te nkgsia yuo htwa uyo dene ot do to eevn ocreped ot stih pe.ts ..Ie gte her pacayitc neht yuo can ceodepr ot .raumbl This si usacebe raumbl upcetnru si omer nvisiave adn luo'yl eend ot assses iacypatc as lewl sa teg hrtiee reh (fi seh sha yia)cctap or tgruhda.e

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submitted by centeno(3)

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I htouthg ahtt hte goniceivt inamrpimte ulodc eb hte sfnotiatineam fo uiihsrn.poysle nI tn,oiaddi the dtroco usoldh ltak dtcryile to eht piantet to ccekh orf luaxes sbu.ea

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j44n The amxmimu SEMM ceosr is 03 nopsti. A coesr fo 20 ot 24 stguessg idlm iemate,nd 13 ot 20 sstsguge daeretom e,dnmieta nad esls nath 21 sciindate eevsre de.aetnmi On are,vage hte SEMM resco fo a prosen iwth reie'mhAzsl endecisl taoub owt to fuor tnpios ahce eeharsy. onyl hsa dmli adent.emi I dha to kloo htis up esh oucdl tsill etnrai hre acyptaic +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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naC nbayyod xpenlia ihst e?no I ptu deeterap tetss scaubee I dssmuae na o-3dlr-y8ae wamno is na suuauln ipaohcregmd fro ipslsihy.

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m-ice 38 tmigh esem an cmounmno ,aeg ubt ew 'odtn know ofr user reh xsuela r.yshiot ehS lnyo yltceenr 8( ostmhn )gao dstraet sngowhi moes gisns of mdil oncviietg inea.pmtrmi hSe sah all ethse ssurtel ynmiigpl that seh ash ih,lsspyi so eth stom ikelyl erwasn si that hse has ipsi,hsly os ew uolhsd sapke to rhe piavytrel batou reh lsuxea .sioytrh heT etsts nto'd ysncelearis eansm esh tog iysiphls very ecnlerty, ti's pbeilsos he'ss had slpsiiyh for a hiwle nda eevnr tog tr.aedet +5

mousie I trndduaesn ttha ehs dulco bispsylo aehv iihysspl but I losa utp ereatp tsest ebucsae I wkon etreh ear a wfe sinhgt htat nac aescu aefls esptiiov DVsRL utb fi esh salo ash a + RRP edos thsi aemk a PF lsse ilylke? nAd also fi ehs sah imld tvngioice mtinpiaerm uyo tills idsssuc wthi hre otn her terduhga cretroc ...? +4

m-ice Tshi entlydfiei dlouc eb a slaef se,otpvii tub oerbef we wtna ot ersnidoc it ot be a flaes iispote,v ew sohuld lkta ot hte npiaett utaob it rpae.ytlvi mssguniA taht tsi' a sfela ptesivio foereb kniasg eth ntitape uatbo ti ulcod eadly atetetnrm of rhe .pisslhyi 'hTrees a naehcc hes nidt'd awnt ot eodsslci erh slaeux oryisht in ofrtn of ehr hedgartu ro beyma ehs asw reemaadbrss or dt'ind ktihn it aws attnriopm to enA ndi omn . t ruo'ey leltusobya t,rhig seh onyl hsa idlm enovitcgi iria,enpmmt so we osmt dntiifeely ldohsu atlk to het eittnpa anelo withtuo hre utredgha tsr.if +4

seagull She hsa dmtni.eea Seh ndteo's vhea the tiapcyac to miendeert hre wno cera 2(20/3 .M)ME I lfee het dhaugetr slhduo eahv eht dwro no hte ecar esinc mandarG lkleiy tesdno' veah het cipaayct to dsadtruenn her inacst.o +5

sajaqua1 oFmr awht I reme,rebm aneedtim si laytylcpi a ibiantcnomo fo dieaprim yermom a*dn* prmdeiia ohttuhg resssec.op ehTre is hitnogn to tcnidiae hatt teh tptniea ash pemraidi uhhtgto srescspoe, nad eht meyrom amentpirim is only .imld Teh ttanpie nac tslil aonsyralbe said ot eb pettem,onc nda so hre eapvrit ifrmanintoo uhldos eb duscdeiss hiwt her ea.lno +12

yotsubato Elred crea hosem ro eydlerl oinsetmcmui tcayaull veah a hhig rate of .SsTD Trnus ,uto nweh ouy put a uhcnb fo diroewdc/oiedvwd slautd getotrhe in a muoctynim eyth ahev esx. +12

yotsubato Al,dainydtlio yuo uhodsl ptecers hte ypvrcai fo a eneptocmt utdal thiw Mdil" omyre"m eam.prniimt I nowk I lodcu hvea ldim mmryoe mtmapinrie sciegrndoin hte cpar I foetrg utgnsydi ofr ptes 1 +14

drdoom ea@llsug eednitam ≠ cseabne fo eccmtpeeon -- hte wto aer trepeaas ccepnsot dan eahv ot be altuveead pyinn.tdeeledn ees hbs//e0s4D=?.rhocn/3vt:0edrup.tmm0nou/ighli7.i nad h?d4/ug.n/bm:sm/7tiu/D.scnr0.vhhe6=1elitoopi3r +3

wowo oasl otamtinpr to enot, d) erepaetd esstt si saol ctrercnio sa eth eianmouotnichirggalmt saasy is a ryarnotfmioc netmalproe sett ga(onl the emas enlsi sa FSTB)A-A ywosah:8woe/.9aehhbih/tfallrwhhrtm3g.ur-/l5ptw/t +5

sunshinesweetheart loa...s. I tinhk we nac sesmua ahtt peadt"eer stt"es amens ptaree VLD,R tno iontdiaa"dl esstt to uler tuo fasle e"vsitposi +2

imtiredofstudying teh ereitn onpit of itsh snteoiqu si taht hwne oyu ese an SDT ni an epenedcxut odchigarmep lh,cerdi(n ,)edllrey KITNH XESULA UEASB +

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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eth mnia lgao rof sthi onqisuet is ioadv sgdisunsic seuiss wthi versaeilt itwhuot het ttnpei’sa oir.eissmpn tub smoe oplepe erew ydpele ekcdosh ot ees that a trnghdmeaor hsa iyssph.li Btw I aelev a nilk fo a rrahsece oabtu inllaciC tiyitlU of het -lnMniiteaM aSustt Emxainaiotn hWen Aingsesss -aoikiDeginnsMc aiC.apytctsj0r2/p19beba3o4i..m8aduglos8770a19.u0://8cp/9177ss2o/1nt/h7

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submitted by komodo(4)

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I hknit neo of teh nsciosnuof eerh is hatt hte nhimnaiuaetgilgocmort syasa onet'ds raeyliscsne ctiadnei cnurrte ftcinnoei wiht s,pilyhsi ausebec elaortpemn ssett acn ytsa epsiivto veen rof aesry rafet atetemnrt (0iaw//ochsn.wsnpeMwiv.5gb:/0Pltmhp20ri.c9/cnmt/l./C2tt h)aT ni obmco whit hte vrey low RPR etrit ulcdo etaidcni dtteare l.isiphsy So llarye het tsbe tnigh ot od wdulo eb to aks hte nettiap ilcryted butoa ti boefre yuo ewsta tmie ingdo oissypbl eacynusensr egtstni nd(a I lwduo ntiidyeefl ask hre iecrldty niesc sotm polepe tdon' ltak uatob ithre ITsS itwh thrie hie)crdnl

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submitted by ∗deathbystep1(21)

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pooitn B) hte( ortercc inptoo sa epr mn)eb eht: ttpiean hsa a imni ntemla tstae of /32,30 so htta osluhd aenm that she tsni' bcpalae of namkig hre now !coisndesi so sthwa eht opitn ni nkiltga to rhe yeivltarp whitout rhe ?ugdteahr

inpoto A) si wrgon cuesabe uyo cant juts dehi het isiagonds rmfo hte ittaenp adn saehr it tiwh hte lfimay

ooptin C p;ma& )Dyuo oanntc rsaegdrdi the tets or petear eht ttse sa btoh het tste are ,psoiitev PRR si a nnigrsece etts hwti less cpiyicitefs tub gomthmecaunliiingrtao is a lyghih iecipsfc ttes os hes tedyelifn sah silsphil!y

pntooi E) dsonte eamk ssnee acuebes wyh udlow you od uambrl runeputc rfo yspliihls!?

i htkin ehty troogf to iveg na pnoito F) sjut nfarike terat ehr for yils!!hispl!

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saturdaynightpalsy stin"tPea wtih eptesucds lsihenposriyu shdoul geduonr blumar pcturuen dna nqustesube ,RLDV ATS-ABF nr/aod PRC of epresoncbarli l"duif per ym senot and eht iarLtbenrt menu erutcnpu si dues to oegdsnia siysohli,epunr os shatt' ahwt I utp. +2

saturdaynightpalsy oT dda ot hat,t I idtnd shcooe het ohret esrwans ouy destil rof het eams eaosrns uyo editsl. +1

ac3 hwihc of the wlnilfoog si teh NTEX STEB SETP imngena you dwultno tnwa ot upjm trhsaitg ot a murbla pruetcnu ilpcealesy ehnw erhte rae snaewr chiesco hatt gsegtus scsigsdiun hte ssigodani itwh hte eiattnp tri.fs If ouy tnew ot teh trocod dna eyht iadnsoge you ythe llwi susscid shti wthi oyu bfoeer igoerndr ioalntdida ni.etstg +1

yerpderp 3/320 is aosl sjut dmli tiveoicgn ammrnietip os I jstu tohtuhg hes itlls dha oeidicsn nkmagi tlcaabiypi sa 0423/ si slilt rlonma +3

cbreland rAe we dextceep ot pinteertr ICM rcoses +

madamestep ldMi eomymr imitnrpema eosd TON eamn deesdaerc aegcnnms-oiiikd pyac.icta nA 38 ayre ldo whit na soatml oamnrl metnla tsatus aexm how ybmae has a nwe eoiydrnbf at erh unnsgri mheo olabrbyp t'nuwold watn her gtduhear ot nwko ahtt esh ash an STI. dnA if this si eelrd besua, ud'yo aosl natw ot tkal to erh tiapyrelv ot ees if shse' .efas No ettmar ,tahw erdol usaltd iwht dilm tdniemea rea ltisl noamrl ppolee adn uoy ndee to sessas tihre mkin-ociedgnisa cypicata cendisoi ot di.cinoes Tshi nmwao tmos kielyl ahs hte ciatypac to cedide if hes natws to dgoeunr hpislisy tream.ttne +

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