09-07-2014, 04:51 PM
OMG...30 is D
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Discuss NBME F3 B1 - grazie
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09-07-2014, 04:53 PM
q30)
Ans: D D) Tell the supervisor that written consent from the patient is necessary Rule #15 (Sounds like Olivia the piggy cartoon  -Ok Rule #15 Confidentiality is absolute!!! ==================== Physicians can not tell anyone anything about their patients without the patient’s permission!
09-07-2014, 04:55 PM
There are some exceptions to breaking patient confidentiality
09-07-2014, 04:59 PM
yes!
Love my kindle  Breaking Confidentiality to Prevent Harm to Others An exception to the privacy rule is in the circumstance of protecting other people. If a patient has a transmissible disease, such as tuberculosis or HIV, the physician can violate the patient’s confidentiality to protect innocent third parties. If you have tuberculosis, for example, your doctor can contact your close associates without your consent if they are at risk. If you have syphilis, HIV, or gonorrhea, your doctor can safely inform others without your consent that they may be at risk. The classic example is of a patient with a psychiatric illness who may be planning to harm others. They physician has the right to break your confidentiality to alert the person at risk to prevent harm. This issue comes down entirely to whether another person may be harmed by the patient’s illness or actions. If you have a dangerous disease and your doctor does not inform the innocent third party at risk, then that physician is liable for harm that befalls the innocent person. Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 12847-12856).
09-07-2014, 05:01 PM
31.
An 11-month-old infant is brought to the office by her mother for a routine health maintenance visit. She has been your patient since birth. The mother tells you that her infant recently has started to awaken several times each night and that she has been giving the infant a bottle each time. Physical examination shows the following: Head Circumference 44 cm (17.5 in; 25th percentile) Temperature 37.6°C (99.6°F) Pulse 110/min Respirations 18/min Her growth chart is shown. Developmental screening is age-appropriate. The patient's mother should be advised of which of the following? A) She should expect further investigations of her daughter's condition because she may be having seizures in her sleep B) She should give her daughter a bottle when she awakens at night because she is obviously not getting enough calories C) She should pick up and comfort the infant each time she awakens because she is probably having nightmares D) She should question the babysitter because frequent nighttime awakening may be a sign that the infant is being mistreated during the day E) She should taper nighttime feedings to allow the infant to learn how to comfort herself 32. A 31-year-old bodybuilder comes to the office because of frequent headaches for the past 8 weeks. He tells you that the headaches extend from his temples to the back of his head. The patient is 183 cm (6 ft) tall and weighs 88 kg (195 lb); BMI is 27 kg/m2. Vital signs now are temperature 36.9°C (98.4°F), pulse 88/min, respirations 14/min, and blood pressure 190/105 mm Hg. Physical examination is normal. In addition to obtaining a social history and information about alcohol use, it is most important to obtain information regarding which of the following? A) His intake of creatine B) His intake of vitamin supplements C) His smoking history D) His training routine E) His use of anabolic steroids 33. An 81-year-old man comes to the office with his son 2 months after diagnosis of adenocarcinoma. The patient has been losing weight since being diagnosed. At this visit his son tells you that the patient gathered his family and told them all that he did not want further evaluation or treatment of the cancer, and that he never wanted to return to the hospital under any circumstances. "Just take care of me at home, as best you can," he told the family. Three days later, the son calls you because he found the patient unresponsive but breathing. He is not sure what to do and asks for your advice. You suspect that the patient had a stroke. At this time which of the following is the best response to the son? A) "Are you sure he meant what he said about not going back to the hospital?" B) "Are you prepared to continue caring for him at home now?" C) "I'll arrange for his admission to a chronic care facility." D) "Tell me about his condition so I can decide whether he should go to the hospital." E) "You must take him to the hospital—call 911 immediately." 34. A 27-year-old woman and her husband come to the office for the first time. The husband is concerned that his wife is "jumpy all the time" and that she "can never get any sleep." She says, "I know I've been irritable, but otherwise I've been feeling quite well and I'm really happy about the new diet that I've been on." She denies stress and says, "Another doctor checked my thyroid 2 weeks ago and said it was normal." Height is 170 cm (5 ft 7 in) and weight is 50 kg (110 lb); BMI is 17 kg/m2. Vital signs are pulse 110/min, respirations 18/min, and blood pressure 140/100 mm Hg. On physical examination pupils are dilated, reflexes are brisk, and plantar responses are flexor. The rest of the physical examination is normal. At this time it is most important to ask the patient about which of the following? A) Current medications B) Family history C) Menstrual cycle D) Psychiatric history E) Use of alcohol 35. A 52-year-old teacher returns to the office for a periodic health evaluation. Three years ago, you diagnosed menopause and discussed estrogen replacement therapy with the patient. She declined therapy and said, "I prefer a more natural approach. I'll deal with menopause when I need to." Her last menstrual period occurred when she was age 49 years. Today she says that she has begun using dong quai pills and vitamin E supplements, and has increased her intake of soy protein in an attempt to reduce menopausal symptoms. Within 3 months of beginning this regimen, she says, "I began to feel like my old self again and haven't had any more of those hot flashes that had started after my periods stopped. Why, I even have a period every 2 or 3 months now." The patient is 160 cm (5 ft 3 in) tall and weighs 47 kg (104 lb); BMI is 18 kg/m2. Vital signs are normal. Pelvic examination discloses pink vaginal mucosa with normal rugae. The cervix appears normal. The uterus is small, in the midline position, and is mobile and nontender. No adnexal masses are palpable. Results of Pap smear and serum cholesterol concentrations are pending. At this time, which of the following is the most appropriate conclusion regarding this patient? A) She has a prolactin-secreting tumor B) She has a source of unopposed estrogen C) She has adequate estrogen levels to prevent osteoporosis D) She has developed endometrial carcinoma E) She is not postmenopausal 36. An 82-year-old man is brought by his wife to the office for an urgent appointment. He has chronic obstructive pulmonary disease, prostatic hyperplasia, and arthritis. The wife tells you that this morning she found him slumped over the breakfast table. He was minimally responsive for several seconds and then fell to the floor, after which he immediately regained full consciousness. This type of episode has never happened before. The patient now feels well. Vital signs are pulse 80/min and blood pressure 130/80 mm Hg. Physical examination is normal. ECG shows evidence of trifascicular heart block (first-degree AV block, left anterior hemiblock and right bundle-branch block). You arrange for the patient to be admitted to the telemetry unit of the hospital. Which of the following is the most accurate statement concerning this patient? A) He has had a mild stroke; the ECG abnormalities are normal for his age B) He will be evaluated for open heart surgery C) He will require a pacemaker D) If he has no periods of irregular beats he can be discharged in 24 hours E) Medications are available to correct the ECG changes
09-07-2014, 05:07 PM
Gotta go now, dinner
I wish I could just go to a cave with wifi, my electronic devices and study until my exam  but my 2 kiddos will be nuts without me Ok, I will be back after dinner, bathing my kids and put them to sleep. I will try to do this in a record time Thank you guys! this is fun because of you
09-07-2014, 05:14 PM
I got most of these wrong!! Please someone help us with these answers!!
31) I put A and got it wrong 32) E? 33) B? 34) A Restless leg syndrome due side effect 35) D 36) C These were the questions that gave me trouble on this block sorry i wasn't helpful this time around
09-07-2014, 06:15 PM
31.
An 11-month-old infant is brought to the office by her mother for a routine health maintenance visit. She has been your patient since birth. The mother tells you that her infant recently has started to awaken several times each night and that she has been giving the infant a bottle each time. Physical examination shows the following: Head Circumference 44 cm (17.5 in; 25th percentile) Temperature 37.6°C (99.6°F) Pulse 110/min Respirations 18/min Her growth chart is shown. Developmental screening is age-appropriate. The patient's mother should be advised of which of the following? A) She should expect further investigations of her daughter's condition because she may be having seizures in her sleep B) She should give her daughter a bottle when she awakens at night because she is obviously not getting enough calories C) She should pick up and comfort the infant each time she awakens because she is probably having nightmares D) She should question the babysitter because frequent nighttime awakening may be a sign that the infant is being mistreated during the day E) She should taper nighttime feedings to allow the infant to learn how to comfort herself |
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