BS NBME q

[MudPhud20XX]

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Four children, ages 2 through 6 years, are brought to the physician by their mother b/c of a 2 week hx of irritability and forgetfulness. Their mother says, "Their behavior is the last straw. They fight all the time and copy each other's bad behavior. They are also lazy, when they're not fighting, they're sleeping. And when I ask the older ones to do their chores, they whine and say they can't because they have a headache or they're dizzy." She adds, "I barely have enough money to buy food, and I've been trying to avoid having our electricity turned off by using my portable heater." Which of the following initial actions by the physician is most appropriate?

A. Offer the mother a behavior program with the use of time-out for her children
B. Review the adequacy of the children's diet
C. Suggest that the mother consider medication for her own stress level.
D. Assess the possibility of carbon monoxide toxicity
E. Call child protective services

I want to choose D, but then, it's kind of strange that the mother is not affected by it, if it's really CO toxicity. So I am leaning toward B or E. Anyone has any idea?

 

[SBR249]

Since it's a portable heater, it's likely restricted to a room, the smaller the room, the warmer it is. It's possible the mother put the heater in the kids' room which may be smaller but decided to forego the comfort for herself.

 

[MudPhud20XX]

Since it's a portable heater, it's likely restricted to a room, the smaller the room, the warmer it is. It's possible the mother put the heater in the kids' room which may be smaller but decided to forego the comfort for herself.

i see, so it's indeed D, the CO toxicity. Dang this type of question scares the hell out of me, I feel like I will get wrong by over-thinking or perhaps doing the opposite I guess lol!

 

[Priapism4tooLong]

well, that and their kids.. they probably get affected faster by lower levels of CO before the mother has symptoms.

 

[Fatalis]

Four children, ages 2 through 6 years, are brought to the physician by their mother b/c of a 2 week hx of irritability and forgetfulness. Their mother says, "Their behavior is the last straw. They fight all the time and copy each other's bad behavior. They are also lazy, when they're not fighting, they're sleeping. And when I ask the older ones to do their chores, they whine and say they can't because they have a headache or they're dizzy." She adds, "I barely have enough money to buy food, and I've been trying to avoid having our electricity turned off by using my portable heater." Which of the following initial actions by the physician is most appropriate?

A. Offer the mother a behavior program with the use of time-out for her children
B. Review the adequacy of the children's diet
C. Suggest that the mother consider medication for her own stress level.
D. Assess the possibility of carbon monoxide toxicity
E. Call child protective services

I want to choose D, but then, it's kind of strange that the mother is not affected by it, if it's really CO toxicity. So I am leaning toward B or E. Anyone has any idea?

An ER Dr once told me: when a family comes in with flu like symptoms/fatigue, always have CO poisoning as a differential. I had a similiar question on my step 1. MudPhud, if you are thinking that an answer is correct, choose is regardless if you think "oh thats too easy/stupid"...you will be surprised!

 

[MudPhud20XX]

thanks for the advise Fatalis! I really appreciate it.

 

[cruCiATE]

Yeah I got this one on my NBME, its definitely D, portable heater=CO poisoning as well the car inside the garage with the running engine.