NBME 5 discussion

[Convalaria]

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Couldn't find thread about NBME form 5..I guess because it is quite old.
Anyway, just did this form offline (this was my 1st and I think the last time, different forums have different correct answers..)

So there are few questions that I'd like to discuss:

#1: A 62-year-old man comes to the physician with a 3-month history of fatigue and depression. He lives alone and has been drinking more (up to 6 mixed alcoholic drinks daily) since his wife of 40 years died 6 months ago. He says, "Yeah, I know I've been drinking a lot lately, but I'm so down in the dumps there's nothing else I want to do. I miss her so much. " Which of the following responses by the physician is most appropriate?

a) "Anybody in your circumstance would be depressed. Time will help you overcome the loss of your wife."
b) "Drinking isn't going to bring your wife back. You need to get on with your life and put this sad experience behind you."
c) "I know you have been through a lot recently. Have things been so bad recently that you have thought about killing yourself."
d) "I'd like to start you on some medication for depression. It sometimes takes a few weeks to work."
e) "You seem to be developing an alcohol problem. You need to quit drinking. I can refer you to the local chapter of Alcoholics Anonymous."

I chose A, but most say it is C..why? why would you put suicidal thoughts in patient's head when he is that sad because of his wife death?? Normal grief may last 6mo - 1 year. He clearly states that he misses her. I don't know...may be there's smth I can't get..

#2: A 65-year-old man comes to the physician 2 weeks after noticing a nodule on his neck. He is an avid goffer, but he does not always use sunscreen while playing. Examination of the neck shows a 10-mm, pearly pink, raised nodule An excsional biopsy specimen shows basal cell carcinoma Which of the following is the most appropnate treatment?
a) Tretinoin therapy
b) Cryotherapy
c) Ionizing radiation therapy
d) UV irradiation
e) Wide excision and lymph node dissection

Chose B, some think it's E. I don't think that basal cell carcinomas are that bad..

And question #3: The ventilatory response to decreasing levels of inspired oxygen concentration for an experimental animal is show. [there is the same graph as A answer in attached file, y-axis - Minute ventilation, x-axis - Inspired oxygen ventilation]. Which of the following labeled figures best represents the response in this animal after removing of the carotid bodies?

Carotid bodies are removed, but there are still aortic bodies that can detect oxygen decreasing. I put A, but found that the correct answer is either D. I can agree that it also might be E, but D..?

Thanks in advance!

 

[ijn]

When you get a depression question that asks for the next move, the #1 thing you should try to figure out is if they've had any suicidal thoughts, and if so do they have a plan on how they're going to kill themselves. Even if you don't think they're suicidal based on the prompt, it's important to always screen. He might not look like it on the face, but in terms of risk factors an elderly widowed male alcoholic is highly likely to successfully kill himself. I think Kaplan said something like 80% of people who eventually kill themselves saw a doctor in the preceding few months. We aren't doing a good job of catching suicidal people, and the NBME wants us to get better at it by asking these kinds of difficult questions.

E might be an answer for melanoma? Basal cell carcinoma rarely (if ever) metastasizes so lymph node excision is way overkill. Cryotherapy is right.

Bilateral carotid ressection results in loss of the normocapnic hypoxic drive from all of the papers that I've seen. I don't think that the aortic body does much in man.

 

[maryzein]

B should be logical answer!