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Someone gave me these as examples of hard questions the USMLE could ask me, but didn't give me the answer. What do you guys think the answers are? Thanks!
3. A 9-year-old boy with type I diabetes goes to the pediatrician’s office accompanied by his mother. The boy requires several daily insulin injections for his diabetes, and his condition has been well-controlled. The pediatrician would like to introduce the patient to a newly released insulin-delivery system that makes administration of insulin much easier, convenient, and with less pain. In order to introduce this new system to the boy, what would the pediatrician require?
a. Consent from the mother and the boy
b. Consent from the mother and assent from the boy
c. Assent from the mother and the boy
d. Assent from the mother and consent from the boy
e. Neither consent nor assent from the mother or the boy
5. An 85-year-old female with past medical history of HTN, hyperlipidemia, DM2, and gout, presents to the ED after her family members found her down on the floor in the bedroom in the morning. The patient is initially observed to be awake and alert but noncommunicative and has focal neurologic deficits such as right-sided hemiplegia. A noncontrast brain CT was obtained which shows no evidence of intracranial hemorrhage, but demonstrates a dense left middle cerebral artery and subtle hypoattenuation and loss of grey-white matter differentiation in the left MCA territory. She is not a thrombolytic therapy as her last known well was the night before. Over the next several hours, the patient’s neurologic status deteriorates as she becomes obtunded, requiring immediate endotracheal intubation and mechanical ventilation to protect her airway. However, it was later discovered in the patient’s medical records has a “Do Not Resuscitate” form that she had filled out in the past, as well as a written statement from the patient stating that she specifically does not wish to receive “aggressive treatments in the face of futility”. A team of neurologists and neurosurgeons who were consulted went to examine the patient, and agreed on the assessment that appropriate intervention with hemicraniectomy to relieve the intracranial pressure of toxic cerebral edema from the stroke would provide a small but realistic chance for her full recovery. What would be the most appropriate action in this case?
a. Keep the patient intubated and bring her to neurosurgery for hemicraniectomy
b. Keep the patient intubated and continue to observe but do not undergo surgery
c. Extubate the patient immediately
d. Allow the family to decide what to do
e. Consult the hospital ethics committee
3. A 9-year-old boy with type I diabetes goes to the pediatrician’s office accompanied by his mother. The boy requires several daily insulin injections for his diabetes, and his condition has been well-controlled. The pediatrician would like to introduce the patient to a newly released insulin-delivery system that makes administration of insulin much easier, convenient, and with less pain. In order to introduce this new system to the boy, what would the pediatrician require?
a. Consent from the mother and the boy
b. Consent from the mother and assent from the boy
c. Assent from the mother and the boy
d. Assent from the mother and consent from the boy
e. Neither consent nor assent from the mother or the boy
5. An 85-year-old female with past medical history of HTN, hyperlipidemia, DM2, and gout, presents to the ED after her family members found her down on the floor in the bedroom in the morning. The patient is initially observed to be awake and alert but noncommunicative and has focal neurologic deficits such as right-sided hemiplegia. A noncontrast brain CT was obtained which shows no evidence of intracranial hemorrhage, but demonstrates a dense left middle cerebral artery and subtle hypoattenuation and loss of grey-white matter differentiation in the left MCA territory. She is not a thrombolytic therapy as her last known well was the night before. Over the next several hours, the patient’s neurologic status deteriorates as she becomes obtunded, requiring immediate endotracheal intubation and mechanical ventilation to protect her airway. However, it was later discovered in the patient’s medical records has a “Do Not Resuscitate” form that she had filled out in the past, as well as a written statement from the patient stating that she specifically does not wish to receive “aggressive treatments in the face of futility”. A team of neurologists and neurosurgeons who were consulted went to examine the patient, and agreed on the assessment that appropriate intervention with hemicraniectomy to relieve the intracranial pressure of toxic cerebral edema from the stroke would provide a small but realistic chance for her full recovery. What would be the most appropriate action in this case?
a. Keep the patient intubated and bring her to neurosurgery for hemicraniectomy
b. Keep the patient intubated and continue to observe but do not undergo surgery
c. Extubate the patient immediately
d. Allow the family to decide what to do
e. Consult the hospital ethics committee
