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  • Which of the following statements regarding panic disorder is correct?
    Which of the following statements regarding panic disorder is correct?
    1. ssris and cognitive behavioral therapy are the current treatments of choice-the answer is c, ssrls and cognitive behavioral therapy are the current treatments of choice. panic disorder is characterized by recurrent, unexpected, brief episodes of intense anxiety or fear accompanied by various somatic symptoms. these episodes, referred to as panic attacks, can be situationally bound or cued but must occur spontaneously for a diagnosis of panic disorder to be made. women are two to three times more likely than men to develop panic disorder, and the age of onset is typically from late adolescence to the mid-30s. medical conditions such as hyperthyroidism, hypoglycemia, hypoxia, mi, and pheochromocytoma can present with anxiety as a predominant feature, highlighting the need to rule out medical causes before attributing symptoms to a panic attack. short-acting benzodiazepines such as alprazolam are efficacious for short-term treatment and should be considered when rapid control of panic symptoms is desired. however, the combination of selective serotonin reuptake inhibitors (ssris) and cognitive-behavioral therapy is the current treatment of choice and can typically be initiated in an outpatient setting. although efficacious, ssri treatment takes at least 4 weeks for most patients to notice significant benefit and is therefore not effective for rapid control of symptoms.(marx [rosens], 1751; tintinalli, 1826-1829)

  • Which of the following enhances cerebral and cognitive functions?
    Which of the following enhances cerebral and cognitive functions?
    1. Vitamin B12

  • What would your diagnosis be? A 4-year-old female who lives at the homeless shelter with her mother displays developmentally inappropriate social relatedness. For example, she displays...
    What would your diagnosis be? A 4-year-old female who lives at the homeless shelter with her mother displays developmentally inappropriate social relatedness. For example, she displays...
    Reactive Attachment disorder of Infancy or Early Childhood

  • What is the appropriate disposition? A 67-year-old retired police officer is brought in by his son for frequent crying and excessive sleeping. The patient has a history of lung cancer and 6 months...
    What is the appropriate disposition? A 67-year-old retired police officer is brought in by his son for frequent crying and excessive sleeping. The patient has a history of lung cancer and 6 months...
    1. insist on psychiatric admission-the answer is d, insist on psychiatric admission.suicide remains a major cause of death throughout the world, and emergency physicians are often in the position of determining the disposition of potentially suicidal patients. this patient is manifesting symptoms and signs of major depression (frequent crying, excessive sleep, flat affect, psychomotor retardation) and has multiple risk factors placing him at very high risk for suicide. these include his age, sex, presence of depression, possible alcoholism, prior suicide attempt, chronic illness, being widowed, and likely access to firearms. for this reason, insisting on psychiatric admission is the best option, even if he promises not to hurt himself. various scoring instruments that incorporate various risk factors are available to assess a patients likelihood of suicide. the presence of depression or hopelessness, rational thinking loss, an organized or serious attempt at suicide, and stated future intent to commit suicide are considered particularly heavy weighted risk factors. it is recognized that, although scoring systems are helpful, ultimately none is perfect, and that assessing suicide risk is an individualized process. although this patient might benefit from antidepressant medications, none of them acts immediately, and he would be at high risk of overdosing on them.(marx [rosens], 1737, 1767-1773; tintinalli, 1814-1815)

  • What is the most likely diagnosis? A 65-year-old woman presents for evaluation of weakness. Her daughter says that she is a "serious alcoholic" and has become unable to remember things correctly....
    What is the most likely diagnosis? A 65-year-old woman presents for evaluation of weakness. Her daughter says that she is a "serious alcoholic" and has become unable to remember things correctly....
    1. wernicke syndrome-the answer is e, wernicke syndrome.wernicke syndrome is characterized by a thiamine deficiency this is a rare but serious neurologic and cognitive syndrome with 10% to 20% mortality rates. it occurs in alcohol-dependent people; the classic triad of oculomotor disturbances, confusion, and ataxia occurs in only 12% of patients, which makes it a difficult diagnosis. wernicke syndrome must be considered in all alcoholic and malnourished patients. current literature suggests a possible genetic inborn enzymatic error. this distinguishes wernicke syndrome from korsakoff psychosis or amnesic state, which is characterized by recent memory loss and the inability to learn new information. korsakoff psychosis often accompanies wernicke syndrome but can be an isolated finding. central pontine myelinolysis is caused by a loss of myelin in the central pons, often the result of a rapid rise of sodium. symptoms might include fluctuating levels of consciousness, behavior disturbances, dysarthria, dysphagia, or convulsions. these symptoms can progress to paralysis. alcoholic psychosis occurs in approximately 3% of alcoholic patients. auditory and visual hallucinations are the hallmarks of this disorder and typically occur with very heavy drinking. symptoms can be so severe that they mimic schizophrenia. this illustrates the importance of measuring the patients alcohol level prior to making the diagnosis of psychosis . alcohol withdrawal occurs in people who have been drinking over a long period of time. the rapid decline in blood alcohol level causes a coarse tremor, insomnia, anxiety, tachycardia, hypertension, fever, and tachypnea. this can progress to delirium or convulsions. symptoms can begin after 8 hours of abstinence and reach peak intensity in 2 to 3 days.(marx [rosens], 2869; sadock, 1172-1179)

  • What is the most likely diagnosis? A 23-year-old man presents complaining of abdominal pain and headache. He appears quite knowledgeable about the differential diagnosis of his symptoms and tells...
    What is the most likely diagnosis? A 23-year-old man presents complaining of abdominal pain and headache. He appears quite knowledgeable about the differential diagnosis of his symptoms and tells...
    1. munchausen syndrome -the answer is d, munchausen syndrome.the most likely diagnosis for the patient in this case is munchausen syndrome, an uncommonly seen factitious disorder. it is characterized by a pattern of medical imposture that typically occurs over years. it is more common in men; munchausen by proxy, on the other hand, is more common in women with children. they often lie pathologically and use great detail when describing their symptoms; symptoms are often elaborate and have a dramatic flair. common complaints in munchausen syndrome include abdominal pain, headache, seizure, shortness of breath, asthma, chronic pain, chest pain, renal colic, and fever of unknown origin. symptoms can be created by self-abuse, such as self-injection of a foreign substance or putting feces in urine. the goal is not to obtain secondary gain, but rather relates to psychological needs to be in the patient role. conversion disorder and hypochondriasis are considered psychosomatic disorders. comversion disorder typically presents as a single symptom of neurologic character, most commonly voluntary motor or sensory symptoms such as paralysis, numbness, or tingling. hypochondriasis is common and occurs more commonly in men, with a peak incidence in the 30s. these patients typically complain of head, neck, and/or trunk pain. they place a high value on their health and have an increased sense of responsibility for their health, as well as a heightened aversion to death and dying. malingering is frequently associated with antisocial personality disorder; there is typically secondary gain. these patients might be homeless, drug-seeking, or avoiding a situation. there is often a discrepancy between the objective physical examination findings and the claimed stress or disability. they also can abandon their symptoms when no one is watching. somatization disorder is characterized by chronic or repetitive illness with numerous symptoms, often starting in childhood. the diagnosis is not typically made in the emergency department. there are seven characteristic symptoms, as follows: dysmenorrhea; sensation of a lump in the throat; vomiting; shortness of breath; burning in the sex organs; painful extremities; and amnesia lasting hours to days. prospective studies have demonstrated that the diagnosis of somatization disorder is correctly predicted when four or more of these symptoms are present.(marx [rosens], 1754-1765)

  • What is your diagnosis and a reasonable treatment plan? A 5 year old male and his mother present to your office for the childs unintentional defecation during kindergarten once a month for the last...
    What is your diagnosis and a reasonable treatment plan? A 5 year old male and his mother present to your office for the childs unintentional defecation during kindergarten once a month for the last...
    Diagnosis: Encopresis with constipation and overflow incontinence Treatment plan: Educate the parent, design a program and provide the child with a system of positive reinforcement for successful use of the toilet as well as initiate treatment of underlying constipation with suppositories and enemas

  • What would your diagnosis and treatment be? A 7-year-old and his mother present to your office for the childs intentional spontaneous defecation during inappropriate times and at inappropriate...
    What would your diagnosis and treatment be? A 7-year-old and his mother present to your office for the childs intentional spontaneous defecation during inappropriate times and at inappropriate...
    Diagnosis: Encopresis without overflow incontinence Treatment: Educate the child and parents, design a program for toilet use, and provide the child with a system of positive reinforcement for successful toilet use

  • What would your diagnosis and treatment be based on this information? A 5-year-old female presents with her mother for the child's urination during church on several occasions. These...
    What would your diagnosis and treatment be based on this information? A 5-year-old female presents with her mother for the child's urination during church on several occasions. These...
    Diagnosis: Diurnal (only) Enuresis Treatment: behavioral therapy and anticholinergics

  • What is your diagnosis based on the information provided? A 5-year-old child presents with repeated regurgitation of food for a period of at least 1 month following a period of normal functioning....
    What is your diagnosis based on the information provided? A 5-year-old child presents with repeated regurgitation of food for a period of at least 1 month following a period of normal functioning....
    Rumination

  • What is the most reasonable diagnosis at this time? Jon is a 24 year old male presenting to your office accompanied by his mother, with whom he is presently living. For the past five days his...
    What is the most reasonable diagnosis at this time? Jon is a 24 year old male presenting to your office accompanied by his mother, with whom he is presently living. For the past five days his...
    Schizophreniform Disorder

  • What GMCs would you screen for in a patient with repeated voiding in bed or clothes? A 6-year-old and his mother present to your office to address the mothers concern that the child has been...
    What GMCs would you screen for in a patient with repeated voiding in bed or clothes? A 6-year-old and his mother present to your office to address the mothers concern that the child has been...
    Diabetes, spina bifida, and seizure disorders

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