Title: Usmle Step 1 MCQ's # 18
Subject: Behavioral Science
Q NO 18: A 25-year-old male presents to his family physician with the following statement “Doctor, I can’t urinate in public restrooms. I can if there is no one around, but if I go to the restroom in a movie, an airport, at the ball park or anywhere that someone else comes in, I can’t urinate. Even if I have already started, it just stops and I can’t get it going until the other person leaves. I am so embarrassed. What do they think of me if they see I can’t do what every other man can do?” Which of the following is the most likely diagnosis?
A. Anxiety disorder due to a general medical condition
B. Panic disorder
C. Social phobia
D. Specific phobia
E. Substance-induced anxiety disorder
Explanation:
The correct answer is C. In the condition described, a person is in a social situation and fears that he or she will not be able to perform in the same manner as most everyone else can. The two most common social phobias concern public speaking and restroom performance (sometimes called “shy bladder”.)
Anxiety disorder due to a general medical condition (choice A) is diagnosed when a medical condition precipitates anxiety, e.g., hypoglycemia.
Panic disorder (choice B) is characterized by sudden paroxysms of anxiety. It can strike unexpectedly in uncued situations so it would not occur only when others are present.
Specific phobias (choice D) are unreasonable tears of some identifiable thing, not situation (e.g., elevators).
Substance-induced anxiety disorder (choice E) is diagnosed when anxiety is precipitated by ingestion of a psychoactive substance e.g. hallucinogens.
Subject: Behavioral Science
Q NO 18: A 25-year-old male presents to his family physician with the following statement “Doctor, I can’t urinate in public restrooms. I can if there is no one around, but if I go to the restroom in a movie, an airport, at the ball park or anywhere that someone else comes in, I can’t urinate. Even if I have already started, it just stops and I can’t get it going until the other person leaves. I am so embarrassed. What do they think of me if they see I can’t do what every other man can do?” Which of the following is the most likely diagnosis?
A. Anxiety disorder due to a general medical condition
B. Panic disorder
C. Social phobia
D. Specific phobia
E. Substance-induced anxiety disorder
Explanation:
The correct answer is C. In the condition described, a person is in a social situation and fears that he or she will not be able to perform in the same manner as most everyone else can. The two most common social phobias concern public speaking and restroom performance (sometimes called “shy bladder”.)
Anxiety disorder due to a general medical condition (choice A) is diagnosed when a medical condition precipitates anxiety, e.g., hypoglycemia.
Panic disorder (choice B) is characterized by sudden paroxysms of anxiety. It can strike unexpectedly in uncued situations so it would not occur only when others are present.
Specific phobias (choice D) are unreasonable tears of some identifiable thing, not situation (e.g., elevators).
Substance-induced anxiety disorder (choice E) is diagnosed when anxiety is precipitated by ingestion of a psychoactive substance e.g. hallucinogens.
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