Friday, 23 November 2012

Usmle Step 1 MCQ's # 23

Title: Usmle Step 1 MCQ's # 23
Subject: Behavioral Science

Q NO 24: A 35-year-old homeless and unemployed man comes into the emergency department, stating he needs to be in the hospital. He is very vague and makes poor eye contact. He reports being “suicidal, homicidal, and paranoid.” When the psychiatrist insists on more details about the symptoms, he gets irritable and threatens that if he leaves the hospital and kills somebody, the doctor will be blamed. He admits to using marijuana, crack, and cocaine occasionally, but not recently. His physical examination is unremarkable. During his interview, his associations are tight, and there is no evidence of psychotic symptoms. A urine drug screen is negative. Which of the following conditions should probably be ruled out first?

A. Delusional disorder
B. Factitious disorder
C. Malingering
D. Schizophrenia
E. Substance-induced mood disorder

Explanation:
The correct answer is C. Malingering is diagnosed when there is a voluntary production of physical or psychological symptoms to accomplish a specific goal. Patients are usually vague or have poorly localized complaints. They are easily irritated if a doctor is skeptical of the history
Delusional disorder (choice A) is characterized by one fixed and unshakable delusion. The delusion is non-bizarre and has to be present at least a month. A part from the impact of the delusion, the functioning is not markedly impaired in other areas of life.
Factitious disorder (choice B) is diagnosed when there is a deliberate production of symptoms to attain the sick role and meet unconscious needs. It can be present with physical or psychological symptoms and is associated with early parental abuse or rejection.
Schizophrenia (choice D) is defined by the presence of active symptoms of delusions, hallucinations, and disorganized speech or behavior in the past month. The continuous signs must be present longer than 6 months and cause significant impairment in social or occupational functioning.
Substance-induced mood disorder (choice E) refers to the mood induced shortly after the use of substances. Depending on the type of substance, the mood can be depressed or elated.

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