Title: Usmle Step 1 MCQ’s # 41
Subject: Behavioral Science
Q NO 41: A 47-year-old man comes to the physician 1 year after his wife died in an automobile accident. Ever since the accident, he has had feelings of worthlessness, self-blame, insomnia, and fatigue. He does not go out with friends and never goes to football games anymore, formerly his favorite pastime. He is “sad all the time1” has lost 15 pounds frequently spends nights and weekends crying on the couch, and finds it difficult to move. Sometimes he cannot even get up to go to work. He says that his symptoms have been worsening over time. He is not so sure that wants to “be around” without his wife anymore. Which of the following is the most likely diagnosis?
A. Conversion disorder
B. Dysthymic disorder
C. Major depressive disorder
D. Normal grief
E. Separation anxiety disorder
Explanation:
The correct answer is C. This patient most likely has major depressive disorder. He has had depressed mood insomnia fatigue, weight loss anhedonia, psychomotor retardation, feelings of worthlessness, and suicidal ideation for a year. These symptoms are causing severe distress and functional impairment. They are severe enough to meet the criteria for a major depressive episode and are not better accounted for by normal grief and bereavement. Normal grief (choice D) is usually characterized by a depressed mood, feelings of loss crying spells, and decreased enjoyment in life. Dysfunction may occur, however alter several months the individual should led less sad and become more functional with time. Suicidal ideation, psychomotor retardation, and marked functional impairment are consistent with depression and not normal grief.
Conversion disorder (choice A) is characterized by the sudden onset of motor or sensory symptoms and dysfunction that are without an identifiable physical cause. The symptoms are temporally related to a psychological stressor, however the deficit is not intentionally produced. This patient does not have motor or sensory symptoms.
Dysthymic disorder (choice B) is a chronic, persistent feeling of mild depression that lasts for more than 2 years. These patients do not meet the criteria for a major depressive episode. The patient in this case meets the criteria for major depression.
Separation anxiety disorder (choice E) is an anxiety disorder that occurs when the individual leaves home or relatives. It is most common in children and often presents with headaches stomach cramps nightmares and school avoidance. The patient in this case is not experiencing anxiety, he is depressed.
Source: http://www.usmleworldwide.com/blog/?p=861
Subject: Behavioral Science
Q NO 41: A 47-year-old man comes to the physician 1 year after his wife died in an automobile accident. Ever since the accident, he has had feelings of worthlessness, self-blame, insomnia, and fatigue. He does not go out with friends and never goes to football games anymore, formerly his favorite pastime. He is “sad all the time1” has lost 15 pounds frequently spends nights and weekends crying on the couch, and finds it difficult to move. Sometimes he cannot even get up to go to work. He says that his symptoms have been worsening over time. He is not so sure that wants to “be around” without his wife anymore. Which of the following is the most likely diagnosis?
A. Conversion disorder
B. Dysthymic disorder
C. Major depressive disorder
D. Normal grief
E. Separation anxiety disorder
Explanation:
The correct answer is C. This patient most likely has major depressive disorder. He has had depressed mood insomnia fatigue, weight loss anhedonia, psychomotor retardation, feelings of worthlessness, and suicidal ideation for a year. These symptoms are causing severe distress and functional impairment. They are severe enough to meet the criteria for a major depressive episode and are not better accounted for by normal grief and bereavement. Normal grief (choice D) is usually characterized by a depressed mood, feelings of loss crying spells, and decreased enjoyment in life. Dysfunction may occur, however alter several months the individual should led less sad and become more functional with time. Suicidal ideation, psychomotor retardation, and marked functional impairment are consistent with depression and not normal grief.
Conversion disorder (choice A) is characterized by the sudden onset of motor or sensory symptoms and dysfunction that are without an identifiable physical cause. The symptoms are temporally related to a psychological stressor, however the deficit is not intentionally produced. This patient does not have motor or sensory symptoms.
Dysthymic disorder (choice B) is a chronic, persistent feeling of mild depression that lasts for more than 2 years. These patients do not meet the criteria for a major depressive episode. The patient in this case meets the criteria for major depression.
Separation anxiety disorder (choice E) is an anxiety disorder that occurs when the individual leaves home or relatives. It is most common in children and often presents with headaches stomach cramps nightmares and school avoidance. The patient in this case is not experiencing anxiety, he is depressed.
Source: http://www.usmleworldwide.com/blog/?p=861
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