Title: Usmle Step 1 MCQ’s # 44
Subject: Behavioral Science
Q NO 44: A 53-year-old widowed female is brought to the emergency room by her family after they noticed increasing irritability, agitation, and abusiveness. She recently had a loud altercation with a new neighbor. Her past history is significant for depression, which was treated with paroxetine for 4 years. Recently, the woman has been staying up all night doing housework, and denies feeling tired the next day. She recently surprised a family friend with sexually inappropriate, seductive remarks. She denies any hallucinations at the present time, but acknowledges that she has heard voices in the past, telling her to kill herself. She currently denies suicidal ideation and states that life is “just great” except that she is woring about her grandchildren while she is in the hospital. Which of the following is the most likely diagnosis?
A. Adjustment disorder
B. Anxiety disorder
C. Mood disorder
D. Personality disorder
E. Thought disorder
Explanation:
The correct answer is C. The patient has a history of depression. She now presents with symptoms of mania, including increased goal-directed activity, possible hyper sexuality (seductive remarks), irritability, and decreased need for sleep. While the primary diagnosis has been unipolar depression, the current presentation is consistent with bipolar disorder (manic-depressive). Both depression and bipolar affective disorder are mood disorders.
A healthy individual should be able to adjust to new conditions such as a new neighbor, but the patient is clearly exhibiting symptoms of an affective disorder, rather than an adjustment disorder (choice A)
Anxiety disorder (choice B) is characterized by excessive worrying. This alone does not explain the current presentation; anxiety disorder can occur simultaneously with mood disorder, or as part of it.
Personality disorders (choice D) are diagnosed when maladaptive and rigid traits in an individual produce distress and/or functional impairment; these traits are usually stable and predictable. Personality disorders are classified as axis II in DSM IV. Diagnosis of axis II is usually deferred until the patient’s axis I disorder (the mood disorder) is stabilized.
The patient has history of auditory hallucinations, which suggest the presence of a thought disorder (choice E) such as schizophrenia. However, mood disorders can present with psychotic features. This patient heard voices telling her to kill herself, probably during a period of severe depression; these hallucinations were congruent with her likely mood at the time, evidence that they were part of the underlying affective disorder.
Source: http://www.usmleworldwide.com/blog/?p=1119
Subject: Behavioral Science
Q NO 44: A 53-year-old widowed female is brought to the emergency room by her family after they noticed increasing irritability, agitation, and abusiveness. She recently had a loud altercation with a new neighbor. Her past history is significant for depression, which was treated with paroxetine for 4 years. Recently, the woman has been staying up all night doing housework, and denies feeling tired the next day. She recently surprised a family friend with sexually inappropriate, seductive remarks. She denies any hallucinations at the present time, but acknowledges that she has heard voices in the past, telling her to kill herself. She currently denies suicidal ideation and states that life is “just great” except that she is woring about her grandchildren while she is in the hospital. Which of the following is the most likely diagnosis?
A. Adjustment disorder
B. Anxiety disorder
C. Mood disorder
D. Personality disorder
E. Thought disorder
Explanation:
The correct answer is C. The patient has a history of depression. She now presents with symptoms of mania, including increased goal-directed activity, possible hyper sexuality (seductive remarks), irritability, and decreased need for sleep. While the primary diagnosis has been unipolar depression, the current presentation is consistent with bipolar disorder (manic-depressive). Both depression and bipolar affective disorder are mood disorders.
A healthy individual should be able to adjust to new conditions such as a new neighbor, but the patient is clearly exhibiting symptoms of an affective disorder, rather than an adjustment disorder (choice A)
Anxiety disorder (choice B) is characterized by excessive worrying. This alone does not explain the current presentation; anxiety disorder can occur simultaneously with mood disorder, or as part of it.
Personality disorders (choice D) are diagnosed when maladaptive and rigid traits in an individual produce distress and/or functional impairment; these traits are usually stable and predictable. Personality disorders are classified as axis II in DSM IV. Diagnosis of axis II is usually deferred until the patient’s axis I disorder (the mood disorder) is stabilized.
The patient has history of auditory hallucinations, which suggest the presence of a thought disorder (choice E) such as schizophrenia. However, mood disorders can present with psychotic features. This patient heard voices telling her to kill herself, probably during a period of severe depression; these hallucinations were congruent with her likely mood at the time, evidence that they were part of the underlying affective disorder.
Source: http://www.usmleworldwide.com/blog/?p=1119
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