zaki
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A 39-year-old Vietnamese woman comes to your office because of headache, cough, and difficulty sleeping over the past several months. She has been in the United States for 3.5 years, and her history is obtained through an interpreter. She has seen several physicians and has always had a normal physical examination except for a palpable spleen tip. She has had a variety of diagnostic studies, which yielded no discrete diagnosis. Symptoms have been unrelieved by a variety of herbal remedies, physical traditional remedies (for example, coin rubbing and cupping), and empiric Western therapies (nonsteroidal anti-inflammatory drugs, bronchodilators, and sedative hypnotics).
Computed tomography of the brain, blood chemistries, complete blood count, and chest radiography have all been negative or normal. Laboratory study is positive for hepatitis B surface antigen; liver function studies and erythrocyte sedimentation rate are normal. Stools have been repeatedly negative for ova and parasites.
The most likely diagnosis is:
(A) Polymyalgia rheumatica
(B) Depression
(C) Disseminated tuberculosis
(D) Malaria
(E) HIV disease
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Maverick
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| guest
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choice C
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| helpful
Forum Junior
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(B) Depression.
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| peace
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D) Malaria
it's cerebral malaria due to P. falciparum
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| zaki
Forum Guru
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Posts: 398
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Answer: B
Educational Objective: Recognize depression in the Southeast Asian immigrant.
There is a high prevalence of depression — and a high level of underdiagnosis by primary care physicians — among Vietnamese refugees, who may somaticize their dysphoric affect because of their cultural prejudice against mental health problems. Depression can be diagnosed, however, using such instruments as the culturally specific psychologic assessment. Treatment may be difficult if the patient is unwilling to differentiate between psychologic, physiologic, and supernatural causes of illness.
Polymyalgia rheumatica is unlikely with a normal erythrocyte sedimentation rate and no myalgias. The spleen tip is often palpable in persons from areas that are endemic for malaria, such as Vietnam, but malaria would not explain her current symptoms of headache, cough, and difficulty sleeping. In addition, malaria, disseminated tuberculosis, and HIV disease are ruled out by her extensive workup. Hepatitis B–related diseases, such as polyarteritis and hepatoma, should also have been ruled out by physical examination or the laboratory studies done to this point.
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Maverick
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Dear Zaki
So I did well any way how is Karichi. I still remember few of my friends in JPMC, AKMU.
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| zaki
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yap u did well helpful.
like always karachi is great and the weather is excellent these days, good to hear that you are from karachi.
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Maverick
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| asmi
Forum Hero
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salamalikum zaki,
Are you done with step 1 ?
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| zaki
Forum Guru
Topics: 92
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WS asmi,how are u
yes now preparing for step 2 :-)
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Maverick
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| zaki
Forum Guru
Topics: 92
Posts: 398
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WS asmi,how are u
yes now preparing for step 2 :-)
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Maverick
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| asmi
Forum Hero
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good, what was your score ?
All the best for step 2 
Do pray for me :|
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my score is 99
inshallah u will do well in your exam, wish u best of luck
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| helpful
Forum Junior
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Good luck Zaki and asmi and pray for me as well I had to prepare for both the steps but still don't know what to do can I mail you for any help.
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