sunny2
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Miss Martha Stewart ,23 years and 6 months of age ,female student of New York University comes to the office with complaints of having episodes of Palpitation and sweating sometimes accompanied with fine tremors of the hands, she tells you that these episodes are sudden in onset peaks within 10 minutes and usually last for 4 minutes and 35 seconds and sometimes 5 minutes and 24 seconds . During an episode she is usually overcome with fear and her freinds Rick,Martin, Suzanne and Maria Gonsalvez have noticed that she becomes pale and trembles during the episode. Her final term exams are in September .These symptoms have started on 14 June 2006 todate and have been occuring more frequently now for last three weeks in which she had 3 such attacks .Which of the following can be most commonly associated with this patients symptomatology ?
1.Hyperthyroidism
2.Alcoholism
3.Depression
4.Coccaine Abuse
5.Somatization disorder
6.Obsessive -Compulsive disorder
7.Substance abuse
8.Bipolar disorder
9.Malengering
10.Prion disease
11.Stupid question
12.I don't know
13.What the heck
Edited by sunny2 on 08/14/06 - 03:02 PM. Reason: missed a term
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| GDS2008
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Looks like Panic Disorder. Depression (3. Depression) is commonly associated with it. I will go for that...
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| HighHopes
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I agree, what about substance abuse? mm I am thinking Coccaine but she should be pretty stupid to take Coccaine before exam.. 
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| frank100
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Iīve never seen a patient with such a perfect time description of symtoms. perhaps she is malingering. but not sure
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| sunny2
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 ,is it depression, is it malingering or is it somethin else going on !!!!
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| study_ing
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hnyperthyroidism and pheo wud be a possibility too, though thte former wud not be episodic.
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| AAAAA
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study_ing wrote:
hnyperthyroidism and pheo wud be a possibility too, though thte former wud not be episodic.
Pheo is sooooooo rare but there are always 2-3 questions about pheo.
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| AAAAA
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I have once yelled at by my Chief Resident never mentioned about how many seconds, or anything after the decimal point. 4min 35 sec is useless (I am sorry to mention that but 4 min is fine or 4 minutes 30 seconds round up is fine)
it is just an advice when you go on to an American residency program. No need to mention the seconds, minutes is fine !
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| sunny2
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I wrote min. and seconds just to make the questions more intresting and deceptive, so enjoy on that note
hyperthyroid ,pheo is wrong...wanna think more or shall i write the answer !!
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| study_ing
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a hint wud do...
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| study_ing
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caffiene overdose= substance abuse?
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| sunny2
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no substance abuse
Hint- focus on palpitation , sweating ,tremor, sudden onset, gets pale...occuring frequently....
now guess
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| study_ing
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hypoglycemia
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| study_ing
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insulinoma?
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| study_ing
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or malingering
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| study_ing
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mayb thats y shea a student!
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| frank100
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OK, ELIMINATION TIME!!!
1. hyperthyroidism, could be, but in the question there is not enough information to get such a conclusion. in this case I expect at least labs or something more solid.
2. alcoholism: nothing is telling me she has alcohol problems. the word alcohol is not even mention, not a single CAGE answer yes...so no clue to get to this one.
3. depression: not a single clue or criteria either to major or minor.
4. cocaine abuse: maybe, but same thing, there is not a single clue leading me to this one.
5. here we should have many physical symptoms affecting many organ systems and no medical explanation can be found., etc..so no solid criteria for this one too.
6. not a obsession, no a compulsion
7. substance abuse: since there is only one answer, if this is the answer, then D is the answer also. so them both. are not the answer.
8. bipolar disorder: no criteria for mania at all
9. malingering: never first choice, but fits very well, perhaps she is not ready to take her exam.
10. prion diseace: no travel history. I asume she in th US
11. no stupid questions in medicine. rule of thumb!!!
12. good option...but not for this forum
13. same as (i).
my answer is (9) Iīd prefer PANIC DISORDER with agoraphic features AS AN OPTION. because I canīt tell a 100% whatīs going on here, since there are no labs or solid clues to a specific diagnosis.
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| sunny2
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Good job on elimination round frank100, but please try and focus on the particular question.....what they are asking...Which of the following can be most commonly associated with this patients symptomatology ?
you have to find an association of somethingh with somethingh .......don't focus urself on finding the diagnosis so hard that you loose the concept of what is being asked...I also went wrong like this and was corrected by someone afterwhich I felt good on knowing yet another style to score high
....look at the hint I wrote earlier and try one more time ...good luck Doctor
and yes, the answer is not Malingering
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| frank100
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I donīt like to change my mind but...SOMATISATION DISORDER
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| sunny2
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Somatisation Disorder is not the right answer .
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