sweetybokhari
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a 20 year old college student presents to you with a history of intermittent chest pain for about 6 months.he states that the pain can occur at any time,but often occurs late in the day.the pain can be sharp,dull,or aching and may last for hours.he is physically active and is carrying a full academic load.the pain is unrelated to exercise and does not restrict his activities.his father and paternal uncle have both had mycardial infarctions within the past year.physicalexamination is normal,although the patient appears restless and has a heart rate of 100/mint.which one of the following is the most likely diagnosis ?
1) reflux esophagitis
2) generalized anxiety disorder
3) transient myocardial ischemia
4) myocardial infarction
5) costochondritis
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| doc_clotaire
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Nocturnal chest pain in a young male , mmmmmmmmmmmmmm
Most likely A ) GERD
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| new_n_lost
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2) generalized anxiety disorder ?? College Student, Full Academic Load, thinking too much on his family history
My Initial Option was A but reflux Esophagitis will accompany him with a weight loss or lethargy in my opinion which is based on very limited knowledge.
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| Justice
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3) transient myocardial ischemia
Prinzmetal type (vasospastic angina): Circadian appearance (in the morning though), in males predominantly…
Nothing else comes into my fatigued mind
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| vradojc1
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2) as for the Prinzmetal goes, I think his pain lasts a bit too long (hours)
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| Justice
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sweetybokhari,
where is this question from? And do you have a right answer to post later on when ppl exhaust their brains on this Q?
Thank you
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| Justice
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vradojc1 wrote:
2) as for the Prinzmetal goes, I think his pain lasts a bit too long (hours)
I agree but nothing else from these options would last for hours... Or anything would?
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| new_n_lost
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Justice wrote:
sweetybokhari,
where is this question from? And do you have a right answer to post later on when ppl exhaust their brains on this Q?
Thank you
LOL Well Said Mate!!!!!!!!!!!
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"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| vanshita
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generalise anxiety disorder
1) in pain burning like mostly occur in supine position
3) nt possible because pain is not related exertation
4)in myocardial infarction pain continous age 20 yrs
pthas tacycardia and restlessnes so generalized anxiety disorder
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| sachida
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Genralised anxiety disorder will be my choice
reasons: vague nature of pain, long lasting, family history on his mind and tachycardia during examination
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| Justice
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MY ARGUMENTS AGAINST GAD:
Generalized Anxiety Disorder
Generalized anxiety disorder is defined by a protracted (> 6 months’ duration) period of anxiety and worry, accompanied by multiple associated symptoms (DSM-IV). These symptoms include muscle tension, easy fatiguability, poor concentration, insomnia, and irritability. In youth, the condition is known as overanxious disorder of childhood. In DSM-IV, an essential feature of generalized anxiety disorder is that the anxiety and worry cannot be attributable to the more focal distress of panic disorder, social phobia, obsessive-compulsive disorder, or other conditions. Rather, as implied by the name, the excessive worries often pertain to many areas, including work, relationships, finances, the well-being of one’s family, potential misfortunes, and impending deadlines. Somatic anxiety symptoms are common, as are sporadic panic attacks.
Generalized anxiety disorder occurs more often in women, with a sex ratio of about 2 women to 1 man (Brawman-Mintzer & Lydiard, 1996). The 1-year population prevalence is about 3 percent (Table 4-1). Approximately 50 percent of cases begin in childhood or adolescence. The disorder typically runs a fluctuating course, with periods of increased symptoms usually associated with life stress or impending difficulties. There does not appear to be a specific familial association for general anxiety disorder. Rather, rates of other mood and anxiety disorders typically are greater among first-degree relatives of people with generalized anxiety disorder (Kendler et al., 1987).
IN SUMMARY:
# Difficulty concentrating
# Fatigue
# Irritability
# Impatience
# Being easily distracted
Could the Pt having these classical symptoms (in fact, don't see any in Q), be fully physically active and be able to carry a full academic load, and be unrestricted in his activities?
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| new_n_lost
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I really Hope that Sweety Bokhari has an Answer to this question cos its gonna scratch the brains till the end.
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"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| chemamr
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I think it's 1.
SWEETY....: what's the answer please? answer as soon as you can.
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| doc_clotaire
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Why I choose A
Reflux is the most common cause of noncardiac chest pain, accounting for approximately 50% of cases. Patients can present to the emergency department with pain resembling a myocardial infarction. Patient often presents with nocturnal chest pain (often occurs late in the day in our patient ) . Heartburn usually is described as a burning pain in the middle of the chest. It may start high in the abdomen or may extend up into the neck. In some patients, however, the pain may be sharp or pressure-like, rather than burning. Such pain can mimic MI .
Weigh loss is seen in more advanced GERD and depend on severity of underlying illness , not all patient with GERD would have weigt loss and lethargy .
I could be BIG TIME WRONG ( could be GAD too  ) but I am still sticking to my GUN  , Let 's see what 's popping !
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| sweetybokhari
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sorry i donot have answer of this qustion,this is question from SAEE of canadian medical council.they donot provide answers.i am also confused between 1 and 2 options that is the reason i post this question to find right answer.thanks
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