new_n_lost
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A 16-year-old girl is brought to emergency room by her parents for severe right foot pain. The patient states that the pain started 1 day prior to presentation. She cannot recall any recent trauma, and denies any past medical or surgical problem. She is active and walks at least 1 hour daily in the nearby forest. She goes to high school and is doing very well. She gets along well with her parents except that they insist she should eat more, as her weight has dropped from 130 to 105 pounds over the past year.
Which of the following is the most likely diagnosis?
A. Conversion disorder
B. Depression with somatic manifestation
C. Injured medial ankle tendon
D. Metatarsal stress fracture
E. Tick bite
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| hope4dabest
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D
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| SURVIVOR
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A?
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| milee99
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E?
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| drgho
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D
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| SOS
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D
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| new_n_lost
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hope4dabest wrote:
D
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| new_n_lost
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The correct answer is D.
The patient is not eating well, as mentioned by her parents, and her weight loss (over 15% of baseline), as well as her school performance and activity level, is consistent with anorexia nervosa. Metatarsal stress fracture is a complication of rigorous prolonged walking or running in this population. While she is malnourished and underweight, she has poor insight and continues to decrease her input and increase her output with prolonged physical activity. The fracture is a complication of increased output beyond the patient's physical limitation.
Conversion disorder (choice A) is manifested by chronic neurologic pain or deficit without any objective organic cause. This patient's chief complaint is acute pain without any sign of another neurologic deficit.
Diffuse muscle and joint aches, in conjunction with lack of energy and reduced physical activity, is characteristic of depression (choice B). This patient's pain is localized and she is very active.
Ruptured or injured tendon of the ankle is a common injury, but the patient does not recall any recent injury, and localization of the pain is not consistent with medial ankle injury (choice C).
The girl's daily walking in the nearby forest raises suspicion for tick bite (choice E)and Lyme disease with secondary joint pain. Arthritis associated with Lyme disease is generally centered around joints, and does not present as acutely as in this patient.
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| milee99
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why is it bone pain and not superficial pain?
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Do not pray for easy lives,Pray to be stronger men; Do not pray for tasks equal to your powers, Pray for powers equal to your tasks; Then the doing of your work shall be no miracle, but you shall be the miracle.
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| new_n_lost
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milee99 wrote:
why is it bone pain and not superficial pain?
i m sorry couldnt understand your question. Are you asking why does have to be bone pain or something else??
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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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| mytime
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D.  And I thot u wanted to be a SUPERMODEL NNL. 
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| xthine
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D for me
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| new_n_lost
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mytime wrote:D. And I thot u wanted to be a SUPERMODEL NNL.
Well i dont need to be ............... Cos I am one already .
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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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| mytime
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hAHAHAhaaaaaaaaaaaaaaaaa  That u are!
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| Interferon18
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she is suffering from anorexia nervosa whihc has lead to hormonal disbalance and weaking her bones..leading to Metatarsal fracture....so choice D..
# guys any Qs coming with teenage girls do not rule out AN....keep it in mind always.
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| Ig F
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hmmmn..D.......
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i m not perfect but i wanna get close to it......
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