DrVirgo
Forum Hero
Topics: 1008
Posts: 3,191
|
A 59 year old white woman was brought to the ER with sudden onset of B/L lower extremity paralysis. No other symptoms. Physical exam is normal. She has 3/5 Motor strength in both lower extremities. The patient dramatically imporves after being injected with Sodium Amital. What is the most likely diagnosis:
A. Histrionic PD
B. Malingering
C. Munchausen by proxy
D. Conversion Disorder
E. Factitious Disorder
F. Somatization Disorder
G. Body Dysmorphic Disorder
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| arlete
Intern in 2009!!!!!
Topics: 25
Posts: 1,788
|
D
___________________
Don't charge for what you've received for free!
|
| DrVirgo
Forum Hero
Topics: 1008
Posts: 3,191
|
Yes, its conversion, and I got it only through the process of elimination, so I have a question about this one: Conversion disorder occurs when there is a Stressor or a Trigger (like emotional distress, relationship breakup, etc) followed by a psyhoneurologic condition (sensory or motor)...
However this question DID NOT mention any stressor or trigger, so is it safe to assume Conversion disorder? I thought that the presence of such a preceding event was necessary for the diganosis of Conversion disorder... Please correct me if i'm wrong.
Thanks.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| arlete
Intern in 2009!!!!!
Topics: 25
Posts: 1,788
|
My rationale was the same as yours. Maybe the question should have given the information about the stressful event. 
___________________
Don't charge for what you've received for free!
|
| DrVirgo
Forum Hero
Topics: 1008
Posts: 3,191
|
But the stressful event IS necessary for the diagnosis, correct?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| arlete
Intern in 2009!!!!!
Topics: 25
Posts: 1,788
|
I don't know... For some people the simple fact they are alive is stress enough... They are that dramatic...
Maybe the fact that she got better with barbiturate is the clue they are throwing us to show it's a psychological process, not physical. 
___________________
Don't charge for what you've received for free!
|
| smalley
Forum Elite
Topics: 42
Posts: 241
|
agree with arlete..
___________________
But they that wait upon the LORD shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; and they shall walk, and not faint-Isaiah 40:31
|
| usmletopper2
Forum Junior
Topics: 8
Posts: 47
|
dramatic improvement with sodium amatal clinches the answer,thats how i answered.
whats the effect of sodium amatal on cns i do not know thow some light 
|
| DrVirgo
Forum Hero
Topics: 1008
Posts: 3,191
|
usmletopper2 wrote:dramatic improvement with sodium amatal clinches the answer,thats how i answered. whats the effect of sodium amatal on cns i do not know thow some light
According to an in vitro study conducted at the University of British Columbia, amobarbital works by activating GABAA receptors, which decreases input resistance, depresses burst and tonic firing, especially in ventrobasal and intralaminar neurons, while at the same time increasing burst duration and mean conductance at individual chloride channels; this increases both the amplitude and decay time of inhibitory postsynaptic currents.
^ Kim HS, Wan X, Mathers DA, Puil E. "Selective GABA-receptor actions of amobarbital on thalamic neurons." British Journal of Pharmacology. 2004 Oct;143(4):485-94. Epub 2004 Sep 20. PMID 15381635
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| arlete
Intern in 2009!!!!!
Topics: 25
Posts: 1,788
|
It's used for seizures. What it does for conversion disorder, I don't know. I'll try and find something about it.
___________________
Don't charge for what you've received for free!
|
| DrVirgo
Forum Hero
Topics: 1008
Posts: 3,191
|
usmletopper2 wrote:dramatic improvement with sodium amatal clinches the answer,thats how i answered. whats the effect of sodium amatal on cns i do not know thow some light
It's known as the "truth serum" -which we see in the movies.
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
|
| |
| | | | | | | | | | | |
