nbme5

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Prep4USMLE Forum » USMLE Step 2 CK Forum » Psychiatry & Ethics

nbme5

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lq2006
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05/15/08 - 09:21 PM

A 78-year-old retired autoworker from Puerto Rico is brought to the office by his son because of a 4- to 7-kg (9- to 15-lb) weight loss in the past few months. You have been treating this patient for hypertension with hydrochlorothiazide for the past 3 years. Today he reports that he eats only one or two bites of food and feels full and that he has a low energy level. He feels he is just "too old." He has never smoked cigarettes and rarely drinks alcoholic beverages. Which of the following is the most appropriate question to elicit further history that would be helpful in the differential diagnosis of this patient?

A

) "Are you having headaches?"

B

) "Did you stop taking your medication?"

C

) "Have you had a change in bowel habits?"

D

) "Have you had any visual changes lately?"

E

) "What has been going on in your life recently?"

kjs
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05/16/08 - 10:55 AM

e i think

hir
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05/16/08 - 11:16 AM

lq2006
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05/16/08 - 04:53 PM

Agree with E.

godfather1212m
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05/22/08 - 03:46 PM

E is an open ended Q for pseudodementia

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WE MIGHT HAVE COME FROM DIFFERENT PLACES, BUT WE ARE HEADING IN THE SAME DIRECTION

godfather1212m
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05/22/08 - 03:47 PM

Agree with E. It is an open ended Q for pseudodementia

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WE MIGHT HAVE COME FROM DIFFERENT PLACES, BUT WE ARE HEADING IN THE SAME DIRECTION

Vietnamese
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05/22/08 - 11:14 PM

C- "Have you had a change in bowel habits?"

The elderly has often microcytic anemia of colon cancer and he has weight loss, anorexia and feels low energy level.

Differential diagnosis between C and E?

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hir
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05/24/08 - 11:21 PM

always start the conversation with open ended question n listen whotever pt says firsst n if he doesnt come up with any significant thing , then only rule out differential diagnosis by asking direct question........

paheli
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08/10/08 - 08:38 AM

E

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Oussama77
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08/14/08 - 03:34 PM

#10

E).

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kpmle2
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08/15/08 - 08:48 AM

#11

E) "What has been going on in your life recently?"

nightflight1945
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08/16/08 - 09:13 AM

#12

"Have you had a change in bowel habits?" seems better , however I can not ignore E!

papio
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08/16/08 - 09:35 PM

#13

Well both seem good to me,

C is definitively not to miss but E) would be better to start the encounter...

So, ...?

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lampard
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10/09/08 - 08:33 PM

#14

He has a clear reason to be malnourished... he is eating just 2-3 bites of food .... So we are not looking for any organic cause here.

problem is clearly psychiatric..

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