Question of the Week # 353

353)  A 54 year old woman is found by her husband wandering and trying to undress herself two miles away from her home . Her husband tried to question her, however, she did not recognize him, did not respond to his questions and when he tried to restrain her, she became physically aggressive. Upon presentation in the Emergency Department, she appears confused and does not recall the event. There is no history of drug abuse or alcoholism. There is no history of any significant past medical problems. Examination shows normal vitals. There are no focal neurological deficits. She is confused and not oriented to place and person. Which of the following is the most likely diagnosis?

A)  Temporal Lobe Epilepsy

B) Depersonalization Disorder

C) Domestic abuse

D) Dissociative Fugue

E) Manic Episode

Question of the Week # 352

352)  A 26 year old man is brought by the Emergency Medical Services because he was found on the streets of Miami and as per by-standers, was unable to recall where he came from. Upon questioning in the Emeregency Room, he denies any drug abuse or alcoholism. He reports that his name is John and he worked as a plumber. He does not remember if he had a family or what work he did.  He says he can not remember how he got to Miami and where he traveled from. A flight ticket receipt from Las-Vegas to Miami is found in his coat pocket. He has an identity card in his wallet that states his name as Steven and that he serves as a Cop in Los Angeles Police Department. He appears comfortable.  Examination shows normal vitals. There are no focal neurological deficits. An official from Los Angeles police department reports that Steven had always been a great colleague, did not have any problems in the past and he was surprised that he suddenly did not show up at work for the past two days. Which of the following is the most likely diagnosis?

A) Post Traumatic Stress Disorder

B) Dissociative Identity disorder

C) Dissociative amnesia

D) Depersonalization

E) Dissociative Fugue

Question of the Week # 351

351)  A 22 year old woman presents to the emergency room with complaints of shortness of breath, dizziness and tingling in her extremities. Her past medical history is unremarkable.  She denies any history of blood clots in her family.  She denies any recent long flight trips. She does not smoke. On examination, pulse is 110/min and  respiratory rate is 26/min. She is afebrile and blood pressure is within normal limits.  Pulse oximetry reveals 99% on room air. There are no physical abnormalities . A D-dimer level is 50µg/l . An electrocardiogram shows sinus tachycardia without ant ST-T changes. Chest x-ray is unremarkable. Which of the following is the most appropriate next step in management?

A) Start Conazepam

B) Re-breathing in to a paper bag

C) Start Calcium Gluconate

D) Re-assure and teach to deliberately slow down respiration

E) Admit to ward and start high flow oxygen

Question of the Week # 350

350)  A 68 year old man with recently diagnosed Parkinson’s disease is evaluated during a follow-up visit. He was started on medications to help with the motor symptoms of his disease. He reports that the medications have not helped him much however, he has been experiencing difficulty concentrating on his job and has lost interest in life. He reports inability to relish his life, sadness and decreased appetite. On examination, his mood is depressed . His facial expressions are masked. He has a resting tremor and generalized slowness of movements.  Which of the following is the most appropriate next step in management?

A) Discontinue Anti-parkinson’s medications

B) Increase the dose of anti-parkinson’s medications

C) Inquire about Suicidal ideation

D) Refer to Neurology

E) Admit to Psychiatry ward

Question of the Week # 250

250 )  A 30 year old woman presents to your office with complaints of fatigue and headache.  She reports that the headaches occur almost daily and are mild to moderate. They are not associated with nausea or vomiting and are unrelated to menstrual cycles. She also reports chronic diffuse abdominal pain and pelvic pain for the past several months for which she did not seek any medical attention. Her chart reveals that she was seen by your colleague few months ago for similar complaints. She was asked to return after few laboratory investigations but she had been non-compliant with her follow-ups. Physical examination reveals an anxious appearing woman who otherwise appears healthy. She does not make an eye contact. Abdominal and pelvic examination is benign. There are no tender points. There are no neurological deficits. The most appropriate next step in managing this patient:

A)     Support and Counseling

B)     Refer to Psychiatry

C)      Start Selective Serotonin Reuptake Inhibitors

D)     Trial of Tricyclic anti-depressants

E)     Screen for Domestic Violence

Question of the Week # 132

Q132] While you are on rounds in psychiatry wards, a 50 yr old depressed female patient tells you that she wants to be discharged soon. She says sometimes she feels like stabbing herself with a dinner knife provided along with her food. Your most important next step:

A] Discharge the patient according to her request
B] Replace the knifes and forks with plastic utensils
C] Arrange one-on one supervision
D] Arrange a nurse to visit her every 30 minutes

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