question
a 47 y/o woman comes to the doctor because of difficulty sleeping for 2 months. during this period, she has been awakening at 3 AM and remain awake worrying about work, even though she is tired. she has stable angina and required stent placement 6 months ago and a second one 4 months ago. her chest pain started to recur 1 month ago and now she has it almost daily. evaluation shows no organic cause of her recurent pain. she works as an attorney for a large firm and reports that she has been giving more responsabilities during the last year. for the past year, she has not enjoyed her work as previously. she forces herself to go to work and has difficulty paying attention while she is there. she is a gourmet cook but no longer prepares food because she does not enjoy the taste of it. physical exam shows no abnormalities. on mental status exam, she has a sad and worried mood and a reactive affect. she is allert and orriented to person, time and place. she states that she frequently becomes despondent especially when she thinks about her heart disease. which is the most likely diagnosis:
a. adjustment disorder
b. dysthymic disorder
c. generalized anxiety disorder
d. major depressive disorder
e. primary insomnia
this is an offline question...i don't have the right answer; what i choose is different from the list of right answers and i don't agree with the right answer listed for this question.....if anybody has an ideea, please post it(with explanations will be even better)....thanks guys
I believe the answer is Generalized anxiety disorder ,
as her life affected in 2 or more settings (work, hobbies...) and its for more than a year,
adlu67139227. hello; can you tell me which QBANK is better usmlew qbank orkaplan qbank.do you have any idea about nbme 2&4 exam. it will help me in real exam. how to get it online .do you know any good book for pediatrics beside kaplan notes. thanks SHME77646266
HI YOUR PSYCHIATRIC QUESTION iread it in my opinion the answer would be dysthymic disorder;SHME77646266
answer is primary insomnia ...
she had a stressor that is stent, so it could be adjustment disorder
i think it is adjustment disorder
B- Dysthymic disorder
i have seen this question some where but can't remember the source
Are you going to give answer In your book or not?
munabhaimbbs wrote:
Are you going to give answer In your book or not?
hi there...like i said in my initial post, this is an offline question....so I DON'T have the right answer; somebody did this test and post his/her answer which i did not agree with that(he/she give as the right answer primary insomnia).....
anan54446797 hello; how are you .i want to ask you more information about step2.last time you advise me that MTB3 is better than MTB2. I already have MTB2.i am doing FA Q&A.subjectwise and idont know about KAPLAN Q BOOK 2009 .i have 2006 edit.can i do nbme4 now .i will take my in june.FLASH CARDS will help me if i dont buy MTB3.WOULD YOU TELL ABOUT HY TOPICS OF PEDIATRICS &SURGERY.iam just reading KAPLAN NOTES 2008-2009. I DONT have 2010 notes. if MTB3 is exellent for PEDIATRICS / SURGERY sould i buy or not.one more when i will do USMLEW QBANK/KAPLAN Q BANK before the real exam could i manage my study in a proper way with all subjects and all blocks in bothQ BANK .B/C it takes 2 months for usw /kaplan qbank.where did you read ETHICS/PREVENTIVE MEDICIN.let me know about that.how about you .are you going to prep step1 or step2cs.pease reply me soon.thankyou again.shme776426
SHME77646266 wrote:
anan54446797 hello; how are you .i want to ask you more information about step2.last time you advise me that MTB3 is better than MTB2. I already have MTB2.i am doing FA Q&A.subjectwise and idont know about KAPLAN Q BOOK 2009 .i have 2006 edit.can i do nbme4 now .i will take my in june.FLASH CARDS will help me if i dont buy MTB3.WOULD YOU TELL ABOUT HY TOPICS OF PEDIATRICS &SURGERY.iam just reading KAPLAN NOTES 2008-2009. I DONT have 2010 notes. if MTB3 is exellent for PEDIATRICS / SURGERY sould i buy or not.one more when i will do USMLEW QBANK/KAPLAN Q BANK before the real exam could i manage my study in a proper way with all subjects and all blocks in bothQ BANK .B/C it takes 2 months for usw /kaplan qbank.where did you read ETHICS/PREVENTIVE MEDICIN.let me know about that.how about you .are you going to prep step1 or step2cs.pease reply me soon.thankyou again.shme776426
hi...i will try to answer all of questions but before that i wanna tell you that what i'm suggesting to you is to do what you are confortable with; i will copy your questions and then give my adivice which you can take it or do whatever you feel it will work better for you....
MTB3 is better than MTB2. I already have MTB2.....i don't remember to say that MTB 3 is better than MTB2; what i said was i USED MTB3 and i can't tell anything about MTB2
about KAPLAN Q BOOK 2009 .i have 2006 edit......from what i know, 2005/2006 edition is pretty much the same with the 2008/2009 edition(2008 edition is a reeditation of the old ones with maybe some few extra things added)
can i do nbme4 now.....i suggest you not to do it right now; NBME 4 is the lastest and from what i've read the hardest one....so if i would be you i would take it after i go at least 1 time through UW(if you really wanna take an NBME now to see where you are, take another form....1,2 or 3)
FLASH CARDS will help me if i dont buy MTB3....flash cards are very good with or without any kind of additional source of studying; i don't know anything about buying them but i wrote them by myself.
WOULD YOU TELL ABOUT HY TOPICS OF PEDIATRICS &SURGERY.iam just reading KAPLAN NOTES 2008-2009.....in my opinion kaplan surgery and pediatrics are enough for step 2 CK; maybe other guys will recommend you something else but i did not use something else besides kaplan and MTB
i will do USMLEW QBANK/KAPLAN Q BANK before the real exam could i manage my study in a proper way with all subjects and all blocks in bothQ BANK.....what i did with UW qbank was untimed+subjects wise at first view and at second view i did them timed+mixed; some say is good to do tutor mode; this is up to you and how you feel more confortable about doing them; but in any way you are doing them, make sure you read ALL the explanations given(good or bad answers)
where did you read ETHICS/PREVENTIVE MEDICINE.....kaplan and MTB; maybe somebody can help you with this and will suggest you an extra source because this is a highly tested topic(especially preventive medicine); besides kaplan and MTB i can't suggest you anything else because i did not use something else.
about me....i post my score for step 1 and ck; so, next is CS(in march); in the rest i'm doing fine and studying for CS; all the best and good luck!
anan54446797 wrote:
a 47 y/o woman comes to the doctor because of difficulty sleeping for 2 months. during this period, she has been awakening at 3 AM and remain awake worrying about work, even though she is tired. she has stable angina and required stent placement 6 months ago and a second one 4 months ago. her chest pain started to recur 1 month ago and now she has it almost daily. evaluation shows no organic cause of her recurent pain. she works as an attorney for a large firm and reports that she has been giving more responsabilities during the last year. for the past year, she has not enjoyed her work as previously. she forces herself to go to work and has difficulty paying attention while she is there. she is a gourmet cook but no longer prepares food because she does not enjoy the taste of it. physical exam shows no abnormalities. on mental status exam, she has a sad and worried mood and a reactive affect. she is allert and orriented to person, time and place. she states that she frequently becomes despondent especially when she thinks about her heart disease. which is the most likely diagnosis:
a. adjustment disorder
b. dysthymic disorder
c. generalized anxiety disorder
d. major depressive disorder
e. primary insomnia
this is an offline question...i don't have the right answer; what i choose is different from the list of right answers and i don't agree with the right answer listed for this question.....if anybody has an ideea, please post it(with explanations will be even better)....thanks guys
The answer is : Dysthymic Disorder
According to Taber's Dic, defination of dysthymic disorder- a chronically depressed mood that is present 50% of the time for more than 2 yrs in adult or 1 yr in children. Affected person describe themselves as sad. Symptoms: include poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions and feelings of hopelessness. The diagnosis of this disorder is not made if the patient has ever had manic, hypomanic or mixed episode.
It seems to fit the profile!
DrAbia; hello. i already said that PSYCHIATYY QUESTIONS ANSWER DYSTHYMIC DISORDER .you also say the same answer .how much are you sure about that answer imean 80% or 90% sure. please tell me where did you see that question.(USMLW QBANK/ KAPLAN QBANK) THANKS SHME77646266
anan54446797 wrote:
a 47 y/o woman comes to the doctor because of difficulty sleeping for 2 months. during this period, she has been awakening at 3 AM and remain awake worrying about work, even though she is tired. she has stable angina and required stent placement 6 months ago and a second one 4 months ago. her chest pain started to recur 1 month ago and now she has it almost daily. evaluation shows no organic cause of her recurent pain. she works as an attorney for a large firm and reports that she has been giving more responsabilities during the last year. for the past year, she has not enjoyed her work as previously. she forces herself to go to work and has difficulty paying attention while she is there. she is a gourmet cook but no longer prepares food because she does not enjoy the taste of it. physical exam shows no abnormalities. on mental status exam, she has a sad and worried mood and a reactive affect. she is allert and orriented to person, time and place. she states that she frequently becomes despondent especially when she thinks about her heart disease. which is the most likely diagnosis:
a. adjustment disorder
b. dysthymic disorder
c. generalized anxiety disorder
d. major depressive disorder
e. primary insomnia
this is an offline question...i don't have the right answer; what i choose is different from the list of right answers and i don't agree with the right answer listed for this question.....if anybody has an ideea, please post it(with explanations will be even better)....thanks guys
anan54446797 wrote:
a 47 y/o woman comes to the doctor because of difficulty sleeping for 2 months. during this period, she has been awakening at 3 AM and remain awake worrying about work, even though she is tired. she has stable angina and required stent placement 6 months ago and a second one 4 months ago. her chest pain started to recur 1 month ago and now she has it almost daily. evaluation shows no organic cause of her recurent pain. she works as an attorney for a large firm and reports that she has been giving more responsabilities during the last year. for the past year, she has not enjoyed her work as previously. she forces herself to go to work and has difficulty paying attention while she is there. she is a gourmet cook but no longer prepares food because she does not enjoy the taste of it. physical exam shows no abnormalities. on mental status exam, she has a sad and worried mood and a reactive affect. she is allert and orriented to person, time and place. she states that she frequently becomes despondent especially when she thinks about her heart disease. which is the most likely diagnosis:
a. adjustment disorder
b. dysthymic disorder
c. generalized anxiety disorder
d. major depressive disorder
e. primary insomnia
this is an offline question...i don't have the right answer; what i choose is different from the list of right answers and i don't agree with the right answer listed for this question.....if anybody has an ideea, please post it(with explanations will be even better)....thanks guys
i think the answer is adjustment disorder.
Dysthymic requires two years for the illness to be present.
Does not meet the criteria for major depressive disporder
i can definitely rule out
dysthymic disorder : coz the history has to be more than 2 years
Genralised anxiety disorder : coz there have to be multiple stressors, and she should be worried anxious of everyday activities
primary insomnia: where there should be a history that she has difficulty falling asleep.
so i think it should be either adjustment disorder or major depression, inclining more towards the later.
its in nbme form 4 ,i put adjustment disorder but it was wrong so answer should be major depression <mid night awkening>
anan54446797 wrote:
a 47 y/o woman comes to the doctor because of difficulty sleeping for 2 months. during this period, she has been awakening at 3 AM and remain awake worrying about work, even though she is tired. she has stable angina and required stent placement 6 months ago and a second one 4 months ago. her chest pain started to recur 1 month ago and now she has it almost daily. evaluation shows no organic cause of her recurent pain. she works as an attorney for a large firm and reports that she has been giving more responsabilities during the last year. for the past year, she has not enjoyed her work as previously. she forces herself to go to work and has difficulty paying attention while she is there. she is a gourmet cook but no longer prepares food because she does not enjoy the taste of it. physical exam shows no abnormalities. on mental status exam, she has a sad and worried mood and a reactive affect. she is allert and orriented to person, time and place. she states that she frequently becomes despondent especially when she thinks about her heart disease. which is the most likely diagnosis:
a. adjustment disorder
b. dysthymic disorder
c. generalized anxiety disorder
d. major depressive disorder
e. primary insomnia
this is an offline question...i don't have the right answer; what i choose is different from the list of right answers and i don't agree with the right answer listed for this question.....if anybody has an ideea, please post it(with explanations will be even better)....thanks guys
THE answer is "D". the pt meets the criteria for MDD and she does not have to be suicidal. Dysthemia must be with mild depression for two yrs. Primary insomnia must be for one moth or more and is not associated with any specific cause. Adjustment disorder must be for three months or less and is associated with a change in the status of the pt. such as divorce and there is a mild impairment in the pt function. Generalized anxiety disorder has to be for six months or more and is related to several events (job, bills, rent,car,...)all at the same time. Note the time frame for each).
i also think its MDD coz pt doesnt enjoy things she used to enjoy b4 which cant be explained by any other option
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