MD#26 QuiZz

A 28-year-old woman is brought to the emergency department after being found in her car. She is unable to recall her name, address, or any other information about herself. She denies being the woman on her driver's license, and says the license belongs to someone else. When her husband arrives at the emergency department, she does not recognize him. He reports that his wife has been under a great deal of stress at work. She was anxious to tell her boss that she will not meet the deadline of her current project. She has had two major depressive episodes within the past four years, but no other psychiatric history. On mental status examination, she is oriented to time and place but not to person. Which of the following is the most likely cause of this woman’s condition?

A 35-year-old man comes to the clinic because he has been feeling "strange" since he survived a violent motor vehicle collision six months ago. He suffered no injury in the accident, but he feels like the world around him is foggy and like a cartoon. He has been accused of daydreaming at work, and fears he may lose his job. Family history is significant for depression in his brother and mother. He denies alcohol, tobacco, or recreational drug use. On physical examination, he appears mildly anxious with downcast eyes. Routine laboratory studies and CSF show no abnormalities. Which of the following is the most likely cause of this man’s presentation?

A 40–year-old woman is brought to the office by her brother. She is a librarian with few friends who lives alone. Recently, she was recognized by a friend at a casino. She was playing blackjack, flirting with men, and claiming to be the daughter of a famous actress. The patient has no memory of these events and does not believe they took place. Her brother says she was a victim of sexual molestation when she was five-years-old. Toxicology screen is negative for alcohol or substance abuse. Which of the following is the most likely cause?

A 26-year-old man is evaluated for a sore arm and difficulty using his right hand. He has a history of cocaine abuse, for which he was admitted to a substance abuse rehabilitation facility. In two hours, he has a scheduled court appearance for violating probation. Physical examination and X-rays of the right arm and hand are normal. A urine toxicology screen is negative. When the patient is told he is being discharged, he endorses worsening pain and demands admission. Which of the following is most consistent with this man’s presentation?

A 5-year-old boy with a history of asthma and multiple hospital admissions is brought to the emergency department by his mother because of a sudden loss of consciousness. The boy’s mother is a type I diabetic who found her son unresponsive at home after returning from a visit with her endocrinologist. The child has had 3 previous admissions for unexplained loss of consciousness. No underlying etiology has been identified. On examination, the boy is somnolent and diaphoretic. Serum studies show a glucose concentration of 22 mg/dL (normal 70-110) and a potassium concentration of 2.4 mEq/L (normal 3.5-5). Dextrose is administered, after which glucose concentration normalizes and the boy’s symptoms improve. He is admitted to the hospital for further observation. Overnight, he has another episode of decreased consciousness while the mother is at his bedside. Serum studies taken during the episode show a glucose concentration of 19 mg/dL, an insulin concentration of 108 mIU/L (normal 2.6-24.9), and a C-peptide concentration of 0.1 ng/mL (normal 1.1-4.4). Which of the following is the most likely diagnosis?

A 23-year-old college student with no prior medical history presents for a second opinion with a concern for breast cancer. She has been doing self breast exams on a daily basis and recording the findings in a notebook. She reports minimal tenderness of her left breast but has no pain, lumps, or nipple discharge. Several months prior, she watched a documentary about breast cancer and is certain that she has invasive ductal carcinoma of the left breast. Since viewing this documentary, she has spent many hours researching breast cancer and has missed several of her classes as a result. Physical examination shows no abnormalities. An ultrasound of her left breast is normal. Which of the following is the most likely cause?

explanation

A 29-year-old woman presents with abdominal, head, and shoulder pain that she has had for over a year. This is her first consult at this clinic, but she brings copies of charts from three other clinics where she has been evaluated over the past year. She says she saw three other physicians who were “useless” and “they couldn't diagnose what I have”. She is at risk for losing her job for missing too many days at work due to pain. She does not like using pain medication and wants to receive a diagnosis, “before it is too late.” Temperature is 36.0°C (96.8°F), pulse is 75/min, respirations are 12/min, and blood pressure is 120/82 mmHg. There are no abnormal findings on physical examination, imaging, or laboratory studies. Which of the following is the most likely cause of this woman’s presentation?

Explanation is in the comments

Explanation is in the comments

A 26-year-old man is brought for evaluation by his wife. He reports right upper extremity paralysis for the past three days, after a contentious telephone conversation with his father. Upon hanging up, he was unable to move his right arm. His wife states he is unconcerned about the paralysis, and she had to insist that he come for evaluation. Medical history is significant for chronic headaches, major depressive disorder, and anxiety. Physical examination shows 0/5 strength in his right upper arm but intact sensation and vibratory sense. Which of the following is the most likely cause for this patient's symptoms?

2 witness needs to conform refuse of patient