NEED HELP WITH some impossible..

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medm6

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QUESTIONS!

a 29 year old woman with no previous psychiatric or medical history is admitted to the nuero service for evaluation of acute onset of numbness and weakness of the right side of her face and right arm and leg. physical examination shows symmetrical 2/4 reflexes in all distributions, downgoing plantar reflexes bilaterally, and 2/5 strength in the right upper and lower extremity in all muscle groups. no atrophy of fasiculations are noted. Her gait is ataxic and staggering with extreme exaggerated movements of her arms: howevere she does not fall when ambulating with assistance. Extensive neurologic workup is negative, Given the severity of her deficits shes seems unconcerned by her level of disablity. The diagnosis that best captures the patients symptoms is which of the followig

a. factitious disorder
b. somatization disoreder
c. malingering
d. undiagnosed nuerologic disease
e. conversion disorder


A 4 year old girl fails to develop intelligible speech and simply repeats senetence fragments thats she has heard. SHe spends hours sitting alone facing a wall and rocking back and forth. She shows little affection for others and sometimes bangs her head agaisnt the floor. which of the following is the most likely etiology for her symptoms?

a. maternal concaine abuse during pregnancy
b, emotionally distant parents.
c. intrauterine rubella
d. childhood exposure to lead
e. childhood sexual abuse


A 60 year old patient has suffered from bipolar illness for decades developing along the way severe reactions to each of the mood stabilizers you have tired him on. he is currently in the midst of a severe manic episode. His family is " at wits end", according to the daugther. you suggest ECT to which the patient agrees. His daughter, howeer says she has head of " depressed and pscyhotic poeple who had it done to them, with little or no benefit. And it seems so barbaric. You respond by saying you advice is to still consider ECT. which of the following describes the factor you base this on?

A. ECt is proven to be safer in bipolar illness than in any other of the disorders for which ECT is used
b. ECt is proven to have more lasting results in bipolar disorder than in the other two.
c. Bipolar illness is shown to respond best in late life to ECT
d. ECT is shown to have more lasting effects than medications
e. Bipolar illness, esp in manic episode, has extremely high rate of response to ECT, perhaps higher than either of the other two disorders the daughter mentioned.
 
1st one: conversion d/o.
2nd one: rubella leading to mental ******ation.
3rd one: i ain't sure but if i had to guess, ECT is proven to work better in late life.
 
If you have specific questions about why the answers are correct then we might be able to provide further assistance. I assume your source has an answer key, if not explanations.
 
The first one is definitely conversion d/o. The non-controllable tests (reflexes and atrophy/fasciculations) are normal, while the controllable ones, muscle strength have positive findings. Plus the patient shows la belle indifference.

The other two I am not sure about. I would say rubella, but without cataracts or deafness I don't think it is a good question.

The third one I have no clue, but I would guess E if I saw it on a test.
 
Alright the answer they are looking for is conversion disorder, but in real life I'd be more concerned of malingering or factitous disorder is this scenario. There is no hx in the question given of trauma or stress that caused it that should really be in any conversion disorder question. To a pt with conversion disorder the sx are real so really the pt should be very concerned about their sx. Obviously this would be fake with factitious or malingering, but la belle indiferrence is a crappy prognostic indicator for conversion disorder as well around 1/5th the time. I know they want conversion here but really there's nothing that rules out factitious disorder.
 
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Yeah they are def looking for rubella in the second question. You can usually tell what they are looking for in these, but they should have mentioned cataracts, heart disease, deafness or blueberry muffin rash as well. I never get why they leave out information from questions that could be obtained in real life easily and are pretty common.
 
Alright the answer they are looking for is conversion disorder, but in real life I'd be more concerned of malingering or factitous disorder is this scenario. There is no hx in the question given of trauma or stress that caused it that should really be in any conversion disorder question. To a pt with conversion disorder the sx are real so really the pt should be very concerned about their sx. Obviously this would be fake with factitious or malingering, but la belle indiferrence is a crappy prognostic indicator for conversion disorder as well around 1/5th the time. I know they want conversion here but really there's nothing that rules out factitious disorder.
Crappy indicator has nothing to do with tests though. La belle indiference is taught to occur in people with conversion d/o whether it actually happens or not. Half of the signs that you are taught in medical school are crappy diagnostic indicators, but they are taught because they are classic signs and that is what is often tested.
 
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