Official Nbme 7 for step 2 discussion thread-please paraphrase questions

[1dayatatime]

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Searched around and couldn't find an official thread discussing questions. There is a good thread on another forum site that has a lot of answers by guy named orthopod, however he doesn't answer this question and I couldn't find it elsewhere on the Internet. To avoid copyright issues please paraphrase questions.

32 year old man has changes in his behavior for the past two weeks. 4 weeks ago he witnessed a close friend die in an MVA. The evening of the MVA, the patient had offered to drive his friend home after they had had some alcohol but the friend declined and was struck by a car. The patient states he does not remember much about the incident. During the past two weeks, his wife reports that he's been awakening nightly in a sweat and shouting watch out. She says he's more emotionally distant and doesn't want to socialize. He is not driving his car. He reports difficulty sleeping and concentrating and says that "things just don't seem real." He says he used to drink alcohol only rarely but has been drinking a lot more to help him calm his mind and sleep. His vitals are normal with some high blood pressure 144/80. Physical exam unremarkable. Mental status exam: he has a flat affect and is irritable. He says he has not been feeling much of anything. He has thought about death a lot but says he does not want to commit suicide. Lab studies are unremarkable. Which of the following is the most likely diagnosis?
acute stress disorder
adjustment disorder
bereavement
dissociative identity disorder
major depressive disorder
panic disorder
substance-induced mood disorder

adjustment disorder is wrong. I didn't think that he had typical bereavement symptoms since he was waking up shouting watch out, and I thought MDD might be a possibility but he didn't have five of the sig e caps. I ruled out all the other ones unless I'm completely wrong? Thanks guys!😛

 

[Vexare]

32 year old man has changes in his behavior for the past two weeks. 4 weeks ago he witnessed a close friend die in an MVA. The evening of the MVA, the patient had offered to drive his friend home after they had had some alcohol but the friend declined and was struck by a car. The patient states he does not remember much about the incident. During the past two weeks, his wife reports that he's been awakening nightly in a sweat and shouting watch out. She says he's more emotionally distant and doesn't want to socialize. He is not driving his car. He reports difficulty sleeping and concentrating and says that "things just don't seem real." He says he used to drink alcohol only rarely but has been drinking a lot more to help him calm his mind and sleep. His vitals are normal with some high blood pressure 144/80. Physical exam unremarkable. Mental status exam: he has a flat affect and is irritable. He says he has not been feeling much of anything. He has thought about death a lot but says he does not want to commit suicide. Lab studies are unremarkable. Which of the following is the most likely diagnosis?
acute stress disorder (PTSD-like w/ re-experiencing the event and flashbacks, needing EtOH to calm down and sleep, avoidance of driving, hyperarousal, but time frame is <1 mon)
adjustment disorder
bereavement
dissociative identity disorder
major depressive disorder
panic disorder
substance-induced mood disorder

 

[MDKASH]

acute stress disorder