Psychosocial Disorders
Questions
486.A 31-year-old woman presents to the emergency department (ED)
20 minutes after the sudden onset of chest pain, palpitations, shortness of
breath, and numbness of her mouth, fingers, and toes. She tells you that it
feels like she has a lump in her throat. Her medical history includes multiple
visits to the ED over a period of 6 months with a similar presentation. Her
only medication is an oral contraceptive. She occasionally drinks a glass of
wine after a busy day of work when she feels stressed. She tells you that her
mom takes medication for anxiety. Her blood pressure (BP) is 125/75 mm Hg,
heart rate (HR) 88 beats per minute, and oxygen saturation 99% on room air.
An electrocardiogram (ECG) shows a sinus rhythm. Her symptoms resolve
while in the ED. Which of the following is the most likely diagnosis?
a. Paroxysmal atrial tachycardia
b. Hyperthyroidism
c. Major depressive disorder
d. Panic disorder
e. Posttraumatic stress disorder
487.A 23-year-old woman is brought to the ED for vision loss in her left eye
that began shortly after waking up in the morning. She states that she is very
depressed since her father was diagnosed with terminal cancer. She was sup-
posed to visit her father today in the hospital but is now in your ED because
of her vision loss. Your physical examination is unremarkable. An evaluation
by the ophthalmologist is also normal. A head computed tomography (CT) scan
is normal. Which of the following is the most likely diagnosis?
a. Somatization disorder
b. Conversion disorder
c. Hypochondriasis
d. Retinal detachment
e. Anxiety disorder
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