Psychosocial Disorders
Answers
486.The answer is d.(Tintinalli, pp 1826-1827.)A person with panic
attackswill often present to multiple EDs and be discharged after a workup
is normal. A panic attack is a discrete period of intense fear or discomfort
in which four or more of the following symptoms develop acutely and peak
within 10 minutes: accelerated HR, palpitations, pounding heart, diaphoresis,
trembling or shaking, sensation of shortness of breath or a choking feeling,
chest pain, nausea, dizziness, lightheadedness, paresthesias, fear of dying, chills,
or hot flushes.
(a)Paroxysmal atrial tachycardia is a conduction defect of the heart
characterized by random episodes of tachycardia. This disorder is seen on
an ECG. The above patient’s ECG is normal. (b)Hyperthyroidism can mimic
a panic attack, but there is usually greater autonomic hyperactivity. In addition,
thyroid hormone levels are increased. (c)There are no symptoms of depression
described in the patient’s presentation. Nonetheless, panic attacks can occur
with major depressive disorder. (e)The diagnosis of posttraumatic stress
disorder cannot be made with the patient’s history.
487.The answer is b.(Tintinalli, pp 1830-1831.)The diagnosis of conversion
disorderis made by fulfilling the following five criteria:
- A symptom is expressed as a change or loss of physical function.
- Recent psychologic stressor or conflict.
- The patient unconsciously produces the symptom.
- The symptom cannot be explained by any known organic etiology.
- The symptom is not limited to pain or sexual dysfunction.
Conversions disorders generally involve neurologic or orthopedic manifes-
tations.The disorder usually presents as a single symptomwith a sudden
onsetrelated to a severe stress.In this case, the stress is the diagnosis of
terminal cancer in the patient’s father. Classic symptoms of conversion disorder
include paralysis, aphonia, seizures, coordination disturbances, blindness,
tunnel vision, and numbness. The diagnosis cannot be made until all possible
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