Reaction Formation

ID CC A 24-year-old woman with a history of systemic lupus erythematosus (SLE) begins bedwetting and throwing tantrums at her biweekly appointments for dialysis. HPI Since being diagnosed with SLE, she has had to leave graduate school and move in with her parents. She has found dialysis to be a painful and very trying experience and often sucks her thumb to ease her anxiety. Discussion Regression is characterized by childlike behavior under stress, such as physical illness or hospitalization.

Bulimia Nervosa

ID CC A 37-year-old man presents for a work physical to document loss of vision that arose ifter exposure to a volatile toxin at the work site. H PI There is no significant medical history. He reports total intractable blindness since the accidental work and is seeking disability payments from the company he works for PE VS normal. PE visual field testing demonstrates apparent total visual loss. Pupils equal, round, and reactive to light and accommodation patient's eyes move rapidly back and...

Info

ID CC A 38-year-old man reveals a three-year history of depressed mood during a routine physical exam he states that he is always tired and feeling blue. HPI The patient reports thai he is doing fine at work but does not hope for advancement because I'm just, not good enough. He also states, I don't remember ever really being happy. The patient reports difficulty making decisions. Upon questioning, he denies any suicidal ideation or substance abuse. Labs Normal T3, T4, and TSH (rule out...

Dissociative Identity Disorder

ID CC A 14-year-old female is brought to the physician by her mother because her body weight is less than 85 of that expected and she has missed her last three periods (amenorrhea) . HPI The patient reports that she is fat and strongly fears gaining weight. She also reports intense hunger but prefers not to eat. She admits to abusing laxatives. Treatment individual and family therapy along with antidepressant medication in severe cases, hospitalization may be required. Discussion There are two...

Borderline Personality Disorder

A 49-year-old female homemaker complains of disillusionment .with her marriage and general sadness she states that she feels insecure when left on her own and has great difficulty asserting herself. HPI She adds that she considers herself a follower who has always left all decision making to her husband. She describes her husband as an intense and domineering man who makes many demands. She has few friends other than the acquaintances she has met through her husband. Treatment Counseling and...

Cyclothymic Disorder

ID CC An 80-year-old female who was recendy diagnosed with breast cancer complains of significant weight loss and forgetfulness as well as multiple vague somatic complaints. H PI She was scheduled for a mastectomy, and she had been undergoing presurgical evaluation. Her best friend died a few days ago. PE Old, frail woman with hard lump in left breast lymphadenopa-thy no meningeal or focal neurologic signs higher mental functions normal no organomegaly found on abdominal exam admits to being...

Hypochondriasis

ID CC A 30-year-old male complains of persistent inability to maintain an erection during intercourse. HPI He states that his disorder is causing difficulty in his marriage. He has no history of psychiatric disorder and denies any drug or medication use. He has no acute or chronic illness and no history of genitourinary surgery. Labs Lytes normal. Testosterone, TSH, LH, FSH, and prolactin normal nocturnal penile tumescence reveals erection during REM sleep. Treatment Individual and couples...

Frotteurism

ID CC A 49-year-old male teacher is placed in police custody for allegedly undressing and fondling one of his 10-year-old male students upon questioning, he reveals that he is attracted only to boys in the third-grade age group and that he has an extensive collection of pornographic images of children. HPI The patient attempts to rationalize his behavior, saying that the boy enjoyed the experience and that it was educational. He has long understood the social ramifications of his actions and...

Autism

ID CC A 10-month-old female is brought to the doctor by her mother, who feels that the baby is retarded, cannot see properly, and falls repeatedly the child has bruises in different stages of healing (suggestive of child abuse). PE No lacerations or fractures noted normal physical development for 10 months of age bilateral retinal hemorrhages seen skin, sclera, joints normal. Imaging XR no old or new fractures seen. Treatment Health care workers are required by law to report any suspicion of...

Vignettes

Study with the student-to-student publisher you can trust From the authors of FIRST AID Blackwell's Underground Clinical Vignettes Behavioral Science, 3rd Edition is your primary source for clinically relevant, case-based material essential for Step 1 review. Each clinical vignette book presents approximately 100 cases with over 1000 classic buzzwords in Hx, PE, lab, imaging, pathology and treatment. High-yield updates to nearly every case Links to Basic Science and Clinical Science Color...

Pseudocyesis

ID CC A 36-year-old woman presents to the ER with a 2-day history of progressive right lower quadrant pain. HPI A review of systems reveals numerous symptoms. Further questioning reveals that she has been sickly since early adolescence with numerous chronic symptoms, including nausea, bloating, polyarticular joint pain, dyspareunia, dysmenorrhea, and difficulty swallowing. She is frustrated with her many ailments and by her failure to find a medical explanation for them despite visits to...

Exhibitionism

ID CC A 22-year-old male student claims that he uses objects of women's clothing, especially stockings and socks, to become sexually aroused he frequently masturbates while rubbing such objects, which he has stolen from various women. HPI The patient fears that he is abnormal and that he will not be able to have a regular sex life because women will not understand his desires. He adds that he has never had a sexual relationship or encounter, although lie is somewhat attracted to women. His...

Alcoholic Hallucinosis

A 20-year-old male is brought to the emergency room in a severely agitated state. HPI According to a friend, the patient took angel dust about an hour before his arrival in the ER. PE Patient severely agitated, belligerent, emotionally labile, and frightened speech slurred (dysarthria) vertical and horizontal nystagmus noted. Diminished response to painful stimuli. Labs UA phencyclidine (PCP) metabolites. Treatment Diazepam and minimizing sensory stimulation are useful in controlling agitated...

Fetishism

A 31-year-old man reveals at the end of his annual physical that he has had recurrent urges to rub against and fondle the buttocks of women during his daily travels on the subway. HPI He has occasionally followed through on these desires but feels guilty and embarrassed about both his actions and thoughts. His personal report and a review of his medical chart reveal no significant medical or psychiatric history. The patient is single and not sexually active, which he attributes to his shy and...

Premenstrual Dysphoric Disorder

ID CC A 32-year-old male architect is in police custody for allegedly exposing himself and masturbating in front of a group of people in a subway station he admits that he often feels an overwhelming urge to expose himself to people he does not know, adding that he becomes aroused by the shock in their faces. HPI The patient is ashamed of his actions but claims that he cannot resist his impulses. He has been arrested on three previous occasions over the past 10 years, each time involving...

Rationalization

ID CC A 15-year-old boy being seen for a sports physical reveals his disgust at his best friend's confession that he might be gay, stating that he can't stand being near that faggot and that all homosexuals should go to hell. HPI He and the young man have been best friends for years he admits that he has never been closer to anyone else. He appears shaken by the process of recounting his experience. Discussion Reaction formation is an inhibitory ego defense mechanism marked by the replacement...

Splitting

A 27-year-old man tells his physician of his decision to go into civic law upon his graduation from law school this summer. He plans to pursue a career in criminal prosecution law despite his father's desire that he enter a more lucrative field. He repeatedly mentions that his brother was killed by a drunk driver who received a minimal sentence. In sublimation, an unacceptable instinctual impulse is channeled into a socially acceptable action. Here, the unacceptable desire for vengeance through...

Rd Edition

BS Behavioral Science BC Biochemistry Ml Microbiology, Vol. I M2 Microbiology, Vol. II PI Pathophysiology, Vol. I P2 Pathophysiology, Vol. II P3 Pathophysiology, Vol. Ill PH Pharmacology Step 2 Book Codes are ER Emergency Medicine IM1 Internal Medicine, Vol. I IM2 Internal Medicine. Vol. II NEU Neurology OB OB GYN PED Pediatrics SUR Surgery PSY Psychiatry MC MiniCase

Paranoid Personality Disorder

ID CC A 48-year-old obese diabetic woman consults a physician for help in dieting, after which the doctor prepares a diet for her and discusses it with her in detail. HPI The patient misses her next two follow-up appointments and does not return calls from the office staff. She eventually returns for another visit but is 30 minutes late. She has gained some weight but claims that she has followed the diet regimen. Treatment Insight-oriented therapy may help these patients express anger and...

Avoidant Personality Disorder

ID CC During a routine physical exam, a young female patient tells her physician that she has fallen in love with him when he recommends that she see another physician, she threatens to commit suicide. HPI She denies any depression or suicidal ideation in the past. Treatment Psychiatric consultation and behavioral psychotherapy can be effective over time. Discussion Characteristics of such a personality disorder include unstable mood and behavior, suicide attempts, boredom, splitting, feelings...

Generalized Anxiety Disorder

ID CC A 21-year-old female student having a routine physical exam appears distracted and focused on the office ceiling when confronted by the physician she is embarrassed but admits that she is counting the number of tiles on the ceiling. HPI For the past 5 months, she has experienced an irresistible urge to count objects on a daily basis. She estimates that she spends 1 to 2 hours counting tiles each morning, often missing her classes or meetings as a result. The patient adds that she is...

Cd

PE large laceration on lip fundus normal 110 meningeal signs no focal neurologic deficit vitals maintained. Lytes normal. Blood glucose normal. EEG normal background interrupted by generalized spike and slow-wave discharges ranging from 3 to 5 Hz can be elicited by hyperventilation, photic stimulation, and sleep. Anticonvulsant therapy widi phenytoin or valproate. A seizure is a paroxysmal, abnormal discharge of neurons of the cerebral cortex that alters neurologic function. Epilepsy...

Vaginismus

ID CC A successful 50-year-old business executive becomes agitated upon his admission to an orthopedic ward with a fractured femur he complains that people are making derogatory comments about him and are accusing him of impotence (paranoid delusions). HPI On persistent questioning, he admits to moderate alcohol intake. There is no personal, past, or family history suggestive of any major psychiatric illness. PE Psychomotor agitation anxious and slightly tremulous but well oriented remainder of...

Malingering

ID CC A 37-year-old female with a history of insulin-dependent diabetes mellitus (IDDM) is admitted to the hospital for severe diabetic ketoacidosis (DKA). HPI The patient is educated, articulate, and assertive and seems to be extremely knowledgeable about her disease. She claims that she controls her diabetes rigorously. After some phone inquiries, it is discovered that she has been admitted for hypoglycemia 01 DKA at various local hospitals 23 times over the past 18 months. When confronted...

Gender Identity Disorder

ID CC A 40-year-old white female comes to the emergency room claiming that she is Jesus Christ. HPI She is now medically stable and admits thai she is not Jesus as the voices had told her. Over the past week, she has slept fewer than 3 hours per night. She initially excelled at work but recently became irritable and unable to concentrate. She then experienced auditory command hallucinations which told her that she had special powers. She recalls a similar episode several years ago and reports...

Schizophreniform Disorder

ID CC A 52-year-old female accountant complains that she has had difficulty falling and staying asleep for 2 months she states that the sleep she does manage to get is not restful and that she is easily awakened by noises. HPI The patient adds that she is fatigued during the day and as a result is performing poorly at her job. She says that she has always been a light sleeper. She denies feeling depressed, although she admits that she gets irritable when tired. She takes no medications and...

Panic Disorder

ID CC A war veteran complains of intense and vivid flashbacks with associated anxiety and hyperarousal. HPI The patient has witnessed and experienced traumatic events but cannot recall certain details of these events, and he becomes anxious both when questioned about the events and when he encounters cues that remind him of them. He also reports difficulty falling asleep, hypervigilance, emotional outbursts, difficulty concentrating, and recurrent nightmares that have begun to interfere with...

Anorexia Nervosa

ID CC A 20-year-old female college student reveals a secret problem to her family physician. HPI She has always been preoccupied by her body. Several times a week, she suffers uncontrollable eating binges. She almost always follows these binges with a visit to the bathroom, where she discreetly makes herself vomit. Following each such episode, she feels depressed. Treatment Pharmacologic approach uses antidepressants psychological approach tises psychotherapy, cognitive behavioral therapy....

Sublimation

ID CC A 28-year-old woman presents with a 3-month history of anxiety and depression following her breakup with her fianc of 3 years. HPI She has been overwhelmed by feelings of sadness, tearfulness, and depression and is concerned thai she will never be in a relationship again or fulfill her dream of having a family. Since her breakup with lier fianc , she has lost touch with friends and family, and her performance at work has steadily declined. PE Physical exam reveals a cachectic and poorly...

Pi

A female patient complains of uncontrollable anxiety of more than 6 months' duration together with daily symptoms that she attributes to a heart condition. The symptoms interfere with her social and professional life because she never knows when the anxiety will begin. She is irritable, fatigues easily, has poor concentration, and has difficulty falling asleep. She reports that during the exacerbations, her heart beats quickly, she sweats, and she occasionally has diarrhea. The patient has no...

Icu Psychosis

ID CC A 20-year-old man is brought into the ER after lie was discovered trying to hang himself. HPI The patient has become quiet and withdrawn, avoiding social activities and school events. His roommate reports that for the past 6 months, many friends have commented on his increasingly peculiar behavior. The roommate also reports that 2 months ago the patient began mumbling to himself and often pausing as if he were listening to someone else. Upon psychiatric evaluation, the patient speaks in a...

Dvt

ERCP endoscopic retrograde cholangiopancreatography ESR erythrocyte sedimentation rate FTA-ABS fluorescent treponemal antibody absorption GM-CSF granulocyte macrophage colony stimulating factor hcG human chorionic gonadotrophin HEENT head, eyes, ears, nose, and throat HIV human immunodeficiency virus HRIG human rabies immune globulin ID CC identification and chief complaint IDDM insulin-dependent diabetes mellitus LVH left ventricular hypertrophy MCHC mean corpuscular hemoglobin concentration...