Tuesday, 27 November 2012

Usmle Step 1 MCQ's # 7

Title: Usmle Step 1 MCQ's # 7
Subject: Behavioral Science

Q NO 7: A 28-year-old woman visits a cosmetic surgeon for evaluation for surgery to modify the shape of her nose. She has had two other minor surgeries on her nose in the past for cosmetic reasons. During this evaluation, she is accompanied by her mother, who demanded to come to the appointment with her daughter. Her mother asks the surgeon not to perform further cosmetic surgery on the patients nose because she believes that it looks just fine, Instead, she claims that her daughter has been obsessed with the appearance of her nose and spends much of her of time looking at her nose in the mirror. Which of the following is a feature of this disorder?

A. Agoraphobia
B. Disruption of day-to-day functions
C. Pain symptoms
D. Panic attacks
E. Search for secondary gain

The correct answer is B. The patient is most likely suffering from body dysmorphic disorder, a preoccupation with an imagined bodily defect or an exaggerated distortion of a minimal or minor defect. To be considered a mental disorder, the concern must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Patients with this disorder are more likely to go to dermatologists and plastic surgeons than psychiatrists. Additionally, patients with this disorder have a high lifetime prevalence of depressive and anxiety disorders. This patient’s presentation is typical for body dimorphic disorder. The cosmetic surgeon should seek psychiatric consultation.
Agoraphobia (choice A) is a fear of public/open places. It is a specific type of phobia that causes the patient to become introverted and avoid being seen in public.
Pain symptoms (choice C) are associated with somatoform pain disorder, in which a complaint of pain is unsupported by any physiologic process that can be identified by lab tests or physical examination.
Panic attacks (choice D) are a major feature of panic disorder, which is characterized by discrete periods of intense fear and discomfort with palpitations, abdominal distress, nausea, increased perspiration, chest pain, chills, and a choking sensation.
Secondary gain (choice E) is an unconscious drive for medical attention, often accompanying somatoform pain disorders, somatization disorders, or conversion disorders.

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