Friday, 30 November 2012

Usmle Step 1 MCQ's # 8

Title: Usmle Step 1 MCQ's # 8
Subject: Behavioral Science

Q NO 8: A 29-year-old woman is admitted to the outpatient surge department for an elective operation. She undergoes general anesthesia and, because of an intraoperative complication requires additional hospital days on the inpatient unit. Two days after surgery, she becomes agitated and starts developing tremors. She says she beds as it insects are crawling on her. A history of which of the following is most relevant in determining this patient’s current medical management?

A. Alcoholism
B. Depression
C. Past LSD use
D. Schizophrenia
E. Traumatic childhood

Explanation: The correct answer is A. The patient’s hallucinations, agitation, and tremor point to the diagnosis of delirium tremens (DT5), which should always be considered in cases in which a patient does not have access to alcohol as they did before admission. Depression (choice B) is nota cause of tremor, although it can be associated with agitation in depression with psychotic features.
Past LSD use (choice C) can lead to flash back visual hallucinations but it would not cause the DT5 that this patient is experiencing.
Schizophrenia (choice D) is a disorder of thought associated with auditory hallucinations. It is not associated with formication the feeling that insects are crawling on one’s skin.
Childhood trauma (choice E) has no demonstrated link to autonomic instability alter a surgical procedure, as in this patient.

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