amruta
A 42-year-old, unemployed laboratory technician is admitted to the hospital for nausea, vomiting, and abdominal pain. She tells the physician that she had been diagnosed in the past with disseminated lupus erythematosus and that she had Hodgkin disease. She seems worried that an extensive medical workup failed to confirm any of the previous diagnoses or find a cause of her actual symptoms. She insists on being given meperidine to relieve her pain. On examination, the only physical findings are scars and some abscesses on her thighs. She explains that she had been intentionally injured by the nurses in a previous hospital. Which of the following is the most likely diagnosis?
A. Factitious disorder
B. Ganser syndrome
C. Hypochondriasis
D. Malingering
E. Somatization disorder
TAC
D -- she is likely addicted to opioids.
:o)
TAC
amruta
that's what I thought too....I thought it was drug seeking behavior...especially with the mention of abcesses on her arms and all.....the answer is actually A though :0)
amruta
A. In factitious disorder, the individual deliberately feigns the signs of a medical or mental disorder to assume the "sick" role. The symptoms are under voluntary control and cannot be explained by other underlying condition. External incentives for such behavior are usually absent. The disorder is severely incapacitating to the patients, since they usually have multiple hospitalizations and submit themselves to invasive procedures and surgeries. Ganser syndrome (choice B) belongs to the group of dissociative disorders, not otherwise specified. It has been reported in incarcerated populations and is called "prison psychosis." It is characterized by the provision of approximate answers to questions and is commonly associated with conditions such as amnesia, disorientation, and perceptual disturbances. Hypochondriasis (choice C) involves the excessive and pervasive preoccupation with the fear of having a serious illness based on a misinterpretation of bodily symptoms. It must be present at least 6 months and causes significant impairment in all areas of life. It does not respond to reassurance and it persists despite medical evaluation. Malingering (choice D) is the voluntary production of physical or psychological symptoms to obtain obvious recognizable secondary gain, such as receiving financial compensation and avoiding work or legal problems. Somatization disorder (choice E) is characterized by multiple somatic complaints that begin before the age of 30 and result in medical treatment and significant impairment of social and occupational functioning. The patient has to meet all four criteria: four pain symptoms, two gastrointestinal symptoms, one sexual symptom, and one pseudoneurologic symptom. The symptoms are not due to any medical condition.
TAC
The abscesses suggest she is addicted to heroin.... and she comes to the ER requesting specifically an opioid... That sounds malingering to me! Her tertiary gain is the opioid... I dont think she just wants to assume the sick role....
Where did u get that question from?
TAC
amruta
kaplan q bank....although that is what they claim the answer is, I stand by D. I think this stem gives us more than one reason to suspect that this is drug seeking behavior!!
When's the big day for you?
TAC
Funny.. I dont remember that Q from kaplan qbank. But I am definitely sticking to D... It looks a lot more like malingering then facticious disorder.
Big day is next tuesday, august 17th.... ai ai ai!
:o)
TAC
docespy - docespy
I agree with TAC regardless of what your source says, thats a clear case of malingering with an obvious drug seeking behavior and a seconary gain.
amruta
so we all agree it's maligering eh? Great....I was worried that I was not seeing something in the question.
Good luck TAC.....I know you're going to kick some serious BOOTY!!!