WS SbebeeeuuNaaveeesercnar ‘2b youd man and ns motor ano fra psychiatric evaluation, Sho ‘concord about his heath ae behavior evr sine he dropped out of aracate choo and moved back nome 6 monhs age. Hee aways vey ansous and recccupied wih outs a schoo and gating ajab. He also saams a behave ‘very dey a eres sch a wearing his wna ake in summa. He say hath hears voices but ne cannot understand what ty are saying, hon prompted he Aeseibes apt to have hin kled wih psson seeping om the walls. Today. NS hoot at 90min, espiaory rate ie imi, boos presses HOIGS mn Hg, and temperature 36.8 (98.27. On physical exam. he appoars gauxt ane anos. HIE heat has 2 ela fate and ym and his ngs ae cea fo austin tera (CMe CBC, and TSH are norma. urine tencoogy tate negative What is the mest aly dagnoss? © A Schaoptventfom disorder © © Seteopteoni dsorder © E Bret psyco dsorder‘2b youd man and ns motor ano fra psychiatric evaluation, Sho ‘concord about his heath ae behavior evr sine he dropped out of aracate choo and moved back nome 6 monhs age. Hee aways vey ansous and recccupied wih outs a schoo and gating ajab. He also saams a behave ‘very dey a eres sch a wearing his wna ake in summa. He say hath hears voices but ne cannot understand what ty are saying, hon prompted he Aeseibes apt to have hin kled wih psson seeping om the walls. Today. NS hoot at 90min esiaor rate ie imi, boos presses HOIGS mm Hg, and temperature 36.8 (98.27. On physical exam. he appoars gout ae ais. His hear has area ate nd hyn and is ngs ere dea! oauscutaten Is the most ly ogress? © A Schioptvenfoo asoder Schizophrenia dorder aeias £ fret psjenote acoder Result: WS SbebeeeuuNaaveeesercnar ava. " ” = » gees Explanation: ‘comct answor C: This paint prosents with signs and symptoms of _schizophreia and he has expressed these charactors for over 6 ‘months Schizophr seen i fhe popular and des nt Rave any arcu gender predominance. The age of onset sin he late eens. Women Inno a lar onset. Chilchood (1 years) onat is aszociaed wth mere severe form while a ate ad 40 years) onsets associat wth amide fox. The exact eiology lsnot known, but any tices exist. Theve saat bea genctic component. amanazygete tun wthachzopheia means 2 50% ‘kof eeelopng stizopenta forthe other tn There may ao be ‘exrodevelopmenta pathotogy dng the perinatal period. The lesions are Sort un iggerd by enevonmoral cts, seh a to stesses of toa In schzophreia, dopamine, ammonoamine, thought be hypoacivein the ‘mesocorical rat eseng to negatve symptoms whe hyperactive the ‘masoimec vat leaing to postive symptoms. ‘Tero ate 5 psycho symptom domains: | Deusons: hc false beefs that do ot waver inh af any objective 2 Hallcnatons: sensory perception inthe absence of stn anican be Related Videos: ‘chzophrana Spectum and che Psycho Disorders -Payehceaca Deerder PSY) Onin Schaoptvena: Assesment First Aid References: Fst Ad fr the USMLE Step 12019, 20h e547 Fst Ad forthe USMLE Step 1 2048, 2th oh: 544 Fst A forthe USMLE Step 12017, 27H dh 530References: Fst Ad forthe USMLE Stop 12019, 28h: 547 Fst Ad forthe USMLE Step 12018, 280 od: 54 Fst Afr the USMLE Step 12017270 ed 530 ‘mesocontica act, leading to negative symptoms while hyperactve in the First A oral tact lesing to poste symptoms. ‘There ate 5 poyenote symptom domains: | Dotan: hed also Bets hat do nat waver in ght a ny ebyctvo encerce 2 Halucinatons: sensory percption inthe abcence of tml and can be visual aud nore common), 23 Disorganized speoctthinking les of logical connections between ‘tours «4 Disrganzea behavior or cattnic Behav: charactor by aims bohavior ane catatonia respecte '5. Negative symptoms can be remembered asthe A, -emotions ‘expression, avoon slog anhadonta, and acl ‘Note tat ony anneconia shared netween the negative symptoms and major pressive episode (MDE} Thos four omar havo postive symptoms (tank exces] wh the ast domain isthe cry one wih negative smptone (tink dished or abso). The fst zee domain ate CORE domains ‘To make a dlsgnat of schzophenia, patent musthave symptoms fom 0 patent mist have symptom fort est month waft! dation of ‘5mptome for month an ll ther eauees for tree symptoms mus bead ‘utinctuding mnoication, ‘Option A: Schizoptvertom dscrder' charactrza by tho same tina ration requirement of symptoms (monty bute tal curation ‘smptoms ies than 6 months, Whe a patent wth scizoptrenform ‘sordermay progress 10 seizopvenia dserde by meeting tat oath ration taro, unl such ine, hey get a agnosis of schizephreniform Bisctcio tt WS See BeeeUuNaaveseserssarecarevsaasus|WS See BeeeUuNaaveseserssarecarevsaasus| ‘Option A Sctizoptvertnm dtd i characterized by the came te ‘urasonrequremant of symptoms monty, but total aration “smptoms fess than 6 months, While a patent wth scizophrnform ‘dsordermaypreeress to scizophreniaSeerde by meting tat Smenth ‘uration cron, unl such un, ey get a lags of schizophrnitorm sore, Option 8: Schcosfectve disorder must have concurent ative phace ‘symptoms of schiopirena and major mood symp. The mar meee ‘symptoms cn be ether manic epsodes o major depressive episodes DE ‘The proportion ofthe mood symptoms ae peyote symplame shod bo anpcoeeatey or the eae dation Mi appronnate, rt abi, because ‘he 3and st rteria to meet ths lagnost are et he actve phase ample must have a periodof ho weeks or more ere hate me no mood samptoms. ‘Option D: This patent isa nonnalib paeland a urne screen or toxtobogy Is also negate ‘Option The diagnos of be psychotic dsorder only requires one ofthe care doman symptom, ana protons must befor ies than month Ar as be epodo, the pabent may retina tht neal baci funclonng ‘Tees epieodes sy ocr wth or nove a enero Leaming objective: A peychons ia break in ely ether the patents ‘nding or percepuon. ‘Tomoko. diagno ofschzopteri, «patent must hve sympms om S40 ‘utothe fue coma, one of ih must come tm he CORE domains and ‘the toa duration of symptoms musta atleast 6 months ong. A, al ther ‘etologes must be red out neudng argue. Tha Sekzopventom dort asthe same te duration requrement of activepihase symptoms (I mont BSc ttVAUBH Ec as¥uuspabsasaecessacacec hea. o-8 CAuaionctaton,wsich ne, hey gl ogon ofschnoptrenonm ‘order Option: Schicoaectve dorder must have concent active phase symptoms of schzopivena and major meod symptoms. The maj eed Symptoms ean bo other manic opsades o major depressive apsodos (MDE) ‘The proportion ofthe mood symptoms are psyhete symptoms shou be appecematey orth same duration. Rs approximate, net absolut, because ‘ho 3and ast rtra to moots claghsis ar at ne actvo paso _smptoms must have a petiod of two weeks or more were here are no mood, symptoms. ‘OptonD This patent ie noma lb panel anda une sere for txcobogy 'salso negate ‘Option: The dlagnest of bet poychte doer ony request one ofthe care doman symptoms, ne protons must befor iess than mnt Ar as ‘ne epode the patent may returntothet nema sane inclonng ‘hese epsodes may occu with or witout a suesso. Leaming objective: A pojchoes isa break in realty ether nthe patents stinking erpercepton ‘Tomoko dogs of schzopheri. patient must have symptoms fom ‘outofthe fue domains, one of heh must come rm the CORE domaine ane ‘to tal duration of symptoms must ast atleast 6 mons ong. As, al her ‘tologies must be red out neluing rug ue. The schicopvenfom cord ‘ast sme eve dation equramant of ctue pha symptoms mont ‘but ett duration of symptoms tess han 6 mons. eae}WS SbebeeeuuNaaveeesercnar ‘30 yoa.o mao presents toa ecal nich acomplatof a tt nock TRS tert sno to be sporadic wth fol. op appointments but was ls 007 recerty tora rag cepot inaction = italy presente wth complains of Paranal dotusons and auatary naichations Wat sted ot T mnths ae caused sianfcat soci and nec detonation He was brougtint the cic by is ‘older bother wo Inter moved back othe Unter States be th fay Because of helack a socal support and tepals tandency tobe norecomplant with mockeaions th patent was ploced ona spocc drug to mitigate thi palten. Whi of he folowing madestionssresponsbie for tho patents movement © A. otanzapine © Chsepine © D.Haoponde1 > 2 2 a ‘30 yoa.o mao presents toa ecal nich acomplatof a tt nock TRS tert sno to be sporadic wth fol. op appointments but was ls 007 recerty tora rag cepot inaction = italy presente wth complains of Paranal dotusons and auatary naichations Wat sted ot T mnths ae caused sianfcat soci and nec detonation He was brougtint the cic by is ‘older bother wo Inter moved back othe Unter States abe th fay Because of helack a socal support and he palen'stendency tobe no compliant wh medion the patent was placed on a speci drug to mitigate this pate. hic of the flowing mediatins responsible forthe patents a © A.cunepine ~ —_ B.Benztropine ™ ae © Chosspne wm 3 Dtpant os — = Ds 2 Result: x @ rconea 2 ave emmm] Explanation: Related Videos: Sane tn can on cotcopb Set pope war ot a ee . " ” = » any vn ume. Men and wemon are affectod at the same ate, bulmen ten to De aloo aarrn te and plagued wth mero negatve symptoms, hus leading o worse outcomes. The cause of scizphreni apes tobe uct th rong genetic component eames by tn tice Showng nig concordance between monozygotic ns ‘Symptons of scizoponta ate usualy sont url sinteant ronmental First Ald References: stressor, such as toring trary education. The postive and negative Fst Ad forthe USMLE Step 12019, 2th ed: 561 Spun hove bee ate hh hws fan = (dopamine Thee ae # major dopamine pathways nthe ban, 2 of when are hai Sia oe aaa bom 2a ok BS) ‘rect rlaed to ctzophreia and to large of phamacoogi realment Frat Aid forthe USMLE Stop 12017, 27 ed SA the thor 2 are adore te tacts reed with side eet. Halopergl Palio sa uaciona ant-psychote that acts 2 DA2 receptor antago s2e mage below Thus, tis medication can improve the postive “Sympoms associated wih nciased lovl of dopamine nt masctmble twat Both atonal ard atypia arbpsychotis are equal eee in geesHaloperidl Paldo is a taciona ant poychoi that cs s 2 DAZ receptor antagonist see mage below). Thus hs medication can improve he postive “Smploms aszoioted wit incised evel of dopamine inthe mesolimbic {rec doth atonal snd typical an paychotie ae cual ineocive in "weateg negative Symptons, which result fom insula ievels of dopamine Inthe mesocerical ack. The wadtona ant pychots hae en undesed fet ota pyamial yndtoe EPS) which dus to nigrottal DAD ‘blockade, Medetion slated movement sede, 963 pat of ES smptons, area leaing cause of mediation non complnce Mosolinbie Paty Unieated Schizopenio Mesolmbie atay D2 Antagonist Bas BUSRd ye SevesssarecazeevseseWS See Be eeeu Seay eves esses acacenwoas Inthe mesocerteaYac. The Wadena ant psychotes have an undested tect oxrapyamial synctome EPS), wich due 9 nigfostatal DAZ ‘lockade. Metaton sled movement dlseders. asa pat of EPS sptons, area ieacing cause of medeston noncompliance Mesolinbic Pathay Untreated Sehizopirenin EM 'b2 Antagonist fj e Understanding tho cferent pes of movement orders and when the ‘movement aserdets appoa dung tha couse atthe weston. mey be Help cio eyton,WS See Be eeeu Seay eves esses acacenwoas © onccncin Understanding the cferent Woes of mevemert sores and when the ‘movement dsedets appending the couse af he vectnent.mey be Hep In edoquntely minmiang symptoms. EPS smpomsincido ait dystonia, parkinsonism (breyknes) kaso dyskinesia. andneurcept ‘malgnantsyndome NMS). Acute dystonia the frst movement dsrde to velop. Acute estonia usualy occurs ft Twook of sartng he ‘medicalon The common symptoms are the est of sustained muscle ‘ontacton Sustained muscle cortacione occuring in he necks refered to a8 torcls. Dopamine hasan ivory elect onto leas f acciyehotne (ACH. The anagersm of dopamine by art-psychots, ke haloperidol. resus In uninhbted cholinergic ovo. leading te movement asorces, uch 35 ‘acute dystnta ae pakinsonism dykinesi. \Wheshot a pavonthas a movement dsxcer om decreased dopamin a a result reuron degeneration inte nigrcetiatal pathway. 2 in Prkrsonis ‘leease oF neuroleptic lniced EDS schaophrets, decreased doparane ll lead incteasedaceychone hus, patients wih parkinsonism can be oven seein or atngis tor pata onan Reh ‘@tvapyranial smptoms of acute dstrta and bradenesa con be wend wah t-chotnergs, sch as benavopine (cogent), dpherhyaramine {boned or tihenpenidit ‘Option A: Oanzapine an ajypea at psjehate Atypical ant psyehots are ‘uly the cg of hoe forint eotment because at-paychokes Nave ltletono risk of EDS. Olanzapne, nowever, he the greatest wolght gang eto any ofthe anipsyenots ‘Option B: Benzepine, aso known as cogent an arichoterlc hats(Opn A: Oanzapine an abypca ant paychot Atypical ant paychoti are ‘cual the cg of hoe forint eatment becaure a paychotcs Nave litle to-no sk of EPS Olanzapine, owes has the gestest welt ening ecto anya te anya ‘Option B: Benzvepine, aso known as cogent san anichotnetge mats sed treat neurolepcinduced EPS, Neurleptics is nether tery for n= ayehots. ‘Optonc: cezapine ean apical anti psycot, and athough this ae of ‘modications sualy te crug a chee fr inal ug moray, Cazeoie ‘ol Gozapine has the eed severe side elect of agranulocytosis For his ‘reason, clozapine reseed for teatnent resistant patents, Patt 260 ‘equeo blood esto deterane the wht blood cel count wa arent before testmont ane regal dng estment. ‘Option: Thoncain a eorworionalaypica!anspeychose wh ow potency. Because ofthe low potency. the probabity of EPS isles key Leeming objective: Although convertors antinychoties ae no longer fc.ne teatment forint dug therapy, here are stustons where cormertonaltgiclenipaychotca may stl be the beat choice. Heloprtt ‘ean be ven as a depot Fiecton every ment, nd ths may be Kel er on omplamt pats. Unfortunate, ths dase of ant-psycotc has the greatest {ssocation wi EPS. To mioate some of ho mediate oates movement ‘sorders tho appropriate dose shoud be assured and he acon of anon holnergc shouldbe considered er syrpioms of acute aytena or parensonism (raaykneso, Hct WS See Be eeeu Seay eves esses acacenwoasWS SbebeeeuuNaaveeesercnar ‘A 60,yoaotd woman and arson a vied at Rr hemo by ahaa ald Ho ot ‘caregiver buthes ely geting er out ofthe house. Her sons concerned about Continous and repettive uth an tongue movernnts hat sane about 2 weeks ‘ago andhave become more evden ever since. Shes non vorbal a bases and ‘can complete mest activi of dative Sho sur roman unspectiod Doyo: eorex Her medicabon nce fuphenazne Today, Ne heat ao ‘90min spat aes Yn. blood pressures 12587 mm Hg, and temperature is 370°C [986F}. On physical ex, sho appears gaunt and wits. Sh erooing and her mouths making chewng moten tats occasional esrupted by wang her ongue back and oth, Se sae tobe perorming hese mation stsentmindey, Her her has arogear at and hn and her ngs ae auseftaonbsterty CMP, CBC. and TSH are nema A ne toxicology ests hogatve, Whats the nest bes step inher management? © Astat dezapine Sitch to cHorpromazine Reduce tne coeage © D.epectant management © E Step the mediation‘A 60,yoaotd woman and arson a vied at Rr hemo by ahaa ald Ho ot caregiver buthes ely geting her out ofthe house. Her sons concerned about ‘continuous and repettive meth and tongue movernens tha cated 260182 \wooks 290 and have become more evden ovr sinc. Shes nen veal at bossino and can complete most acts of doy ving, She sues rom 29 Unspected pacha order Her medcatone nie fuphenainn ody het heat ate 20min, esata fates 7m, blood pesareeY25/87 men Hana temperate & 370°C (88.67) On pric! exam she appenteguunt and anus ‘She's droeing and her mouth making 2 chowhg motion tats occasional ‘astpted by waggHg Net tongue back and fh. She seemsto be pefoming ‘hese mations absoniindedy- Herhoarthac a regular ato and yt andor lungs are lear o auscultation bata CMP, CBC, and TSH ae normal Ane tovcclogy test negative, Whats the net bes step inher management? fA Sta ezapine 2B. Sitch to cHorpromazine Reduce tne coeage 0. Bepecant management Sp the mediation Result: ava WS SbebeeeuuNaaveeesercnar. " ” = » gees Explanation: CCorect answer E: The paint is uring from tardive dyskinesia, ar the ‘ext best tp inher management io sop tre medication Tare dyskinesia |S crmactenzed by lvauntay and nonin repettve mevertent ofthe ‘vocalzatons wth ky speech rom dlaphragmat dyskinesia. The patents ‘sre val not anate of ese movements This etapyaidal symptom EPS) ‘most commonly acca in ede fra wha havelbeen on yea Srtinsychotis for at eat 6 mont About ha of these paints may hve spontaneous regresio of mptoms ‘utthore i ako the chance thal thece symptoms can become permanent The ‘fencing mediation shoud be promplydscortrucd and oplcod wah an type antipychotie suchas Cozapie or uetioine. The bora Involuary movement cae (AIMS) canbe used to quatty ane mont patos or tarve dyskinesia. Fuphanazo, along wi halopeio., feNgh- potency odtonaltyplealconveonalist generation rtipychots. Tey have te grestast astociton wn ES. The occurence of EDS 6 a commen auso of nencomptance The movorent scr ange fom acto dystonia totadivedyekinsi, Related Video: Postural Temas Hunton Dow, Teurots Symrome, Walon: Diesae and Dg Insiced Oykinosa — Meceaton of Move Dicorders anupsycnotes First Aid References: Fst Ad forthe USMLE Sep 12019, 2th od 561 Fst Ad forthe USMLE Sop 1 2018, 28h od 57 Fst Ad forthe USMLE Stop 12017, 270 SAWS Seb eeeUuN aay Beesercnaracasewoas! Lesva rotarave oyeenest onset fete Hoare ‘ystonla days Brooykinesia Days ‘anita Weoke Tendve Mont Dysinesia years Symptoms Sostanes palntlmusce Poverscrim temess, gay motor trv ‘cause of ancomplance The moverent sores ange fom ace dystonia Amchotneaes benztpine or uheryheniyh OR antcholneri poperies (G@oneanycanine) Amchotinerges benztpine or uheryrnenay OR antchotnerie poperies (cpneanyeramne) ‘st - Does reducton ns Bata biockars (propanoion O8 aicholnersis foontopine) Aorazepam) ‘sop ypc apenas andanten to atypical Sntpsychotis he lzapine orauetopine Fst A forthe USMLE Step 12017, 27th ec 543months esessnesS 2) ota iockare teropranci) OR Aantcholnergisfoenzrepine) 2 Benzocazepines . Uovazepam - Tardive Months~ Choresatetosis Stop plea antpeychotis a Dyskinesia years andother—_andewente atypical Involuntary antpsyenatis ta clozapine a movements of or avetopine . rrouth ans a tone ‘Option A: The moe appropriate nxt stp inthe management of this paint is {stop the typiea antipsychotic tat caving te exrapyramial emptor ‘The subsequent step in management would be 0 sata atypical ‘Option: Chlorpromazine is alow potency tst.gontaten atipyehos IE ‘beter to sch pints For FAs to 2nd generation antonychotis SCs) such clozapine or quetiapine when thy present wth : oo 2 Result: x Conca 2 ave" ” = » gees AGS Explanation: ‘Comet newer The patent erring rom ator halaciations secondary to etactoryneuebastome,Phartsma aso knew 25 atfacary hallucation isan magia oder experienced by the patnt in tho absence of ‘tm Thiele nto be etre ts ange, whi cone oe of ‘moe paresmia whic ast perception of mol. Tho phantom sn ‘moylarturt for ashort pied or become persistent nd is variable fom Derronto parson, sath some experiencing pleasant odors whe oer 0 ‘Phantosmia may be te est of damage tothe ofan system tome severe espiatory infection, be the aura azocntad wth seizures or migyincsB some cases, may bo the result of tempor be rodent Strokes obra ‘umers Lesions ecg he pafhippocanpal unas or newoblstoma afectng ne otacory nave eat alco cause actery haute, ‘Physical oxomination wi focus en determining he Sensations eat to seller taste are urter eve real or perceived ional testing ‘may vole nasa endoscopy fr dec evalzabon and maging stuses, such {25 CT or Mil of ho bran and natal caves Patient wih neuroblastoma may ‘eed surges excision of ofectory neurons wth an endescoperansnasal approach flowed by radaton andor chemotherapy ‘Option An eptepi ur is more conan. somatorenEO Related Videos: Pyehot, Osueons ans Halucnatone First Aid References: Fst Ald forthe USMLE Stop 12018, 29th of: Fst Ad forthe USMLE Step 12018, 25 ea: 333 Pst Ad forthe USMLE Step 1 (207 27 32‘spproach fled by radaton andor chemotherapy ‘Option A: An epepic ara s more comm airy, somatoreneoy | ‘sua These con be dstnguished om other causes by he assole Ka ‘manfostaions. The sae seul nt oconds to minutes with some of tho commen factory hatuchasions reported smeling anc eal or burt odes ‘The tal phase may be cinecented by los of conscousness and body shaking. The phase fmm floured bythe portal tte, where the Sensorum ot completely ac. Both thecal and postal phases are sent the patient above ‘Option: Hypnagosic end hypnopempichallucaton are commonly seen in parcolopy But are ao soon normal indkiats. The haluchations 26 congruent and complex ¢multimeda— ncuting commorty sua auctor and tact seneations. These halucratons occur who gaint sleep (typneceg) or who waking up frypnopompie These paints have preserved sight The patent above his no slep-oatd complaints, ‘Opton: Substance abuse fe more commonly associated th vit hurts andi een nthe trict of sola gs sich cocaine ‘or sedate windcwal (achat ~ dlnum wemens. Theres thing nthe ‘Option E: Actor haltcations ar mare common in saepmania Patents Inve 9 dear sans andve other nssocted pay eres (delusions and organized though, These paints general lack insight ‘The patent above has he ether psychic symptoms ther tan the akactony WS See beaeUuNaaveeesersnarecaceeseWS See beaeUuNaaveeesersnarecaceese soraotium ot completaly ntact. eth hosel and posit phases are bsentin the pation above ‘Option: Hpnogoi are hypnopampic hacen are common seen parclepey but are abo seon noma indhiduls. The halucnations ae ‘congruent and complox¢nutimeda -induding comment vu auctor nd tact sensations. These halcations occur wile going to sleep (typnagegc ewe waking up (rynopempie. These paints have lesened sig The patent above has no slop eet compat ‘Option D: Substance sbuso k mora commonly essaiated wan visu halurations andi seen inthe intoxication of simula dugs such = cocaine ‘or sedative witirawal cohol - delim remens. Theres nothing nt Stem suggest substance abuse lh the patent above ‘Option EAuctoryhalications ar mace common in chzoptneia Patents ‘vo a oar snark and havo other eesocatod peje oatures (delusions and dsorgarzed thought, These patients general ack insight ‘The patent above has ne ether psychic symptoms other than the akacory Leeming objec: Mato halucinatons ae commenty associated wat ‘pops. nd less commonly wih nevodogeneatve seas ad paychiatric onctons rare satons, maybe related ran tumor Invling the paranippocampal unus or attocung te ctatry nerve So as 8 exrobacioms Rs impertant to cfererdote phantosma fom anosna and arcemia as the aforentals are qute ferent Further, the derentals cn be arewed by lokig fo symptams that may be eat ome phates,WS SbebeeeuuNaaveeesercnar ‘wo ezygc tans aro Seto the unhrsty cfr unusual esertmont nates thor professors, The patents wore son by various focuty members over the past ‘ow manne anata conceme wee acerca bit they conn express Uunsharabie vow of ein ag2ted by to seool. oth of than are average students with some song eject areas and weak boc rea as dawerstratd by hit ‘ouse grado-book. They have no known medal conden and are no known to abuse lic sustances. Mone ofthe pers sate te same concerns, Which tHaleront bent deserves the coniion tat these palin have? | Theddnorder ss own neon ent OSM, (© B.A separation hal te worsen symptoms © C.conattect no or mora dosol related iid _.Tieatrent canbe augmented wth antipsychotics, £ Cognitive betacel therapy i good stimWS SbebeeeuuNaaveeesercnar Lesva ‘wo ezygc tans aro Seto the unhrsty cfr unusual esertmont nates thor professors, The patents wore son by various focuty members over the past ‘ow months anata conceme wee acerca bit they conn sprees an lnshakabl vow of boing egcted by to seco. Both of thom are average studnts wth ome strong subjoc areas and weak subject aren as dementated byte course grade book. They have ne known medal conditions and are not @ A The dior town diese ey nS wo {At epaton ayo wren a o can tector mar dose reat ea. os 0 ietnent an be ered wth tect. ox Cog betray 2 goad de. a La) Result:" ” = » gees Explanation: Ccorect answer : Shared delusional order, also known fle @ deus. 9 ‘ave deorder that deeb a shared detucon among two or more individuals ‘mat are na ose relationship (or example In prent ch, spousal ana ‘sng relationships). There have been changes ots sore rom OSM wien itgot he name shated delusional cso to being removed asa Separate dsoase erty in DSN, Under DSM Io secand patent co ets itera for delusional order then hats the gros Note thatthe irtrnatonaclessifcation of seaces 1th revision CO 10) ‘efor tofole 8 deux ae an iced deicna ceo anaes e ou ‘agnostic citer Two or more nd\seuals share te sao dolusion and have ‘suppor sytem that serve to reeYores thot bet Ths is made possible by ‘aud in he passive naval by an nda! wn the ace paycasc lsorder Tesimont is armed lal zepraton encourage ey estng and amipsychotes. ‘Option A: The name shred ceksional corde st arosaredn the OSM ‘utten wa removed nthe DSM ae own ent. Any idan wh & ‘Shard dousinal sotdor got the dognoss ef aeusina cord ‘Option B: el Sopaation ' nocossaryto aw eters ntuonce realty testing, Belg olntedto the cove reaorehip withthe acto ncwidualwth Related Videos: First Aid References: Frat Ad forthe USMLE Step 1 2019, 29h oh: 548 Fst Afr the USMLE Step 1 2018, 2h 544 Fst A for ne USMLE Sp 3 2047, 27409580WS Sex beeeUuNaaveeesersnarecaceese eee ee eee ere eee Sen ee tab 9 Se eee. | asco ee ope cote eee Sees, = ‘Option A: The name shred cesiona order st appeared nthe OSM ‘ulten we removed nthe DSM Sate own ent Anya in wh & ‘taro deusional dsotdar gots the dognoss ef aatusina corde ‘Option B: me Soparation ' nocossayto aw cers atuonco ratty testing, Being kolsodto the cose elaonship wh tho actveincvidual wth ‘the delusional dsr doris thought nparttocentibute ots phenomenon of ‘Option: Arpsycnotics are the fst he eatment ofthe celustonl lsorder Insitutions where hoor more people ae raved, i aparaton ofinolved partes is hlpuin increasing sources of realty toon, ‘OptonE: Cognitive behaworal therapy s partly nefectve in dekstonal ‘dsordrs. By defn, delusion are feed alse bots and hance are Lurmateabie to psyenstorapy. The snes pharmacotbrapy wh antoschots, Learing objective: Shared delusions dsrder which sehr known {ole deus nowsimpy logosed a a Selisioral order foreach ‘navaual voted. Teanentncudesantpsjehotes and ta separation. HctWS SbebeeeuuNaaveeesercnar ‘47. year-old man's feta othe outpatient psych cinco dopressed mood, He was dagroced wth pancreatic cancer recent, Snco thon he has not boon able ‘ogo to work Over he past several weeks, he has had simian unitentena \wolgt ss and Sovoral bouts of epgastic pan. Hoot is father to cancar when ho was 1 yoo ol. fer 3 complete hor and physica xamination the patents lagnosed wih majer depressive deorde, provisional. Which ofthe eller Statements eoaaing his patents payhitic canton sue? ‘A Te paont must me arden cr doprossed mood, £8. Ts patent may have history of lated mood © C.Thispaventnae preserved acl and aecupetenalunetoning. (© 2.Ths pasemtmay neve pressed speceh, 9 E This patents symptor: musthave boon present fr atleast sontWS SbebeeeuuNaaveeesercnar Lesva ‘47. yoorots man's tote othe oupationt psycnaty cnc or depressed ‘mood, He was dagnosed wth pancreaicancerrecanty. Since then heh not been able o go to work Over te ast several weeks, he hs had sinficnt Unitertonal weight oes and sovral bois of opigesic pa, Ho ot is father to ‘cancer when he was 10 years ok After 2 complete istoy and physical fromination the patient dagposed wih major depressive deed, rows ‘Which fhe folowing statements egording His paentspeyeatic condone {A This patent mst have arhedoria or depressed mood. 18. Ts patentmayhave a history of lated mood CTW patent nas preserved soil and occupational tuncionng .This patent mey havo pressured speech guue f Thispatents symptoms mosthave been present or at ast Result: @ covet" ” = » gees Explanation: ‘Comect answer A: Nood disorder desc pattem of need episodes. A ‘mand epeode cn be did mod aust of te neal goth ‘some lve of loss of contro. Mood srders include moor depressive otedo have an axoused autonomic systom.Symptams canbe memodzed by the mnemonic PARICS! Abdominal rss + Nowses + ches pon choking + Sweating, short of beath ‘The fete prevelene can be up 1 ofthe general popuation. occuring ‘mote common in fomales. PO may be mutfactral bu has been shown to hve 2 tong genetic component Ago of onsets usualy around 25 years PD Related Videos: © Mie Dans arcane First Aid References: Fst A forthe USMLE Step 12018, 2h oa 551 Fst A forthe USMLE Step 12018, 2h: 547 Fst Ad forthe USMLE Step 12017 27h ch 533WS see be aeuuyzaveseserss Lesva ‘Chost pan enoking Shooting. shortof breath ‘The tine prvalone can be up to othe general population, ecuing ‘mote common in foals. PO may be mulfatral but hasten shown to have tong genetic component Age onsets usualy atouné 25 years. PD ‘ten has a rene couse, ann up 0 20% of he pan the symotoms can become debitating. The single best reatment is selacte serotonin reuptake Inter (S56. ‘OptonB: By detnton pane deorder har recurant and unaxpacted stacks. ‘Option: There tno spect rumber of stacks hat psient must havin ‘etda tebe eiagnosed win panic asoxde ‘Option D: Symptoms need ony last fort month or mateo 2 lags ot ‘Option: Tho tear ofnat bing abet escape fete of agraphada ‘Agoraphobia con occur wah oF without pane sore. nether e958 he alerts merely aad of not beng able to get te appropriate hep or escape ‘Loamingobjacv: Patan with panic casodor nave cure ant ‘unerpected parc attacks. These usually lst fora month or longer and aro [sesonntdweh tar ort ne tack anor enange Denavir elton Fst Ad forthe USMLE Stop 12019, 29h od 551 Fst Ad forthe USMLE Step 12018, 25 od: 547 Fst Ad forthe USMLE Step 12017 270 dh 533‘ho pt ate cated to vestige a domestic asurbanco. The neighbors topo hearing. aman shouting" gonna il you" forthe pas 30 minutes flowed by ‘ecasonl screaming. The house wes only recent cecupled By RE new ewe, 3 milo. aged vy Tho poco wer gcc ao door by a man ling @ broomstick When askod wht the disturbance was about he admitted to sing ‘eemely take spor and had come across cne a he was unpacking. What would be the sng bes couse of westment or patent? ‘& Cognive bohavra orapy 8. anectyoes ¢ Berzodezepines .tcpressas E Bototiockers‘ho pt ate cated to vestige a domestic asurbanco. The neighbors topo hearing. aman shouting" gonna il you" forthe pas 30 minutes flowed by ‘ecasonl screaming. The house wes only recent cecupled By RE new ewe, 3 milo. aged vy Tho poco wer gcc ao door by a man ling @ broomstick When askod wht the disturbance was about he admitted to sing ‘eemely take spor and had come across cne a he was unpacking. What would be the sng bes couse of westment or patent? WS se ebeaeuuNsayvEsesees|eas¥usuavusesaes| gees Explanation: Ccorect answer A: This patient hae specie phobia for an animal a spider to be pede. His fer is dseroportonate othe abject and has parssied eo is {voidance behavior There emated ders rknpaent, ae anahee ‘dsorder does nt beter explain Other subtypes nude natural envionment (09, fom of Meccan stunned jection juny, and ctor, ‘Te amy responsi fr nating our foo tesponsos. modulates he exrcharorl acon vite hpothalame-putar-adrenal axis. The preronal center nbs the amyeela when is netneedee The ‘ppocempus cn be thought of the medatr betwoan tom alps by cide wernt ete emnv a wordt ren fr ore of ‘he eye the smygaine clined tone amit ne» cangeroue eae. Bt ‘acettonaldetatssurounding he Stick such 5 ho mia of watt and {hat snes ar cold blooded anal, can hel suppose tat il smultion, Peters with specie phobia Hay lerned thei farrooponse i clastic onctoning ad ths can be unleared wih cognitive behavioral therapy {BM Patents may nocd te meaty thar thoughts regrcng thet phobia and lator uso exposure tactniquas oexngueh that fare, systematic esenstaaton Related Videos: Phobias First Aid References: Fst Ad forthe USMLE Step 1 2019, 2h ed 551 Fst Afr the USMLE Step 12018, 2h oh 547 Fst A forthe USMLE Step 12017, 270 e533,Wess reeeeuuaaavesesees| ‘ppocampus cn be thought of the mediator between then: lps by ‘2cng context othe equation Ifa wooden stk is seen om the corner of (hn oye ery stn ok ightbn odengaro snl El accom deta sounding the eck sich ae the mle of wrt an {hat snakes are cold blooded animal, can help suppress a also, Patents with speci phobias hel learned the fear response via cessle ‘condoning and thus can be unleated with cogntive betas therpy (CBM. Povens may need © meaty ther hough regrcng thet phobia and later use exposure tectnique to exingush that fear eg, systematic esonstznton ‘Option BC: Analyse as benzodiazepines (Option C) toon best voided because of thor akctve potontal Artes are aay frst-ne or stand-lone therapy fer ancetycsordars sich as specie phobias. stead, toy may havea ein concomitant use ‘option D: Aridepressans, such as selectveSeotonin uptake MNS, Provide somo aricly fb However, they are ifr ao slo thotpy to COT fox specie pba. ‘Option Bet-bockers a drug commenty use for caro conor. can be sede decteae some ofthe autonomic symptoms, They may have & erect talein calming 2 patent down st oto a speech or animporant Interven bt havero partinteatng he specie phot Leaming objective: A spec phobi an arwety oor ae fs most ely leamec trough ene condoning Patents can beeen rates th Hct Fst Ad forthe USMLE Stop 1 2018, 28h od 547 Frat Aid forthe USMLE Stop 12017, 27 ec 533Beebe beeeuu Naar uses eel ‘4.48 year-old man ant is vt prosonttoapsychologsts ofc tor a terapy scsi. He wos enecuraged to vist the psychiatist 6 ments ago by his wife and ‘theyhaue been meeting wth he pychsogiet several mes month eve eines Ine, ho was concerned abeubichaoral changes she cbservad ae bo Wes posted up fora prometon at work, She felt ho was aking on a new prseralty and was acting ike is coworker, wh acwal ed getthepromatn. Ho woul so Wak about is comorer ana praise hisaetigence and suategi character Ove the mans dothes He changed hs have and stated using phases that were sist ‘ois coworkt Tey. they beth seem wel. The patent silldoes pet seam think hor hisband recent bought ew a of he exact aks an model oie coworker Which ofthe folowing defense mechanisms best descrbes ths patent's conden? 8. conversion invojcton © D.Regression © ESptitingBeebe beeeuu Naar uses eel ‘4.48 year-old man ant is vt prosonttoapsychologsts ofc tor a terapy scsi. He wos enecuraged to vist the psychiatist 6 ments ago by his wife and ‘theyhaue been meeting wth he pychsogiet several mes month eve eines Ine, ho was concerned abeubichaoral changes she cbservad ae bo Wes posted up fora prometon at work, She felt ho was aking on a new prseralty and tear actng ke is como, who atl get he prometion He woul eo wok about is comer and paises ineligence ond state catacer Over the course of overs manta the palin bus new clothes tat looked Bk the other aris dethes. He change his haste an started using vases that were stn ois coworker. Today. they bet sem we The patent sl doesnt seem because her husband recety bought anew car fhe exact make and model of is comes Which ofthe following defense mechanisms best deserbes this patient's © A Sublimation co 8. Converton 8 Cmwejction a8 E spitieg mm ee” = » = Explanation: ‘Correct answer: This pation wing inojectin, an immature ego doers mechanism Hes repiicatng characteristics of is Cowher, who I Success oe dete machariams ate unconsclous ations that ae supposed they prevent unwanted feetngs. They ebb mediate reactions tinea conic ‘uigpeted by edema sossos. Mase mechan ate cassie nto arent rus mature, rmatre paola, and neurobc Vollants Casifcaton of Ege Defense Mechanisms Psychotic vote aston of atty + etusona + Dena Inmate Maladapve reactions to confiet_ + Projection + typocronerasts + acang out Nowrtic temps to change ieas ane + Displacement Related Video: © meee compute Beat oc (0c: ype Aesessment and Teatment First Aid References: Fst Ad forthe USMLE Step 1 2018, 29% 0: Fst A forthe USMLE Step 12018, 2h oh: 547 Fst A forthe USMLE Step 1 (2017, 27 ec 533‘Vattants Casitcaton of Ego Datense Mechanisms ‘Psychotic Involve distortion of reality Delusional First Aid References: on Fra rhe USL Sop 2019, 2 Shani Fro Ar beUBMLE Sep 120,208 0 07 Fst Ad forthe USMLE Stop 12017, 27th oh 533 Inmate Meladopive reactions to confit + ‘Projection Hypochensnasts + acang out Neurotic temps to change eas ane + Osslocement feolngs + Repression Mature Adaptive reacons to conict + ateuem + ‘Subleaton ‘Option A: Subtimation sa mature ogo detnso and raters to satjing 2 ‘negative impulse or emotional response wit a secialy acceptable substton, Fer example pryical aggressions channeled oa sport ke hockey eno ‘Option B: Conversion sa psychote ego defense teers to thentrnalzation ‘ltecings and emotion and conversion ino phys spt such 08 prays or bngnes. Thi ao eal yatta. ” = » =Beebe beeeuu Naar uses eel Mature Adapt reactons conic. + aleuem ‘Option a: Staton sa mate ogo detnso and raters to satsjing 2 egatve impulse or emotional response wi a secialy acceptable substton, For example pysical aggressions channeled into a sport he hockey eung ‘Option B: Conversion ia psjchote ago tonsa. trator to thointrnalzation offetings and emotions aed conversion nto physical symptoms such as parayse or none. Thi sin ele yearn. ‘Option D: Regression fa nowt eg defense ae erst em porary eetsion oan eat stage of developmentinespanse to an enema sess. ‘Sranple fregreasion chad thumb sucking ara wenn. ‘Opton:spiting a patoioge ogo defense mechanism. The paint wal defense mochansms ate unconscious actions tha are ‘supposed to eb revert unwanted footngs They help medio reactions to ‘stoma cones vggeredby sera sresor.Thees mechani ro lasted nto ferent groups: mature, nature, pact and neueWe seebeeeeuysayeees ‘1 36 year-old woman presents tothe oo fr aout exam. Sho nas no ‘complains an offs vory to nformaton voluntary She answers och aueston ‘wth sof sor sentences and avoids eye contact, She appears maou and ars thar is Sono ofthe very fw tines Sho oaves tho uso. Medal stony sianfcant reson hypertension Sho teks ygroclorothiazie area daly amin every ay Se hae worked rm home ae ab graph deer for 20 years: Upon askrg question about he soci fe, she states ha shes very Sy ‘rth fw tert nd often sees vet to avid patient soci gehen. Despite sche expresses a szong dsr oben aelatonshp, dey. he blood presses 25/85 mm Ho, neat fate 95m, respustry ate im, a tomperatrs 370°C 68.57) On physical exam, her heat has 3 regu oto and ‘tytn and ner ings are clear to asco latraty Wich ofthe fonng ‘ost constr wh her behave? © A toy aysmorpni serdar 1B, Shield personaly asorder (voident personaly esorder (© D.Anacocalpersonaty asocer © E Agoraphobiasafes: We seebeeeeuysayeees Lesva ‘1 36 year-old woman presents tothe oo fr aout exam. Sho nas no ‘complains an offs vory to nformaton voluntary She answers och aueston ‘wth sof sor sentences and avoids eye contact, She appears maou and ars thar is Sono ofthe very fw tines Sho oaves tho uso. Medal stony sianfcant reson hypertension Sho teks ygroclorothiazie area daly amin every ay Se hae worked rm home ae ab graph deer for 20 years: Upon askrg question about he soci fe, she states ha shes very Sy ‘rth fw tert nd often sees vet to avid patient soci gehen. Despite sche expresses a szong dsr oben aelatonshp, dey. he blood presses 25/85 mm Ho, neat fate 95m, respustry ate im, a tomperatrs 370°C 68.57) On physical exam, her heat has 3 regu oto and ‘tytn and ner ings are clear to asco latraty Wich ofthe fonng ‘ost constr wh her behave? 2. Bea aysmophic disorder 2B, Shiai personality asorder Avolent persona csorder 0. esocal personaly sender Agoraphobia Result:‘W ” = » gees Explanation: ‘Corect answer C: Tis ptont presents wih symptoms that ae consistent ‘eh Avoidant Personally Deore The OSM Soups personaly orders Imo clusters. vlcant personel sore (APD pat cust ‘soi th ary. Paton with APO ae aso eacessvaWy shy with ow soesteem. They Seo themsetes 25 socaly inept, and therfore, voids al sil gaterngs an confentatons tf mportant to nate tha they donot el they have a problem, and tus i Bo non compllont wth weatment. Th DSM ca for avokoe personaly sorder is 35 follows: DSM 5 citer for avoidant personality disorder APO) “Auten ofzocl nbn, hyperscratty, nd featnge of Inadequacy since early acutnood 2 Atleast 4 of the folowing must be present + Avoids occupation that involves ntrpercena cortact du oa far of cetsm and rejoction + Ung to inorct ess cetin of bng thee + caitousofinirpersonal relationships Related Video: © eer reenat Sees First Aid References: Frat Ad forth USMLE Stop 12018, 2h 552 Feat Ad forthe UEMLE Sep 12018, 20 wt 549 Fst Ad forthe USMLE Step 12017 27h ch 535a We seebeeeeuysayeees ‘thomeetes 25 social inept, and therfore, voids all zl gaterings and corfertatons ts important te not that they donot fel they have 2 problem, and wus, il be non-complont wih ueatment The DSM eta {or avodont personality order ia flows: OSM 5 eel for avoidant personaly sro PO) “La patio of soca inblon,hypescnstuty, nd footings of Inodeusy nee carly acthood 2 atleast of he folowing mustbe present + vids occupation that involesintrperscnal comtact de o fear of cette and eection + Cautousofitrperonal relationships + Precccuped wth being cilclzd or rejected n sci tuations + ined in now soci stuatons because he she feo inadequate + Boteves that he or she socal nept arene + Raluctantto engage in new aces fr fear of embarassment ‘Option A Indus with body csroreic order have a goes msnorpctton or exaggoraton a usin tax physica fates. Thay do ‘ethave any apparent asiguatiors, but ela hey de and undergoes ‘uote plat urgenee ana extreme erections fr etneton.thoigh {hs patont ha low so-stoem, she docs not have a percoptualpobirn about her appearance Option B: cto personaly cnarder i snl in tho sense tat hey Keep to themeates, te loner However, chic have no arse or preoccupied First Aid References: Frat Ad forthe USMLE Stop 1 2018, 2th of 59, Frat Aid forthe USMLE Stop 12018, 28 e549, Frat Aid forthe USMLE Stop 12017, 77 53S (Ia ” = » eather appearance. ‘OptonB: Schizoid personaly esorder smi in the sence tat hey keep to smemsctes atu loner However shacks have no anxiety or prooccupiod wah how others se thom Schizot personality is part of custo A, associat ‘wth oe and eecentic related symptoms. The main ference between these ‘wo condos that aesdant personalities stongly deste toe accepted by socey whe schizo porzanalite simply do nol ete. ina sina oa nonitam ‘Sentero ae ‘Option D: This patent oes not the cri fr ance parsonaty ‘sordoc This group has a pater of volatng the ras of thes. Tey usualy hve n problem hing or stoaing andotenactimpukel Option E: Ths pint my hve soci ney, btherclectve symptom eae= G ‘Option D: This patent oes ot the ctl for anol parsory| ‘sorde This group has a patern of voltng theres of thers. Tey usualy hve ne problem hiner stoning andlten actual, ‘Option E: hs patint may have sci andy, buthercolocve symptom suggest a personaly sore, not» phobin, Agoraphobia she ear ofan {Greate enaronment wth ne escape, Leaming objective: Avcicant pereonaty Acordes unser cluster C of petsonaty srders. Symproms Include excessive shyness fata ejection ‘nd abandonment avokdng soc unctlons, anda strong dest to be accepted by society. Scio patients ae loners ané donot cre about bing accepted ma secey We seebeeeeuysayeees becWe seebeeeuuyaayveees ‘8 2tyoa-ld woman's acid oho hosp for Sovte manution wih a BML ct 1 ki, Past medial storys sionticat for conic nore nervosa, Ding the ‘ours of here, ae teste wrth parenteral si at ton management On| ‘to day ho status changes, Her ood prssute is NOV75 men Hg, hoa ates {2otmin respiratory ate 25inn, and temperature is 320% (88.6. On physical ‘ora er ears tachycarce wth a regu thm ae her ung re cea to uscltaton bist She appears contused, soit and tated, Strength ter lower etromitis 4. Whol is th net sap in maengemend? A. MR bean (© 8.Arange for outpatentcounsetng © C Mossi aocroyos minster sn £ Doppler utascunt on ker exons‘8 2tyoa-ld woman's acid oho hosp for Sovte manution wih a BML ct 1 kim, Past medial storys sionticat for conic nore nervosa, Ding he ‘course of her say, she tested wth parenteral ul and nutten management ‘Onto at day. nor stats changes. Hr bod pressure te O75 mm Fg oat ato is 120i, esprator rao 25min, and temperatures 70°C B.EP).On Physical oom herheat is cheat wih regular rm ans her ngs are dae ‘wo ausctaton tate She appears contused sore ae apa Seg hr lmer nvraoc 248 hate nat ep gas? Bm) | = A narmeicam o ” 2. Arange fr upon couse o <= Monae lacrobes mm : Adtran ™ : Doppler utrascund on ower extomites * Result: We seebeeeeuysayeees Lesva” = » gees Explanation: ‘Core answer This paint is suteing from refeeding synome wth signs and symptoms of lecvoye disturbance Eleclytes should be ‘equal measured ane crealy managed. ny abnormeliy should be comected, The most common dstrbanceishypophosphatemi. In sats of starvation ital ness or major surgery he body undergoes ‘etal sees. Under nema reimtanoss th boo izes sini sous of cabotarates. tata potin but na fasting sate the body ches to using stores of glucose favcogen nto ve and keotl muscles ‘igyeerdes (red in adpose ste and faty ac (stored nacposetssue) land amin a em most tssues an espocay in msc). During unos of {sever starvation. otter changes occ Red bood call Segadstion shite (teteeang. insula secretion fetus to nema a response to elevated eves of blood ‘lucose. sun inceases anabote acy touzpout he body ncaNg lcogenes pt sythess, and poten shes. These processes equre hesphate. mognesan, and ptasiun, and elecvoytes become depleted ‘sulin in typophosptami, hypomagnesemia, nd hypkalania Tho ew prowde source of sources stiulatesthe Iver an! skeletal mice Related Videos: Extra Dre Adolescens Bulmia Nervosa & Anorexi Nerina First Aid References: Fat Ad forthe USMLE Step 1 2019, 29: 555, Fst Ad forthe USMLE Step 12018, 28th 0: 550 st for tne USMLE Stop (247, 27 ox, 557‘sul secretion tus to noma respone to elevated ves of blood ‘lucose sun inceases anabolic acy tnousheut the boy incing ‘lyeogenes a syahess, and potin sytess. These procosss que ‘hosp. mgneskan nd ptassion, ad elecrotes become depleted ‘sulin n hypophosphatemi,hypemagnesemia, nd hypokalemia The ely provide source of esoucossulates tho Iver and sheet muscle Into moking ATP and doping srum phosphate even moe. Refooding Synaral aeons wn the th dy of resent wh lees Asordrs and eatin compheatons such a5 hs patent. “Tochycataa and aria amhmias ae he st symptoms ane the most ‘commen eases of deat re sete hea fore ae cecoc entra. Tt ‘best eatment fr refeeding syndrome s prevention. Feeding shoud be how ‘and seco lees and should be monitored ely Regul physica inciing a croc anesomerd shouldbe prtomed. Ary electro ‘lstrbances shouldbe corected releedng symtoms uxpected tow fecing even futher and reevaluate electra love, ‘Option A: Other more common contns should be ued out nth patient Defoe cnsidaring an MAL MRS ao expensive and me consume an il key not stabs a dagnoss inthis patient, ‘Option B:Fefoodng sndrome affects up to 25% of pains with ores ‘evans When not ecagrzed and West, a numb of mee! cone mone ‘ensue, nduding the carcovescla, pumonaygastowestal, and nexrcogic systems, Based on th physical digs ts aly that is patent ‘oe an dating seco dtrbance whic al reqare hosp ton ‘Option D nun secretion the rime cpt in restarting the biochemical rocesses to eat Invaceulyenatay an using ub serum elec We seebeeeeuysayeees‘detrances shouldbe corected. refeeding syns uxpacted, sw teaang even futher and revauae elect eves ‘Option A: Other more common condtions shouldbe ued out nti patient Delo considering an MRL MRS ao expensive and ne consume an Wl ly not estab a dagnoss inthis patient ‘Option B:Refeedng synrome afc upto 25% of pars with ores ‘evs, When not ecog7zed and West, a number of mel coneatone ‘ensue, nding he celovesclat pumonaygastoumastal, and pexroogle ates, Bose on tho physical dings ts kay that bs patent o has an unsenying electro esturbance, whieh wl requrehospalzaten, ‘Option D nsun secretion th prime cup in restarting the biochemical processes to cea nace enagy and using up setumeletoyes. ‘amiitereg eutn wil worzen the malance ‘Option E: Dapper erascund cued to dtect deep vin trombose _atents wh pf swoln, and etethromaese lower extents. deep ‘von thrombosis ao sual untoa. This patent's muscular weakness Is ota nomuzoigiea probe, We seebeeeeuysayeees Leaming objective: overs maincurshec patents hat beg o oat again te high sk refeeding syndrome, Symptoms nude tachyeard, oth, {onfion, orantaton agen, ans wales, There patente ehoide ‘arty mortor incuding cate psc am th a focus on cardiovascular healt and olecrlves, Ary elect abnormal: shoud be orecod immediate, refeeding symdrome suspected slow feeding chock for cotovaselarabnormaties, nd evaluate ecvoye ves. HctWeseebeaeuusaayeeal ‘A 25,yoa oc woman presents 0 mo cfco complain boating actoctng ‘od tho me. Past medical notes on record show that she as seen sever octors at ho cs nthe pe yea forthe cameconcems. During the dlecssion sho ads tat coming to th doctor infnsiis nor ant and she coos ot voy i: However sos hore because sho fears that she has colon cance and 97s "Theres gota bo someting wrong with me can eel” Past medal sty i slgnscant or chsesive-cmpulsie dace (OCD) She ees a therapist ew pressures 20/80 mm Hg, Heart rates 90min. respratery at mina he Temperature 370°C 98.67), Pascal amination evens o weknoutshed wal developed woman wo appears arcu andted, Her hosthas areata ‘tytn and ners are lero ausctaton bistraby He abdomen sf. non- ‘tender nan-dstended. Nomasses are palpated. Aig etl exami negatve Laboratory resuts ate fotos ‘Serum Chemisty Henesobin ‘Bok Hematoent 2% 13H suum Fecal cccutbood est negate Whi fhe tolowing the mesty agree? © A Malngerig © 8 Somatic symptoms derese ea Valo} cn