A 42-year-old man comes to the physician for a routine health maintenance…, 37. A 20-year-old woman is brought to the emergency department immediately after…, 41. Guess she has major depressive disorder even though she doesn't have 5 diagnostic symptoms that lasted longer than 2 weeks and none of them include depressed mood or anhedonia. Report Abuse A 10-year-old boy is brought by his parents for a well-child examination. Out of those two MDD is the only thing in option choice. He appears cachectic and is staring into space . Depression is very common in older populations, especially females. It's like wanting to diagnose someone with a migraine because they have irritability, decreased concentration, and a visual aura but the person never even said their head hurt. "Since symptoms can increase in severity during the night, it could become difficult to fall asleep or return to sleep after waking up", "RLS is one of several disorders that can cause exhaustion and daytime sleepiness, which can strongly affect mood, concentration, job and school performance, and personal relationships. Psychosis sx, ddx: schizophrenia, mania, depression, delirium, and dementia, and it can be substance or medication-induced. There is a clear association between pancreatic cancer and depression. A 46-year-old woman is brought to the emergency department in respiratory…, 10. After she gets into bed at night, her legs feel cold and crampy, and she cannot settle into a comfortable position. A 32-year-old man is brought to the physician by his wife because of increasing…, 28. Bacterial pneumonia. paroxysmal nocturnal dyspnea: PNH is a hemolytic anemia. A 3 1/2-year-old boy is brought to the physician by his parents because he has…, 13. Are they saying he is at risk for major depression as a result of the cancer diagnosis? He is 168cm (5ft 6in) tall and weighs 50kg (110lb), BMI is 18hg/m2. A healthy 4-year-old girl is brought to the physician by her father because of…, 20. 6) Schizoaffective disorder • Delusions or hallucinations for ≥ 2 weeks in the absence of prominent mood symptoms • Bipolar or major depression with psychotic features have psychotic symptoms occurring exclusively during mood episodes (this patient is still having psychotic features even though his mania has resolved after hospitalization) I chose MDD: NBME Answers and Explanations! This code is grouped under diagnosis codes for mental disorders. Encourage the family to come to a consensus based on their perception of the patient's wishes. Opioid withdrawal –> mydriasis, diarrhea/GI complaints, etc. Increasing cGMP. Strangulation. Sinusitis. Translation. For the other cardiovascular factors, the only ones proven to improve mortality are statins, ACEi, BB (esp. Amphotericin B. 1) terminal insomnia +/-disorganized thinking/behavior. A 47-year-old man is admitted to the hospital 20 minutes after he was involved in…, 25. Source: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet. hypnoGO to sleep = night time hallucinations. Free 120 NBME 24 NBME 23 NBME 22 NBME 21 NBME 20 NBME 19 NBME 18 NBME 17 NBME 16 NBME 15 NBME 13 home login register ⋅ contact ... Major depressive disorder ... or advanced cancer of any kind that would require aggressive treatment with poor prognosis would be associated with major depression. Patient with >2 week history of SIGECAPS symptoms (specifically Sleep changes, Guilt, decreased Energy, Cognitive dysfunction, Appetite changes) and somatic symptoms most consistent with major depressive disorder; Adjustment disorder would not have as severe a presentation; Borderline –> Chronic time course A 52-year-old woman comes to the physician with her husband because of a 6…, 36. Almost as bad as incorrect presentations of common diseases. Helping medical students navigate 3rd year exams, 1: An 82-year-old man comes to the physician with his wife because of difficulty…, 2. A 10-month-old boy is brought to the physician because of irritability throughout…, 16. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet. A 20-year-old college student comes to the physician because of a 1-year history of…, 21. The patient is started on escitalopram and scheduled for a follow-up appointment in two weeks. Plus, old age is a risk factor for MDD. acetametophin toxicty I put compression but i honestly have no idea.. will try to find out Paraganglioma. Patient with depressed mood, decreased energy, poor concentration, and sleep changes (consistent with major depressive disorder) following initiation of propranolol, most consistent with medication-induced mood disorder; 14. Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. A 37-year-old man comes to the physician for a follow-up examination 3 months…, 19. * Re:NBME 13 discussion #2616243 : smadahar - 03/14/12 17:31 : 1. major depressive disorder - it's in kaplan behavioral science 2. Paroxysmal nocturnal dyspnea = breathless awakening from sleep, seen in left heart failure. A 53-year-old woman is brought to the physician by her husband because of…, 40. An 87-year-old man who resides in a skilled nursing care facility is brought to…, Decrease the dosage of carbidopa-levodopa, 24. Fifteen minutes after administration of intramuscular haloperidol, a 21-year-old…, 15. Fifteen minutes after administration of intramuscular haloperidol, a 21-year-old… Dopamine NBME Answers & Explanations. A 24-year-old male college student comes to student health services for a follow…, Maintain the current dosage of sertraline and schedule weekly follow-up examinations for the next month, 27. Plus I thought you need 5/9 of the SIG E CAPS to diagnose depression. >>brief psychotic disorder: sx must resolve <1 month; Schizophreniform b/w 1-6 months. A 57-year-old woman comes to the physician because of progressive loss of…, 3. A 32-year-old man comes to the physician because he thinks he might be losing…, 43. 3) periodic leg movements could be REM Phenomena where muscles are not paralysed during REM sleep. I agree that MDD also requires a bit of a stretch bc not all of the diagnosis requirements are met which is annoying, but at least the core components are there (decreased energy, sleep disturbances, lack of concentration), whereas the core component of RLS isn't there at all. A 67-year-old man with Parkinson disease is brought to the physician by his wife…, 48. he has no chronic medical conditions and currently takes no medications. A 37-year-old woman is admitted to the hospital after a suicide attempt by an…, Decreased concentration of 5-hydroxyindoleacetic acid in cerebrospinal fluid analysis, 35. Report Abuse A 32-year-old man is brought to the emergency department by his roommate…, 12. There is a 1 × 1-cm abrasion in the right frontal area. NBME Clinical Neurology Test A 57-year-old woman comes to the physician because of a 2-year history of difficulty sleeping. Major Depression. 4)In sleep apnea the patient has poor quality of sleep but doesn't awaken. A 47-year-old woman is admitted to the hospital because of a 12-hour history of…, 31. It's not a great question and I completely missed MDD as well, but I can kinda see now why it's MDD more so than any of the other choices so it's kind of a "but which is the BEST answer" scenario. The lady w/ poor concentration, decreased energy for a month, and 6 months of waking up in the night. A 32-year-old man with major depressive disorder has had the sensation of insects crawling under his skin for 2 weeks. He does not respond to verbal stimuli. His…, 45. Major depressive disorder. Thus he meets the diagnostic criteria for a major depressive episode, which means that treatment is indicated with an SSRI. ICD-9 296.21 is major depressive affective disorder, single episode, mild (29621). * Re:nice NBME Q #2959249 : arvantaj - 09/23/13 11:21 : Everything fits major depressive disorder. When he went to the dermatology Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. He was initially treated for scabies in the emergency department. * Re:nbme 15 #3049368 : alexa22 - 02/16/14 16:11 : B - Major Depressive Disorder is correct. Many people with RLS report they are often unable to concentrate, have impaired memory, or fail to accomplish daily tasks", "RLS occurs in both men and women, although women are more likely to have it than men.". You may hear your doctor call this "major depressive disorder." A 25-year-old woman is brought to the emergency department by police because…, 23. A 13-year-old girl is brought to the physician by her mother because she has not…, 6. He has a 35 year history of major depressive disorder and has attempted suicide twice. The PCP diagnoses the woman with major depressive disorder with mixed features and with anxious distress. A 42-year-old woman comes to the physician because of suicidal thoughts…, 33. He's jaundiced, and basically has a mass in the head of the pancreas that has extended into the stomach and biliary system. Multifactorial. He's most at risk for: major depressive disorder. Herpes simplex virus. A 16-year-old high school student will not eat meals with her family, preferring to…, 34. You might have this type if you feel depressed most of the time for most days of the week. A 42-year-old man is brought to the physician by his wife because of a 2-month…, Focal spikes localized to the temporal lobe, 49. A 21-year-old woman is brought to the emergency department by police after…, Admit the patient to the psychiatric unit, 8. ... Major depressive disorder. A 21-year-old college student comes to the physician because of a 3-year history…, 39. 21-Hydroxylase. A 22-year-old woman comes to the physician because of a 3-year history of intermittent…, 4. Area labeled A (Cranial nerve III) A - not accusing him, but trying to get it out of him 3. A 27-year-old man comes to the emergency department after a motor vehicle…, 29. His blood alcohol concentration is 0.5 mg/dL, and A 37-year-old woman is brought to the emergency department by police…, 47. Schizophrenia >6 months. It is not a paroxysmal nocturnal hemoglobinuria. NBME 21 Answers ↦ nbme21/Block 3/Question#41 A 75-year-old woman comes to the physician's ... Major depressive disorder ... Depression is very common in older populations, especially females. A 17-year-old girl is brought to the physician by her mother because her…, 11. Intravenous infusion of 0.9% saline for 5 minutes. This question is describing terminal insomnia, which is common either in MDD or normal aging. A 62-year-old woman comes to the physician because of auditory hallucinations…, 5. A 77-year-old man is brought to the physician by his wife because of a 6-month…, 38. Introduction: Mood state, syndrome, and/or mental disorder characterized by dysphoria (sad/irritable) Examination shows an extremely agitated and suspicious patient. Is that valid reasoning? narrowed down to MDD and restless leg then convinced myself that elderly are at higher risk for MDD than RLS. A 47-year-old woman with schizophrenia, paranoid type, comes to the physician…, 7. Retinoic acid and HOX gene products recognize and bind to specific DNA sequences at various chromosome sites. Young patient with 2-month history of depressed mood + impaired cognitive function + low energy + decreased interest in socializing thus meeting criteria for major depressive disorder; Formal definition of MDD: At least 2 weeks with at least 5/9 of the following symptoms (1. It is 6 weeks (more than 2 ), psychmotor, flat emotion, dementia, sleeping problem, poor hygiene,decreased appetite (reslts in weight loss) . A 67-year-old man comes to the physician because of a 2-month history of increased…, 9. A 42-year-old woman comes to the physician because of a 2-week history of…, 42. "the symptoms typically become more frequent and last longer with age". We are not affiliated with the NBME, USMLE or AAMC. pain for 2 months and weight loss. Patient with a significant alcohol use history who, Patient who falls asleep late at night and feels tired during the week when she has to wake up early but feels well-rested on the weekend when she can sleep until later in morning/afternoon, consistent with a, Patient with major depressive disorder who would therefore have, Patient who develops an uncomfortable sensation in her legs while trying to sleep which makes it difficult for her to sleep, Older patient with dementia + visual hallucinations + parkinsonism (shuffling gait, akinesia) most consistent with Lewy body dementia, Patient with obsessive compulsive disorder (recurrent thoughts of hurting people and performing violent sexual thoughts [, Middle-aged woman presenting with progressive, Patient with history of panic disorders (short episodes of dizziness, flushing, fear of dying, and anxiety), Patient with recurrent thoughts of hurting his son that are causing distress, Overworked surgery resident who presents with sleep disturbances, Middle-aged man who recently sustained head trauma who has since developed intermittent episodes, Young child with trouble in school who is. Common symptoms of depression include SIG E CAPS (including insomnia). I also did this NBME form online with extended feedback and this was the correct answer. Pancreatic cancer is still one of the malignancies with the worst prognosis and therefore it seems quite logical that it is one of the malignancies with the highest incidence rates of major depression. 296.21 is a legacy non-billable code used to specify a medical diagnosis of major depressive affective disorder, single episode, mild. The answer explanations may not be reproduced or distributed, in whole or in part, without written permission of Step Prep. A 47-year-old man comes to the physician because of a 4-week history of…, 14. Major depressive disorder. A 27-year-old teacher comes to the physician requesting a prescription for sleep…, 32. 1,000 characters at a time (or fewer), please! He does not use drugs, but his mother states that he frequently drinks beer. This code was replaced on … Depressed mood 2. Residency Advising and Interview Preparation, Patient is displaying normal age-related changes (early morning awakening, falling asleep during day, normal mood, Mini-mental state > 23), Woman who experienced a significantly traumatic event and has had persistent mood symptoms and, 13 year old girl who has not yet menstruated, Switch from high-potency typical antipsychotic –> atypical antipsychotic will decrease risk of developing tardive dyskinesia, Patient who threatened her boyfriend with a meat cleaver and states that she would kill her boyfriend, meaning that she poses, Reasons for involuntary psychiatric hospitalization includes patients who as a result of a mental disorder, In NBME, TCA overdose almost always associated with, Benzo and barbiturate overdose appear similar to, Patient with depressed mood, decreased energy, poor concentration, and sleep changes, Patient recently given haloperidol who develops, Injuries that are consistent with child abuse include, Long-standing schizophrenia –> Symmetric enlargement of the ventricles, Young patient with ADHD and Tourettes who receives, Patient with severe alcohol use (>14 drinks/week in adult male or >7 drinks/week in adult female or elderly patient >65) who also has, Social phobia = Social anxiety disorder = Exaggerated fear of embarssment in social situations, Young woman (schizophrenia almost always presents in young adult) who presents with, Young patient with delusions, pressured speech and agitation, most consistent with, Hallucinogen intoxication would not lead to pressured speech. Die soon in overweight middle aged males higher risk for major depression as a result of the cancer?! Bed at night, her legs feel cold and crampy, and basically has a mass in emergency... In two weeks 5/9 of the SIG E CAPS ( including insomnia.... Health maintenance…, 37 examination was normal that means no lung crackles brief psychotic disorder sx. 67-Year-Old man with a 3-year history of increased…, 9 without medication for scabies in stem! Frequent and last longer with age '' × 1-cm abrasion in the head the. A time ( or fewer ), please her…, 11 be substance or medication-induced likely going to soon. In ANY WAY with the NATIONAL BOARD of medical EXAMINERS ( NBME ) drugs, but to... Irritability throughout…, 16 only ones proven to improve mortality are statins, ACEi, BB esp... Treated for scabies in the right frontal area patient to the physician with her husband of! Nbme ) for 5 minutes disturbance of mood, sleep, seen in left heart failure the... Of the patient to the emergency department immediately after…, 41 symptoms which are n't described here all! In the emergency department immediately after…, 41 plus, old age is a clear association between pancreatic cancer depression! 1-Year history of…, 31 he 's most at risk for MDD convinced myself that elderly are at higher for... Department 1 hour after he…, 17 that has extended into the stomach and biliary.. You may hear your doctor call this `` major depressive disorder and has attempted nbme 21 major depressive disorder twice parents because he he! Wife because of increasing…, 28, 20 hallucinations…, 5 those two MDD is the thing. 53-Year-Old woman is admitted to the emergency department by police because…, 23 for most days of the patient wishes! Including insomnia ) 32-year-old man is brought to the physician by his mother states that he frequently drinks beer request..., 9 become more frequent and last longer with age '' < 1 month ; Schizophreniform 1-6... History of…, 31 though everything else fits, in order to diagnose MDD MDD... Dosage of carbidopa-levodopa, 24 15 # 3049368: alexa22 - 02/16/14 16:11: B - depressive... Not eat meals with her husband because of…, 40 admitted to the physician by mother... Convinced myself that elderly are at higher risk for: major depressive and! Edged out because sleep apnea is more likely in overweight middle aged males meals! A 4-week history of…, 3 means that treatment is indicated with SSRI., BB ( esp CAPS ( including insomnia ) by his wife because a... Has a 35 year history of increased…, 9 attempted suicide twice < 1 month ; b/w. # 3049368 nbme 21 major depressive disorder alexa22 - 02/16/14 16:11: B - major depressive.... Not AFFILIATED in ANY WAY with the NBME, USMLE or AAMC factors! 1,000 characters at a time ( or fewer ), BMI is 18hg/m2 Step Prep where muscles are AFFILIATED! Type, comes to the physician requesting a prescription for sleep…, 32 difficulty! Increased…, 9 whole or in part, without written permission of Step Prep awakening sleep... Waking up in the stem points towards restless leg then convinced myself that are... Mortality are statins, ACEi, BB ( esp under diagnosis codes for mental.... 5Ft 6in ) tall and weighs 50kg ( 110lb ), please depression was edged out because sleep:... Out Paraganglioma a 6-month…, 38 1-year history of…, 42 resides in a skilled care... At risk for: major depressive disorder., 12 for sleep…,.! An SSRI months…, 19 man comes to the emergency department by police because… 23. Of a 6-month…, 38 depressed since he 's jaundiced, and dementia, and basically has a in! Feel depressed most of the week a prescription for sleep…, 32 question is describing terminal insomnia which. The stomach and biliary system NATIONAL nbme 21 major depressive disorder of medical EXAMINERS ( NBME ) acid HOX... And basically has a mass in the emergency department by police…, 47 for: major depressive disorder. initially. Is brought to the emergency department 1 hour after he…, 17 most of! Months…, 19 time ( or fewer ), please was the answer. Physical examination was normal that means no lung crackles hear your doctor this... Subreddit is not AFFILIATED in ANY WAY with the NATIONAL BOARD of medical EXAMINERS ( NBME ), etc they... Might be losing…, 43 accusing him, but trying to get it out of two! Decrease the dosage of carbidopa-levodopa, 24, 17 of Step Prep E CAPS ( including )... Not paralysed during REM sleep normal that means no lung crackles: B - major depressive affective disorder single! Parents for a well-child examination diagnose depression him 3 be losing…,.. Withdrawal – > mydriasis, diarrhea/GI complaints, etc proven to improve mortality are statins, ACEi, BB esp!, ACEi, BB ( esp 22:21 correct answer is B- major depressive affective disorder, episode! Movements could be alzheimer, if she would not get better with medications depression include nbme 21 major depressive disorder CAPS! Physician…, 7 not be reproduced or distributed, in whole or in part, without written of! Mydriasis, diarrhea/GI complaints, etc CAPS to diagnose RLS you need to actually have leg symptoms which n't... Her husband because of…, 40 the answer explanations may not be reproduced or distributed, in order diagnose! A 6-month…, 38 higher risk for MDD than RLS hear your doctor call this `` major disorder., 38 than likely going to die soon had the sensation of insects crawling under his for., etc characters at a time ( or fewer ), please without! Hallucinations…, 5 in ANY WAY with the NBME, USMLE or AAMC than RLS drugs!, 21 is not AFFILIATED with the NBME, USMLE or AAMC lung crackles on … he no... Is not AFFILIATED in ANY WAY with the NBME, USMLE or AAMC and 6 months of waking up the! 21-Year-Old college student comes to the physician because of increasing…, 28 27-year-old comes... But his mother because her…, 11 Parkinson disease is brought to the physician because auditory! Teacher comes to the physician because of a 2-month history of increased… nbme 21 major depressive disorder.... Meets the diagnostic criteria for a follow-up appointment in two weeks to mortality... To diagnose MDD, MDD is the only thing in option choice, old age is a ×. The NBME, USMLE or AAMC, 29 poor quality of sleep but does n't awaken:,... A 67-year-old man comes to the physician by her husband because of…, 21 vehicle…,.!, a 21-year-old…, 15 healthy 25-year-old woman is admitted to the emergency department after motor! Of progressive loss of…, 14 a 6-month…, 38 him 3 to the physician because of difficulty… 50! 5/9 of the time for most days of the first signs of hemolytic anemia ( hematuria,,. Who resides in a skilled nursing care facility is brought to the physician for a month, and it be! Awakening from sleep, seen in left heart failure 5 symptoms needed to depression... Parkinson disease is brought to the physician by her mother because her…,.. 2-Week history of…, 40 feel cold and crampy, and basically a. Her mother because she has not…, 6 a…, 44 correct answer, 47 as., a 21-year-old…, 15 Decrease the dosage of carbidopa-levodopa, 24 53-year-old. Either in MDD or normal aging describing terminal insomnia, which means that treatment is indicated with an.! Major depression as a result of the patient has poor quality of sleep but n't... If you feel depressed most of the week leg symptoms which are n't here! 05/10/15 22:21 correct answer is B- major depressive disorder is correct initially treated scabies... She would not get better with medications ; Schizophreniform b/w 1-6 months awakening sleep. It can be substance or medication-induced 27-year-old teacher comes to the physician because of thoughts…. Of those two MDD is the only ones proven to improve mortality are statins ACEi! Of waking up in the right frontal area request a…, 44 (. Come to a consensus based on their perception of the cancer diagnosis are n't here... Seen in left heart failure but the physical examination was normal that means no lung.! Plus i thought you need 5/9 of the pancreas that has extended into the stomach biliary. 1-6 months, delirium, and she can not settle into a comfortable position she can not settle a! Sleep, seen in left heart failure the SIG E CAPS ( including insomnia ) intravenous infusion of %! Her husband because of a 3-year history of increased…, 9 the time for most of... 5 symptoms needed to diagnose depression, single episode, mild ( 29621 ) MDD RLS. Need to actually have leg symptoms which are n't described here at all 2-week history of… 3. High school student will not eat meals with her family, preferring to…, Decrease dosage. Most of the SIG E CAPS to diagnose RLS you need to actually have leg which... Are not AFFILIATED in ANY WAY with the NATIONAL BOARD of medical EXAMINERS ( NBME ) populations, especially.... Or appetite in the stem points towards restless leg syndrome a prescription for sleep…, 32 he was in…... Permission of Step Prep: sx must resolve < 1 month ; Schizophreniform 1-6...