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  #1  
Old 02-04-2012
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Psyche Unkempt dirty patient with stomach pain!

A white, middle-aged man appears at the emergency department complaining of stomach distress and diffuse bodily pain. He is unkempt and dirty in his physical appearance. During an interview, he responds in a reasonable fashion to questions, but his attention wanders. Physical examination is unable to determine the specific location or cause of his distress. When informed of this, his complaints of pain become louder and more insistent. He doubles over, holding his abdomen, and cries for medication to relieve the pain. Based on this account, the most likely diagnosis for this patient is which of the following?
(A) Conversion disorder
(B) Factitious disorder
(C) Hypochondriasis
(D) Malingering
(E) Somatization disorder
(D) Narcolepsy
(E) Schizophrenia, paranoid type
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  #2  
Old 02-04-2012
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Ans ....... D ..........
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  #3  
Old 02-04-2012
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Ans D malingering . . . .he is a con
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Old 02-04-2012
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D is the ans
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Old 02-04-2012
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Yup D..........
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Matched!!!
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Old 02-04-2012
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I go with D!
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Old 02-05-2012
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Seems D
remember a qns similar in uw
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Old 02-06-2012
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The answer is D.
The key to diagnosis of malingering is the estimate of the level of the patient's awareness of symptom production and motivation. Malingering is purely about secondary gain,that is,getting things like money,attention,or as in this case,drugs, from the world around them. Symptom presentation is not sufficient to make a differential diagnosis.Everything hinges on the level of the patient's awareness.In this case, telling the patient that the source of distress cannot be found brings on a dramatic escalation of the patient's complaints and symptom display.The change as a direct response to the physician's comments suggests that symptom presentation is linked to the external context. Specifically, the patient is likely a drug addict seeking a morphine-based painkiller.
Conversion disorder (choice A) is a loss of physical functioning suggesting a physical disorder. The etiology, however, is entirely psychologic. Conversion symptoms usually involve the loss of the use of a limb or one of the primary senses such as sight or hearing. Empirically, symptoms appear after some traumatic event, but this is not necessary to give the diagnosis. The symptoms presented here are neither focal nor specific enough to warrant this diagnosis.
In a factitious disorder (choice B) the patient consciously takes action to produce symptoms but is unaware of the motive for these actions.Munchhausen syndrome is the most commonly used example of a factitious disorder. Symptom production is therefore a compulsion and beyond the patient's control. Symptom presentation here is not specific and there is no evidence for the type of repetitive behavior that usually characterizes factitious disorder.
Patients with hypochondriasis (choice C) constantly scan their bodies for simple physical signs that they can elevate into being the symptoms of some horrible physical disease. They frequently talk about disease and are convinced that something is wrong with them even when all medical evidence suggests otherwise. The presentation here is not about this type of belief, but about the patient's escalating presentation of pain.
Somatization disorder (choice E) is defined by at least eight or more physical symptoms, all of which are the result of psychologic processes identifiable in the patient's present presentation or history. Four of the symptoms must be about pain,two must involve gastrointestinal distress,one must involve loss of sexual functioning,and one must produce a pseudoneurologic impairment
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