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  #1  
Old 10-05-2014
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Default NBME 4 Bipolar disorder vs. MDD?

hey guys

i know this is an easy question but on block 1 there's this vignette of a 23 year old college senior who is having a difficult time after not getting into the grad school of her choice, she's pretty mean to her bf about it too its been happening for 3 weeks since she found out she didn't get accepted, hasn't affected her ability to fxn tho...

i thought it was MDD but its not...could it be bipolar type 2? its q 36 for anyone who wants to know on the first block.

thanks a bunch!
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Old 10-06-2014
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Hi
I had another question on NBME 4

57 yo woman c 6 hours of progressiv confusion...family says she smoked for 40 years...not oriented..vital signs wnl, x-ray indicates 2 cm mass in right upper lobe of lung...CT scan of head shows no abnormalities...which of the following mechanism of confusion?

a decreased extracellular fluid volume,
b decreased serum ADH concentration,
c decreased serum sodium conc,
d. decreased urine sodium excretion,
e. increased serum creatinin
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  #3  
Old 10-06-2014
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Originally Posted by microshara88 View Post
hey guys

i know this is an easy question but on block 1 there's this vignette of a 23 year old college senior who is having a difficult time after not getting into the grad school of her choice, she's pretty mean to her bf about it too its been happening for 3 weeks since she found out she didn't get accepted, hasn't affected her ability to fxn tho...

i thought it was MDD but its not...could it be bipolar type 2? its q 36 for anyone who wants to know on the first block.

thanks a bunch!
Sounds more like an adjustment disorder. No mention about depressed mood, anhedonia, decreased concentration, etc.

To be bipolar she must have had 1 manic episode for at least 7 days (not sure 5 or 7) characterized not only by irritability but also grandiosity, impulsiveness, etc.
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Old 10-06-2014
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Originally Posted by microshara88 View Post
Hi
I had another question on NBME 4

57 yo woman c 6 hours of progressiv confusion...family says she smoked for 40 years...not oriented..vital signs wnl, x-ray indicates 2 cm mass in right upper lobe of lung...CT scan of head shows no abnormalities...which of the following mechanism of confusion?

a decreased extracellular fluid volume,
b decreased serum ADH concentration,
c decreased serum sodium conc,
d. decreased urine sodium excretion,
e. increased serum creatinin
I think this is siadh from lung cancer paraneoplastic syndrome. So there's increase in ADH - - Inc in free water retention - - decrease in serum osmol (low sodium / C, from dilution).
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Old 10-11-2014
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Originally Posted by IMlover View Post
I think this is siadh from lung cancer paraneoplastic syndrome. So there's increase in ADH - - Inc in free water retention - - decrease in serum osmol (low sodium / C, from dilution).

thanks yeah! was thinking the same
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