share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!

NBME 20 Answers

nbme20/Block 1/Question#15 (49.8 difficulty score)
A 30-year-old man who completed a successful ...
Adjustment disorder with anxietyπŸ”,πŸ“Ί

Login to comment/vote.

Tutor box

Members from the Leaderboard offering 1-on-1 help: Want to be listed here? Email us!

submitted by hayayah(1081),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

Dnftineioi of sdaetmutjn rdeis:rdo

Eolnaiotm sommytps e(g, etxinya, ersosipde)n taht ccrou niwhti 3 sohnmt of an ltbiidefinea laposcschoiy ssresotr ,ge( o,dcrevi ns)eills ilsntag t;&l 6 mhsnot once teh oresstrs ahs e.ndde

fI ymstsomp ptsesir &t;g 6 hsmtno reatf oesrsstr dens, ti si D.GA

hello  Yep, and I think what we are supposed to take from this Q is: The only info. we have for this patient is that he ended chemo 2 months ago and has been calling the doctor a lot -- this is supposed to mean he has been calling a lot since ending chemo 2 months ago. His frequent calls starting after ending chemo and within 3 months of the stressor fits with the above-stated definition of "adjustment disorder" with anxiety. I stressor in this case could possibly be either the actual illness or the ending of chemo/treatment. It probably does not matter much in this case. +4  
charcot_bouchard  I think doing uw done me wrong here. Adjustment disorder isnt diagnosed when symptom match another disorder --- it was like never a right answer. But ofc its right answer in nbme +5  
maxillarythirdmolar  Just to add to that, the tingling in his fingers may seem like a distraction/it probably is. Likely has some relation to his Chemo. +3  
j44n  shit I thought this poor guy had OCD with all the repetitive behaviors. +1  

submitted by johnthurtjr(145),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

elihW I nca etg on abdro hiwt msentuAjdt Dd,roiser I 'notd ees hwo tish newras si ayn bteert hnta mociSta Sotypmm os.erirdD Fmor :FA

aVrtyei fo oldyib tpmslcnaio gtlains omhnst to sreay seaiatcdos ihwt xe,siesvec pessrietnt hughstto dna tyaixne autob ysmostmp. aMy cepoar-ap htwi lss.elin

DSS sbogeln in a upgor of edsordsir teairrdahccze by isaclhyp mstmyops igucasn gicnafinits srtidsse nad a.nmipmiter

savdaddy  I think part of it stems from the fact that this patients symptoms are occurring within the time-frame for adjustment disorder while SSD seems to have a longer timeline. Aside from that I find it difficult to see why SSD wasn't a possible answer. +4  
chillqd  To add to that, I inferred that the obsession with checking temp and with the tingling sensation were signs provided to him by the physicians of recurrence. He is anxious over his cancer recurring, and they are more specific than a variety of body complaints +1  
hello  In somatic symptom disorder, the motivation is unconscious. I think for the patient in this Q-stem, his motivation is conscious -- he wants to make sure that recurrence of cancer is not going "undetected". +15  
cienfuegos  I also had issues differentiating these two and ultimately went with SSD, but upon further review it seems that a key differentiating feature was the timeline. His somatic symptoms would have had to have been present for at least 6 months per the DSM criteria +3  
almondbreeze  @chillqd Same! Why not OCD? He's fearful that something bad might happen (=cancer relapse; obsession) and calling his doc (=compulsion) +  
kevin  great reasoning @hello, this was confusing me but that makes perfect sense +  

submitted by arkanaftus(12),

The best answer would be Illness Anxiety Disorder, however it is not an option here, therefore it can't be right... so NBME...

j123  Both somatic sx disorder and illness anxiety disorder must be persistent for >6 months. Since this pt has only been acting excessively worried for 2 months, then it would have to be Adjustment disorder with Anxiety. (PS I got this question wrong since I at first thought Somatic Sx disorder) +2  

submitted by foodi(0),

why can't this be OCD? fits the time frame, his obsessions are checking his temp and he relieves these with calling the physician (compulsions)...

hiroshimi  According to DSM-5, with OCD, the disturbance is not better explained by the symptoms of another mental disorder such as preoccupation with having an illness, as in illness anxiety disorder. In his case, he was previously dx with cancer, treated, then develop these anxieties that he may have missed some sign is more fitted with illness anxiety disorder. Moreover, OCD is characterized by ego-dystonic, which is "thoughts, impulses, and behaviors that are felt to be repugnant, distressing, unacceptable or inconsistent with one's self-concept", which clearly doesn't apply to the pt case, as checking the temperature is actually meaningful and goal-directed. +  
utap2001  I think the most important hints are stressor and timeframe. I believe the description in the Q stem have some distractor. Maybe the definition of OCD should be no reason. A stressor and <3 month time make adjustment disorder more likely. +