A 43-year-old man is admitted to the neurology service after he went blind suddenly on the morning of admission. The patient does not seem overly concerned with his sudden lack of vision. The only time he gets upset during the interview is when he is discussing his mother’s recent death in Mexico—he was supposed to bring his mother to the United States, but did not because he had been using drugs and did not save the necessary money. Physical exam is completely negative. Which of the following is the most likely diagnosis?
a. Conversion disorder
c. Factitious disorder
e. Delusional disorder
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is a; Conversion Disorder.
A conversion disorder usually presents in a monosymptomatic manner, acutely, and simulating a physical disease. The sensory or motor symptoms present are not fully explained by any known pathophysiology. The diagnostic features are such that the physical symptom is incompatible with known physiological mechanisms or anatomy. Usually an unconscious psychological stress or conflict is present. In hypochondriasis, a patient is overly concerned that he or she has an illness or illnesses; this conviction can temporarily be appeased by physician reassurance, but the reassurance generally does not last long. Factitious disorder usually presents with physical or mental symptoms that are induced by the patient to meet the psychological need to be taken care of (primary gain). Malingering is similar to factitious disorder in that symptoms are faked, but the motive in malingering is some secondary gain, such as getting out of jail. In delusional disorder with somatic delusions, the patient has an unshakable belief that he or she has some physical defect or a medical condition.