A 45-year-old woman who has been on chronic steroid treatment for her asthma has thin arms and legs but has a large amount of fat deposited on her abdomen, chest, and shoulders. Her skin is thin and atrophic, and she bruises easily. She has purple striae on her abdomen. Physical examination shows elevated blood pressure, and lab tests show decreased glucose tolerance. Which of the following psychiatric conditions is the most likely diagnosis?
a. Major depression
c. Substance-induced mood disorder
e. Schizoaffective 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 c; Substance-induced mood disorder.
Cushing’s syndrome due to exogenous administration of corticosteroids, and more rarely to adrenocarcinoma or ectopic production of ACTH, is often associated with psychiatric disturbances. Depression and mixed anxiety and depressive states are the most common psychiatric manifestations of the syndrome (from 35 to 68%, depending on the study). Since the affective symptoms are directly secondary to the administration of a substance (in this case, steroids for the treatment of asthma), the patient’s diagnosis would be a substance-induced mood disorder. Mania, psychosis, delirium, and cognitive disturbances also occur, but at a much lower rate. Depressive symptoms occur early in the disorder (in the prodromal period in 27% of cases). Most patients improve after the primary disorder is treated and serum cortisol decreases.