Day 19
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1. A patient with known peptic ulcer disease presents with sudden abdominal pain. She is thought to have peritonitis but refuses an abdominal examination due to the discomfort caused by previous examinations. Which of the following maneuvers will provide reasonably specific evidence of peritonitis without manual palpation of the abdomen? A. Bowel sounds are absent on auscultation. B. Forced cough elicits abdominal pain. C. Hyperactive bowel sounds are heard on auscultation. D. Pain is elicited with gentle pressure at the costovertebral angle. E. Rectal examination reveals heme-positive stools. Justify yr answer and give related rubrics
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2. A 45-year-old male says that for the last year he occasionally has regurgitated particles from food eaten several days earlier. His wife complains that his breath has been foul-smelling. He has had occasional dysphagia for solid foods. The most likely diagnosis is A. gastric outlet obstruction B. scleroderma C. achalasia D. Zenker’s diverticulum E. diabetic gastroparesis. Explain your answer
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3.  An elderly female comes to your clinic with symptoms of insomnia nearly every day, fatigue, weight loss of over 5% of body weight over the past month, loss of interest in most activities, and diminished ability to concentrate. Although further testing may be necessary, based on this history the most likely diagnosis is a. Alzheimer’s dementia b. Anemia c. Collagen-vascular disease with CNS involvement d. Depression e. Hypothyroidism f. Parkinson’s disease. How you arrived at a diagnosis
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4. A 4-year-old child is brought to you by her mother. Although the child is developing normally, she is scheduled to have her tonsils removed. The mother wishes to make this operation as smooth and atraumatic as possible. Using Piaget’s theory, what should the psychiatrist tell the mother about how this upcoming event should be explained to the child? a. No explanation will be helpful; the mother should try to stay with the child at all times. b. No explanation need be given, but the child should be asked what questions she has about the upcoming event and those questions should be answered. c. Verbal explanations will not be helpful. The upcoming event should be role-played with the child through the use of dolls and toys. d. A simplified verbal explanation should be given to the child. e. A verbal explanation of the operation should be given, with all the terms the child will hear in the hospital used. The child should be engaged in a question and answer session afterward.
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5. A 35-year-old woman is referred to you by a plastic surgeon. According to the referral letter, this person has consulted three cosmetic surgeons in the last 6 months about what she perceives to be a deformity in her upper lip. All the physicians have told her that there is no deformity and that there is no need for any surgery. But the woman firmly believes that there is a deformity, and this belief has hampered her socially and occupationally. What is the diagnosis? A. Hypochondriasis B. Somatization C. Body dysmorphic disorder D. Delusional disorder, somatic type
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