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Review Question - QID 109922

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QID 109922 (Type "109922" in App Search)
A 26-year-old man presents to his primary care physician for a routine physical exam. He is concerned about a burning sensation that he feels in his throat whenever he eats large meals and is concerned he may have esophageal cancer like his uncle. The patient has a medical history of irritable bowel syndrome and constipation. His current medications include whey protein supplements, fish oil, a multivitamin, and sodium docusate. The patient is concerned about his performance in school and fears he may fail out. He recently did poorly on an exam and it has caused him significant stress. He also is worried that his girlfriend is going to leave him. The patient claims that he thought he was going to be an incredible doctor some day, but now he feels like a terrible person. The patient also states that he feels guilty about his grandfather's death which occurred 1 year ago and he often reexperiences the funeral in his mind. He regularly has trouble sleeping for which he takes melatonin. The patient has been praying every 4 hours with the hopes that this will make things go better for him. Which of the following is the most likely diagnosis?

Acute stress disorder






Generalized anxiety disorder



Obsessive compulsive disorder



Post traumatic stress disorder



Select Answer to see Preferred Response

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This patient presenting with significant worries regarding health, school, career, and personal relationships likely has generalized anxiety disorder.

Generalized anxiety disorder presents with excessive anxiety related to multiple unrelated issues for 6 or more months. Symptoms include restlessness, sleep disturbance, muscle tension, fatigue, irritability, and trouble focusing. Patients are often distressed with regards to their symptoms even if they may seem minor. Treatment options include cognitive behavioral therapy, SSRIs, and SNRIs. Buspirone is sometimes used as well.

Tyrer and Baldwin review the evidence regarding the diagnosis and treatment of generalized anxiety disorder. They discuss how this disease can be treated with cognitive behavioral therapy. They recommend also considering selective serotonin reuptake inhibitors.

Incorrect Answers:
Answer 1: Acute stress disorder presents with anxiety and post-traumatic stress disorder-like symptoms that occur within 1 month of a life stressor. Treatment is supportive.

Answer 2: Depression is the diagnosis when a patient presents with SIGE CAPS symptoms of Sleeplessness, Interest loss, Guilt, Energy changes (fatigue), Concentration changes, Appetite changes, Psychomotor retardation, and Suicidal ideation. This patient's multiple worries/concerns make generalized anxiety disorder a more likely diagnosis. Treatment is with selective serotonin reuptake inhibitors.

Answer 4: Obsessive compulsive disorder presents with anxiety-provoking thoughts (obsessions) which are relieved by ritualistic behavior (compulsions). This patient's praying does not necessarily represent a compulsive behavior that is related to his thoughts. While this diagnosis is plausible, the concerns regarding most aspects of his life is more consistent with generalized anxiety disorder. Treatment of obsessive compulsive disorder is with cognitive behavioral therapy.

Answer 5: Post-traumatic stress disorder presents with anxiety, stress, and flashbacks to a very stressful event. This patient is not experiencing these symptoms. Treatment is with cognitive behavioral therapy and selective serotonin reuptake inhibitors.

Bullet Summary:
Generalized anxiety disorder presents with excessive worry and anxiety related to multiple unrelated issues for 6 or more months.

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