Property:AnswerDExp
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The calculation of A-a gradient in this answer is incorrect. Please see the explanation for a proper calculation. +
Intravenous metronidazole is used along with oral vancomycin in the treatment complicated disease with peritoneal signs and abdominal distension. +
Small bowel biopsy cannot necessarily establish the diagnosis of disaccharidase deficiency. +
There is no evidence of myocardial ischemia or infarction in this patient. Hence urgent cardiac catherization is not needed in this patient. +
The right to confidentiality holds true even in this case. A valid warrant is needed for a physician to divulge patient information. +
Tourette Syndrome is associated with attention-deficit hyperactivity disorder (ADD or ADHD), obsessive–compulsive disorder (OCD), learning disabilities and sleep disorders. Disruption from tics is commonly overshadowed by comorbid conditions that present greater interference to the child. Tourette’s Disorder may be diagnosed when a person exhibits both multiple motor and one or more vocal tics (although these do not need to be concurrent) over the period of a year, with no more than three consecutive tic-free months. The DSM-IV included a requirement for "marked distress or significant impairment in social, occupational or other important areas of functioning", but this requirement was removed in the most recent update of the manual, in recognition that clinicians see patients who meet all the other criteria for Tourette's, but do not have distress or impairment. The onset must have occurred before the age of 18, and cannot be attributed to the "direct physiological effects of a substance or a general medical condition". Hence, other medical conditions that include tics or tic-like movements—such as autism or other causes of tourettism—must be ruled out before conferring a Tourette's diagnosis. There are no specific medical or screening tests that can be used in diagnosing Tourette's; it is frequently misdiagnosed or underdiagnosed, partly because of the wide expression of severity, ranging from mild (the majority of cases) or moderate, to severe (the rare, but more widely-recognized and publicized cases). The diagnosis is made based on observation of the individual's symptoms and family history, and after ruling out secondary causes of tic disorders. In patients with a typical onset and a family history of tics or obsessive–compulsive disorder, a basic physical and neurological examination may be sufficient. If a physician believes that there may be another condition present that could explain tics, tests may be ordered as necessary to rule out that condition. Medication is available to help when symptoms interfere with functioning. The classes of medication with the most proven efficacy in treating tics—typical and atypical neuroleptics including risperidone , ziprasidone, haloperidol, pimozide and fluphenazine can have long-term and short-term adverse effects.
Selective mutism is by definition characterized by the following:
* Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.
* The disturbance interferes with educational or occupational achievement or with social communication.
* The duration of the disturbance is at least 1 month (not limited to the first month of school).
* The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
* The disturbance is not better accounted for by a communication disorder (e.g., stuttering) and does not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder.
* Shyness, social anxiety, fear of social embarrassment, and/or social isolation and withdrawal
* Difficulty maintaining eye contact
* Blank expression and reluctance to smile
* Stiff and awkward movements
* Difficulty expressing feelings, even to family members
* Tendency to worry more than most people of the same age
* Desire for routine and dislike of changes
* Sensitivity to noise and crowds. +
According to the American Psychology Association, separation anxiety disorder is the inappropriate and excessive display of fear and distress when faced with situations of separation from the home or from a specific attachment figure. The anxiety that is expressed is categorized as being atypical of the expected developmental level and age. The severity of the symptoms ranges from anticipatory uneasiness to full-blown anxiety about separation. +
Münchausen syndrome by proxy (MSBP or MBP) is a term that is used to describe a behavior pattern in which a caregiver deliberately exaggerates, fabricates, and/or induces physical, psychological, behavioral, and/or mental health problems in those who are in their care. With deception at its core, this behavior is an elusive, potentially lethal, and frequently misunderstood form of child abuse or medical neglect that has been difficult to define, detect, and confirm. +
DSM-5 wants doctors to use their judgement to differentiate grief and major depressive disorder. Most of the times depressive symptoms in grief does not indicate major depressive disorder. The given patient has family history of depression. With a worsening of symptoms over each visit and development of cognitive and neurovegetative symptoms, diagnosis of major depressive disorder is more just. DSM-5, unlike DSM4 TR do not limit the use of an MDD diagnosis between 2 weeks and 2 months. +
Schizoaffective disorder is defined by mood disorder-free psychosis in the context of a long-term psychotic and mood disorder. Psychosis must meet criterion A for schizophrenia which may include delusions, hallucinations, disorganized speech, thinking or behavior and negative symptoms. Both delusions and hallucinations are classic symptoms of psychosis. Delusions are false beliefs which are strongly held despite evidence to the contrary. +
'''Correct'''-Total thyroidectomy is the preferred initial treatment of choice for both minimal (diameter up to 1.0 centimeters) as well as gross (diameter over 1.0 centimeters) papillary carcinoma of thyroid. It reduces the risk of recurrence, avoids any residual disease since papillary carcinoma is a multifocal disease, allows easy monitoring with thyroglobulin since sensitivity for picking up recurrence is increased following total thyroidectomy, and allows for easy detection of metastatic disease by thyroid and neck node ultrasound. +
IM testosterone may promote bone formation. However the levothyroxine dose reduction is the indicated in this patient. +
CAT scan is not indicated, it can cause excess radiation exposure. Osteoporosis is followed up with a bone density scan or DXA. +
Incorrect! Anterior spinal artery occlusion manifests as,
* Complete motor paralysis below the level of the lesion due to interruption of the corticospinal tract
* Loss of pain and temperature sensation at and below the level of the lesion due to interruption of the spinothalamic tract
* Retained proprioception and vibratory sensation due to intact dorsal columns
* Areflexia, flaccid anal sphincter, urinary retention and intestinal obstruction may also be present in individuals with anterior cord syndrome. +