Monday, September 29, 2008

Practice Question

A 30 year old colleague approaches you for a curbside consult. A friend of his who is 4 days status post a recent comprehensive psychiatry exam is now complaining of malaise, headache and frequent urination. He has rhinorrhea, and is complaining of frequent sneezing and a "throat tickle" that requires frequent clearing of his throat. He denies throat pain, ear pain, nausea or vomiting. Your colleague humored his friend with a brief physical exam. On exam, there were engorged nasal turbinates with profuse clear discharge, there was a mild white discoloration of pretonisilar pillars; tonsils were absent. His breath smelled faintly sweet. Bilateral mobile, tender, 3 cm sub-mandibular nodes were appreciated. Chest exam was clear. Further history revealed nocturnal urinary retention and dry mouth that awakens him several times at night. A thorough social history indicated the 'friend' felt a sense of impending doom, especially when presented with web-based tutorials. Your differential diagnosis includes:

A) Antihistamine use
B) Panic Disorder
C) Viral upper respiratory infection
D) USMLE Step 2 CK
E) Sleep disorder NOS
F) Caffeine dependence, sustained
G) Specific Phobia

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