Answer quizzER Vol 1.3

quizzER Winners:

Chris Guyer            Allison Loynd             Rob Klever

Sam Lee                  Scott Ottolini             Brian Kern

Marjan Siadat          Julie Nguyen             Maria Pak

Devon Moore          Dave Mishkin

Richard Gordon      Brian McMichael

Last Week’s Question

The answer is B.

The diagnosis of conversion disorder is made by fulfilling the following five criteria:
• A symptom is expressed as a change or loss of physical function
• Recent psychological stressor or conflict
• The patient unconsciously produces the symptom
• The symptom cannot be explained by any known organic etiology
• The symptom is not limited to pain or sexual dysfunction

Conversions disorders generally involve neurologic or orthopedic manifestations. The disorder usually presents as a single symptom with a sudden onset related to a severe stress. In this case, the stress is the diagnosis of terminal cancer in the patient’s father. Classic symptoms of conversion disorder include paralysis, aphonia, seizures, coordination disturbances, blindness, tunnel vision, and numbness. The diagnosis cannot be made until all possible organic etiologies are ruled out. Treatment involves identifying the stressor and addressing the issue.

Click here for the latest review article on conversion disorder, published in the May 2008 edition of Current Opinion in Psychiatry.

(a) Somatization disorder involves patients with many complaints with no organic cause. (c) Hypochondriasis involves the preoccupation of serious illness despite appropriate medical evaluation and reassurance. (d) Retinal detachment can cause unilateral vision loss and generally presents with progressively worsening vision loss with patients complaining of “floaters.” (e) Anxiety disorders involve excessive fear and apprehension that dominates the psychological life of a person.

Thank you for everyone who submitted an answer.  Please stay tuned for next week’s quizzER.

quizzER is a weekly contest consisting of a question selected from various areas of emergency medicine that are central to the education of medical students and residents in training.

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