Medical Case Study: Abdominal Pain

A 42-year-old woman is admitted to the hospital for complaints of abdominal pain. Her history notes that her mother was a nurse and she herself is trained as a phlebotomist. On physical examination, she presents with multiple abdominal scars and marked abdominal tenderness. The patient is evasive when asked where she had the surgeries, but she can describe in great detail what was done in each.

An 18-year-old man is brought to the emergency room by his college roommate, after the roommate discovered that the patient had not left his room for the past 3 days, neither to eat, nor to go to the bathroom. The roommate noted that the patient was kind of “weird.” Mental status examination reveals that the patient has auditory hallucinations of two voices commenting upon his behavior. The patient’s parents note that their son has always been somewhat of a loner and unpopular, but otherwise did fairly well in school.

A 32-year-old woman comes to the psychiatrist with a chief complaint of anxiety. She notes that she worries about paying the mortgage on time, whether or not she will get stuck in traffic and be late for appointments, her husband’s and daughter’s health, and the war in Iraq. She notes that she has always been anxious, but since the birth of her daughter 2 years ago, the anxiety has worsened to the point that she feels she cannot function as well as she did previously.

A 23-year-old woman comes to the emergency room with the chief complaint that she has been hearing voices for 7 months. Besides the hallucinations, she has the idea that the radio is giving her special messages. When asked the meaning of the proverb “People in glass houses should not throw stones,” the patient replies, “Because the windows would break.” Which of the following mental status findings does this patient display?

A 22-year-old woman is seen in the emergency room after a suicide gesture. She swallowed 10 aspirin tablets in the presence of her mother, with whom she had just had an argument. The patient has a long history of cutting herself superficially with razor blades, which her psychiatrist of the last 5 years confirms by telephone. The patient currently lives in a stable environment (a halfway house) where she has been for 3 years. Which of the following options is the best course of action for the physician in the emergency room assuming that the patient has been medically and psychiatrically cleared?

A 69-year-old man is brought to see his physician by his wife. She notes that over the past year he has experienced a slow, stepwise decline in his cognitive functioning. One year ago she felt his thinking was “as good as it always had been,” but now he gets lost around the house and can’t remember simple directions. The patient insists that he feels fine, though he is depressed about his loss of memory. He is eating and sleeping well. Which of the following is the most likely diagnosis?

A 24-year-old woman comes to a psychiatrist with the chief complaint of hearing voices. During the interview, the patient is intermittently tearful when she speaks of hearing the voices. She states that she has been feeling sad for the past 6 weeks, and she appears this way to the interviewer as well. During the course of the interview, the patient is able to smile and occasionally laugh at appropriate times in response to the physician’s questions. How would this patient’s

A 6-year-old girl is brought to the physician by her mother, who says the child has been falling behind at school. She notes that the girl did not speak until the age of 4, though her hearing was tested at age 3 and found to be normal. She is friendly at school, but is unable to complete most tasks, even when aided. She is noted to have a very short attention span and occasional temper tantrums at school and at home. She enjoys playing with her toys at home. Which of the following tests would be most helpful in establishing the diagnosis?