Chapter 15 Single best answer questions

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. Which of the following is TRUE regarding the management of medically unexplained symptoms?

CBT is ineffective correct incorrect

Repeating investigations often helps to reassure a worried patient correct incorrect

A physical examination should be performed correct incorrect

Antidepressants should be avoided correct incorrect

It should be explained that there is nothing wrong correct incorrect

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. Which of the following are true of chronic fatigue syndrome?

For diagnosis, it must follow a viral infection correct incorrect

Other symptoms e.g. aches and pains exclude the diagnosis correct incorrect

It is characterized by fatigue after strenuous exercise correct incorrect

Extreme fatigue is precipitated by physical or mental exertion correct incorrect

Exercise avoidance is important in the management correct incorrect

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. You admit a 58 year old man with a broad Yorkshire accent to a medical ward in a London hospital. He is unable to remember where he came from, his name, or any personal information. You note that he can use the coffee machine without difficulty, and easily orders food from the ward menu. He is flustered but there is no evidence of physical trauma. He remembers your name at the morning ward round, the next day. He is polite, but keeps asking to leave the ward. You eventually track down his identity, and discover that his wife died suddenly, a day before he appeared in your hospital.
What is the most likely diagnosis?

Fugue state correct incorrect

Malingering correct incorrect

Factitious disorder correct incorrect

Somatisation disorder correct incorrect

Amnesic syndrome correct incorrect

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. A 68 year old man whose wife recently had an ischaemic stroke presents with sudden onset of bilateral leg paralysis. On examination he denies sensation to the groin, though twitches slightly as you test pinprick sensation. Reflexes and tone are normal. Motor function is 0/5 throughout, though staff report they have noticed him moving his legs while he is sleeping. CT and nerve conduction studies are normal.
What is the most appropriate management?

Rest for 4-6 weeks followed by gradual increase in activity levels correct incorrect

Reassure him that symptoms resolve completely in 75% of cases correct incorrect

Provide a temporary wheelchair to improve mobility and independence correct incorrect

Reassure him that normal function should return quickly correct incorrect

Avoid providing further care for his wife, since this will reinforce his symptoms correct incorrect