qq 1,2 -

[ArchivalUser]

Mido

and is MIGRATORY joint pain something that is related to depression??

[ArchivalUser]

amruta

F and A

The patient most likely has stage three of lymes disease which is characterized by muskulaskelatal and neuroloogical manifestations. The muskuloskeletal complaints are join pain and periarticular pain without objective findings. Neuologically, the long term sequelae can be sunacute encephalopathy which is characterised by memory loss, modd changes, and sleep disturbances.

Again, I am not sure that this is the answer, it is only an educated guess. If anyone knows for sure, please let us know!

Thanks!

[ArchivalUser]

Jian

After reading the following and ABC's post, i think the frist q should be F. Check lyme antibody first since it is the etiology diagnosis

Up to 40% of patients with Lyme disease develop neurologic involvement of either the peripheral or central nervous system. Dissemination to the CNS can occur within the first few weeks after skin infection. Like syphilis, Lyme disease may have a latency period of months to years before symptoms of late infection emerge. Early signs include meningitis, encephalitis, cranial neuritis, and radiculoneuropathies. Later, encephalomyelitis and encephalopathy may occur. A broad range of psychiatric reactions have been associated with Lyme disease, including paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa, and obsessive-compulsive disorder. Depressive states among patients with late Lyme disease are fairly common, ranging across studies from 26% to 66%. The microbiology of Borrelia burgdorferi sheds light on why Lyme disease can be relapsing and remitting and why it can be refractory to normal immune surveillance and standard antibiotic regimens.

Conclusions: Psychiatrists who work in endemic areas need to include Lyme disease in the differential diagnosis of any atypical psychiatric disorder. Further research is needed to identify better laboratory tests and to determine the appropriate manner (intravenous or oral) and length (weeks or months) of treatment among patients with neuropsychiatric involvement. (Am J Psychiatry 1994; 151:1571-1583)

[ArchivalUser]

cool dude

1st question...ask for suicidal thoughts....he is depressed..if he has lyme disease...there should b a clue in ques stem like tick bite ..n so on...even if its lyme disease...assess for suicidal thoughts should b next step coz someone said pt with lyme disease could have depression too..checkin serology for lyme wont cure him of his depression right now..well thats wat i think.
second question-------a)

[ArchivalUser]

amruta

that's a good point. If someone seems depressed, we need to ask him about suicidal ideation before we try to find the source of the depression...I agree that it is likely to be lymes disease associated depression, but the question is, do we look into the lymes disease first? or do we make sure the pt isn't sucidal?

[ArchivalUser]

warit

YES I AGREE WITH COOLDUDE

[ArchivalUser]

carlos canova - teresacanova

Q1 (f) Yo no se hasta que punto pueda tener un major depres disorde? sea melancolica or atipica porque los sintomas siquiatricos son muy vagos no hay referencia al sueno, su estado emocional, alimentacion, sociabilidad, creo que la esfera psiquiatrica es vaga, el tiene la sintomatologia hace 3 year pero su preocupacion por la en fermedad cuando comenzo? que tiempo se mantuvo(2 semanas ) tuvo alucinaciones?
Q2 (a)


Q2(a)

[ArchivalUser]

Lou - lmcgyver@earthlink.net

Hey everyone, I am pretty sure 1 is C. This sounds like depression. "future appears bleak, too tired to think about it." The age is also significant, even though gender is male. If I were asked in the test, I would go with C...

[ArchivalUser]

Jian

may be C, since it can be done when you take history. For diagnosis of Lymes, you need wait for the test after you take the history

[ArchivalUser]

amruta

yeah the more I think about his question, the more I think it should be c. unless they are trying in a messed up way to see how good your knowledge about lymes disease is.

My final answer is C