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Patient Management Exercise for Psychosomatic Medicine

This exercise is designed to test your comprehension of material presented in this issue of FOCUS as well as your ability to evaluate, diagnose, and manage clinical problems. Answer the questions below, to the best of your ability, making your decisions as you would with a real-life patient.

Questions are presented at "decision points" that follow a section that gives information about the case. One or more choices may be correct for each question; make your choices on the basis of your clinical knowledge and the history provided. Read all of the options for each question before making any selections. You are given points on a graded scale for the best possible answer(s), and points are deducted for answers that would result in a poor outcome or delay your arriving at the right answer. Answers that have little or no impact receive zero points. On questions that focus on differential diagnoses, bonus points are awarded if you select the most likely diagnosis as your first choice. At the end of the exercise you will add up your points to obtain a total score.

The management of psychiatric conditions in patients hospitalized for medical or surgical treatment poses special concerns. In addition to the classic issues posed by managing the biological and psychosocial aspects of a psychiatric condition in a patient with multiple other problems, the current system of care of inpatient hospitalization can unexpectedly add complicating factors.

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