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NBME 18 Answers

nbme18/Block 4/Question#22 (reveal difficulty score)
A 55-year-old woman who is a physician is admitted
Alcohol withdrawal ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pharm

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 +3  upvote downvote
submitted by โˆ—flapjacks(109)

I feel like whenever there is a physician as the patient in the question stem, you should just start thinking substance abuse disorders. Not the first time I've seen this.

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 +3  upvote downvote
submitted by โˆ—solidshake(25)

Acute stress disorder involves flashbacks of traumatic event, avoidance of triggers, depressed mood, and nightmares; lasts 3 days - 1 month; can evolve to PTSD if lasts >1 month

Panic Disorder is recurrent and happens unexpectedly without known triggers

Biploar and Histrionic easily ruled out

Alcohol Withdrawal is left as the right answer. Symptoms also match with time course. Delirium tremens 2-4 days after last drink

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an1  Totally agree with you. But I don't think she's having DT just yet. It's been 2 days (48 hours) so we can expect to see Alcoholic Hallucinosis, which explains the vague shapes she's seeing. +1

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