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nbme24/Block 2/Question#6 (31.3 difficulty score)
A 50-year-old woman is admitted to the ...
Factitious disorder🔍

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submitted by seagull(1567),
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shiT is a ince cahpraop ot fideiitnngy adn ientgrat atciosufit ierddsor.


cinnapie  Not all heros wear capes +  
privwill  Mother of mine strongly believes in this method of treatment... +9  
aisel1787  lmao +1  

submitted by drschmoctor(94),

How does one differentiate factitious disorder from being thirsty w poor impulse control?

therealslimshady  If you're asking how to rule out diabetes insipidus, I think it's because: Diabetes insipidus is caused by a lack of ADH effect, so they will be peeing out too much water, thus making them dehydrated and hyperosmolar (thirsty). This CHF patient is presenting with signs of fluid overload +3  
an_improved_me  I think that ADH also has affects on central structures that increase thirst? Or is that only Angiotensin II? +  

submitted by sunshinesweetheart(82),
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ectau aatiercnboex of CFH aslde ot ecddrue CO -&-;tg vpocheirmlye emiy,aanrptoh dbyo epcrsevie it as oevmyiplhco o(s yuo exctep ghhi )HDA ntcnisoo[om-" eaerles fo "H]AD

  • hits tp si nllilyciac heevipcylmro me,a(ed srlae, estnddedi ecnk )nvsei

  • iernu shlduo eb rncnetacetdo mUO(s ;00gt1& msg/k)Om ucsaebe nksiedy udshol eb enif dan HAD is igdon ist jo,b usjt twhi adb morafinntoi

  • if eruin si l,iudet its' ont ,CFH ist' goyhsnecpci (anc eb sacued yb hohariepisnzc or oitaufitcs drosd)rie

s'tle say hse aswtn' zaycr nda allery wsa ianhvg FCH eroaxantibc-e tx htiw iicrdtue and fidlu ctsrioeirnt as yhte -d;-ig&td teno atht oyu nca alos sue avpnta rdsgu for CdFte-Hrlae ciyteahonrpm ohlviemrpeya okb(cl A)DH ;->- shudol scuea teh rnieu to be deutli hchwi lwil rdueec the aieleyrhvpom dan druece stla ntroiopres to ecrtroc het mtonaparihey

nmdaor tiabdees ispisndiu ides eotn for sychcgepino lIp(dpiaoDsy i dx si ,or/amehyipnarmnaeltr vyphiool,mae detliu ineur t1gO&ls)/;km0m0

  • can oasl ues eht rtaew aptirvioend tset for a pt thiw aopurlyi and ppaldiosiy

--t;&g fi rieun rtstnnoeace,c t'si yhcpconsige

-g;&t- if it soed ont ean,ecrnottc gvei srsmpdiseneo and if it netcrsotcaen = enratlc ,ID sdeo nto nacrenocte = nneoregipch DI

submitted by am4140(1),

This is a BS question - I still picked the “right” answer because nothing else made sense, but this is not how this happens in real life. Having taken care of a million of these patients, they’re not trying to fake a disease or symptoms -> they’re thirsty and selfish with no ability to regulate their own behavior, and they throw temper tantrums and ring the call bell all day long asking for water - they’re definitely not hiding their water consumption. I’ve even seen people get desperate enough to drink out of the toilet because they’re “dying of thirst.”