Match each patient's clinical presentation with the most appropriate first-line management… — USMLE Step 2 CK

Match each patient's clinical presentation with the most appropriate first-line management strategy or pharmacological principle.

A $22$ -year-old woman with a normal body mass index presents with hypochloremic metabolic alkalosis, parotid hypertrophy, and dental enamel erosion.Initiation of fluoxetine is indicated as the first-line pharmacotherapy, whereas bupropion is absolutely contraindicated due to an increased risk of seizures.
A $31$ -year-old man with a body mass index of $34 \text{ kg/m}^2$ experiences marked distress over recurrent episodes of rapidly eating uncomfortably large amounts of food, without engaging in compensatory behaviors.Management primarily involves cognitive-behavioral therapy, with lisdexamfetamine serving as a potential pharmacologic adjunct.
A $19$ -year-old woman with a body mass index of $14.5 \text{ kg/m}^2$ exhibits an intense fear of gaining weight, amenorrhea, and engages in daily self-induced vomiting.The most critical initial intervention is supervised nutritional rehabilitation and weight restoration; selective serotonin reuptake inhibitors are generally ineffective at this stage.
A $45$ -year-old woman experiences persistent health anxiety and spends excessive time worrying about multiple diffuse joint and abdominal pains, despite completely normal medical evaluations.The standard of care involves establishing regular, scheduled follow-up visits with a single primary care physician to prevent unnecessary medical testing.

Answer

Bulimia nervosa matches with fluoxetine/bupropion contraindication; Binge-eating disorder matches with cognitive-behavioral therapy and lisdexamfetamine; Anorexia nervosa matches with nutritional rehabilitation priority; Somatic symptom disorder matches with regular, scheduled primary care visits.

Each clinical vignette describes a unique psychiatric disorder requiring a highly specific initial management step. Bulimia nervosa is managed with cognitive-behavioral therapy and fluoxetine, and bupropion is strictly contraindicated due to electrolyte-induced seizure risk. Binge-eating disorder is effectively treated with cognitive-behavioral therapy and lisdexamfetamine. Anorexia nervosa necessitates urgent nutritional rehabilitation and weight restoration above all pharmacological options. Somatic symptom disorder is best managed by establishing a therapeutic alliance with one primary care provider via regular, scheduled visits to avoid iatrogenic harm from repeated diagnostic testing.

Step-by-Step Solution

Diagnose the patient in each vignette based on their clinical features and physical parameters.

Patient 1 has Bulimia Nervosa (normal weight, purging signs). Patient 2 has Binge-Eating Disorder (obesity, bingeing without purging). Patient 3 has Anorexia Nervosa, binge-eating/purging type (severe underweight, fear of weight gain, purging). Patient 4 has Somatic Symptom Disorder (persistent somatic symptoms, high anxiety, normal workups).

Accurate psychiatric diagnosis is the prerequisite for selecting the appropriate disease-specific management algorithm.

Identify the primary treatment or critical pharmacological principle specific to each diagnosed disorder.

Bulimia: Fluoxetine is first-line, bupropion is contraindicated. Binge-Eating Disorder: CBT and lisdexamfetamine. Anorexia: Nutritional rehabilitation is the immediate priority. Somatic Symptom Disorder: Scheduled follow-ups with a single provider.

Each disorder in the somatic symptom and eating disorder spectrum has a distinct, standard-of-care intervention pathway that must be accurately applied.

Key Concept

Diagnosis and tailored management of somatic symptom and eating disorders

Question

Answer

Step-by-Step Solution

Key Concept

Common Mistakes

Topics

More questions from this topic