NMS Q&A Family Medicine

Somatic Symptoms without Organic Basis 30311. The answer is E. Malingering. This is a consciouseffort by the patient to feign a positive straight-leg test,which, if genuine, would have been matched by a positiveLesegue test, extending the knee on the ostensiblysymptomatic side while the patient was in the sittingposition.12. The answer is C. Depression. There is a subtle butdefinite line between persistent worry and insistence inthe patient who resists reasonable evidence against herhaving the serious organic disease, cancer of the stomachin this case. In the case of insistence, especially when associatedwith agitation, there may be depression, borderingon psychotic depression or other psychotic illness. Suchagitation, especially when attached to fixation on bodyimage or an unreasonable life issue such as employment,may signal a suicide risk.13. The answer is E. Anxiety. One might well refer to thisconstellation as an anxiety somatic equivalent. As opposedto a patient with hypochondriasis, somatization disorder,conversion reaction, or depression, this patient has fearsthat are closely related to reality, amenable to reason, andsubject to reassurance after presentation of the proof oftesting and explanation.14. The answer is C. Depression. Some psychiatristswould refer to this syndrome as somatic depressive equivalent.Whereas most patients with chest pain are anxiousabout the possibility of coronary disease, this patient lacksthat symbolism. In fact, the two-finger mild touch analogyis more symbolic of “pressure” – that is, depression.ReferencesMargo KL : Psychological interventions for noncardiac chest pain(cochrane for clinicians) . Am Fam Physician. 2005 ; 72 : 1701 .Post DM , Rudy DR . Somatic symptoms without organic basis .In: Rudy DR , Kurowski K , eds. Family Medicine: House OfficerSeries . Baltimore : Williams & Wilkins; 1997 : 829 – 842 .R ake l RE , B op e EP : Conn’s Current Therapy . Philadelphia: WBSaunders ; 2009 .