Answer :USMLE step 2 Mcq 58:A 40yr old man working in a chemical factory dealing with nitrates


Correct Answer: C
Monday disease is a phenomena often seen in persons who handle nitrates as a part of their occupation. These workers find that upon starting their work week they suffer from headache, dizziness and tachycardia. These symptoms occur due to the vasodilatation caused by the inhalation of the nitrates. After a day or so, these symptoms disappear due to the development of tolerance to the vasodilatation effect of these nitrate compounds. But over the weekend when there is no exposure to nitrates the tolerance is lost and the worker again experiences these symptoms when he returns to work on Monday. Hence the name Monday disease.
Munchausen's Syndrome is incorrect since in this condition the patient gives false history and symptoms to the doctor due to variety of mental and psychological reasons. But in this case the patients history and occupation are clinically related and hence true.
Malingering is again a condition in which patient gives false history and symptoms to the doctor. In this case the patient is not malingering. His condition and history are relevant and can be correlated.
Tachyphylaxis is rapid development of tolerance to repeated doses of a drug and manifests as decreased response to the drug. It is clinically relevant with the use of certain drugs but has no correlation with the symptoms and occupation of the patient in the above question.Migraine is a disorder characterized by a pulsating headache restricted to one side of the head and not generalized. It has no association with day of the week or work place. It is usually associated with nausea and vomiting.


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