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A 42-Year-Old Woman Comes to the Office Due to Repeated

question 54

Multiple Choice

A 42-year-old woman comes to the office due to repeated episodes of chest pain, dizziness, and shortness of breath over the past 3 months. She says, "I am worried that I have some kind of heart condition. I can be fine and relaxing at home and then all of a sudden I start sweating, my heart starts pounding, and I feel like I can't get any air. Now I feel anxious all the time because I never know when it will happen again. At work, I'm afraid to give presentations because I had an episode while giving a talk. I even stopped driving to work for fear that it will happen while I'm driving and I'll lose control of the car." The patient has a history of hypertension that is well controlled. Her medications include hydrochlorothiazide and multivitamins. She does not use tobacco, alcohol, or illicit drugs. She lives with her husband. Family history is significant for hypertension and coronary artery disease in her father. She was seen in the emergency department 2 months ago for similar symptoms, and her ECG and cardiac enzymes were normal. Vital signs, physical examination, and routine laboratory results are within normal limits. The patient says, "I am really concerned that I could have heart disease like my father." Which of the following is the most likely explanation for the patient's symptoms?

Definitions:

Manifest Content

In psychoanalytic theory, the apparent, remembered content of a dream or thought, as opposed to its hidden or symbolic meaning.

Dreams

Sequences of thoughts, images, and sensations occurring in a person's mind during sleep.

Denial

A psychological defense mechanism where an individual refuses to accept the reality of facts or feelings, to avoid dealing with uncomfortable emotions.

Projection

The psychological process of attributing one's own thoughts, feelings, or motives to another person or object.