Admission #77: Gunnerhea
Description: biopsychosocial infectious disease occuring in students of the medicine.
Etiology: USMLEs, boards, shelf exams, presence of a famous, well-to-do lecturer or physician, finals that are scheduled closely in time; cumulative finals have shown a sharp spike in gunnerhea incidence. Can also exist in a chronic state, etiology unknown. Studies suggest psychosocial, emotional, and genetic predispositions lead some to be more susceptible to gunnerhea than others.
Transmission: Verbal and physical transmission. Staying in libraries or in close proximities with infected individuals.
Signs and Symptoms: Twitching, irritability, anxiety, insomnia, mood-changes, weight lose or gain, pressured speech, poor social skills, paranoia. In severe and/or acute forms, can lead to uncontrolled aggression, frontal cortex compromise of executive functions (planning, social acumen, judgement, orientation to place, date, and time), panic attacks, and general anxiety disorder.
Diagnostic Tests: Question Test: Ask patient a medically-related question of narrow range (ex. So how can you tell if someone’s macrocytic anemia is due to B12 or folate deficiency?). If answer exceed 5 minutes in duration and topic begins to diverge, it is a positive Question Test. Another, more subjective test that can be used by the seasoned physicians: Assessment of Social Stability (ASS) Whole-Person Evaluation. This requires a detailed social history and mental status exam.
Example of a positive ASS-Whole: “A guy cut me off in traffic today and started cussing me out. I pulled the nine-iron out of my trunk to show him who’s boss. You know who won THAT fight.”
Example of a borderline ASS-Whole: “How did you know that answer? I didn’t know that answer. Oh my God, I hate my life. Stop being so happy.”
Example of a negative ASS-Whole: “I’m kinda tired but I’d love to grab coffee and go over some pharm with you. Two heads are better than one!"
Treatment: avoid contact with individuals with gunnerhea; isolation is recommended for these individuals. Usually self-limiting once the stressors are resolved (ie, finals are over or the physician leaves).
(That nine-iron story? That was my friend…whom I am more than a little afraid of now. Morale: don’t lose yourself to scores, tests, or pressure. Be healthy in mind, body, and spirit!)