Mark Abbott, a new surgical resident at the hos-pital where you work, telephoned you and statedthat he has been having some difculties with hisjob and would like to talk with a therapist. An ap-pointment was scheduled for the following day forMark to meet with you.Initial Intake SessionUpon meeting Mark in the waiting area, you ob-serve that he is a tall, attractive young man whoappears to be nervous. He paces back and forth infront of a large window overlooking the hospitalgrounds. He shakes your hand but has difcultymaking eye contact with you. He follows you toyour ofce without making any conversation.Mark seems anxious and uncomfortable seatedin a chair next to your desk. You ask him if he'dlike some water, which he accepts gratefully. Heglances at the pictures on the walls as he taps hisfoot on the oor. After explaining what you do asa counselor, you ask Mark what he wanted to dis-cuss with you.Mark states that he is a rst-year surgical resi-dent at the hospital. He did well in medical schooland in his internship in another, smaller hospital,but he is having difculties with his new job as asurgical resident. He is beginning to wonder if he'schosen the wrong eld."Why do you think surgery might not be theright eld for you?" you ask."Well, it's been a difcult adjustment for mecoming to this large metropolitan hospital. MaybeI'm just a small-town type of guy. I'm not used tohaving to perform for so many people," Mark tellsyou. You notice that Mark's voice is a bit shaky."What do you mean exactly that you have toperform?" you inquire."Well, unlike the small hospital where I did myinternship, this is a huge hospital. The operatingrooms have observation booths, and there are se-nior physicians and medical students up there allthe time watching everything I do when I'm operat-ing," Mark says anxiously."And it bothers you that they are watchingyou?" you ask."Well, yes, it makes me extremely nervous. Infact, it's making me so nervous my hands begin toshake, and there have been times when I didn't thinkI could stand up. I've got a microphone attached tomy scrubs, and I'm supposed to be explaining whatI'm doing. I can hear my voice shaking when I talk. It is so embarrassing, and I'm sure everyone can tellI'm nervous as a cat.""How long has this nervousness been goingon?" you ask.Mark thinks for a moment and then says, "Well,if you want to know the truth, I've always hatedperforming in front of other people. I'm just notgood at it. I never played sports in high schoolor college because I didn't like the idea of peoplewatching me perform. I learned to play the violinwhen I was very young, and I hated having to playin recitals. I can remember throwing up before bigrecitals where I was being graded. I guess somepeople might have considered me a nerdy kind ofguy. But it never really bothered me because I al-ways made good grades and did well in school, soI never really worried about it much before. I justdidn't put myself in situations where I'd have toperform.""Okay, so you can remember getting nervouswhen you had to play the violin in front of peoplewhen you were young, and you avoided other situ-ations where you might have to perform in frontof others. So, it's been okay until recently. Is thatcorrect?" you inquire."Yes, I've been okay until I came to this hospitala couple of months ago. I do okay with one-on-onesituations. For example, if I'm talking to one otherperson, I'm not too nervous about it. But if I've gotto get up in front of an audience, I worry about itfor hours before doing it, and then I'm a mess whenI'm trying to do something in front of a crowd. I know it's really ridiculous how I react, but I justcan't seem to control it," Mark responds "It's not that uncommon for people to feel uncom-fortable when they are presenting to an audience,"you suggest. "Let me ask you some questions aboutyour experiences when you're in front of an audi-ence. You said that you feel very shaky and yourvoice trembles a little. Do you have a hard timebreathing?" you ask."No, but I do break out in a sweat," Mark res-ponds."Does your heart feel like it's beating too fast?"you ask."No, not really, but I'm aware of the fact thatI'm nervous," Mark responds."What about nausea? Have you ever felt likeyou're going to throw up?" you inquire."No, just overly anxious, I guess," Mark states."Have you ever felt panicky or like you're goingto faint?" you ask."No, I just feel like I can't control the shakinessin my voice or my hands," Mark states. "And whenI'm in the operating room, that's a big problem.""I'm sure it could be," you suggest. "What aboutin other situations? For example, if you go to aparty, do you feel the same kind of nervousness oranxiety?" you inquire."Well, honestly, I don't go to many parties. Idon't really like parties much. Probably becausethey do make me anxious and uncomfortable. I don't mind going out with a small group of peo-ple, like if I have a date and another couple comesalong. That's okay with me.""Okay. Are there any other situations that youcan think of that make you feel anxious?" you ask."Well, the only other one is when I have to do acase presentation in front of a big group of doctors.Grand rounds, for example. That makes me verynervous, too," Mark tells you."So, it sounds as if whenever you have to getup in front of an audience and either perform orspeak that it can make you feel very anxious. Is thatright?" you ask."Yes, exactly. I'm okay as long as I don't haveto get up in front of an audience, but I can't avoidit at this hospital, so I need some help getting thisanxiety under control," Mark says."Mark, I think this anxiety you're experiencingis something that can be resolved. Would you bewilling to come for several sessions so we can workon it?" you ask."Sure, I'll do anything to get rid of this prob-lem," Mark says with relief.You schedule another appointment, and Markappears much more relaxed when he leaves youroffice

can you please summarize the presenting problems and symptoms along with pertinent history and social factors that led to diagnosis. and can you justify diagnosis and any differential diagnosis if any