sandra
Forum Guru
Topics: 200
Posts: 468
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25. An 18-year-old man comes to the physician for an initial examination because of a 3-year
history of fatigue and migrating joint pain. He has brought a large folder containing information
about previous medical consultations, laboratory tests, and x-ray films. He takes no medications. He
weighs 50 kg (110 lb) and is 173 cm (68 in) tall. Physical examination shows no other
abnormalities. On mental status examination, he is preoccupied with his symptoms. When asked
about his mood, he states that the future appears bleak, and that he is too tired to think about it.
Which of the following is the most appropriate next step in management?
A
) Ask about further symptoms of obsessions and compulsions
B
) Ask about sexual history including sexual orientation and practices
C
) Ask about suicidal feelings
D
) Ask about travel history over the past 6 months
E
) Obtain a detailed exercise history
F
) Measurement of serum Lyme (Borrelia burgdorferi) antibody level
G
) Urine toxicology screening
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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mmm....tricky...Is it A?
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| sandra
Forum Guru
Topics: 200
Posts: 468
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why not c?
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| nootropic
Forum Newbie
Topics: 1
Posts: 17
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Ok...let's start rule out some answers
F. Lyme disease? After three years? Don't think so.
E. Eating disorder? His BMI is low but no evidence of other probs
D. No evidence and the problem started 3 years ago
A, C or G.
A: he is preoccupied with his symptoms, he may has hypochondriasis overlapping with OCD
C: he is kind of depressed (low weight, bad thoughts about the future)
G: weird symptoms may be explained by a drug
I would go with A 
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| fandarast
Forum Junior
Topics: 15
Posts: 53
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The boy has hypochondriasis + depression. I would rule out suicidality first as the most dangerous thing related to depression.
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