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* CMS psychiatric form 3
 #847951  
  honey123rich - 02/07/18 14:48
 
  1.A 37 year old man comes to the physician because of a 3 week history of fatigue , insomnia and anxiety.His divorce was finalized 1 month ago,ending his 10 year marriage to his wife,who he learned was having affair with his best friend.He feels anger towards his ex-wife and his friend, but he says, 'i know what they did was wrong and that i am a good person who got hurt by them". He has no regrets about the divorce because he believes that he never would have been able to trust her again. He is relieved that they have no children.He often thinks about whether he will remarry which causes anxiety and prevents him from sleeping.He has had no change in appetite. He works as a middle school teacher and has missed several days of school because of tiredness. His mind wanders when he watches television or reads at home. He has decreased energy but still enjoys activities with family and friends. He has no history of medical or psychiatric illness and takes no medications. Vital signs are within normal limits.Physical examination shows no abnormalities. On mental status examination, he is cooperative and engaging and exhibits a full range of affect.He says that his mood is okay.His thoughts are organized. There is no evidence of suicidal or homicidal ideation. Which of the following is the most appropriate pharmacotherapy?
1.Fluoxetine
2.Lithium carbonate(wrong)
3.Methylphenidate
4.Olanzapine
5.Zolpidem
 
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* Re:CMS psychiatric form 3
#3360205
  virgo32 - 02/07/18 15:12
 
  5.?
 
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* Re:CMS psychiatric form 3
#3360207
  honey123rich - 02/07/18 15:31
 
  yeah,i think so too.It should give anxiolytic and he said he mood is okay.

2. A 32 year old woman comes to the physician because of increasingly severe pain that originates in her left shoulder and radiates to her elbow. She describes the pain as constant and burning rating her current pain as a 7 on a 10 point scale. Eighteen months ago, She sustained a nerve injury of the left upper extremity in a motor vehicle collision. Since that time, she has been unable to return to work.Current medication include oxycodone and gabapentin. Physical examination shows atrophy of the left thenar eminence.Muscle strength in the left forearm and finger flexors is 3/5.On sensory examination, there is severe pain with light stroking of the anterolateral aspect of the left arm. Further sensory testing is deferred.During the examination she tells her physician," i am tired of all this.My medication is not strong enough, It only takes the edge off my pain, which is only getting worse.I'm realizing I'll be like this forever." which of the following is the most appropriate response by the physicain?
a.are u worried about more nerve damage developing?
b.do u ever use more pain medication than is prescribed? (wrong)
c. have u been feeling like just giving up?
d.is the pain caused by touch socially limiting?
e.let's review your medical concerns.

 
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* Re:CMS psychiatric form 3
#3360212
  cardio69 - 02/07/18 16:45
 
  Unrelieved pain has been cited as a compelling case, what?  
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