03-24-2006, 05:51 PM
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?
1 Ask about further symptoms of obsessions and compulsions
2 Ask about sexual history including sexual orientation and practices
3Ask about suicidal feelings
4 Ask about travel history over the past 6 months
5Obtain a detailed exercise history
6Measurement of serum Lyme (Borrelia burgdorferi) antibody level
7 Urine toxicology screening
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A 13-year-old girl is brought for a well-child examination. Menses have occurred every other month since menarche 10 months ago. Her last menstrual period was 1 week ago. She is not sexually active. Sexual development is Tanner stage 3. Examination shows no abnormalities. Which of the following is the most appropriate next step in management?
1 Discussion of pregnancy prevention
2 Measurement of serum luteinizing and follicle-stimulating hormone levels
3 Urine β-hCG test
4 Pelvic examination
5 Estrogen therapy
6Diagnostic laparoscopy
7 blood cultures
8 Echocardiography
1 Ask about further symptoms of obsessions and compulsions
2 Ask about sexual history including sexual orientation and practices
3Ask about suicidal feelings
4 Ask about travel history over the past 6 months
5Obtain a detailed exercise history
6Measurement of serum Lyme (Borrelia burgdorferi) antibody level
7 Urine toxicology screening
___________________________________________________
A 13-year-old girl is brought for a well-child examination. Menses have occurred every other month since menarche 10 months ago. Her last menstrual period was 1 week ago. She is not sexually active. Sexual development is Tanner stage 3. Examination shows no abnormalities. Which of the following is the most appropriate next step in management?
1 Discussion of pregnancy prevention
2 Measurement of serum luteinizing and follicle-stimulating hormone levels
3 Urine β-hCG test
4 Pelvic examination
5 Estrogen therapy
6Diagnostic laparoscopy
7 blood cultures
8 Echocardiography