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+--- Thread: next step in mg? - aashi (/showthread.php?tid=80498)
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next step in mg? - aashi - ArchivalUser - 03-24-2006
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
0 - ArchivalUser - 03-24-2006
1. ask about suicidal
2. discussion pregnancy prevention
0 - ArchivalUser - 03-24-2006
I agree about the girl , but what is the Dx of the 18 boy ?/ is he GAD or somatization
0 - ArchivalUser - 03-24-2006
sucidal ideation
pregnancy prevention
0 - ArchivalUser - 03-24-2006
thanks for nice question
very informative
0 - ArchivalUser - 03-24-2006
djyoti what is the Dx of that guy ?
0 - ArchivalUser - 03-24-2006
why pregnancy prevention in girl ???
0 - ArchivalUser - 03-24-2006
why ? b/c she is NORMAL...and she is at the age of sexually active...so prevention is the key
about the dude....he is CRAZY that's all I know....there is one sentence in there that I think is the key..."future appears bleak"..so sound like he is depress...therefore it's appropriate to ask him about suicidal
0 - ArchivalUser - 03-25-2006
about the girl, she had menarche 10 month ago, but stage 3 sexual development. is it normal?
0 - ArchivalUser - 03-25-2006
cady its ok because thelarche first then menarche then pubarche adrenarhe and somewhere growth spurt along this time/ sorry for loosing the systemic tract but what i mean it menarche can be earlirer / if there is menarche probabl other hormone are fine she is ovulatory
iam confused here will comeback after some time