12-15-2007, 02:59 PM
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