08-07-2006, 12:35 PM
A 41-year-old woman comes to the office because of a 40-pound weight gain in the past 6 months. She is very upset because she has always been thin and never had to watch her diet before. She has no change in appetite, no change in eating habits, and has no other symptoms. She takes no medications, does not drink alcohol, and smokes a pack of cigarettes a day for the past 10 years. She rollerblades with her daughter every evening and tries to eat a well-balanced, low-fat diet. She denies anxiety and any psychiatric problems. She tells you that her mother and sister have always been overweight and they always complain about their "apple-shaped" bodies. Her temperature is 37 C (98.6 F), blood pressure is 120/80 mm Hg, pulse is 70/min, and respirations are 16/min. Physical examination shows an obese abdomen and thin lower extremities, but is otherwise unremarkable. The most appropriate next step is to
A. determine thyroid stimulating hormone levels
B. order a biochemical profile
C. order a dexamethasone suppression test
D. refer her to a nutritionist
E. schedule a CT scan of the abdomen
A. determine thyroid stimulating hormone levels
B. order a biochemical profile
C. order a dexamethasone suppression test
D. refer her to a nutritionist
E. schedule a CT scan of the abdomen