08-11-2009, 04:46 AM
15. A 49-year-old man, who is accompanied by his son, comes to the office for the first time for follow-up of mild depression. He recently moved to the area and he tells you that his previous physician initiated fluoxetine therapy 4 weeks ago. He has a history of stage I malignant melanoma, which was treated with wide, local excision 2 years ago. He mentions that he was adopted as a young child and his family history is unknown. The patient is friendly and engaging, seems to be full of energy and calls you by your first name. He reports that he has been unusually productive at work recently and is able to "get by" on 1 to 2 hours of sleep nightly. His son says, "Dad isn't acting like himself. He talks about weird things and he's become religious in a creepy way." On physical examination the patient is well developed and well nourished. Vital signs are: temperature 37.0°C (98.6°F), pulse 95/min, respirations 14/min and blood pressure 135/90 mm Hg. There is a mild, nonpainful increase in tactile sensory acuity. He says, "My skin is really sensitive." The remainder of the physical examination, including neurologic examination, is normal. Which of the following is the most likely precipitant of this episode?
A
) Family conflict
B
) Fluoxetine
C
) Recurrence of melanoma in his central nervous system
D
) Stress
E
) Unknown; this cannot be determined
What shud be the ans?
A
) Family conflict
B
) Fluoxetine
C
) Recurrence of melanoma in his central nervous system
D
) Stress
E
) Unknown; this cannot be determined
What shud be the ans?