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nbme q - ketty
#1
A 52-year-old woman is brought to the office by her husband for evaluation of increasing tearfulness, restlessness, difficulty sleeping and weight loss for 1 month. During the visit, the patient appears restless and upset. She acknowledges her husband's account of her symptoms, but she does not volunteer any additional information. They have been married for 15 years and have a good relationship. Both the patient and her husband are teachers and they have a healthy 13-year-old son. She was previously healthy. Physical examination today is normal. The most appropriate initial management of her symptoms is to do which of the following?

A

) Prescribe haloperidol

B

) Prescribe lithium

C

) Prescribe lorazepam

D

) Prescribe sertraline

E

) Refer them for couples therapy
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#2
c lorazepam
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#3
why not sertaline?
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#4
Prescribe lorazepam
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#5
It looks as depresion, she has 4 sympstoms.

I would say, D.
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#6
sertraline
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#7
I would choose E, the patient does not have typical depression, she is probably going through menopause, Why does she not offer more voluntarily? Can we diagnose depression based on second hand information when the pt is competent? I think we should interview the patient separately with her husband, but not in the option. Hence, refer for couple therapy will carify the issue if it is due to depression or menopause.

Any comment?
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