05-23-2010, 07:10 AM
A 27-year-old Caucasian female presents to your office with a one-year history of periodic irritability, anger, tension, and sleep disturbance. The symptoms begin one week before her periods and resolve with menstrual bleeding. She also noticed increased appetite, headaches, breast tenderness and ankle swelling before her periods. Her past medical history is insignificant. Her cycles are regular, lasting 29 days. She has no intermenstrual bleeding or vaginal discharge. She has never been pregnant. Her Pap smear taken 6 months ago was normal. She denies smoking, alcohol consumption, and any recreational drug use. She has been sexually active with one partner over the last three years and uses condoms for contraception. She has no known allergies. Her blood pressure is 110/70 mmHg and heart rate is 90/min. You prescribe standard dose (20 mg/day) fluoxetine. The patient returns after several months and says that the symptoms failed to improve significantly.
What is the best next step in the management of this patient?
A. High-dose fluoxetine
B. Alprazolam
C. Leuprolide
D. Danazol
E. Spironolactone
What is the best next step in the management of this patient?
A. High-dose fluoxetine
B. Alprazolam
C. Leuprolide
D. Danazol
E. Spironolactone