Terms in this set (41)

A 37-year-old male police officer comes to the physician at the request of his superiors 1 week after he witnessed a terrorist bombing during which several civilians and three fellow police officers were killed. He sustained only minor injuries and assisted in rescuing survivors and gathering body parts. Since the bombing, he has felt emotionally numb and has been unable to enjoy activities he used to find pleasurable. He has continued to work but has requested assignments far removed from the site of the attack. He describes his sleep as fitful. Two years ago, he sustained a bullet wound to the right calf, which left him with a slight limp. He has no other history of medical or psychiatric illness. He says he used to drink one to two beers nightly but has been drinking two to three beers nightly for the past week. Physical examination confirms the previous gunshot injury to the calf and shows no other abnormalities. On mental status examination, he is irritable and says he is not depressed. He tells the physician, "They made me come. I'm not interested in talking with anyone. I just want to spend time with my buddies and be left alone." Which of the following is the most appropriate initial step in management?
A) Encourage the patient to discuss the trauma in detail
B) Provide information about the range of reactions to trauma
C) Recommend group therapy with other trauma survivors
D) Recommend a 1month medical leave of absence from active duty
E) Recommend a physician led trauma debriefing series
F) Recommend a 12step program
G) Begin clonazepam therapy
H) Begin fluoxetine therapy
A 13-year-old girl is brought to the physician by her father for a wellchild examination. He is concerned about her weight and eating habits. He says that she is always "on the go" and never sits down for a full meal. She will often just grab a piece of fruit when she is on her way to an activity. She will eat a full meal when the family has dinner together every Sunday. She has talked about wanting to become a vegetarian because of her concern for animals. She has had the same group of friends since elementary school. She is the captain of her soccer team and practices 4 days weekly. She is active in an afterschool drama program 3 days weekly and is the lead in this season's play. She maintains a B grade average. Her father says that she talks on the telephone "constantly" and is animated and cheerful most of the time. When she is in her bedroom, she prefers to keep the door closed and stops talking if she is on the telephone and her father walks into the room. She has a disorganized bedroom and often falls fast asleep on a bed covered with piles of clothes. Menarche has not occurred. She appears thin and muscular. She is at the 50th percentile for height and 35th percentile for weight, which is unchanged from last year. Vital signs are within normal limits. Breast and pubic hair development are Tanner stage 2. Physical examination shows no abnormalities. When interviewed alone, she is animated. She shrugs and rolls her eyes when asked about her diet and weight. She thinks she is fine and does not understand why her father is so upset. Which of the following is the most appropriate next step?
A) Reassure the father that this is normal development
B) Recommend individual psychotherapy
C) Recommend nutritional counseling
D) Recommend that the father keep a log of what his daughter eats
E) Schedule weekly examination and weighing
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