MKSAP: 36-year-old man with history of fatigue

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old man is evaluated for a 1-year history of fatigue, intermittent headaches, sore throat, and joint and muscle pain. He reports no difficulties falling asleep and gets 10 hours of uninterrupted but nonrestorative sleep each night. He has seen several physicians over the past year. Evaluation has included a complete blood count with differential, thyroid-stimulating hormone level, and plasma glucose level that were normal at the time of initial presentation and again 2 months ago. HIV testing performed 4 months ago was negative. He is in a monogamous heterosexual relationship, and there is no history of blood transfusions or injection drug use. Medical history is otherwise unremarkable. Family history is significant for depression and type 2 diabetes mellitus. He takes no medications. On physical examination, the patient appears anxious. Vital signs and the remainder of the physical examination are normal. The patient’s evaluation for sleep disorders is normal. A screening test for depression is negative. Which of the following is the most appropriate diagnostic test to perform next? A. Epstein-Barr virus titer B. Lyme disease titer C. Repeat HIV testing D. No further testing Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Endocrinology Infectious Disease Pain Management Primary Care Rheumatology Source Type: blogs