07-16-2010, 05:28 AM
A 20-year-old white woman comes to the office because of increasing fatigue for the past 3 weeks. She is 24 weeks pregnant with her first pregnancy. She says she has noted increased difficulty maintaining her usual pace in the local factory where she works packing boxes. Prior to pregnancy, she had no health problems and was considered an above-average worker. Other than the fatigue and an occasional backache, she has had an uneventful pregnancy. Results of initial prenatal laboratory studies were normal, and she has attended all of her prenatal office appointments. Complete blood count is obtained at this visit and a peripheral blood smear, also obtained during this visit, is shown. At this time, the most likely explanation for the patient's fatigue is that she has which of the following?
A
) Iron-deficiency anemia
B
) Vitamin B12 (cyanocobalamin) deficiency
C
) Folate deficiency
D
) Leukemia
E
) Physiologic anemia of pregnancy
A 15-year-old white girl is brought to the health center by her mother for a periodic health evaluation and refill of tetracycline for acne. Upon entering the examination room, the patient's mother asks to speak alone with you. In private, she says, "My daughter has been like a different person for the past 4 months. She used to be on the honor roll and is now failing school. She received detention six times for truancy and for talking back to teachers. She argues with her brother and me over everything. She quit the tennis team and doesn't see any of her friends." The mother can think of no explanation for these changes. When you interview the patient alone, she becomes angry and says, "Mom should mind her own business and stop talking about me behind my back." She denies use of drugs or alcohol. She tells you, "I don't want to go out of the house because my acne makes me feel ugly. Plus, I've put on ten pounds." Today she weighs 54 kg (120 lb); she is 165 cm (5 ft 5 in) tall. Which of the following is the most appropriate advice to the mother?
A
) Her daughter is just going through a normal adolescent phase
B
) Her daughter would benefit from a diet program
C
) Her daughter would benefit from a trial of antidepressant medication
D
) She should use a behavior-modification program to control her daughter
E
) No advice is indicated because it would violate patient confidentiality
A
) Iron-deficiency anemia
B
) Vitamin B12 (cyanocobalamin) deficiency
C
) Folate deficiency
D
) Leukemia
E
) Physiologic anemia of pregnancy
A 15-year-old white girl is brought to the health center by her mother for a periodic health evaluation and refill of tetracycline for acne. Upon entering the examination room, the patient's mother asks to speak alone with you. In private, she says, "My daughter has been like a different person for the past 4 months. She used to be on the honor roll and is now failing school. She received detention six times for truancy and for talking back to teachers. She argues with her brother and me over everything. She quit the tennis team and doesn't see any of her friends." The mother can think of no explanation for these changes. When you interview the patient alone, she becomes angry and says, "Mom should mind her own business and stop talking about me behind my back." She denies use of drugs or alcohol. She tells you, "I don't want to go out of the house because my acne makes me feel ugly. Plus, I've put on ten pounds." Today she weighs 54 kg (120 lb); she is 165 cm (5 ft 5 in) tall. Which of the following is the most appropriate advice to the mother?
A
) Her daughter is just going through a normal adolescent phase
B
) Her daughter would benefit from a diet program
C
) Her daughter would benefit from a trial of antidepressant medication
D
) She should use a behavior-modification program to control her daughter
E
) No advice is indicated because it would violate patient confidentiality