A 44-Year-Old Man Comes to the Office Due to Fatigue

question 33

Multiple Choice

A 44-year-old man comes to the office due to fatigue for the past 6 months.  He says, "I've fallen asleep at work a few times, and I really have to push myself to concentrate.  I can't seem to get a good night's sleep either because I keep waking up."  The patient feels guilty that he has been spending less time with his kids due to feeling tired and states his mood has been low the past week.  He worries that his wife is annoyed with him because he has not been helping with household chores as much and keeps her up at night due to his snoring.  The patient drinks 3 or 4 beers a week and does not use tobacco or illicit drugs.  Medical history is noncontributory.  Blood pressure is 146/94 mm Hg and pulse is 78/min and regular.  BMI is 32 kg/m².  Which of the following is the most likely diagnosis?

• A)Major depressive disorder
• B)Narcolepsy
• C)Obstructive sleep apnea
• D)Primary insomnia
• E)Somatic symptom disorder

---

Definitions:

Neurologic System

The network of nerve tissues that controls the body's movements and transmits signals between different parts of the body.

Ability To Communicate

The capacity to convey thoughts, feelings, or information effectively through verbal, non-verbal, written, or other forms of expression.

Blood Pressure

The pressure of circulating blood on the walls of blood vessels, often measured as an indicator of heart health.

Mobility And Turgor

This term describes the skin's elasticity and ability to move and return to place, which can indicate hydration and health status.