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

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Definitions:

Cultural Issues

Concerns related to the values, beliefs, practices, and customs of a society that affect individuals and groups, particularly in contexts of diversity and interaction.

Cross-Cultural Fairness

The quality of being impartial and equitable across different cultures, especially in the context of assessments or tests to ensure they are free of cultural bias.

Informal Assessment Techniques

Methods used to gather information in a non-standardized manner, often through observation or conversation, for the purpose of understanding an individual's abilities or progress.

Objective Measures

Quantifiable assessments that minimize bias and subjectivity, often used in research and evaluation.