A 30-Year-Old Man Comes to the Physician Because of Decreased

question 13

Multiple Choice

A 30-year-old man comes to the physician because of decreased sexual desire over the last 3 months.  He says that he is otherwise healthy and has no other complaints.  His other medical problems include hypercholesterolemia and migraine headaches.  He was prescribed topiramate 4 months ago by his previous primary care physician for frequent headaches, but it did not seem to help much.  He does not use tobacco or drink alcohol.  He has a sedentary lifestyle and has gained 24 lbs (10.9 kg) in the past 3 years.  His sister suffers from migraine headaches and his father had a myocardial infarction at the age of 45.
His blood pressure is 132/80 mm Hg and pulse is 72/min.  The patient's body mass index (BMI) is 32 kg/m².  Examination shows no gynecomastia or hepatomegaly.  He has normal secondary sexual characteristics.  His testes are normal in size and consistency.  The remainder of the examination is within normal limits.
Laboratory results are as follows:

Which of the following is the most appropriate next step in management?

• A)Iron studies
• B)Prolactin level
• C)Suggest weight loss and follow up in a few weeks
• D)Testosterone therapy
• E)Topiramate discontinuation and clinical follow-up

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Definitions:

Compounded Annually

Interest calculation on the principal and the accumulated interest once a year.

Annual Payments

Payments made once every year towards a debt or investment.

Future Value

The value of an asset or sum of money at a specific future date, calculated by applying expected rates of growth or interest.

Compounded Monthly

Interest calculation method where the interest is added to the principal each month, and the total becomes the principal for the next calculation.