A 74-Year-Old White, Widowed Man Comes to the Office at the Request

question 468

Multiple Choice

A 74-year-old white, widowed man comes to the office at the request of his daughter due to lack of appetite and a 4.54-kg (10-lb) weight loss over the past 4 months.  Prior to breaking his hip last year when he fell from a horse, the patient had worked as a rancher for over 50 years.  His daughter says he never quite recovered from the fall and refused to participate in an outpatient physical rehabilitation program.  The patient says, "I don't want to be around a bunch of disabled people, and those exercises are a waste of time; I just have to accept that my life is over."  He says his mood is "bad" but that depression is for "the weak-minded."  When asked about suicidal thoughts and plans, he is initially silent; with further prompting he says, "I believe in keeping my options open."  The patient had a depressive episode in his late 40s that responded well to antidepressant treatment.  He has never attempted suicide.  His daughter lives in a nearby city and checks on him once a month.
The patient has a history of hypertension that has been well controlled for many years with atenolol.
Physical examination is notable for decreased mobility, arthritis, and a healed gunshot wound sustained in a hunting accident last year.
Which of the following is the most appropriate next step in management of this patient?

• A)Discontinue atenolol due to its risk of inducing depression
• B)Obtain screening laboratory tests and reassess in 1-2 weeks
• C)Offer home-based physical rehabilitation and nutrition supplementation
• D)Recommend psychiatric hospitalization
• E)Refer for psychotherapy and initiate antidepressant treatment

Interpret genetic data from crosses to determine linkage and gene maps.

Understand the genetic basis of sex determination in humans.

Explain the concepts of heterozygosity, homozygosity, and hemizygosity in the context of genetic traits.

Understand mitochondrial DNA inheritance and maternal impacts on genetics.

---

Definitions:

Escrow Account

A financial account held by a third party on behalf of the two main parties in a transaction, often used to safely hold funds until the completion of contractual obligations.

Charitable Contribution

Financial or material donations made to qualified organizations, which may be deductible from taxable income if itemizing deductions.

Adjusted Gross Income

An individual's total gross income minus specific deductions, used as the basis for calculating taxable income on federal tax returns.

Casualty Loss Deduction

A tax deduction for property losses as a result of a sudden, unexpected, or unusual event.