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A 52-Year-Old Man Comes to the Office Due to Difficulty

question 185

Multiple Choice

A 52-year-old man comes to the office due to difficulty falling asleep, frequent nighttime awakenings, and daytime fatigue for the past several months. It takes him over an hour to fall asleep, and he often awakens at 2 AM and again at 4 AM. During the day, the patient struggles to stay awake during long staff meetings. He experiences no snoring, shortness of breath, or chest pain. The patient recently went through a divorce and is under financial pressure to make childcare payments. He has a history of hypertension and hypercholesterolemia. Family history is significant for coronary artery disease and emphysema. The patient smokes a pack of cigarettes a day. He drinks 2 or 3 cups of coffee every morning, an energy drink in the afternoon 1 or 2 days a week, and a beer with dinner.
On physical examination, blood pressure is 125/78 mm Hg and pulse is 74/min. BMI is 30 kg/m². The remainder of the examination is normal.
Laboratory studies include a hematocrit of 43%, a leukocyte count of 5,300/mm³, a fasting plasma glucose of 100 mg/dL, and a serum TSH level of 2.3 µU/mL. Results of a chest radiograph and ECG are normal.
Which of the following is the most appropriate next step in management of this patient?

Definitions:

Post-traumatic Stress Disorder

A mental health condition triggered by experiencing or witnessing a terrifying event, characterized by flashbacks, nightmares, and severe anxiety.

Acute Stress Disorder

A mental health condition involving symptoms of anxiety and dissociation that occur within a month after exposure to a traumatic event.

External Locus

of control is a belief that outcomes in one’s life are determined by external forces beyond personal control.

Catastrophic Stress

Severe stress resulting from exposure to a traumatic event or disaster that overwhelms an individual’s ability to cope.