A 16-Year-Old Girl Comes to the Office Due to a 3-Week

question 39

Multiple Choice

A 16-year-old girl comes to the office due to a 3-week history of constipation and stomachaches, which are getting worse despite over-the-counter laxatives.  The patient has no significant medical history and takes no medication.  She consumes a vegan diet and exercises 2 hours a day, which she says "is necessary so I don't become any fatter than I am already."  Family history is significant for Hashimoto thyroiditis in her mother, as well as scleroderma and obsessive-compulsive disorder in her sister.
Physical examination is significant for a thin, young female with fine hair on her face and body and with dry skin.  Temperature is 37.2 C (99 F) , blood pressure is 80/55 mm Hg, pulse is 39/min, and respirations are 14/min.  BMI is 16.5 kg/m².  Laboratory results are as follows:
Which of the following is the best next step in management of this patient?

• A)Cognitive-behavioral therapy
• B)Hospitalization
• C)Nutritional counseling
• D)Psychiatric evaluation
• E)Thyroid function tests

---

Definitions:

Mid-Ocean Ridges

Oceanic mountain chains that develop due to the movements of tectonic plates, leading to the formation of new sea floor as a result of volcanic eruptions.

Cracks

Thin, linear fractures or separations in materials or geological formations, typically occurring without the displacement of the sides.

Subduction Zone

A zone in which subduction takes place, either referring to the actual downgoing slab and its surroundings or to the region, including Earth’s surface, above the subducting slab.

Mid-Ocean Ridge

A long mountain range on the floor of the ocean, associated with seafloor spreading.