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A 28-Year-Old Graduate Student Comes to the Office for Follow-Up

question 38

Multiple Choice

A 28-year-old graduate student comes to the office for follow-up of chest pain and poor sleep. The patient continues to experience intermittent, nonradiating chest pain, especially in the evenings when he feels "tired." He describes difficulty relaxing at night and takes up to an hour to fall asleep when he feels the chest discomfort. The patient says, "I'm under a lot of pressure to work on my dissertation," and he is concerned that his chest pain and poor sleep are affecting his productivity. The patient has no shortness of breath or systemic symptoms. He has had similar symptoms for the past year and has been evaluated with repeated ECG and a complete laboratory and radiographic workup; all were negative. Despite reassurance from the physician, the patient continues to be excessively worried about his symptoms. His appetite is normal, and he denies feeling depressed. The patient's medications include naproxen as needed. He does not use alcohol or illicit drugs. Physical examination is normal. Which of the following medications would be most appropriate for this patient's condition?

Definitions:

Mental Health

The state of one's psychological and emotional well-being, which can affect how they think, feel, and behave.

Sense Of Place

The feelings and perceptions associated with a particular location that give it a unique identity and emotional meaning.

Occupational Disease

A disease or disorder that arises as a result of exposure to risk factors arising from work activity.

Musculoskeletal Disorders

Injuries or disorders affecting the human body's movement or musculoskeletal system, including muscles, nerves, tendons, joints, cartilage, and spinal discs.