A 76-Year-Old Man Comes to the Office for Follow-Up of Hypertension

question 197

Multiple Choice

A 76-year-old man comes to the office for follow-up of hypertension.  He says, "I wouldn't be surprised if my blood pressure is up with all the stress I am under.  My wife has been having an ongoing affair with our accountant.  I've known about this for years, and she continues to deny it.  Even my children are in on it.  They tell me that I'm imagining things."  The patient reports that he monitors his wife closely and calls her multiple times a day to check on her whereabouts but admits that he has not found any evidence of the affair.  He reports intermittent insomnia but no change in appetite.  The patient occasionally forgets names and has word-finding difficulty.  He continues to perform household chores and handle finances.  Blood pressure is 132/85 mm Hg, pulse is 82/min, and respirations are 16/min.  Physical examination, including neurologic examination, is unremarkable.  The patient is alert and oriented, and his mood is irritable.  Which of the following is the most likely diagnosis for this patient?

• A)Alzheimer disease
• B)Delusional disorder
• C)Major depressive disorder with psychotic features
• D)Paranoid personality disorder
• E)Psychotic disorder due to another medical condition
• F)Schizophrenia

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Definitions:

Medical Term

A word or phrase specifically used in the field of medicine to describe a particular condition, procedure, anatomy, or disease process.

Neuropathy

Damage or dysfunction of one or more nerves, typically resulting in numbness, pain, and weakness in the affected area.

Diabetic Retinopathy

An issue stemming from diabetes, this condition damages the blood vessels in the retina, the area at the back of the eye sensitive to light, affecting eyesight.

Pathology

The study and diagnosis of disease through examination of organs, tissues, bodily fluids, and whole bodies (autopsies).