A 76-year-old man has had fatigue and loss of interest in daily activities over the past 4 months. He sleeps poorly and has had a 4.5-kg (10-lb) weight loss during this period. He states that he has probably lived long enough. His blood pressure is 110/78 mm Hg, and pulse is 68/min. Examination shows a slow return of deep tendon reflexes. Measurement of which of the following serum levels is the most appropriate next step in management?

A) Calcium

B) Creatinine

C) Glucose

D) Testosterone

E) Thyroid-stimulating hormone

I think E , one of the differential diagnosis of depression in elderly pt. is hypothyroidism , which u should exclude firstly.
absent deep tendon reflex may be normal in elderly people.
edited by alrobo on 8/27/2011

Great, thanks! That was how i had thought of it but wanted to have a second input.
How about this one......

Six months after the delivery of her fourth child, a 37-year-old woman undergoes laparoscopic tubal ligation. Menses occur at regular 28-day intervals. During the operation, she is found to have a small dark lesion in the cul-de-sac and filmy adhesions surrounding the ovaries. A biopsy specimen of a cul-de-sac lesion confirms the diagnosis of endometriosis. Which of the following is the most appropriate next step in management?

A) Danazol therapy

B) Gonadotropin-releasing hormone agonist therapy

C) Oral contraceptive therapy

D) Total abdominal hysterectomy and bilateral
salpingo-oophorectomy

E) No further treatment indicated

I mean, is there a difference in treatment weather the patient has tubal ligation or not b/c she is still going to ovulate and may have symptoms from the ovulation. But then again, are asymptomatic endemotriosis treated in general. (So i couldn't decide b/n C and E)

Hey, How's the studying goin?
well in response to Q2 I think the answer is E, finding endometriosis on laprascopy isnt an indication for treatment, if question provided that the pt was suffering from complaints of dyspareunia(spelling?), dysmenorrhoea, than OCP's maybe indicated, if pt had given blanket consent on procedure than TAH BSO hahah, but in this case your prob just gonna come out of the procedure and inform the pt wat you saw, treatment is her choice.
Glen.